Category Archives: Rationing

Dont ration hearing aids if you want to reduce early dementia (as well as falls and depression), and avoid Regional Disparities

Some health trusts have been reducing the number, access, and quality of hearing aids. This is particularly prevalent in Wales. The message from a large study in Michigan is that this is an important population measure: keep access to the best hearing aids available to all and avoid post code and regional discrimination. England currently offers WiFi connectivity but Wales does not. We pay the same taxes!! Hearing aid technicians often leave NHS (all 4 dispensations) to set up privately. Exit interviews would reveal why.. There is a mixture of management, resource and quality issues which drive them away after being trained at the state’s expense. Are Trusts and Commissioners suffering from selective deafness?

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Andrew Gregory in the Sunday Times a5th September 2019 reports: Hearing aids cut risk of dementia, falls and depression

Wearing hearing aids can dramatically reduce the risk of dementia, depression and serious falls, according to the largest study of its kind.

The analysis found the risk of developing dementia within three years of being diagnosed with hearing loss fell by 18% for those who used hearing aids, compared to non users. The risk of falls fell by 13% and of depression by 11%.

In July, a study of 25,000 adults found aids improved memory and attention.

Elham Mahmoudi, a health economist at Michigan University who led the study based on 115,000 adults, said: “We already know that people with hearing loss have more adverse health events . . . but this study allows us to see the effects of an intervention and look for associations between hearing aids and health outcomes.

“Though hearing aids can’t be said to prevent these conditions, a delay in the onset of dementia, depression and the risk of serious falls, could be significant. We hope our research will help clinicians and people with hearing loss understand the potential association between getting a hearing aid and other aspects of their health.”

Beth Hartley, 29, a food manager for Sainsbury’s, said hearing aids changed her life after she was found to have hearing loss at the age of five. Hartley, of Wheathampstead, Hertfordshire, whose grandfather had hearing loss in later life and had dementia when he died, said: “I consider wearing hearing aids incredibly empowering — both in the short term for integrating socially and in the long term for my mental and physical health.”

Rebecca Dewey, a research fellow in neuroimaging at the University of Nottingham, described the new study as “compelling”, adding: “Too much of the time, hearing aids sit in a drawer to the direct cognitive disadvantage of the person.” Around 7m Britons could benefit from aids but only about 2m use them, research suggests.

Roger Wicks, of Action on Hearing Loss, said: “With the number of people with hearing loss predicted to rise to one in five by 2035, and with the link to dementia increasingly clear, more must be done to encourage greater take up of hearing aids.

“Some areas of the country already have restrictive policies on hearing aid provision — going against all clinical guidelines — in a misguided effort to make short-term savings.”

James Connell, of Alzheimer’s Research UK, said the key advice to ward off developing the disease was not smoking, drinking within recommended guidelines, staying mentally and physically active, eating a balanced diet and keeping blood pressure in check.

The Mirror: Hearing aids can reduce the risk of dementia and depression …

Rob Andrews for Stoke on Trent live reports 5th September 2019:  Will you be affected? Thousands of Stoke-on-Trent patients …

 

 

 

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

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

Link to his book published by the Socialist Health Association

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

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

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

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

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

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

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

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

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

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

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

Pembrokeshire Oncology cancer services in crisis

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

Desperate NHS needs a desperate remedy – care is already rationed

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Enoch Powell 4 Supply and Demand – Rationing

 

My local hospital, manned by locums, is failing – and costing us millions. Now holiday pay should be added!!

The local DGH ( District General Hospital ) in my area is similar to many others around the country. Manned largely by locum doctors the emphasis in the media is always on clinical services. But the old fashioned manager who stayed locally for life, and committed to the hospital, has long gone. In fact managers move on every 2 years, leaving their changes and messes behind to be sorted out and corrected by the next generation of managers. Their short term commitment (in management) is equivalent to that of locum doctors. They never see the long term effects and perverse outcomes of their actions.. and they ever give or receive exit interviews to independent HR ( Human Resources ) staff. The net result is that Trust Boards and government have no idea of the truth. 

