Category Archives: Trust Board Directors

A night (or two) on a hospital trolley is better than living on the street. Asda type performance will not help…

Aneurin Bevan would not have accepted a night on a trolley as a compromise when he set up the former NHS. The cost of looking after overseas visitors is minimal, and not an important financial loss, but it does signify how we expect nobody to pay anything at all! Politicians have big salaries, good holidays, secure pensions, and access to London hospitals. If they want to they can avoid the A&E waits and mistakes and go privately. They usually do…. It will all get worse unless our managers and Trust Board Directors speak out honestly. Co-payments are not as bad as a failing service..

Cartoon 11.02.2017

Michael Sainato in the Guardian 14th November 2019 reminds us of why we live in one of four “Mutualised health services”. ‘I live on the street now’: how the insured fall into medical bankruptcy – Having health insurance is often not enough to save Americans from massive debts when serious illness strikes

Iain Williams on 14th Feb 2015 opined: £1 coin for your hospital trolley? The NHS’s supermarket-style makeover – cartoon

A government minister has said the NHS should be more like Asda. Should we expect bogof deals on hip replacements?

Its easy to say you will fund a treatment, but much harder to say what you won’t fund. How long will the English and Welsh hold out against the media led pressures? Emergency loans for Trusts merely delays the inevitable.

In the National Institute for Health and Care Excellence (NICE) website:

One QALY is equal to 1 year of life in perfect health. QALYs are calculated by estimating the years of life remaining for a patient following a particular treatment or intervention and weighting each year with a quality-of-life score (on a 0 to 1 scale).

In Wikipedia a QALY year is defined: Quality-adjusted Life Year

 

Quality-adjusted Life Year
The quality-adjusted life year or quality-adjusted life-year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value for money of medical interventions. One QALY equates to one year in perfect health. If an individual’s health is below this maximum, QALYs are accrued at a rate of less than 1 per year. To be dead is associated with 0 QALYs. QALYs can be used to inform personal decisions, to evaluate programs, and to set priorities for future programs.

In “Carrying NICE over the threshold” ( 19th Feb 2015 ), Professor Karl Claxton suggests that paying more than £13,000 per QALY for technologies “does more harm than good” by displacing other more effective healthcare from the NHS.

In Scotland it appears that they are taking a lead in commissioning treatment that is very expensive, but effective in prolonging life, for Cystic Fibrosis sufferers. This induces perverse behaviour in families of sufferers, and, in addition, fails to point out what services will be weakened, or not funded, since the resources are limited.  . Cystic fibrosis: Father considers Scotland move to access new drug. BBC News 20th September 2019.  In the end it has to be politicians, with public consent, who agree how to ration. We can afford the CF treatment, but only if we ration high volume low cost treatments, or other more expensive treatments, out. Decisions like that in Scotland, without equivalent saving decisions will make the Health Service (s) worse, and the differences between the haves and the have nots worse. The main expense in the health services is spent on its greatest asset: staff. These are no longer feeling valued, and those that can are making hay as locums. This is an even greater burden to their health services than expensive treatments. Add to this the cost of infections (longer stays and expensive treatments) and litigation, and it is evident that England is correct in putting its population before its CF individuals. How long will they hold out against the media I wonder? Sepsis and Litigation are much larger problems. Emergency loans for Trusts merely defers the inevitable…

A father has spoken of his agonising dilemma about whether to leave England and move to Scotland so his daughter can access life-prolonging medication.

Dave Louden’s four-year-old daughter Ayda was diagnosed with cystic fibrosis shortly after she was born.

The family live in Carlisle, 10 miles (16km) from the Scottish border, where a new drug has become available.

However, despite the position in Scotland, NHS England said the drugs were not cost-effective.

Costing £100,000 per person per year, Orkambi and Symkevi improves lung health and life expectancy for sufferers of cystic fibrosis.

Patients in Scotland can access the drugs after the Scottish government agreed a “confidential discount” with the pharmaceutical company Vertex.

Cystic fibrosis affects about 10,400 people in the UK and causes fatal lung damage, with only around half of sufferers living to the age of 40.

Mr Louden said it was “heartbreaking” that his daughter could not get the treatment…..

