Category Archives: Trust Board Directors

Why won’t anyone in power talk about rationing? “We need to talk about NHS rationing”…

The downside of honesty must be greater than the upside – what an indictment of our media led society. Why are our leaders and administrators, trust chairmen and CEOs so afraid to speak out?

In Pulse 10th October 2017 David Turner opines: We need to talk about NHS rationing

A woman requesting breast reduction.

A child with severe behavioural problems in need of psychological assessment

A seventy year old brought to tears daily with knee pain, waiting for physiotherapy.

A new cancer drug costing thousands per month that has just received NICE approval.

What have these patients got in common? They all have a legitimate claim on the NHS pot of money for funding.

The recent announcement that NICE has approved nivolumab for treating patients with certain types of advanced lung cancer is fantastic news for those patients and will add valuable months to their lives.

There is, though, a rather large pachyderm in the room, which sooner or later needs to be faced. I’m afraid all of us – doctors, patients, managers and politicians – seem reluctant to address the rather obvious reality that NHS coffers are not infinite. Funds for healthcare are always going to be finite and even with the best political will in the world (and we certainly don’t have that at the moment) we cannot pay for everything.

Funding an expensive cancer treatment to give someone extra time on earth will impact on other aspects of healthcare. Increase funding to one area and others will suffer with reduced services and longer waiting lists.

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Do we say only disorders that can be fatal go to the front of the queue?

Many will say we should prioritise the most serious illnesses which can kill quickly such as heart disease or cancer. Nobody dies from osteoarthritis, but thousands suffers tremendous pain every day while waiting joint replacement surgery. It’s also not unheard of for people with mental illness to kill themselves while waiting to see a psychiatrist.

Name virtually any condition or disease and there will be individual sufferers and support groups making their case as to why more taxpayers’ money should be spent researching into or treating their disorder.

The reality is everyone’s health matters to them more than anything else and few people will be altruistic enough to say public money should be spent treating others before themselves and their loved ones.

I don’t claim to have the answers, but unless we start to talk more openly about the very real issue of rationing in the NHS we are just postponing some very serious questions for the future and they are not going to get any easier to answer.

Dr David Turner is a GP in west London

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A stillbirth is not a person: so no coroners inquest. But the rates differ greatly around the country… Lets stop the blame culture winning..

A sad and disturbing case illustrates a greater problem. The rates for Stillbirth in Wates are 20% higher than in England. Has this always been the case? On June 15th this year I wrote to the Chief Medical Officer of Hywel Dda University Trust asking for information on the rates of Maternal Death, Neonatal Mortality and Infant Death for the Trust, compared to the all Wales and to the all UK figures. I received the acknowledgement reply and was informed I would get a proper reply in 7 weeks. It is now some 14 weeks later and I have not had a reply. The case in the news involves intelligent and well informed professionals, who wish to remain part of a team and work  within the health service. They are not trying to “gain”, but wish to change a culture so that learning occurs, and repetitive mistakes do not happen. If we wish to avoid the blame culture we need open and honest debate. No fault compensation would help greatly… Meanwhile I am writing again and including Stillbirths in

Lucy Bannerman reports in the Times 7th October 2017: Parents call for NHS stillbirths to be investigated

Two health professionals whose daughter died during labour after a series of hospital failures have called for coroners to be given power to investigate stillbirths.

Sarah Hawkins and her husband Jack said that it was “absolutely ridiculous” that baby deaths in England and Wales only merited the independent scrutiny of a coroner’s court if the child was alive when born.

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Their daughter, Harriet, died in April last year, at 37 weeks, after errors by Nottingham University Hospitals NHS Trust, including repeatedly denying Mrs Hawkins admission to hospital and failing to declare an obstetric emergency.

Mrs Hawkins was in labour for five days and after being told the baby was dead had to wait nine hours before Harriet was delivered.

Both worked for the trust, she as a senior physiotherapist and he as a consultant, but when they asked for an investigation they said they “were dismissed as mad, grieving parents”.

Mrs Hawkins, 34, said: “It just felt they were saying, ‘This is very sad, these things happen, now go away and grieve’. But we have both worked in the NHS all our careers. We wanted to tell them what they needed to know, to make sure it wouldn’t happen again.”
The couple were told there would be no inquest because the law states that a stillborn child or foetus is not a “deceased person”. “As a mum, to be told that your daughter isn’t defined as a person, because she wasn’t born alive is absolutely ridiculous. She had been kicking around, and had her foot under my ribs for months,” Mrs Hawkins said.
The couple said they were told by the trust that Harriet’s death was caused by an infection. It was only after challenging that and pushing for an external review that the death was “upgraded” to a serious untoward incident (SUI).

