Category Archives: Trust Board Directors

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.

 

Now comes the winter of our discontent – and civil unrest may well follow the expansion of covert post code rationing

The signs are ominous. The runes are clear that we live in an unhappy nation. Recent anecdotes from friends report patients from West Wales moving as soon as a diagnosis of cancer is made, or as soon as a critical investigation is not available.

Now comes the winter of our discontent – and civil unrest may well follow as the reality of differing life expectancy, safety net provision, palliative and hospice care, neonatal care, dementia care and treatment, physiotherapy and clot busting treatments after strokes, just to name some examples, comes home.

Lets get rid of a red herring. Drugs are not that important. New drugs incur vast sums and investment in research, and there are the failures to take into account as well. When PharmExec prints: Will UK Industry Show a United Front on Pricing? it is concerned about business and profits rather than patients.

…..”It has become evident that not of those represented by the ABPI necessarily agree with the stance the Board as a collective has taken. The Telegraph has suggested that one of the main differences between those in favour and those against legal action is their homeland. A headline on the ABPI JR on the 15 July 2017 said “Foreign drug giants behind challenge to NHS rationing.” They report that British board members – GSK and AstraZeneca – see legal action as unconstructive and aggressive. 

It’s also not clear that those representing industry though different industry associations agree either including the BioIndustry Association (BIA) and the Ethical Medicines Industry Group (EMIG).

The ABPI represents more than 80 per cent of all branded medicines used by the NHS, yet that is a fall from the over 90 per cent at the time that the 2014 PPRS was finalized……”

When Professor Sir Mike Richards opines on the NHSexecutive site: CQC chief: There’s a lot trusts can do to improve care without extra cash don’t take much notice. This is false news and is designed to keep his reputation with politicians (his employers) and not to lose his knighthood by speaking honestly. The BBC also covered this: NHS ‘does not need more money to improve’

When the health services are understaffed due to rationing of medical, midwifery and nursing places, and we have to import on an “industrial scale” the rhetoric is vacuous and the Emperor has no clothes.

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Rosemary Bennett reports in the Times 27th July: Care homes demand top-up fees from families and this even from the poorest families. The safety net is badly holed….

….The study found that 48,400 elderly people in care homes — about one in four — were being charged “top-up fees”, even though they met the conditions for their costs to be paid entirely by their council…..

James Kirkup rightly speaks out “for” a dementia tax, With growing cross-party support for a progressive way of funding care, those who inherit should foot more of the bill and says “The children of wealthy parents should pay more from their windfall. ”

Read the whole article about progressive taxation: The children of wealthy parents should pay more for their windfall.

Rationing is covertly expanding:

There is, according to the Week and other media sources: “A surge in exceptional funding requests”. Exceptional by the way is defined differently depending on your post code… and if you live in Wales it has to be more exceptional than in England….Gareth Iacobucci reports in the BMJ: Exceptional requests for care surge as rationing deepens (BMJ 2017;358:j3188 ) and “Pressure on NHS finances drives new wave of postcode rationing” (BMJ 2017;358:j3190 )

There is no good news here. Trust Board Executives could by lynched…. Who will volunteer when they know the job is unsustainable, they cannot change the rules or make a difference, and the whole health edifice is based on lies..

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Stroke survivors ‘are dumped by the NHS’. Dead patients don’t vote, and those near death don’t appear to count…

If you have a stroke on your way to the hereafter, your life expectancy is short, demand for services is high, and nobody listens to you, even if you can be understood.  Dumped is the right political word. Congratulations to the reporter on his understatement however, The real word, especially with regard to intensive physiotherapy, is abandoned. Dead patients don’t vote, and those near death don’t appear to count. Commissioners have a perverse incentive to save money, richer areas can have more physio as more patients go privately, and the post-coded, covert rationing lottery continues..

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Jon Ungoed-Thomas in the Sunday Times reports: Stroke survivors ‘are dumped by the NHS’

Sufferers feel abandoned after leaving hospital and face waiting up to a year for the right treatment — or paying for it themselves

Stroke survivors are being left to languish at home with a “shocking” lack of support. Many say they feel abandoned by the NHS.
Juliet Bouverie, chief executive of the Stroke Association, said a new national plan was required to help the 1.2m stroke survivors in the UK. Some have to wait up to 12 months for psychological help.
“As a stroke survivor, your life and the life of your family is turned upside down,” she said. “Many stroke survivors say they feel abandoned, as if they have dropped off a cliff. The provision in some areas is shocking.”
About 100,000 people suffer a stroke every year in the UK; it is one of the country’s leading causes of death.
Andrew Marr, the broadcaster and journalist, who suffered a stroke in January 2013, said better support for stroke survivors — many of whom are of working age — could help them return more quickly to employment. He was back at work within six months, but largely because he paid for additional physiotherapy.

