Category Archives: Retired

The disintegration of professionals – is happenning all at once. Standards are falling in general, but in exceptional cases they have fallen drastically.

Older people consume more services. Health and social care services. Whilst Health is free and not means tested, Social Care is means tested and only free when down to the last £17.000 or thereabouts. The disintegration of social services, of the ambulance service, and lack of standards in Hospitals is coming all at once. At my own surgery in West Wales the patients today are concerned about the same issues as they were 20 years ago when the PPG ( patient Participation Group) started: Access and appointments… The standard of politicians and politics is the real underlying problem. As a country with short term first past the post politics, we can only expect short term decision making. The quality of life improvement for GPs, who now do little out of hours, has led to NHS111 (useless) and an overworked ambulance service using up vast resources inefficiently.. Continuing undersupply of doctors, despite the applicants to medical school has been rationing of the most inexcusable sort. It is in Primary Care that the big savings in demand can be made, but it needs more GPs and nurse practitioners. How much of the new £20m will go to primary care?

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The Nuffield Trust and the Kings Fund: Reports show it is dangerous to dodge decisions any longer: Nuffield Trust response to Skills for Care data – Unless social care becomes a more attractive sector to work in, ongoing migration will be necessary

The Kings Fund talks about “home truths” through a combination of stats and interviews.

Tom Houghton for the Liverpool Echo reports 15th September: Ambulance service slammed for “continuous failures” as serious incidents soar.The North West Ambulance Service (NWAS) has failed to hit crucial targets in recent months

and in Wales 4th February: Thousands of complaints made against the Welsh Ambulance Service

Today the Neil Johnson of Times’ reports: Shrewsbury and Telford Hospital baby deaths inquiry to cover two decades (This is possibly the result of weak management, and of a midwife led service – lets await the report!!)

The Times 26th September: £20bn cash boost for NHS ‘could be lost to waste’

On September 18th Chris Smyth for the Times Crisis team sent into St George’s cardiac unit

and 10 days later, on 28th September: Doctors fear NHS catastrophe as early retirement depletes surgeries (And this excludes Wales and Scotland and Northern Ireland, emphasising that there is no “N” HS)

More than 2.5 million patients are at risk of losing their family doctor as GPs retire early, according to the Royal College of General Practitioners.

Hundreds of surgeries are likely to close because three quarters of their GPs are close to retirement and not enough younger doctors are coming through to replace them, the college calculates. Falling numbers threaten a collapse of the family doctor system, senior doctors said as they lobby for a bigger share of a promised boost to the NHS budget to go to local surgeries.

However, NHS leaders dismissed the claims as scaremongering. They acknowledged three years ago that a lack of qualified GPs was a key problem for the health system, promising to recruit 5,000 more by 2020. GP numbers have since fallen by more than 1,000, accelerating

the closure of surgeries. (Here there is a map of England with colour coded areas of shortage)

Last year 458,000 patients in England had to find a new practice because their existing surgery shut, up from 38,000 in 2013. The college has found that 762 UK practices are relying on an ageing workforce, with three quarters of doctors aged over 55. The 625 practices in England alone care for 2.5 million people, with a further 71 surgeries in Scotland, 37 in Wales and 29 in Northern Ireland at risk.

“These new figures paint an extremely bleak picture of the scale of the GP workforce crisis,” Helen Stokes-Lampard, chairwoman of the college, said. “If these GPs do leave and these practices do close, it will have a catastrophic impact on our profession and the patient care we are able to provide.”

GPs can start to claim their pension at 55 and the average age at which they retire has fallen to 58, down two years since 2011. Simon Stevens, head of NHS England, has previously blamed rules that cap tax-free pension pots at £1 million for encouraging GPs to retire early.

In Southend, more than a third of surgeries are at risk of closure from an ageing workforce, covering 39,000 people, more than a fifth of the population, the college estimates. In Sandwell and west Birmingham, 85,105 patients, or one in seven, could lose their doctor because a quarter of surgeries are at risk of closure. Only a quarter of England has no surgeries at risk.

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Should dementia from sports injuries and concusion be subject to “deserts based rationing”?