“It has been battle after battle after battle,” said Mrs Hawkins. “We don’t want sorrys. We want answers.” Mr Hawkins, 48, said: “I don’t think they really had a clue that the death of a baby in labour was a major incident. Their attitude was very laissez faire.”

Peter Homa, chief executive of the trust, has apologised but denied a cover-up. “I reiterate my condolences to Jack and Sarah and acknowledge the unimaginable distress and sadness caused by Harriet’s death,” he said.

“I apologise unreservedly that their pain has been worsened knowing that, had the shortcomings in care late in Sarah’s pregnancy not been experienced, Harriet might be alive today.”

The couple believe their daughter might have lived had inquests been held into previous stillbirths at the trust. They want the law to be brought in line with Northern Ireland where coroners can investigate stillbirths.

Mrs Hawkins vowed to keep campaigning. “We want to get justice for Harriet but also for all the other parents before us, and after us,” she said.

ITV News 5th October: ‘Now we want justice for our daughter’: Hospital says failings in …

ITV News yesterday: Hospital trust apologises for failings after stillbirth of employees …

Hospital apologises to parents of stillborn baby for ‘unimaginable … Nottingham Post

 

Sands – Stillbirth and neonatal death charity

Golden goodbyes for NHS managers soar to £39m

Its quite surprising that managers who will not get jobs outside the health service (except in health providers) are so “valued”. The doctors who move into management are considered to have “moved to the dark side”, as their colleagues appreciate that the philosophy is unsustainable and the hoops they are asked to jump through are mostly pointless. This applies in both Hospital and GP land. As referrals are “blocked” more taxpayers will have to go private…

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Nadeem Badshah in the Times 16th September 2017 reports: Golden goodbyes for NHS managers soar to £39m

Spending on golden goodbyes and voluntary redundancy deals has risen eight-fold in a year at the Department of Health, according to official figures.
A parliamentary answer reveals that more than 700 staff left the department in 2016/17 due to restructuring and cost-cutting programmes.
The figures, which cover the DoH and its agencies, showed that £39 million was spent in total, compared with £5 million the previous year.
Across the whole of the NHS, including the DoH, £153 million was spent on redundancies and “exits”, up from £141 million the year before.
Philip Dunne, the health minister, said that “voluntary exits” of DoH staff accounted for £31 million in a parliamentary answer published this week.

An additional £1.4 million was spent on compulsory redundancies, the Health Service Journal reported.

The remaining £6.6 million is thought to have been spent on voluntary redundancies at agencies including Public Health England and the Medicines and Healthcare Products Regulatory Agency. Ministers were criticised in March after revealing that 340 civil servants were to be recruited, despite the mass redundancies, largely to respond to Brexit.

Almost £2 billion had already been spent on NHS redundancies since 2010.

Official statistics released earlier this year showed that in the past three years more than 1,000 civil servants and senior NHS officials were awarded exit payments of more than £100,000, with 165 receiving at least £200,000.

Separate figures disclosed that more than 600 NHS quango bosses are now on six-figure salaries, with a doubling in the number earning more than the prime minister in just three years.

In 2010 the Conservatives pledged to reduce spending on NHS bureaucracy. A reorganisation of the health service reduced administrative costs, but has resulted in almost £2 billion being spent on redundancies.

The DoH said: “The department undertook a redesign and subsequent restructure to make sure it is best placed to meet current and future health and social care challenges. Redundancy and other departure costs were paid in accordance with the provisions of the civil service compensation scheme.”

Carolyn Wickware in Pulse 15th September reports: GPs told to refrain from referring as hospital declares early-season black alert

NHS managers still growing as GP posts fall

HSJ implies Managers and Directors are now at odds with Politicians over rationing..

It’s falling apart, and it’s going to get worse… for everyone except the top managers and politicians.

GPs (Commissioning Groups in England) spend vast sums on temporary managers – no its not happening in Scotland or Wales

NHS middle managers too comfortable to take top jobs “Kafkaesque regulation and rising patient expectations mean that managers and doctors opt for an easier life in less demanding roles”… political courage is needed.