‘Life-changing’ cystic fibrosis drug deal for Scotland is welcomed BBC 20th September

BBC News 16th September: Review launched into Aberdeen hospital project costs

BBC News 20th September: Hospitals relying on ’emergency’ loans

Huw Pym 19th September: How much does diabetes cost the NHS?

Jonathan Ames 14th September in the Times: Locum ruling will cost NHS millions

NHS long term plan to reduce toll of NHS Long Term Plan to reduce toll of “hidden killer” sepsis

Sarah Neville in the FT 7th September 2017:  Cost of NHS negligence claims quadruples to £1.6bn in decade – Soaring bill affects quality of care and increases financial pressure on trusts

Don’t believe we are rationing? Do you believe in transparency and honesty? Why not use the correct word?

Just in the last few days these news items reveal the truth. Despite this the “R” word can never be acknowledged by politicians. None since Enoch Powell has embraced the truth. (Described by Richard Smith, former BMJ editor as “the best book written on the NHS”. A new look at medicine and politics: 1975 and after. Pitman Medical 1976. 2nd edition. ) 

Link to his book published by the Socialist Health Association

Why do you think we had no PET scanners until 20 years late! Why are there waiting lists longer than any other G7 country (and the results to match)? Why have the two countries that emulated the original NHS reconsidered? (NZ and Scandinavia). Why are we only appointing 1 doctor for every 10 who apply and have been encouraged to do so by their careers officers? Why are botched operations so commonplace?  Why does the NHS Ombudsman produce reports which have no notice taken? Do the politicians read these reports?

If you believe in honesty and transparency why not use the correct word? We will never win the hearts and minds of the health service staff if politicians and media and public collude in the language of denial.

Henry Bodkin in the Telegraph 14th September 2019: NHS bosses tried to “gag” father of boy whose life was ruined in botched operation

In The Guardian 30th August 2019 Dennis Campbell: ‘Crumbling’ hospitals putting lives at risk, say NHS chiefs  –  Four in five NHS trust bosses in England fear Tory squeeze on capital funding poses safety threat

Why cannot Cheshire recruit enough GPs? Pulse reported by Lea Legraien 14th September

Why do we still get fraudulent managers promoted (The Independent 19th December 2018)

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

This is particularly important for Pembrokeshire and West Wales as we have a long distance over difficult roads to travel to Swansea at present. Our planned new Hospital, wherever it is, needs Radiotherapy, Radio Isotope Investigations, and STENT treatment for Coronary Heart Disease if our options are to be the same as those in more favoured areas. I reproduce the article at the bottom of this post.

Adam Shaw for the Harrow Times reports 13th September 2019: North-West London CCGs dismiss claims of “rationing” services.

Kat Hopps September 13th in the Express reports: IVF: How NHS IVF treatment is unfair postcode lottery and keeps couples childless

A disgrace and a shame on politicians: “Surge in patients raising own cash for amputations”. Rationig by waiting and by incompetence.

Pembrokeshire Oncology cancer services in crisis

There is a “need to put doctors in charge and force them to take account of patients’ views. Cancer survival rates are (just) one of the prime examples of NHS mediocrity.”

Desperate NHS needs a desperate remedy – care is already rationed

The 3 myths of the NHS…..& …No learning from other countries – no co-payments, and more scandals..

Britain ranked last (out of 20 rich countries) by a wide margin in the number of CT and MRI scanners per head of population. Australia has six times as many CT scanners per head, and spends roughly the same as Britain on healthcare overall as a share of GDP.

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

Almost half of NHS trusts are using outdated radiotherapy machines that are far less effective at killing cancer cells to treat patients.

The revelation comes days after the UK came bottom of an international league for cancer survival rates in The Lancet Oncology journal.

In 2016 the NHS said it was investing £130m in upgrading radiotherapy equipment but the figures, revealed via freedom of information requests, found 46% of trusts are still using outdated linear accelerator (Linac) machines beyond their recommended 10-year lifespan.

Dr Jeanette Dickson, president of the Royal College of Radiologists, said more advanced radiotherapy techniques enable “greater precision when targeting specific tumours and have been shown to be less harmful to surrounding tissue than older types of radiotherapy, depending on the complexities of the cancer being treated”.

Rose Gray, policy manager of Cancer Research UK, said it was “deeply concerning” to hear outdated radiotherapy machines were being used.