Stroke survivors can wait up to four months for speech therapy and up to a year for psychological support, according to data from the Royal College of Physicians. Stroke survivors say there is insufficient physiotherapy, a treatment which would ensure the best recovery.

Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner<img class=”Media-img” src=”//www.thetimes.co.uk/imageserver/image/methode%2Fsundaytimes%2Fprod%2Fweb%2Fbin%2Ffa4fb670-698c-11e7-8ef4-9d945f972597.jpg?crop=2250%2C1500%2C-0%2C-0″ alt=”Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner”>
Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work soonerDavid Cheskin/PA

A stroke strategy, launched in 2007, outlined a 10-year plan to overhaul stroke services and has seen significant improvement in acute treatment. The Stroke Association is calling for a new action plan to build on improvements and outline a new strategy for the rehabilitation of stroke victims.

Nathan Ridgard, 40, a self-employed businessman and a father-of-two from Harrogate, North Yorkshire, suffered a stroke on New Year’s Eve 2012. After being discharged from hospital, he said he was given some leaflets by the NHS on coping with a stroke, but struggled to read them because of his poor vision.

“I just felt I had been dumped out in the world,” he said. He received some NHS physiotherapy, but also paid for private sessions to supplement them. He has since made a good recovery.

Professor Tony Rudd, National Clinical Director for stroke at NHS England, said: “The quality of care and survival rates for stroke are now at record highs. We are working with the Royal College of Physicians and others local health service leaders to improve rehabilitation care for everyone who suffers a stroke.”

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Whistleblowing law is expanded.. but hardly applies to GPs

The Times Law Report on 26th June: More than one employer can be liable to ‘whistleblower’

The trouble is that GPs are self employed and have no whistleblowing liable employer. However, GPs are more and more “portfolio” a career doctors with some time as partner or salaried partner, some time as educator, some time as referral centre letter reader, sometimes as Out Of Hours doctor or A&E assistant.

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Court of Appeal

Published: June 26, 2017

Day v Lewisham and Greenwich NHS Trust and Another

Before Lady Justice Gloster, Lord Justice Elias and Mr Justice Moylan

[2017] EWCA Civ 329

Judgment: May 7, 2017
For the purposes of the protection for “whistleblowers” in the workplace, a person in training might be employed by both the employer with whom he had been placed and the training body that had made the placement, if the training body had substantially determined the terms under which he worked.
The Court of Appeal so stated when allowing the appeal of the claimant, Dr C Day, against the dismissal by the Employment Appeal Tribunal (Mr Justice Langstaff) ([2016] ICR 878) of his appeal against a decision by an employment tribunal to strike out his claim against the second defendant, Health Education England, that it had subjected him to a detriment for making a protected disclosure or “whistleblowing”. The first defendant was Lewisham and Greenwich NHS Trust. Public Concern at Work intervened in the proceedings.

Part IVA of the Employment Rights Act 1996 (as inserted by section 1 of the Public Interest Disclosure Act 1998) provides, so far as relevant:
“43K(1) For the purposes of this Part ‘worker’ includes an individual who is not a worker as defined by section 230(3) but who (a) works or worked for a person in circumstances in which (i) he is or was introduced or supplied to do that work by a third person, and (ii) the terms on which he is or was engaged to do the work are or were in practice substantially determined not by him but by the person for whom he works or worked, by the third person or by both of them . . . and any reference to a worker’s contract, to employment or to a worker being employed shall be construed accordingly.
“(2)(a) For the purposes of this Part ‘employer’ includes (a) in relation to a worker falling within paragraph (a) of subsection (1), the person who substantially determines or determined the terms on which he is or was engaged . . .”

Mr James Laddie, QC and Mr Christopher Milsom for the claimant; Mr David Reade, QC and Mr Nicholas Siddall for the second defendant; Mr Thomas Linden, QC, for the intervener.