If the dementia risk rises by 17% when the risk of dementia is 10%, the absolute risk only rises to 11.7%. The article by Kat Lay in the Times chooses to use relative risk calculation, but it is important just the same. NHSreality has been saying since inception that certain sports persons, especially those that “ask” for head injuries, such as boxing, and riding, should always be insured. The insurance should cover their long-term care. But what if they still participate without the cover? NHSreality is against deserts based rationing. It is for wealth based co-payments and rationing overtly, especially the high volume low cost treatments that each individual should be expected to cover for themselves. The health services are “regional mutuals”, less powerful and with less choice than the former “national mutual” (NHS), but there has to be a disincentive to make a claim, for everyone. Deserts based rationing, along with most rationing, will be regressive, as the poor are fattest, least fit, and least informed…. At least means based co-payments would mean the wealthy pay more.

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Dementia risk rises 17% after suffering a single concussion – Kat Lay in the Times 11th April 2018 – Dementia risk rises 17% after suffering a single concussion

A single case of concussion raises a person’s dementia risk by 17 per cent, a major study has found.

Researchers analysed data on 2.8 million people for the study, published in The Lancet Psychiatry. The findings are likely to lead to renewed calls for contact sports such as rugby to be made safer.

The study found that people who had sustained a traumatic brain injury (TBI) were 24 per cent more likely than their peers to be diagnosed with dementia during the 36-year study period. Some 5.3 per cent of participants with dementia had a recorded TBI, compared with 4.7 per cent without dementia. TBIs occur when a bump or blow to the head disrupts the normal function of the brain – for example in falls, car accidents or assaults.

The study found that the younger someone was when they first sustained a TBI, the greater their risk of developing dementia. Those who suffered a TBI in their 20s were 63 per cent more likely to develop dementia in later life than those who did not. The figure for people who suffered a TBI in their 30s was 37 per cent.

The results are likely to be seized on by campaigners who believe that participation in sports such as rugby or American football is putting young people’s brain health at risk, although the study did not address sports injuries directly.

Researchers found that the risk of dementia increased in line with severity of the injury. A single severe TBI increased the risk by 35 per cent, while a mild TBI – a concussion – increased it by 17 per cent. It also rose in line with the number of injuries. One TBI was linked to a 22 per cent higher risk of dementia, rising to 61 per cent after four TBIs. Five or more tripled the risk of dementia.

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Jesse Fann, a professor at the University of Washington in Seattle, who led the study, said: “Our analysis raises some very important issues, in particular that efforts to prevent traumatic brain injury, especially in younger people, may be inadequate considering the huge and growing burden of dementia and the prevalence of TBI worldwide.”

In a linked comment article, Carol Brayne from the University of Cambridge, wrote: “It is likely that prevention needs to be considered at societal, community, and local levels.”

The researchers also looked for a link between dementia and those who had had fractures not involving the skull or spine, and did not see an association. This suggests that TBIs specifically, rather than general trauma, play a role in developing the disease.

Other studies have suggested that TBIs cause some of the same pathological changes in the brain as those seen in Alzheimer’s disease. About 850,000 people in the UK have dementia and numbers are expected to rise to more than a million by 2025.

The researchers used data held in Danish national registries from 1977 to 2013. Over the 36 years, 132,093 people had at least one diagnosis of traumatic brain injury, with 85 per cent being mild. Between 1999 and 2013, 126,734 people aged over 50 were diagnosed with dementia.

Their models took into account factors linked to dementia such as diabetes, heart disease, depression and substance abuse, but they were unable to account for others, including education, smoking and high blood pressure.

Experts said that more research would be needed to tease out which specific types of head injury, such as sports concussions, were implicated.

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Rugby and Dementia pugilistica…. an unfair cost on the health service

Rugby is sleepwalking into concussion crisis. Touch rugby or sevens seems much safer..

Chronic Traumatic Encephalopathy ? Time for a change to rugby tackle laws

Should sports injuries all be covered by the UK Health Services? The brain damaging season of international rugby is about to begin.

Too many Rugby World Cup injuries?

School rugby plan ‘too dangerous’

Politicians need to speak out for or against deserts based rationing. If they don’t it will occur by post-code and by default.

Obese and Smokers could be “punished” by deserts based rationing?

A deserts based approach to bed blocking and obesity? How could we encourage families to take their relatives home?