At a local stay in hospital I had my history taken 10 times, to paper and never to computer. None of the history takers had bothered to look at the notes and indeed seemed to ignore them. It was in 1996 that as a member of the Local Health Group ( Board predecessor ) I proposed ( and was defeated ) that Pembrokeshire GPs moved to one computer system and had this available in Care on Call and A&E. So no progress in 25 years! Notes still get lost and so much is missing that nobody seems to trust the written record held in 3″ thick cardboard folders.

Many of the doctors are locums. The cost of these is exorbitant, but they get what the “market” has to give. Poor manpower planning ( and rationing of places in med school ) has led to a 15 year shortfall and there is no solution other than recruitment of more potential doctors and nurses. The outcomes of todays policy will feed through only after 2-3 elections!! So which honest politician will take the necessary action in our First Past The Post ( FPTP ) system? To add to the expense, a new legal judgement gives locums holiday rights to add to their pension rights. I wonder if they will get sick leave as well?

Image result for holiday pay cartoon

Jonathan Ames in the Times 14th September 2019 reports: Locum ruling will cost NHS millions

The NHS faces a bill for hundreds of millions of pounds after a court ruled that locum GPs were workers and eligible for holiday pay.

The judgment, which sheds new light on how the so-called gig economy extends beyond fast-food delivery riders and other low-paid jobs, could lead to self-employed locums, who earn on average about £140,000 a year, receiving back-dated holiday pay for up to six years — which could amount to tens of thousands of pounds each.

The development comes after a tribunal backed a claim by a locum GP in Gateshead that she was entitled to holiday pay despite arguments that she was self-employed. Reshma Narayan sued Community Based Care Health, a provider of locum GPs to the NHS, claiming that she should not be considered as self-employed.

She was entitled to holiday pay as a worker, she said. An employment tribunal judge agreed and an appeal hearing in London has upheld the decision this month. “This is a leading-edge ruling,” said Jane Callan, an employment law barrister at Trinity Chambers in Newcastle, who acted for Dr Narayan.

Legal experts told The Times that it was difficult to put a firm figure on the amount to which locum GPs could be entitled. However, Carolyn Brown, an employment law specialist at the business consultancy RSM, said: “This ruling could well cost the health service hundreds of millions.”

Conservative estimates suggest that the cost, excluding back payments, could be about £250 million a year. In 2017-18 the NHS spent £9 billion on 7,543 GP service providers.

Figures from the General Medical Council show that there are about 20,000 locum GPs practising in Britain. The National Association of GPs says that one in five patients attending a surgery is seen by a locum. The highest-paid locum GPs can earn £1,000 a day, but agency fees can reduce the figure by about 30 per cent. The number of locums affected by the ruling is unknown.

Lawyers say that some locums are self-employed because they offer their services to surgeries around the country. However, many work in relatively narrow geographical areas and for a consistent group of surgeries. According to employment law specialists, that group will be eligible to benefit.

“This case serves as a further reminder of the challenges of establishing self-employment in long-term integrated working relationships,” Ms Brown said. She added that the ruling “underlines how challenging each working status determination is and how each determination has to be evaluated on its own facts”.

Community Based Care Health declined to comment.

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A&E waiting times – are a dangerous disgrace. Casualty should be manned by more rather than less experienced doctors.

A recent admission to my local DGH A&E was an eye opener. It was as if nobody cared when a retired GP arrived at 00.30 to say he had a painful infected hand and needed an operation. The time taken to be seen was appalling, with 30 mins to see the triage nurse, 4 hours later to see the SHO and 1 hour later to see an F2 covering orthopaedics from another speciality. (Surgery). The result of a sleepless and painful night without adequate analgesia was my walking away at 06.00 (after being advised that there would be no way to see anyone before 10.00 am!) with a compartment syndrome not yet diagnosed or seen by somebody able to take action. This was a wait of 5 and a half hours, but then I got access to the specialist via my GP by barging in first thing. (GPs are not meant to be an emergency service!). She rang the consultant and arranged for me to be seen mid morning, and an operation ensued at 19.30 which was some 18 hours later than it might have been. The result, even for a doctor who presented himself, was delayed decompression of my dominant R hand, and a long recovery on antibiotics. I suspect that the pain could have been less, the operation sooner and the recovery quicker if the right person had been in A&E. 