She said: “The NHS has grappled with the question of how best to replace outdated equipment for many years, and the government has repeatedly been urged to put a long-term plan in place.

“But . . . that still hasn’t happened. These investigation findings prove the urgent need for a solution to this persistent problem.”

In total, 57 of the 272 Linac machines used this year are 10 or more years old. One of them that is still in operation has been used for 17 years.

Dr Peter Kirkbride, the former chairman of the government’s radiotherapy clinical reference group and spokesman for the Radiotherapy4Life campaign, said: “That radiotherapy has been put on a lower footing than other cancer treatments — such as chemotherapy — by successive governments is an open secret within the NHS.”

The Liberal Democrat MP Tim Farron, chairman of the all-party parliamentary group on radiotherapy, described the figures as “shocking”.

He said they proved the investment in 2016 had been a “drop in the ocean” when compared with what is required to meet soaring demand.

Saffron Cordery, deputy chief executive of NHS Providers, which represents hospitals, added: “What we do know is that for year after year, money earmarked for capital investment has been siphoned off just to keep services running.”

An NHS spokeswoman said 80 radiotherapy machines had been upgraded since 2016 and patients were benefiting from “a range of improvements” to cancer services.

Enoch Powell 4 Supply and Demand – Rationing

 

The NHS is at risk from a no-deal triple whammy. Winter is coming, along with a flu outbreak and a “no deal”……

The risks of Brexit to the 4 health services are in inflated costs (products are bought in US dollars), and staff (many are from overseas, mostly non-European). The triple whammy : Winter is coming, along with a flu outbreak and a “no deal”.  

Chris Hopson in the Times 26th August 2019: The NHS is at risk from a no-deal triple whammy

Whatever your views on Brexit, our key public services need to be fully prepared for no-deal, should that occur on October 31.

Foremost in our minds should be NHS hospital, ambulance, mental health and community service trusts that provide vital healthcare to a million patients every 36 hours.
How ready are they to manage a
no-deal Brexit?

The NHS has a proud tradition of performing well in a crisis. Trust leaders are used to preparing for emergencies, working closely with other public services. As you would expect, there is a huge amount of planning being done. But there are two features of a no-deal Brexit that frontline leaders believe are significant risks for the NHS.

The first, due to the timing, is an awkward potential triple whammy: a difficult winter, a flu outbreak and a no-deal. The NHS is at its busiest over winter. Emergency care performance figures, the worst in more than a decade, show how much pressure the service is under, with concern that we’re heading for a pressurised winter. Levels of flu in Australia, often a good predictor for UK winter flu, are at their highest for some years. Combine that with the prolonged negative impact of a
no-deal Brexit, should that occur, and you have an NHS chief executive’s nightmare scenario.

The second concern is how many risks are beyond the immediate control of NHS trusts and require close and effective working with other public services and, particularly, central government.

Trust leaders are very dependent on the work of others to secure 8,000 medicines and other medical devices from European supply routes. They are similarly reliant on others to ensure that the NHS can feed 120,000 patients a day and to guarantee the free flow of traffic in areas such as Kent so ambulances, patients and vital staff can reach their destination.

Trust leaders need greater support as an NHS free at the point of use for all EU citizens moves to being one where staff will, overnight, become responsible for eligibility checks. They need the government to remove obstacles and uncertainty for European staff on whom the health service is heavily dependent.

NHS leaders are working hard with other public services and Whitehall to manage these risks. But we need to recognise that this is a complex and resource-intensive task, especially when set alongside everything else an overstretched NHS is trying to do.

Chris Hopson is the chief executive of NHS Providers, which represents all English NHS hospital, ambulance, community and mental health trusts

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Hospital chief says family time would give patients a better end to life

The end of most of our lives will not be planned or expected for long. The “handover” from oncology and chemical treatment to attempt cure, and palliative and then terminal care, is not good enough. Those in charge of the former are reluctant to give up and hand over to the latter. The result is a lot of unnecessary discomfort and stress, and often in rural areas, of travelling long distances to achieve very little. The interface between these specialities would be best facilitated by a GP, preferably one with a palliative care interest. 

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Advanced directives would also be helpful, and other countries are showing us the way.

