Category Archives: Trust Board Directors

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.”

There is plenty of room for improvement. Whilst we have got good outcomes in Breast Cancer, the rare cancers                  and Prostate Cancer in men do worse.

Chris Smyth reports 3rd Feb 2018: NHS is crippled by top-down culture

Autocratic management is a leading cause of poor NHS care, according to the compiler of a European health service league table that ranks Britain 15th.

The UK trails Slovakia and Portugal while the best performers such as the Netherlands and Switzerland pull away, according to the Euro Health Consumer Index. Treatment is Britain is mediocre and there is an “absence of real excellence” in the NHS, the report concludes. Only Ireland does worse on accessibility measures such as availability of same-day GP appointments, access to specialists and waits for routine surgery.

The findings come after a global study this week found cancer survival in Britain still lagged well behind the best in the world.

Arne Björnberg, who compiles the Euro Health Consumer Index, said: “Cancer survival rates are one of the prime examples of NHS mediocrity.”

More money is needed to improve care, according to a study that finds a strong correlation between treatment results and how much countries spend on health.

However, Professor Björnberg said that the most urgent lesson the NHS could learn from other countries was about the corrosive effects of an “autocratic top-down management culture”. He said: “As a Scandinavian what strikes you when you visit the UK is British management is extremely autocratic. Managing 1.5 million using a top-down method doesn’t work very well. If you go and ask a secretary or a receptionist anything out of the routine in Scandinavia, the most negative response would be: ‘I’ll see what I can do’. But in the UK they will say: ‘I’ll have to talk to my manager’. Subordinate staff are not allowed to use their brains in the UK and managing a professional organisation like healthcare like that is not a good idea.”

The Netherlands has consistently topped the rankings, which some have attributed to a system of competing insurance companies. However, Professor Björnberg said that the main lesson to be learnt from the Dutch was not about market forces but the need to put doctors in charge and force them to take account of patients’ views.

“If you have intelligent people and make them talk to customers frequently, that is a good idea,” he said.

“You have 1.5 million intelligent and dedicated people working for [the NHS]. Liberate the medical profession and put politicians and amateurs at arm’s length.”

NHS bosses dismissed the findings, preferring an index compiled by the US-based Commonwealth Fund, which ranks Britain top of 11 global health systems. The NHS scores well on measures such as equal access, but ranks tenth at keeping people alive.

In Search of the Perfect Health System – a new book reviewed

 

Compared with 11 other countries UK ranked first – for it’s system and not for it’s outcomes

The Commonwealth Fund compares health systems. Unreality of MPs. ..

Performance relative to other countries. Commonwealth fund “mirror”.

Other countries have sensibly funded healthcare. (Scandinavia and NZ), & “the schemes used by most countries on the Continent are preferable to the NHS model.

Our state-run healthcare model makes winter crises inevitable: the healthcare crisis seen from abroad, and publicised in the City.

Waiting times matter -especially in Wales – to see your GP, for investigation, and diagnosis as well as treatment.

Sky News 2nd Feb: Prostate cancer now killing more people than breast cancer – While breast cancer has benefited from a screening programme and significant research, prostate cancer has been lagging behind.

Its good news: “More people dying from rarer cancers” so less are dying from the more common ones..

 

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Who wants to be a Hywel Dda board member? “Hywel Dda health board looks at hospital closure options”. The obvious solution is to promise a new build at Whitland, and a dualling of roads west.

Health Boards in Wales are made up of professionally experienced people, some from the locality, but others from away. Their brief is to make utilitarian decisions (greatest good for the greatest number) within their area. The area is chosen and defined by the politicians. Hywel Dda is an anathema to Pembrokeshire people because they feel socially and culturally different to the people in Aberystwyth and Carmarthen. This is an accident of history, where Pembrokeshire remains the “Little England beyond Wales”. So any decision which takes away from Pembrokeshire will meet great opposition. The demographics, where more people live in the West, where there is giant important industry in Milford Haven with disaster potential, and where there are more holidaymakers for 4 months in the summer, mean that there has to be a hospital in Pembrokeshire. The lack of a proper dual carriageway road, or failing that a full time air ambulance, compounds the risk for citizens. Life expectancy in Wales is already worse than the rest of the UK, and is going to get even worse.  Some time ago the then board recommended a “New Build” near Whitland, but in our single pressure group (SWAT) and press led society this was rejected. Today the people of Pembrokeshire would welcome a new build on the Carmarthen shire border with open arms, because the proposed option is so much worse. Who wants to be a board member? I was once.. Withybush is already attracting more GP trainees, and a review of the situation might find the obvious solution…

Breaks Ranks 24052006

BBC News 22nd Jan 2018 reports: Hywel Dda health board looks at hospital closure options

A radical shake-up of health services in mid and west Wales includes options to close hospitals.

A leaked document shows hospital closures in seven out of nine options.

Hywel Dda health board will be presenting its preferred options in the spring but said it needed a modern healthcare system, while “keeping hospitals for those who really need hospital care”.

Last week a review urged a “revolution” in health delivery in Wales.