Lord Justice Elias said that Part IVA of the 1996 act, read together with sections 47B and 103A (as inserted by sections 2 and 5 of the 1998 act), protected workers who disclosed information about certain alleged wrongdoing to their employers (colloquially known as “whistleblowers”) from being subjected to victimisation or dismissal as a consequence.

The appeal concerned the proper construction of section 43K and the application of that section to a certain category of doctors operating in the health service.

The claimant was a doctor who wanted to specialise and was accepted by the body then responsible for training doctors in London to take up a post from August 2011. He entered into a training contract that the parties agreed was not a contract of employment. He was allocated to the first defendant NHS Trust. Subsequently, the training body was taken over by a training board that was part of the second defendant, Health Education England.

Trainee doctors were allocated for relatively short fixed periods to NHS trusts. They entered into contracts of employment with each trust. The claimant worked, inter alia, at the Queen Elizabeth Hospital. While there, he raised a number of concerns with both the trust and with the South London Health Education Board about what he considered to be serious staffing problems affecting the safety of patients.

He alleged that those were protected disclosures within the meaning of the legislation on whistleblowers and he asserted that he was subject to various significant detriments by the second defendant as a consequence. He took proceedings before the employment tribunal against both the trust and the second defendant, as the body responsible for the actions of the South London Board.

The second defendant denied any wrongdoing, but took a preliminary point. To bring a whistleblowing claim the claimant had to fall within the statutory definition of worker and the defendant had to be his employer. The second defendant contended that that was not the position and, accordingly, that even if the facts alleged by the claimant were true, the second defendant could not be liable in law for any acts causing him detriment.

The only question was whether the claimant was a worker within the extended definition in section 43K and the second defendant was his employer as defined in that section.

His Lordship would refer to the person for whom the individual worked as the end-user and the party introducing or supplying that worker as the introducer. It was envisaged in section 43K(1)(a)(ii) that the terms on which an individual worked might be substantially determined by both the end-user (the heath trust) and the introducer (the training body). That might be either because the introducer and the end-user determined the terms jointly, or because each determined different terms but each to a substantial extent.

The extended definition of “employer” in section 43K(2)(a) was not limited to the person who played the greater role in determining the terms of engagement. Since both introducer and end-user could in principle substantially determine the terms of engagement for the purposes of the definition of worker, there was no basis for concluding that they could not do so when it came to applying the extended definition of employer.

That would in some cases have the effect that both introducer and end- user were employers and each would then be subject to the whistleblowing provisions. Indeed, that would seem to be an inevitable conclusion if the terms were determined by the end-user and introducer acting jointly. If only one party could be the employer, it was difficult to see by what principle it would be possible to determine who that should be.

The Employment Appeal Tribunal had been wrong to find that the fact that the health trust was a section 230(3) employer precluded the training body from also having that status.

There had to be some limitation on the words of section 43K, which began by providing: “For the purposes of this Part ‘worker’ includes an individual who is not a worker as defined by section 230(3) . . .” The insertion of some such phrase as “as against a given defendant” after “includes an individual who” would allow the section to operate against one of those parties even if there was a section 230(3) relationship with the other.

Accordingly the training body could in principle fall within the scope of section 43K(2)(a), notwithstanding that the claimant had a contract with the hospital trust.

The employment tribunal had not engaged directly with the question whether the training body itself “substantially determined” the terms on which the claimant was engaged. A tribunal should not limit itself to focusing solely on the contractual terms, although no doubt the terms would be overwhelmingly contractual. The section required the tribunal to focus on what happened in practice.

When determining who substantially determined the terms of engagement, a tribunal should make the assessment on a relatively broad brush basis having regard to all the factors bearing upon the terms on which the worker was engaged to do the work.

The case would be remitted to a fresh tribunal for determination of the preliminary issue whether the training body substantially determined the terms of engagement of the claimant.

Lady Justice Gloster and Mr Justice Moylan agreed.

Solicitors: Tim Johnson Law; Hill Dickinson, Manchester; Solicitor, Public Concern at Work.

Whistleblowing in the NHS – how safe are you? (Sharmila Chowdhury 4 August 2014)

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[PDF] Wales’ GP Heroine Whistleblower…. The Spectator reveals “How the …

NHS reality. An NHS soapbox. Speakers’ corner for the NHS …400 × 305Search by image

The Spectator reveals “How the NHS silenced a whistleblowing doctor” – No cultural change yet… | NHS reality. An NHS soapbox. Speakers’ corner for the NHS.