This type of story is commonplace. Retired colleagues all tell me “dreadful” stories of their own experiences. It would have been better for me if I had travelled to a properly staffed tertiary centre than my local DGH, even though it is 90 mins away. We need honesty and transparency in all areas of health, and I suspect increased death and complication rates are already a fact if you happen to live in the wrong post-code.

Rosie Taylor in  the Times 13th September reports: Alarm grows over A&E waiting times

The number of patients kept waiting at A&E departments in England reached its highest level in a decade last year, prompting warnings that pressure on the NHS would rise this winter if it faced the “perfect storm” of high demand and a no-deal Brexit.

Patients kept waiting at least four hours more than trebled in the past five years. Last year only 88 per cent of patients were seen within four hours compared with 98.3 per cent ten years ago, according to the NHS’s Hospital Accident & Emergency Activity 2018-19 report.

Separate NHS figures show that last month was the busiest August ever.

Tim Gardner, senior policy fellow at the Health Foundation charity, said: “A no-deal Brexit would only exacerbate these pressures, intensifying staffing shortages, driving up demand for hard-pressed services, disrupting supplies of medicines and other necessities, and stretching the public finances which pay for healthcare.”

Helen Fidler, deputy chairwoman of the British Medical Association’s consultants’ committee, said: “This summer emergency departments had their busiest August on record. As we move into what will undoubtedly be a difficult winter the situation will get worse . . . A no-deal Brexit threatens to pile even more pressure on overworked staff.”

A&E attendances last month were up 6.4 per cent on the same month last year. Although doctors treated an extra 1,200 patients within four hours, the percentage of people seen within that time dropped from 89.8 per cent to 86.3 per cent.

About 24.8 million people attended emergency departments in 2018-19, a 21 per cent increase on the 20.5 million who visited in 2009-10. However, while attendances rose 2 per cent year-on-year, the population has grown by only 1 per cent a year over the same period.

Miriam Deakin, director of policy and strategy at NHS Providers, which represents hospitals, said the sheer dedication of staff was stabilising A&E performance despite a record number of patients. However, she added: “This winter will be a very testing time for trusts. We anticipate that performance will slip even further, with patients waiting longer for treatment across various services.”

Rising demand has also increased the time patients are left on trolleys. Last month 362 patients waited for more than 12 hours in A&E after it had been decided to admit them, more than double the figure for August last year.

An NHS spokesman said that in July a record number of patients were seen within two weeks of referral for urgent cancer checks, routine tests or treatment for serious mental health problems. He added: “Every part of the health service is playing its part in meeting the rising demand for care.”

Treatment or cure. In cancer the UK lags behind many other systems. No wonder nobody copies us.

It is odd for the WHO to report on the UK when it had previously said that it would report on 4 systems. The earlier the diagnose cancer the better your chance of survival. With a shortage of GPs and access to diagnostic manpower (GP, Radiology, pathology etc) it is not surprising that the UKs 4 systems perform badly. There is a post code lottery in all care, but especially cancer, in the UK. There is also a lottery in handover from oncology treatment to palliative and terminal care. Those trusts who can make this interface more humane and efficient will save more money for better outcomes for those who need treatment for cure.

update 13th September. Times leader: Cancer complacency

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In Scotland the Herald announces today that the UK is “Stuck at the bottom of the cancer survival league”.

And Laura Donelly in the Telegraph points out that ovarian cancer survival in the UK is equivalent to Norway 20 years ago!

in the Guardian attributes Australia’s better result to earlier diagnosis.

Cancer Research Uk reports 11th September 2019: Measuring up: how does the UK compare internationally on cancer survival?

…the latest figures, covering 1995 to 2014, reveal some stark differences in cancer survival between countries. Generally, cancer survival is higher in Australia, Canada and Norway than in Denmark, Ireland, New Zealand and the UK.

…But despite the improvements, there’s clearly more work to be done in the UK.

Science Daily comments: Cancer survival in high income countries is improving, but international disparities persist

An observational study including 3.9 million cancer cases in seven high-income countries between 1995-2014 finds that survival of seven cancers is generally improving, although the overall level and pace of improvement varies between countries and for each cancer type.

The Guardian hails the improved figures but notes how far behind Australia and Canada we are. UK Still behind…

In a world where nobody trusts any experts, who will trust the UN report? Not our politicians it seems…

Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS

To paraphrase Spike Milligan: “I told you the Health Services were all ill”.