The independent panel said without “significantly accelerated” change, services which are already not fit for the future, will decline further.

All health boards are under pressure from Health Secretary Vaughan Gething to move forward with plans for reform the NHS.

Hywel Dda said it faces spending demands of £200m over the next five years on top of its existing budget – currently £800m – if it carries on as it is.

Health board map

The health board – which is responsible for four general hospitals in Carmarthenshire, Ceredigion and Pembrokeshire – has already had an early “listening” exercise with the public and is now designing different potential models for how future services will look.

A document with nine of the options has been leaked to the media – but health bosses say they will be narrowed down and assessed before being presented to the public.

All options currently being considered include a network of community hubs with beds and none of the options involve closing Bronglais in Aberystwyth.

  • Seven of the options in the leaked document include closing one or more hospitals in Carmarthenshire or Pembrokeshire
  • Five of the options would involve the closure of Withybush hospital in Haverfordwest
  • One option suggests a new, major urgent and planned care hospital in an unspecified location to replace Withybush, Prince Philip in Llanelli and Glangwili in Carmarthen, which would all close
  • Two options include keeping all hospitals open but with urgent care being centralised in either Glangwili or Withybush
  • The health board has issued a statement saying it is discussing, “rigorously testing” and narrowing down the options with doctors, nurses and wider staff groups and will be “open and honest” about its preferred option.

    It said all propose “significant change” and a focus on transferring more hospital services into the community where appropriate.

    “A fewer number of preferred options will be released publically in the spring, when the health board is confident they are viable, safe and an improvement on what is currently provided,” it said.

    Medical director Dr Philip Kloer said: “This is a once in a lifetime opportunity for our health service and community to work together to design an NHS which is fit for our generation and beyond.

    “It has been acknowledged for some time across the UK that healthcare services are challenged like never before and we need significant change.”

    ‘Scattered communities’

    He said they would be looking to the latest technology in “fit for purpose facilities”.

    The health board serves 384,000 people.

    “A number of our services are fragile and dependent on significant numbers of temporary staff, which can lead to poorer quality care,” said Dr Kloer.

    “For us specifically in Hywel Dda, the geography we cover is large, with many scattered communities that are getting older, needing more holistic health and social care treatment and support.”

    Dr Kloer said they appreciated the attachment people had to their local hospitals but said it was “about more than the buildings”.

    He added: “This is about investing in our communities, attracting doctors, nurses and therapists by operating a modern healthcare system and keeping hospitals for those who really need hospital care.”

West Wales needs a new Hospital – not improvements to Glangwili Hospital in Carmarthen. Failing to act in a utilitarian way may well lead to unrest..

West Wales Health has to have a future – somewhere in the “middle” ground… Back to 2006 and reversing the wrong decision taken then not to build a new Hospital.

Ominous news for the peripheral DGH. MPs grant powers to close local hospitals..

Closing hospitals can help us save the NHS

Making rural hospitals sustainable – It is both quality hospital doctors and GPs we are short of… Please don’t be tempted to reduce standards..

Local politics and health: Hundreds from West Wales (Pembrokeshire) to protest at the Senedd against ‘downgrading’ of Withybush Hospital

Amazing how England has been able to kid themselves there is an NHS – until now. Manchester’s health devolution: taking the national out of the NHS?

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

When a crisis is the predictable outcome of poor policy making. It will take 10 years to begin to recover, and 20 years to recover completely from the politicians’ cowardice.

Perhaps the politicians (who go privately) think we the people deserve this. The falling standards, lengthening waits and lack of social safety net are now becoming evident. NHSreality started warning over 5 years ago, and even then it was 5 years too late….. It will take 10 years to begin to recover, and 20 years to recover completely from the politicians’ cowardice. … & The captains will NOT go down with the ship…

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Mary McCartney in the BMJ opines: When a crisis is the predictable outcome of poor policy making (BMJ 2018;360:k90 )

When is a crisis not a crisis? The “crisis” may be felt differently in the UK’s four NHSs, but these services are being pushed beyond reasonable capacity. I’ve little doubt that the coping mechanisms—corridor care, ambulance stacking, and a month’s worth of cancelled operations and outpatient appointments—are harmful. And these will contribute to burnout, sick leave, resignation, early retirement, and the cycle of even more rota gaps.

This is not a sudden explosive “crisis” but the predictable, and predicted, result of multifactorial choices over long periods that have made a mockery of evidence based decision making. This is winter: it’s a foreseeable annual event.

Yes, the NHS needs more money. But that money’s wasted if it’s spent on initiatives that don’t work and are driven by party politics, not patients. And it’s been spent on such initiatives repeatedly and avoidably. England has had the internal market and vast monetary waste from administering the legal framework,1 such that Virgin sued the NHS in 2017 in a dispute over tendering.2 This money should have been spent on direct patient care.

In Scotland a quarter of delayed discharges have been due to a lack of residential care beds.3 England has 43% fewer general and acute hospital beds than 30 years ago and fewer beds per head of population than any comparable country.4 People can’t get into hospital, but neither can they safely leave.