Sarah Kate Templeton on June 25th in the Times reported: Professor Marcel Levi: Dying should shun treatment and take final holiday – Hospital chief says family time would give patients a better end to life

Patients who are dying should be allowed to go on a final holiday rather than be subjected to gruelling treatment, according to the boss of one of Britain’s largest NHS trusts.

Professor Marcel Levi, a practising doctor and chief executive of University College London Hospitals, said the NHS is wasting time and money treating dying patients at the end of their lives.

He said: “I often think, ‘You would be better going on holiday with your family and you may have a little shorter but a lot better end of your life.’”

Levi, who is Dutch and was previously chairman of a leading hospital in Holland, said: “I do not find the discussion, ‘Which patients should we not treat any more at the end of their lives?’ very well developed in the UK.

“The patients do get anti-cancer treatment when the oncologist, probably the patient and his or her family know it is not going to contribute a lot and it may cause a lot of safety problems and harm.

In Holland, Levi said it is common for patients to state they have had enough treatment and do not want to go back into intensive care.

In the UK, however, he said patients are automatically continuing with treatment in the absence of an honest discussion about what is going to be achieved.

“Patients who are 85 years old do not have to expect a lot of gain from haemodialysis [kidney dialysis], but they still go there three times a week. They feel terrible on the day of dialysis, they feel terrible the day after dialysis. That is six out of seven days of the week,” he said.

“Somebody should at least discuss with them, ‘Is this useful for you? Are you really having any gain of quality of life by doing this?’

“They have a very short life expectancy and we are actually spoiling the last weeks of their lives instead of making them comfortable and them spending quality time with family and friends.”

About 43% of NHS spending goes on the over-65s, according to the Nuffield Trust healthcare charity. This age group also occupies about two-thirds of hospital beds, National Audit Office figures show. Between 10% and 20% of the NHS budget is spent on people in the last year of life, a government-commissioned palliative care funding review found.

Dr Gordon Caldwell, a consultant physician at Worthing Hospital, West Sussex, agrees that British doctors — himself included — often avoid frank discussions about letting patients die.

He said: “Often, as doctors, we hold on to hopes of marginal benefits — ‘You could live 30 days longer, perhaps to three months’ — but omit, ‘This will involve 60 days attending hospital, so you could not go to see Snowdon and Anglesey with your grandchildren.’

“We have relatives demanding, ‘Do everything, doctor.’ Those same relatives, when the patient dies, ask, ‘He didn’t suffer, did he?’ Well, if we were honest [we would say], ‘Yes, he did because you asked us to do everything.’

“I strongly suspect many patients would want less medical interference, such as tests, treatments, last-ditch attempts at chemotherapy.

“Doctors must learn to be honest about the true likely effects of their tests and treatment — a marginal benefit in a few patients at a lot of opportunity loss. A day spent having chemotherapy is a day not with the family.”

Levi said it is up to physicians to broach the subject and it is often welcomed by patients and their families.

“It is the doctors who start the discussion. It was a bit tricky when we did this [in Holland] but it actually turned out that many, many patients and their families were extremely supportive,” he said.

“There were many families of patients who died of cancer who said, ‘If I knew before this was going to happen, we would not have done this operation or this chemotherapy.’”

Professor Karol Sikora, former chief of the World Health Organisation’s cancer programme and chief medical officer of Proton Partners International, a private cancer and healthcare specialist, said there are now more than 25 cancer drugs available that cost more than £50,000 for one year’s treatment and in most cases these would prolong life for only an extra three months.

He added: “There is so much pressure to be active, driven by the pharmaceutical industry and the breakthrough mentality. Giving patients permission to let go has got a lot harder over the last decade.”

However, Baroness Finlay, a crossbench peer and palliative care consultant, believes patients must be given the options of treatments that could help them live longer.

“Sweeping judgments about a person’s quality of life are dangerous,” she said. “Anyone can refuse or cease treatment and that wish must be respected but it becomes dangerous when people are not given the options that might help them live longer and live well.”

Judith Kerr, 94, the children’s author and illustrator who wrote The Tiger Who Came to Tea, has already made her preparations. Last year she told The Sunday Times she keeps “a little piece of pink paper signed by the doctor, saying ‘Do not resuscitate’.”