The Brexit deadline and the Health Services planning – standards and services are going to get worse..

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Even London and the Home Counties are feeling the squeeze… as standards and staff numbers fall re revert to the pre-NHS divide.

Just some of the pain felt in the rural shires is now feeding into London and suburbia. Standards of staffing and clinical diagnosis and speed are all falling. The blame is long term political neglect and denial from an elected elite who always felt they had access to the best – in London. No longer… it is impossible to report on all GP surgery closures as there are so many. The reality is that private services for ambulance, GP, A&E etc will follow… Bevan wanted the same high standards for the miners as the bankers – instead the standards are falling, but as before we had a health service, the bankers can afford the private option.

Owen Sheppard for MyLondon reports 7th September 2019: West London overspends by £112m!!

GP surgeries across Surrey are facing an uncertain future, with two confirmed closures and a third possibly following suit, which are set to put pressure on those nearby.

Patients say they are worried about the pressures on neighbouring services following the announcement of closures of surgeries in Staines and Guildford.

In Burpham, a petition has been launched to save the Burpham New Inn surgery which is also facing closure.

So why are surgeries closing?

The Guildford and Waverley Clinical Commissioning Group (CCG) has cited problems with leases and premises, which have led to the closures of two practices in the area.

In Staines, the Staines Thameside Medical Practice shut on Saturday (August 31) following a decision by the doctors to end their contract with the NHS to provide GP services. This was reportedly due to personal reasons.

Patients will lose the St Nicolas branch surgery in Bury Fields, Guildford, which will close at the end of October following issues with the premises and its lease.

Guildford and Waverley CCG has confirmed the surgery will close on October 24. All services will instead be provided by the main surgery at Guildford Rivers Practice in Hurst Farm, Milford.

One St Nicolas patient, who did not wish to be named, said: “I am very upset about the closure of St Nicolas Surgery, it came as a shock.

“[I believe] this was pre-planned since last year but without telling patients previously. I have not received a letter as yet about the closure.

“I think it’s been about a year that all the telephone calls to St Nicolas Surgery have been re-directed to the general practice in Milford.

“The closure of St Nicolas Surgery will put extra pressure on other GP surgeries in Guildford as patients who are ill, disabled, elderly or who don’t drive won’t be able to get to Milford.”

The CCG has said it will work with the practice to ensure that despite the changes, patients will continue to receive high quality care.

A spokesman said: “The CCG received an application from Guildford Rivers Practice that proposed the closure of its branch surgery, St Nicolas Surgery, due to issues with the premises and the lease which was proposed to have had a negative impact on the service offered to patients.

“Following a period of engagement with patients and neighbouring GP practices, the application to close the branch has now been approved by Guildford and Waverley’s Primary Care Commissioning Committee (PCCC).”

The spokesman added: “Registered patients of Guildford Rivers Practice will remain so, following the branch closure, with GPs from St Nicholas Surgery transferring to the main site and continuing to offer appointments to patients.

“Any patients who require home visits will continue to receive these in the usual way.

“The practice is committed to providing the best service for patients by operating solely from the Guildford Rivers Practice main site and the CCG will work with the practice to ensure patients continue to receive safe and high quality care moving forward.”

The news comes as patients await the decision on the future of Burpham’s New Inn surgery. A decision was set to be made on August 28 but this has been delayed.

A spokesman for Guildford and Waverley CCG said: “The PCCC has been re-arranged to ensure every option put to the CCG is fully explored, before a final decision is made.

“The committee has been rescheduled for September 13.”

In a letter to patients sent on July 31, the CCG said it was likely the New Inn Surgery in London Road would have to close later in 2019 due to problems securing a long-term home.

The letter said the surgery’s lease was expiring and no other suitable alternative sites have been found.

Patients launched a petition to save the surgery, which has been signed by 282 people to date.

Staines

Around 4,500 patients have had to re-register with another GP surgery after Staines Thameside Medical Practice closed its doors on Saturday (August 31).

Other GP surgeries in the area are accepting new patients despite some having recently had their lists capped.

Two Staines councillors are concerned about the additional pressure on those surgeries.