In 2013, management consultancies were telling us that technology would save us,5 when it couldn’t; and the government said that telehealth could save the NHS £1.2bn a year,6 before a randomised controlled trial found that it wasn’t cost effective.7 This was all money that could have paid for beds, hospital nursing, and community care.

Austerity has meant English councils cutting adult social care by 11% in real terms.8 The privatised, opaque process of carrying out medical assessments of eligibility for benefits has had a “substantial disadvantage” for the people it should have helped,9 while being associated with worsening mental health.10 This is avoidable harm done to patients and picked up by primary care, all while the provider turns a profit.

The origins of the current winter “crisis” have their roots in multiple places, all accumulating harm. Yet several campaigns aim to change behaviour by advising alternatives to visiting a hospital or GP.

These campaigns are untested and may not work—but they may harm. Patients, induced into guilt about “taking up resources,” may delay consultations and incur avoidable, expensive complications. Shifting problems we’ve failed to tackle onto the shoulders of ill people is unfair. This is a systemic problem that needs systemic change. If we can’t get the essentials of the NHS right we’re failing everyone, including the staff.

We’ve had our fill of short termism and party political policy making. We need to plan for the long term, seek cross party agreements, prioritise the basics, and have an “evidence desk” using expertise and systematic reviews, over which we can debate policy, disallow conflicts of interest, and stop wasteful nonsense in its tracks.

GP out-of-hours services struggle to fill shifts amid “intense” winter pressure –  2018; 360 doi: https://doi.org/10.1136/bmj.k97 (Published 08 January 2018)   (BMJ 2018;360:k97 )

Providers of out-of-hours GP services are struggling to fill gaps in their rotas in the face of “intense” pressure this winter, despite a £10m (€11.2m; $13.6m) cash injection to help cover indemnity fees that was intended to ensure full coverage.1

Simon Abrams, chair of Urgent Health UK, a federation of social enterprises that provide out-of-hours GP services, told The BMJ, “My colleagues generally have found it more difficult this year to recruit doctors to shifts. Pressure on health services has been intense this winter, especially over the bank holidays.”

Abrams believed that previous extra funding from government for winter pressure, such as the £335m announced in November,2 had been too focused on hospitals. “In the wider strategy, there hasn’t been that recognition of …

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The Patients’ Association and the Charities should challenge, and define what is happening in the courts… Crawley: NHS “not rationing” hospital treatments and operations.

Denial in the Shires. Of course the Health Boards / Trusts / Commissioners cannot admit to the “R” word. They are “prioritising”, “restricting”, “reducing”, “limiting”, and “excluding”, different services for different people in different post-codes in different years. So no citizen can find out what, consistently, will NOT be available in his or her area of the country. Ask a retired consultant or GP or Nurse, or Physio in an exit interview whether Rationing is happening and they will almost all say yes. But there are no exit interviews… If policy does not conform with delivery, we have a collusion of denial. This is why the health service staff are disengaged. We need honesty in use of the English language before we can progress, so NHSreality calls for the Patients Association and the Charities together to challenge and define  what is happening in the courts… They may find GP commissioners, infuriated at the current “rules of the game“, help them in their case, and want to change them.

Joshua Powling reports for the Crawley Observer Friday 8th December: NHS “not rationing” hospital treatments and operations. 

Hospital operations and treatments for West Sussex patients are not being rationed, according to health chiefs.

Government reforms put clinical commissioning groups (CCGs), which are led by GPs, in charge of planning and buying healthcare from 2013, but all three organisations covering West Sussex are in special measures in part due to financial deficits.

The three CCGs are part of a new regional NHS initiative called clinically effective commissioning, which looks to standardise policies for when patients should undergo certain treatments and procedures.

According to a recent West Sussex Health and Social Care Committee (HASC) report, the aim of the project is to make sure commissioning decisions across the region are consistent, reflect best clinical practice, and represent the most sensible use of resources.

But last Friday James Walsh, vice-chairman of the HASC, asked: “What exactly is being proposed? Is this some form of rationing or delaying treatment?”

He explained that rather than dealing with statistics, they were talking about patients who had problems, many of which interfere with their daily lives.

Geraldine Hoban, accountable officer for the Horsham & Mid Sussex CCG and the Crawley CCG, explained the changes were bringing in more consistent thresholds for treatment.

She said: “We are not doing this for arbitrary reasons or to save money. This is based on up to date clinical evidence.”

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She added: “This is about people having procedures which we do not believe adds the clinical value they need.“It’s not rationing, it’s about adhering to the clinical evidence.”She went on to outline the ‘significant financial challenge’ facing the healthcare system in West Sussex, and how these changes were taking place before ‘we starting making some difficult decisions about difficult services’. They also found that previously some procedures had no formal policy, while in others such as orthopaedics activity the area was a significant outlier.

Other revisions were required were policies did not improve outcomes or patient experience. So far the clinically effective commissioning programme is split into three tranches. The first two have been reviewed by all the CCGs and updated where necessary in line with National Institute for Health and Care Excellence guidance.

Changing the rules of the game

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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.