Whistleblowing in the NHS – The need to regulate non-clinical hospital managers

Perverse behaviours by managers lead to covert and unfair systems for us all. Patients ‘bumped from cancer test waiting lists’

Trying to defuse some of the invective against NHS managers.

A summary of health rationing in the news this last week. Weak (cowardly) politicians have led the NHS to ruin

Just this last week we can see evidence of removal, restriction, limitation or prioritisation decisions made by CCGs or Trusts. In addition the administration are unable to keep up with the complaints and requests for information. I myself have a request on perinatal and maternal mortality pending which is over the 8 weeks at Hywel Dda Trust. There are so many fingers in the dam that there are no hands to repair ur security and health systems.. As for the elderly demented, they don’t vote and don’t seem to matter… An IPR report on Death Dying and Devolution explains clearly the post code and unfair rationing of resources. Weak (cowardly) politicians have led the NHS to ruin 

Mark Smith for Walesonline 6th September: Thousands of complaints against the Welsh NHS are not being handled quickly enough

Health boards claim it is sometimes impossible to respond within the 30-day timescale

Forty percent of Welsh NHS complaints miss target

Tom Knowles exposes the temporary nature of the employment currently offered. In the Times on 12th Septtember: Summer hiring spree for builders and NHS

Adele Couchman in Kentlive on 12th September reports:

The number of nurses specialising in dementia and other mental health problems in the elderly has been cut by a fifth since 2010, according to “incredibly concerning” figures.

Psychiatric nurses treating older people have been among the hardest hit by a reduction in mental health staffing despite government pledges to prioritise the rise in dementia, analysis of NHS data for The Times shows.

While the overall number of NHS nurses has risen slightly over the past seven years, this has been due to increases in acute hospital and maternity services, helped by a recruitment drive after the Mid Staffordshire scandal. Figures from NHS England show that the number of mental health nurses working for the health service fell by the equivalent of almost 5,000 full-time posts between May 2010 and May this year, a drop of more than 12 per cent.

Old age psychiatric nursing is among the worst hit specialisms, with 1,000 full-time posts gone since 2010, a fall of 22 per cent, to 3,541 posts.

Older patients often need more intense monitoring and are susceptible to problems with medication and side-effects. A nurse’s role also involves emotionally supporting patients’ families and helping patients stay independent for as long as possible.

Caroline Abrahams, charity director of Age UK, said: “An ageing population inevitably means we need more psychiatric nurses specialising in work with older people, so the fact their numbers have shrunk by a fifth over the last seven years is incredibly concerning.
“Historically, older people’s mental health needs have often gone undiagnosed and been overlooked and these depressing figures provide no cause for optimism that the situation will improve any time soon.” She called for urgent government action. With psychiatrists for the elderly also overstretched, doctors say they are increasingly reliant on specialist nurses to help manage the rising need for treatment.
More than 850,000 people in Britain have dementia, a figure which is expected to pass a million within seven years.
Hilda Hayo, head of Dementia UK, said that the charity’s specialist dementia nurses and helpline were picking up cases of families under increasing pressure as a result of the loss of nurses.
“These reductions are coming at a time when people live for longer but are not necessarily healthier — and dispersed families are unable to provide the support needed,” she said. “More families are going into crisis and having to make decisions which may result in earlier admission to hospital or a care facility due to the lack of community support.”
A Department of Health spokesman said: “This government is committed to improving care for those with mental health conditions, which is why we have started one of the biggest expansions of services in Europe.
“Our ambition is to create 21,000 new posts by 2021 by supporting those already in the profession to stay and giving incentives to those considering a career in mental health.”

Death Dying and Devolution

Weak (cowardly) politicians have led the NHS to ruin

Stephen Hawking is no idiot… he sees things getting worse and no way back. Hunt is rationing as much as he can get away with..

Stephen Hawking is used to scientific debate and the weighing of evidence. If he accuses Hunt of cherry picking he is really accusing him of rationing as much as he can get away with. Commissioning groups are all using the R word, but the politicians will not… No wonder the professionals are disengaged..

Nick Triggle in the BBC news website reports 19th August: Stephen Hawking: I’m worried about the future of the NHS

Stephen Hawking has said he is worried about the future of the NHS, in a speech critical of government policy and Health Secretary Jeremy Hunt.

The Cambridge University scientist, who publicly backed Labour in the election, accused Mr Hunt of “cherry-picking” evidence to support his policies.