Councillor Jan Doerfel, Green Party member for Staines, said: “Expecting other GP practices to absorb the additional 4,500 patients is likely to result in longer waiting times for all those affected and additional travel for those that had to enrol with those practices. This is not acceptable.”

Councillor Veena Siva, Labour member for the ward, said: “Yet another GP surgery closes. Smaller practices are closing due to underfunding and insufficient GPs which means they can no longer be run safely and sustainably.”

She added: “As it stands, it is unfortunately no surprise that there was no interest from GPs to take over the surgery when in doing so all they would face is under-resourcing, enormous pressure and stress.”

NHS North West Surrey Clinical Commissioning Group (CCG) was responsible for supporting patients as they switched to a different GP service.

St David’s Family Practice Doctor Jagit Rai works at one of the surgeries receiving patients from Staines Thameside and is a governing body member at NHS North West CCG.

Doctor Rai said: “The closure of this practice does not relate to funding or staff shortages. The CCG was disappointed to receive notification from GPs at Staines Thameside of their decision to end their contract with the NHS to run the surgery.

“They made this decision due to a change in personal circumstances that could not have been predicted or planned for. The CCG asked neighbouring practices about the option to take over the running of Staines Thameside and reviewed their capacity to take on new patients.

“The surgeries decided the best way to care for Staines Thameside patients is at their practices where they can benefit from an established team and range of services.”

It’s slightly brighter news for the residents in Chiddingfold, where a new surgery is being built after the former building was destroyed by a fire.

Chiddingfold Surgery in Ridgley Road was gutted on January 7, 2019.

Plans were submitted in March to Waverley Borough Council for the complete rebuild.

The surgery has relocated to Cedar ward at Milford Hospital, where full doctor and nurse surgeries are in place. Expanded opening hours are available for patients at Dunsfold surgery.

Update : Diane Taylor in the Guardian 8th September 2019: London GPs told to restrict specialist referrals under new NHSThe New “Rationing Plan”. Plans for new cuts sent same day Boris Johnson reinforced NHS spending commitments..

The train crash is coming – slowly. Despite Oliver Kamm

NHSreality would like the politicians in our liberal democracy to tell the truth. Debate is only happening where Hospital Staff, doctors and Dentists meet privately: their coffee rooms, and behind closed doors in Whitehall. Occasionally i have heard a retired chairman let it slip
: “all health care is rationed”, but there is no follow up in the implications. Thus the “honest debate” demanded by Mr Stevens 1in 2014 is refused us. In my local Liberal Party we plan a debate on these issues, and possible use of ID cards to help more fairness. Will the members turn out to discuss such an unpleasant subject? If they don’t the train crash gets closer.

We need to be prepared to upset some people – those who are knot open to logic. The result is knee jerk opportunistic locality based rationing which is unfair’.

Oliver Kamm in the Times 30th August 2019 does not seem to support this view in “Private healthcare is no match for our fair and efficient NHS”

His first paragraph ends: “There is no crisis of affordability in healthcare and the model of “socialised medicine” is actually a pretty efficient provider.” Disagree for the future. The cost of new technologies is advancing faster than any state’s ability to pay’.

T&he last reads: “The evidence is that mental disorders (40% of the spend) such as clinical depression have a big impact in reducing labour productivity, and that treatments for it — psychological therapies such as cognitive-behavioural therapy — are time-limited and cost-effective. These remedies should be offered more readily on the NHS; they would benefit public health and the economy, and they are affordable.” Agree. But they need to be offered instead rather than as additional therapies. The reasons he gives for relative efficiency are “in the NHS, there is no perverse incentive for doctors to over-prescribe. That’s not what their salary is based on. Second, because treatment is free at the point of use, this encourages early diagnosis. Third, the decision on treatment is taken by the doctor rather than the patient, which tends to contain costs.” NHSreality agrees with all this, but if we want a universal system where the rich get thie same as the poor (England v Wales, Bankers and Miners of Tredegar) we need the speed and quality of the state service to be so good that private care offers little advantage. The trend is in the opposite direction..

January 6th 2018: “The NHS is like a tumour on the public finances, expanding so aggressively that it threatens to kill other organs of state …. Better still would be a formal policy if provision is to be limited — but the politics is too sensitive”.

21st December 2018: IMF forecast is damning.. A two tier system emerges from denial… A collusion of politicians and leaders…?