Which party will embrace any form of deserts based rationing?

Its not news to GPs or the Surgeons: Covert, Post-Coded, deserts based rationing is official policy

Devon Health Board deserts based rationing – and political dishonesty & denial at Cabinet level at PMQs.

Overt (deserts based) rationing? – “NHS to ‘ration’ routine operations for obese people and smokers”.

Interesting suggestion low cost or high volume treatments to be excluded… GPs will take no notice as their job is to put their patient “at the centre of their concern”.

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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=”//″ 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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A reminder in poetry: “I am a child of the NHS”

On the 60th Year of the NHS I read a poem “I am a child of the NHS”… Unfortunately I don’t have the author… Reader –  let me know..

I am a child of the NHS
And despite my complaints you cannot guess
How grateful I am for the service I get.
Sometimes I reflect on the media and press
Which are patently unable to cope with the stress
Of  projecting the truth to the Nation.
The whole concept
Of cradle to grave
Caring for the dying, the elderly, the depraved,
(of nothing to pay, and no duty to save)
For that rainy day or medical surprise
Is “in place of fear”; A fantastic idea.
Aneurin Bevan was the constructor/designer
But time and reality are mean destroyers
Budgets and acronyms abound
To confuse the public in getting around
The shape of a wonderful dream
Which is becoming a nightmare
Said our friend Anne today:
“you can go to hospital well (if you dare)
And come out smelling of MRSA”.
So what is bringing back the fear?
And to compound the rationing, beware
For now both Dental and Physio care
Are unavailable to most – were you aware
That those  words “commissioning” and “fund-holding”
Were parodies of the truth?
And hidden deep in the morass
Of a beurocracy this crass
Is absenteeism so perverse,
It is shamed by every organisation
In the whole Universe
A reflection of a system designed
For the assertive, with morale much worse.
Forget Equity, Forgive Access,  Remove Choice, Allow unfairness
Remain National, not regional,
Counter litigation paranoia with no-fault compensation (none can afford lawyers)
And save my NHS.
So who is the “gatekeeper” in this mess? Your GP,  would you guess.
(that person who does sustained, unpredictable, often imperative, multitasking, for individuals families or groups)

I am a child of the NHS
And, still, despite my complaints you cannot guess
How grateful I am for the service I get.

and it’s worse in wales..

NHS cuts back on IVF treatment due to cost pressures – The Mail 3rd November 2015

Improving safety needs a “buy in” by professionals. Scapegoating and denial, and causing antagonism are not the way to treat professionals.. but they might start a war.

In the Times 17th July 2015 Laura Pitel, and Jenny Booth  report: ‘Get real’ and work at weekends, doctors told and “Doctors ordered to work at weekends”.… as if they don’t already. This is not the way to win hearts and minds. Improving safety needs a “buy in” by professionals. Scapegoating and denial, and causing antagonism are not the way to treat professionals.. but they might start a war. The problems of August changeover (August comes around again – don’t be ill this month) for trainees/juniors are well known to the profession, and an easy gain would be to change the changeover dates by 3 months. Mr Hunt is betraying how he does not understand the profession, the altruism that drives all new consultants, and the long term mismanagement of manpower planning. The Health services really do need to be de-politicised to win back the hearts and minds of the professionals…

Hospital consultants will be forced to work at weekends, the health secretary announced today as he opened a new front in his war with doctors.

Jeremy Hunt laid down an ultimatum to the doctors’ union, ordering it to discuss a radical overhaul of hours and pay or face having new terms imposed from on high.

He said that 6,000 patients die needlessly each year because of the lack of an adequate seven-day hospital service. Patients are 15 per cent more likely to die in hospital if admitted on a Sunday than if they go in on a Wednesday, he said.

In a stark message likely to provoke doctors, Mr Hunt told the British Medical Association that it has six weeks to negotiate. “I will not allow the BMA to be a roadblock to reforms that will save lives,” he said. “Be in no doubt: if we can’t negotiate, we are ready to impose a new contract.”

The BMA has previously told Mr Hunt to “get real” about seven-day working, but in his speech to The King’s Fund this morning, Mr Hunt accused BMA leaders of being out of touch with what their own members believed.