The 75-year-old also said he was concerned about the involvement of the private sector in the NHS in England…..

 

On Saturday 19th August and report as Hunt responds and is reported in the Guardian: Jeremy Hunt accuses Stephen Hawking of ‘pernicious falsehood’ in NHS row

Health secretary reacts to physicist’s claim that the Conservatives are trying to implement US-style health insurance system

Jeremy Hunt has accused Stephen Hawking of a “pernicious” lie after the physicist said it seemed the Tories were steering the UK towards a US-style health insurance system.

Hours after the health secretary was criticised for claiming Hawking was wrong in the row about the government’s seven-day NHS plan, he leapt back into the fray with two tweets defending the Conservative party’s record on the health service.

Hunt was responding to criticism from the renowned 75-year-old physicist and author of A Brief History of Time ahead of a speech at the Royal Society of Medicine on Saturday.

In the speech, Hawking will accuse the health secretary of “cherrypicking” favourable evidence while suppressing contradictory research to suit his argument.

In a Guardian opinion piece published on Friday, Hawking also criticised the power of profit-seeking multinationals, which he said had contributed to the inequalities rife in the US healthcare system.

“We see the balance of power in the UK is with private healthcare companies, and the direction of change is towards a US-style insurance system,” he wrote.

The shadow health minister, Justin Madders, weighed in on the row: “It doesn’t take a genius to work out the Tories are wrecking the NHS.

“Professor Hawking has given us answers to many of the universe’s most challenging questions, and even he can’t work out why Jeremy Hunt is still in his job.”

Jeremy Corbyn, the Labour leader, said Hawking was a “brilliant scientist” with a “brilliant mind” and “brilliant thought process” who should be listened to.

The former Liberal Democrat leader Tim Farron said: “A renowned scientist such as Stephen Hawking questioning your evidence might normally be cause to think again, but sadly it looks as though Jeremy Hunt has joined the chorus of those who have had enough of experts. ……

A nation choosing to have fewer children, and to import fewer workers for the health and social care services. It does not stack up.

We are a nation choosing to have fewer children, and to import fewer workers for running the health and social care services. It does not stack up.

Things have to get worse unless we export our elderly for warehousing abroad, or they are managed by robots.Image result for nuclear family cartoon

Fay Schopen reports in the Guardian that “IVF was stressful enough even before this new post code lottery. (NHSreality points out it’s not new and is only getting worse and more unfair as predicted)

Fay is paying for private care and pints out the two tier system which is the national effect of current policy.

Ironically, the Economist points out that fewer women in the west are choosing fertility. More and more have either one or no children. Is society getting compassion fatigue for those who choose to have large ffamilies?

The Rise in Childlessness is available in the Economist 27th July but also below.

Childlessness – Economist

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Change the Rationing of Infertility treatments from covert to overt: Schools should tell girls to try for a baby before 30, says fertility expert – and prospective professional be warned..

Patients suffer in GP funding lottery. Anger and civil unrest to follow?

You never knew it was “unavailable” until you needed it.. and then it’s too late

Women denied IVF as 80 per cent of NHS trusts ration fertility treatment

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NHS must cut waste if it wants more cash and NHS “must put it’s house in order before demanding more cash”.

It’s going to get worse though, despite this report. When the professor writes a report without mentioning rationing we know what will happen to it… Writing a report from the provider side will only emphasise that it is not “patient centred”, but government centred. The bureaucracy is unable to change without the rules of the game being changed.. Mental health is a case in point, where desperation has led to a promise of more money, but what will suffer as a result?

(Judge warns of ‘blood on our hands’ if suicidal girl is forced out of secure care

 

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Chris Smyth in the Times 4th August reports: NHS must cut waste if it wants more cash

The NHS does not deserve more money because it wastes so much on poor care, according to the senior surgeon who has the job of driving up standards.
The health service must put its house in order before asking for extra taxpayers’ cash, said Tim Briggs, who is conducting the most comprehensive clinical efficiency audit of the NHS yet undertaken.
His review found huge variations in the cost and quality of common treatments, with low-performing hospitals routinely ignorant about superior methods adopted elsewhere.
The NHS could save hundreds of millions, if not billions, a year if the best and most efficient practices were applied across the country, Professor Briggs concluded.
His programme is backed by the health secretary, Jeremy Hunt, who urged hospitals yesterday to act on the findings, as well as Simon Stevens, the head of NHS England……

Specialists in each area gather data from hospitals then sit down and discuss individual results with clinical staff in each unit, learning from the best and helping poor performers improve. “Just putting it in a drawer and forgetting about it is no longer an option,” he said.