Nov 5th 2018: It’s about to blow up. There is no Mr Fawkes to arrest, blame and punish (hang draw and quarter) for the coming NHS failures

March 12th 2018: No good news for those who think money is the answer….

July 1st 2018: What models of funding are best for a healthy and just society? No other country has chosen our system, even after 70 years and our Olympic boasting. The public need to be led into realising why not.

September 15tih 2018: The 3 myths of the NHS…..& …No learning from other countries – no co-payments, and more scandals..

1st June 2018: The real cost of the English taxpayer subsidising NHS Wales – is twice the official figure

May 15th 2015: Britain ranked last (out of 20 rich countries) by a wide margin in the number of CT and MRI scanners per head of population. Australia has six times as many CT scanners per head, and spends roughly the same as Britain on healthcare overall as a share of GDP.

May 1st 2015: NHS funding advice: GDP worth debating… Showers of money will not work..

Nov 22nd 2014: When and who will eventually speak out honestly? 10% now to 20% of GDP by 2061

October28th 2013: GDP and GVA differences across the UK – a threat from Scottish Independance

Ju;y 18th 2018: Brexit dividend for NHS is a fallacy, says OBR

July 21st 2019: The value of the UK’s health information – and only partial value at that.

Sept 28th 2018: Taxes must rise to pay for NHS funding, Lagarde says. Tax changes need to be considered as a whole.

July 2nd 2018: NHS at 70: Five medical experts diagnose NHS problems – and prescribe cures. The BBC is a government organisation, and funds the Radio Times. It cannot be expected to give credence to rationing overtly.

27th May 2018: Some of the options, all unpleasant, for raising money for the UK Health Services. Tax reform – “fishing for funds” in the Economist

May 25th 2018: Tax rise for NHS can’t be put off much longer

24th May 2018: Addressing the “black hole” in the health budgets – wait for political denial.

25thi April 2018: The NHS at 70: Loved, valued, and too costly (print version) / affordable (on line version) – even the experts don’t know where to stand. The core principles need to be changed..

March 27th 2018: Ten year budgets, fiscal vaccinations: these are all the dying suggestions of a system designed to fail.

March 26th 2018: “An illusory technical excape from spending choice”, “a fourfold revolution is required”, “clumsy and unreliable”…

March 23th 2018: Is Hyporthecated tax a solution, or a distraction? NHSreality is clearly against, but it looks as if we are all going to “share” a lot more..

Feb 9th 2018: A bigger and bigger deficit in West Wales…… Now at £600 per head……

Jan 28th 2018: A cash injection alone won’t cure NHS ills. Lets be clear: there is no more money, and no Brexit dividend.

Jan 27th 2018: Other countries have sensibly funded healthcare. (Scandinavia and NZ), & “the schemes used by most countries on the Continent are preferable to the NHS model.

September 24th 2017: A 150% increase in patients going private is an indictment of the UK Health Services… Successive health ministers have ensured a thriving pprivate system.

20th September 2017: Pragmatic decisions need to be taken to insist on rationing… Are we are gullible enough to believe their lies?

September 18th 2017: Surveys of the uninformed are less valuable than those of the staff: survey doctors and nurses please Kings Fund

As it gets worse, YOU are going to have to wait longer and longer – or pay up. A “grim reality”..

Despite “adequate or average” funding, our waiting lists are much higher than average. Even communication is failing at a basic level…5

Why aren’t the UK Health Services centre stage in this election? All 4 are bust.

If the NHS really is the envy of the world, why don’t countries copy it?

…political “unsayables”. Behind closed doors nearly every politician admits that the current system for paying for health and social care is decades out of date.

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

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

Ju9ne 5th 2018: We need tax and fiscal policies that upset some!..”The role of a leader is to persuade voters of the need for reform, rather than just to follow public opinion.” but we have no leadership, and no honest debate ..

Going bust when it’s not allowed – all English Regions bar one.. The knee jerk response has yet to happen, as has the “honest debate”.

The cost of curing just one congenital disease…. The pace of advance of technology is faster than any government can afford

The good news this week – is usually too expensive. But there is hope on depression, and exchanging drugs for therapy.

The potential for ID cards in accessing health, and progressive redistribution