“I have yet to meet a consultant who would be happy for their own family to be admitted on a weekend, or would not prefer to get test results back more quickly for their own patients ,” said Mr Hunt.

“Hospitals like Northumbria that have instituted seven-day working have seen staff morale transformed as a result.”

He added that he expected the majority of hospital doctors to be on seven-day contracts by the end of this parliament in 2020.

“No doctors currently in service will be forced to move onto the new contracts, although we will end extortionate off-contract payments for those who continue to exercise their weekend opt-out,” he said.

He denied that the reforms were an attempt to claw money back from consultants’ pay, telling the BBC this morning that he thought that they would end up being “cost-neutral”.

Dr Mark Porter, the chairman of the BMA council, said today that many consultants already worked at weekends, and that the whole of the NHS needed to gear up for seven-day working, not just the most senior staff.

“Putting a doctor in is not going to solve the problem – you need the support services to go with it,” he told BBC Radio 4’s Today programme, adding that the NHS was too underfunded and understaffed to move to seven-day working.

A “truly seven-day NHS” was part of the Tory manifesto but it has triggered bitter exchanges with doctors.

Terms agreed in 2003 under the Labour government gave hospital consultants, who earn an average full-time equivalent of £118,000, the right to opt out of non-emergency work outside the hours of 7am to 7pm on weekdays.

Those who agree to work at night or over weekends can negotiate higher rates of pay. A 2012 report by the National Audit Office found that 71 per cent of doctors struck local deals for these shifts, earning up to £200 an hour.

Mr Hunt has tried before to redraw consultants’ contracts but talks collapsed in 2014 after the BMA warned that the plans threatened patient safety by failing to guard against excessive working hours. The BMA also raised questions about how the new system would be funded.

Mr Hunt returned to battle today with a warning that thousands die every year due to a lack of senior doctors who can oversee emergency care and interpret tests and scans. “No one could possibly say that this was a system built around the needs of patients,” he said. “And yet when I pointed this out to the BMA they told me to ‘get real’. I simply say to the doctors’ union that I can give them 6,000 reasons why they, not I, need to ‘get real’.”

While ministers are powerless to change the terms of existing contracts, the government can force an arrangement on new consultants and Mr Hunt made clear that he is willing to do so if the BMA does not co-operate.

The proposed deal would remove the opt-out of weekend working by April 2017 and shake up pay incentives, with rewards for performance rather than years of service. The existing model for compensating doctors who work antisocial hours would be replaced with a system of variable allowances based on the demands of a doctor’s job plan.

Whitehall sources suggested that this new pay model would encourage many existing consultants, particularly those in A&E units or obstetrics wards, to move over to the new contract. They said that the government hoped that half of all hospital doctors would be on the new deal by 2020. They insisted that the aim of the reforms was not to increase the numbers of hours worked by individual doctors, adding that these should remain within safe limits.

Dr Porter has accused politicians of peddling “lazy caricatures” in pursuit of easy headlines. Last month he said that senior doctors were delivering 24-hour emergency care despite inadequate funding. He warned that the biggest danger to patients was an NHS budget shortfall, expected to reach £22 billion by 2021, and questioned whether weekend and evening services should be the priority against this backdrop.

Letters 18th July 2015:

Sir, A costly “one size fits all” solution may not be the best way to avoid 6,000 unnecessary weekend deaths in the NHS (report, July 16, letters and leading article, July 17). It is unlikely that such deaths are evenly distributed across all hospitals. If that is the case, problem hospitals should be identified for intensive correction.

Sadly, as every experienced hospital doctor knows, expertise, leadership and collegiate practice are not evenly distributed. As a workplace, some hospitals are much more desirable than others. That is one of the tragedies of the NHS.

J Meirion Thomas, FRCP, FRCS London SW3

Sir, Your leader implies that hospital doctors can opt out of weekend working. This is misleading. I was a consultant from 1989 to 2014, and can assure you that none of us can opt out. This paragraph in the 2003 contract relates only to non-emergency work. Almost all acute hospitals already have seven-day consultant ward rounds, but scans and operating space remain in short supply.