Reflections on the BMA conference in Bournemouth. A complete lack of trust..

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ARM 2017 in Bournemouth

The annual representative meeting (ARM) is the BMA’s main policy-making body. Around 500 doctors from across the profession and the UK gather to consider and debate key matters of interest to the medical profession.

I have never been to a BMA conference before. his conference from 25-19th June was an eye opener. The volume of business, and the number of people was daunting. Agenda items ranged from the political to the clinical. and some of us thought some issues would be best addressed by politicians. Throughout the meeting there was a complete lack of trust by doctors of government, dishonesty, and denial by politicians and administrators, and resulting anger and resentment in the body politic. This is spreading beyond the profession and the unrest following the Grenfell tower will be as nothing to the unrest as the health safety net is seen to fail.

BMA council chair Mark Porter – opening speech  – Health Service running on fumes

STPs(Stick Toffee Puddings , or Slash Trash and Privatise

Agenda Items on Monday of which I as speaking at 1:34 into the meeting

Dr Roger Burns speaks up abut West Wales. (https://pharmaphorum.com/news/millions-affected-nhs-cuts-doctors/#) in response to Motion 16 (I):

Recognises that greater medical involvement in the design and planning of health care is crucial in ensuring that improved patient services are properly designed and effectively implemented.

There were plenty of retired members present, of whom I am one. It looks as if the retired members are trusted to represent their younger and busier colleagues. What is need is a way to vote from a distance. Members need to log into the website and watch a webcam and be prepared to vote at an instant. This would allow members to check in and relate to any particular motion but ignore others.

There was a couple of motions with the implication of rationing, but without mentioning the word itself:

Motion 12 (v) “Calls for government and NHS lead bodies to have an open dialogue with the public and patients about what services the NHS should provide for the funding available, and what services should no longer be funded by the NHS.

New attendees need to be aware that they need a speedy induction if they are to take advantage of the opportunity to speak. New conference members, and those who vote against a motion are given preference. I spoke out about the reconfiguration of Wales Health Trusts. NHSreality is in favour of one NHS trust for 3 million people, and this would at least endure choice within Wales. I spoke against the motion on the grounds that it failed to mention rationing, and the need for the politicians to get on board with this concept before we can make sense of the health service, and bring the hearts and minds of the doctors on board. Sometimes “hard truths” need to be said. Napoleon did this with the French after their revolution. By offering to bring order he took away a little liberty. Lack of choice is a loss of liberty, but it may be worth it if standards of treatment for important and expensive problems rise.

All local BMA groups need to plan ahead of the ARM to present notices of motion. Clinical and social meetings are also needed, and could be combined with politics.. My suggestions to be considered for the future include:

Wales residents should be given choices within Wales. If this can only be facilitated by one Health Trust then we support this proposal.

All Wales staff should be offered exit interviews by the BMA, and if they wish, in conjunction with other organisations such as the Nurses and Midwives, and other professions. Since no credence would be given to a summarised internal HR report, external consultants should be charged with this task.

In West Wales infrastructure needs to be improved, especially for travel, but also to replace old buildings and plant.

Medical Publications should always inform the reader if the paper was rejected by another publisher. The on line information should then reveal why rejection occurred.

All Wales BMA members should be offered the option of group/mutual medical insurance

and for local debate: A decision not to build a new hospital at Whitland / Narberth in 1996 is to be regretted.

Henry Bodkin in the Telegraph 27th June: Doctors call for abortion on demand as BMA votes to decriminalise terminations for first time ever 

Ann Furedi comments for BPAS: Why UK abortion laws should be scrapped – they are 50 years out of date 

Pharmforum comments on STPs on June 28th: Millions will be affected by STP health service cuts, say doctors

Hunt stayed silent over 700,000 lost letters to patients (The Telegraph)

Crowdfunding of Wheelchairs

UK falls behind in International league of doctor numbers (BMJ)

Government using GPs as scapegoats instead of taking responsibility for crisis in NHS

Margaret McCartney: Health inequality has to be political BMJ 2017;357:j2978

 

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BMA annual meeting: GPs working at unsafe levels should issue “black alert”-style warnings, says BMA (Wales sees steep rise in “at risk” surgeries.