She added: “Having had a good life, to go through this misery, and at great expense to everybody else — expense not only in money but in emotion.”

Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

Social Care is means tested, so why not health? More funds for cancer care is appropriate, but in Wales it could go on free prescriptions.

Selecting doctors, and portfolio careers crossing from primary care to Hospital.

Just like Brexit, health is a complex and long term problem. Decisions on both should be taken only by experts..

The Canadians shame us with their plans for end of life care

Cancer patients given new drugs that won’t help them. GPs needed in oncology clinics…

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Bradford staff: government breaking its promises….. This needs to be a nationwide rather than a local solution.

If we look at pensions as a promise of  future payment, and we assume that the English Health Service, along with the other 3 dispensations, has a “ponzi” scheme type of pension fund, then it is not surprising that Trusts and their boards of directors try to escape future commitments that they cannot fulfil. The whole of the former NHS (when we had one mutual) is funded on this basis, but by denial of the long term problems, politicians are forcing locally based solutions, inequity, and poverty in their workers old age. In effect they are breaking their promise… just as the Greeks had to …. The problem needs a nationwide solution so that the pain if felt equally. The earliest Trust sare those most likely to get away with it, and some already have. The result is post-code rationing by ethically and legally dubious means….  In any event, the whole state as well as health worker pension situation needs review….

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Unison website reports 8th July: Bradford hospital staff strike to stay in the NHS and picket lines will begin

BBC reported 14th August: Bradford Teaching Hospitals staff to strike over outsource plan

and Susie Beever of the Yorkshire Evening Post reported 1st August that there would be a two week strike over jobs 

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The History: Bradford Hospital has a track record. Simon Freemna in the Times 27th November 2004: Hospital’s rescuers charge £160,000 for the privilege

Sarah Kate-Templeton in the Times 2016: Safer births campaign: Shamed hospitals blame high stillbirth rate on the mothers

Rhys Blakeley in the Times 19th August 2019: Plea for state pension age of 75

 

Denial for 5 years. On 4th June 2014 Mr Stevens asked for an honest debate…

The reality that Health and Social Care are not either of them free, has not sunk in to the politicians yet. We cannot have “Everything for everyone for ever” and for free, and in their denial, both houses thus conspire to avoid the important debate that Mr Stevens called for on 4th June 2014, almost exactly 5 years ago. If Social Care is means tested, why not Health Care? 

The unedifying spectacle of two potential leaders trying to bribe 160,000 older and richer people who happen to be their members, is the reality of todays politics. No wonder so many people dont vote. We need an honest party to speak “hard truths” to the nation. NHSreality believes the first party to do this, and be understood as honest and working for the overall good of us all, fairly, will eventually win a landslide. It will also win the hearts and minds of the medical professionals….. and they are trusted, and speak to many people daily.

Our political (moron) representatives need to permit commissioners and trust boards to ration overtly, so that their citizens know what is not available. Initially this will have to be by post code, but national guidelines from NICE would help. Eventually, for those services and treatments that none of us can afford, cancer and big operations for example, there can be a National Health Service again, and for cheap and cheerful, high volume low cost services, we can have local post code rationing if we still want it…

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BBC News reports 4th July: Social care: Hunt and Johnson urged to consider NHS-style free service

Public Service Executive reports: Peers call for NHS-style free social care system and an extra £8bn to tackle funding crisis

and the Guardian today also reports the Peers asking for an extra £80m for “vulnerable elderly people”. 

The reality is that for most of us the state safety net is absent. If social care is means tested, then why not health care?

New and higher taxes will never solve the problems of health and social care…

There is a toxic culture, and disengagement everywhere in Health and Social Care. Also in the CQC …

What principles should underpin the funding system for social care? Surely an ID card with tax status and means is now essential….

The reality of the post-code lottery and rationing of health and social care. It will just have to get worse before the “honest debate”…

A Happy Brexmas to everyone as our leaders duck health and social care funding crisis.. The media failure, and political denial can only get worse..

Nov 2016 NHSreality: NHS funding and rationing: The debate (and the denial) intensifies… It’s going to get worse..

Reality is a word rarely used in Health debate and discussion. The Economist comments on post election realities..

A dishonest and covert dialogue is all that is happening at present.. Simon Stevens says he would like to change this. (U tube 4th June 2014)

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