Tony Narula, FRCS Wargrave, Berks

Sir, Your headline “Get real and work weekends, doctors told” inspired me to go and do just that. Just as I have done for the past 18 years.

dr mark luscombe Consultant anaesthetist and intensivist, Doncaster Royal Infirmary

Consultants have always been reluctant to get involved in management. Doctors treat individuals first, management is divided, and the duty of government is to populations. In this regard the US is no example to follow.. The same Perverse Incentives apply to GPs who are equally reluctant to get involved in Commissioning..

The contract that lays out the terms for hospital consultants was drawn up in 2003, when John Reid was the Labour health secretary.

His predecessor, Alan Milburn, wanted to extend their standard hours to include evenings and weekends, triggering threats of the first BMA strike in 30 years. Mr Reid settled for 7am to 7pm, Monday to Friday. It included an opt-out for non-emergency weekend work.

Margaret Hodge, the former chairwoman of the public accounts committee, said in 2013 that the deal had been a “missed opportunity” to improve performance and provide value for money.

A first debate in West Wales BMA – on rationing – wins a majority in favour

Help families and employers to make it easier for patients to die at home..

Does the Dame feel that doctors are not trained in care of the dying? GP training used to include this as a key part of the curriculum, and most people should be able to be cared for by their GP practice. Unfortunately, the new contract and loss of 24 hour responsibility, has led to less continuity of care, and in effect made “palliative continuity” a voluntary service provided by a few…. Hospice doctors offer no more “continuous care” and their funding is only partial, but they are less distracted by other demands.. Perhaps the “Hospice at home” is the most cost effective and for many of us the most desirable, but the population at large needs to be educated to this effect, and perhaps there need to be incentives to help families keep patients at home, and employers need to be helped to facilitate this.. Traditional In-patient Hospices are not viable in small populations

Rosemary Bennett reports in The Times 1st June 2015: Doctors to be trained on care for the dying

All doctors and nurses would be trained in end-of-life pain relief and how to discuss death openly and sensitively with their patients under a bill to be presented in the House of Lords today.

The Palliative Care Bill would also make it a failure of duty of care if appropriate pain relief were not given in the final stages of life.

The bill has been tabled by Baroness Finlay of Llandaff, a professor of palliative care who came ninth in the peers’ ballot for private members bills.

She has been campaigning for better palliative care for many years and said the recent health service ombudsman’s report into end-of-life care showed that not enough had been done to address the problem.

Communication between health professionals and patients was an important starting point, she said. “Now that we can treat so much there is a kind of unrealistic expectation of us being in control . . . We need to get talking about the end of our days.”

The ombudsman found that hundreds of thousands of people were at risk of a painful, undignified or lonely death because of poor end-of-life care right across the health service. Among many problems, it singled out poor communication, citing examples of patients not even being told they were dying but finding out from their notes.

A spokesman for the Department of Health called the findings appalling and suggested that ministers might back the bill.

Quality of death – is not talked about – General Practice is “Closing Down” …

Charities say letting people die at home could save millions for NHS

Happy with the NHS? Only if you have not used it!

Chris Smyth in an article in The Times, 29th Jan 2015 reports: Voters are happier than ever with NHS

It beggars belief. Who commissioned the report? What were the questions and how much bias was there in both the questions and the questioned? Yes, some targeted areas do very well, but access to A&E and GP services is dreadful, and there is chronic undercapacity. Politicians have ignored the long term investment needed – a natural weakness in our political system. The Regional Health Services, especially in rural areas are imploding. You may feel happy with the NHS if you have never used it. You certainly cannot complain if you are dead.. Without a New Zealand style approach to honest and overt rationing, and especially if Health and Social Services are combined, there will be an increase in covert rationing – mainly directed at the elderly, mentally ill, and inarticulate.

Pugh cartoon

John Appleby points out “… support for the NHS might be rising as health climbed up the political agenda rather than because care was improving markedly…. As well as an actual increase in satisfaction, this may in part reflect a desire among the public to show support for the NHS as an institution.” Read the whole article – Voters are happier than ever with NHS

Dead people don’t vote… End-of-life care ‘deeply concerning’

Alex Neil rules out ‘gagging’ former NHS staff

Anne Clwyd MP, “Husband Treated Like Battery Hen”

Will Hutton “How Good We Can Be” : The Guardian reports 25th Jan 2015 ‘Inequality has become a challenge to us as moral beings’

Pugh cartoon