Frances Gibb in the Times 27th June: Medical negligence payouts ‘unaffordable’

Doctors call for national rules on OTC prescribing (BMJ 25th March)

BBC2: Hospital – How do you cost life? 

Kat Lay in the Times 12th June: NHS blocks drug to help babies with spinal muscular atrophy

London commissioning group plans to restrict cataract surgery

Oliver \moody on 26th June: NHS urged to find money for cystic fibrosis drug

Kat Lay: ‘Overworked’ GPs demand to close their surgery doors

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Why not implement no-fault compensation? Because it needs a longer term perspective and a PR system to get it through.

Frances Gibb reports in The Times 23rd June 2017: Medical negligence payouts ‘unaffordable’

Reforms to curb the soaring costs of medical negligence, which could see taxpayers paying out £2.6 billion a year by 2022, must go ahead, a report has urged.
The NHS spent £1.5 billion on clinical negligence claims last year, enough to train more than 6,500 doctors, the Medical Protection Society said. The not-for-profit organisation , which supports 300,000 healthcare professionals worldwide, is calling for a package of legal reforms that would strike a balance between compensation that is reasonable but also affordable.
Its proposals include a cap on future care costs which would be paid on a tariff to be agreed by an expert working party. It also wants to use national average weekly earnings to calculate damages awarded, to avoid unfairness between high and low-income earners.

and the comments are good as well. In Wales the amount set aside for future litigation/compensation is more than one year’s budget. Why not implement no-fault compensation scheme? Because it needs a longer term perspective and a PR system to get it through. Apologies would then be like confetti..

Image result for confetti cartoonand that’s not to mention apologies from our masters re both contract and staffing levels:

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Scotland (and I hope Wales will follow) has announced legislation to protect doctors if and when they apologise. Doctors in Scotland get legal protection when apologising, explains MDU

Doctors in Scotland are being given legal protection when apologising to patients, the Medical Defence Union (MDU), explained today.

The Apologies (Scotland) Act 2016, the relevant part of which comes into force on 19 June 2017, makes it clear that an apology (outside of legal proceedings) is not an admission of liability. In the new Act, an apology is defined as:

‘…any statement made by or on behalf of a person which indicates that the person is sorry about, or regrets, an act, omission or outcome and includes any part of the statement which contains an undertaking to look at the circumstances giving rise to the act, omission or outcome with a view to preventing a recurrence.’

Mr Jerard Ross, MDU medico-legal adviser, said:

‘Saying sorry to a patient when something has gone wrong is the right thing to do and is an ethical duty for doctors. The Apologies (Scotland) Act provides further reassurance to doctors that apologising is not an admission of legal liability. In the MDU’s experience, a sincere and frank apology and explanation can help restore a patient’s confidence in their doctor following an error and help to rebuild trust. This is important for a patient’s future healthcare and can help to avoid a complaint or litigation.’

Doctors have a professional duty of candour, set out in the General Medical Council’s Good medical practice which states: ‘You must be open and honest with patients if things go wrong. If a patient under your care has suffered harm or distress you should put matters right (if that is possible), offer an apology, explaining fully and promptly what has happened and the likely short-term and long-term effects.’

A legal duty of candour was also introduced for health and social care providers in Scotland under The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 although it has yet to be brought into force by enabling legislation. It will mean that doctors and other health and social care staff in Scotland will have to inform patients and their families when a patient has, in the reasonable opinion of an uninvolved registered health professional, died or been unintentionally or unexpectedly mentally or physically harmed as a result of their care or treatment.

Although the Apologies Act does not apply to the legal duty of candour, the Health Act itself makes it clear that ‘an apology or other step taken in accordance with the Duty of Candour…does not of itself amount to admission of negligence or breach of a statutory duty’.

The GMC has published ethical guidance on the professional duty of candour which explains in more detail what constitutes an effective apology for healthcare professionals. This includes advice that apologies should not be formulaic and that the most appropriate team member, usually the lead clinician, should consider offering a personalised apology, rather than a general expression of regret.

In Wales the amount set aside for future litigation/compensation is more than one year’s budget.

David Williamson for Walesonline 30th Dec 2016 : More than £600m allocated to pay for clinical negligence and personal injury claims against the Welsh NHS in the future

In the last financial year £74.6m was paid out and £682m has been set aside for future payments

NHS faces ‘compensation time bomb’ as clinical negligence …  GP online25 Jul 2016

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BBC News28 Nov 2016

 

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