Profile: Tim Briggs
After a long and distinguished career as a hip and knee surgeon, Tim Briggs admits that he is out of his comfort zone as a crusader for NHS clinical efficiency (Chris Smyth writes).

Yet the former Blackheath rugby forward does not flinch from tackling colleagues.

A consultant at the Royal National Orthopaedic Hospital since 1992, Professor Briggs grew used to seeing patients with complications caused by botched surgery. It was obvious not everywhere was doing as well as they could.

In 2012 as the president-elect of the British Orthopaedic Association, he gathered data on all orthopaedic units, visiting them to discuss their results. It is this, he insists, that makes the “getting it right first time” programme different from the plethora of audits the NHS has seen come and go.

Times leader: Healing the healers.

The British love the National Health Service, but it is in a mess. It was built in the 1940s for a different kind of country. Now it largely looks after a bulging population of the old and chronically ill, and is constantly short of cash. Reform is urgently needed but it has been too slow to arrive. A troubling new report is likely to drive this point home to doctors and health officials. It was overseen by a respected and straight-talking orthopaedic surgeon, Tim Briggs, and was backed by the health secretary, Jeremy Hunt. The report, on general surgery, part of a much broader review led by Professor Briggs, finds the NHS is wasting a great deal of money.

It says that 300,000 patients a year are needlessly admitted for emergency operations, and £23 million wasted on patients staying too long in hospital after bowel surgery. Some hospitals are paying much more than others for surgical supplies, and varying infection rates for hip replacements (between 0.2 per cent and 5 per cent, depending on where people go) cost the heath service £300 million. Hospitals tend to have no idea what others are doing and are surprised when told that they are behind their peers. In sum, Professor Briggs told The Times: “I do not think at the moment we deserve more money until we put our house in order.”

This argument has some merit. Professor Briggs’s report is the latest in a line of government reviews which have pointed out that there is money down the back of the sofa. In 2014 the NHS England chief’s Five Year Forward View found room in the health service for £22 billion in efficiency savings by 2020. In his 2015 report the former Marks and Spencer boss Lord Rose of Monewden concluded that the health service was “drowning in bureaucracy”. And last year a report by Lord Carter of Coles said that hospitals were wasting £5 billion on paying too much for supplies.

The NHS response has been glacial or nonexistent. But its problems are not unsolvable and it has a number of correctable design flaws. There is political pressure not to run deficits but little to invest in innovations, which means that smart new ideas do not often travel from one hospital to another. Hospitals are paid per operation so they are not inclined to cut back. Separate budgets and commissioners for different sections of the NHS (such as preventive healthcare and specialist hospital care) mean ideas that might move money from one to another are often resisted. No single person holds responsibility for smoothing out variations across the health service. The matter can therefore slip under the radar.

Any changes will require considerable political clout. The Department of Health has yet to recover fully after the botched reforms under Andrew Lansley, Mr Hunt’s predecessor. While other public services such as the police have spruced up their technology and adapted to changing needs, the NHS has remained in deep freeze. It should summon the confidence to drive through the reforms that a modern health service urgently needs.Professor Briggs’s project suggests that matters may be moving in the right direction. It is not just a data-gathering exercise — his team take their results from hospital to hospital, talking through how each health centre compares with its peers. Professor Briggs claims that a similar initiative from 2012, on orthopaedics, is now yielding good results.
The health service is not alone in its problems. It shares them with most of the world’s healthcare systems. This year’s Commonwealth Fund survey found Britain’s health service to be the best, safest and most affordable of the 11 countries that it analysed. The NHS is also one of the biggest organisations on the planet. The pace of change, however, need not be so languid. Certainly it will continue to require more cash, but first it must show that it can spend that cash wisely and efficiently.

Changing the rules of the game

Who will be the “last man standing” in your practice? Changing the rules of the game

NHS funding advice: GDP worth debating… Showers of money will not work..

When will public anger over the NHS reach a political tipping point? More NHS mental health patients treated privately…

in 1983 another eminent Orthopaedic Professor reported: His advice was taken at first, fond to be more expensive and then ignored. Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres The difference between Hospital Infection rates is nothing when private hospitals are added to the mix. Instead of a 50 fold difference in infection there is a 500 fold difference in risk of infection.