As the Health services disintegrate, NHSreality will try to highlight the disparities between areas. Post Code rationing is in the main covert, but in some cases patients have found out and moved in order to gain access to treatments rationed out in their own area. Cambridgeshire has had it good, and a three month wait for routine surgery is nothing for the people of Wales. Wait and see the response when “emergencies” are also rationed… Cambridgeshire and the South East are the richest parts of the country, but there are areas of poverty and deprivation within the South…. As the 4 health services disintegrate it will be the poorer people who suffer most: exactly the opposite of Aneurin Bevan’s intent… (In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear)
Patients will be forced to wait at least three months for routine surgery as increasingly desperate health chiefs use treatment delays to cut costs.
Thousands of patients in Cambridgeshire will have to wait twice as long as they do now for procedures such as hip and knee replacements under the most radical rationing plans to come out of a tough NHS savings drive.
Doctors and patient groups condemned the “unjustified” minimum wait policy, which they said would lead to patients getting more ill while they were denied life-changing treatment.
Ministers ordered an end to “unfair” minimum wait policies six years ago after a report found that NHS bosses were attempting to control costs by delaying treatment, during which time some patients would give up, go private or die.
The method is being revived in one of 14 areas of the country that have been told to “think the unthinkable” to bring down spending.
Under an opaque initiative known as the capped expenditure process, bosses have been told to do what it takes to get outgoings below a certain figure.
NHS Cambridgeshire and Peterborough says in recent board papers that demands from regulators for further savings mean that it will have to introduce a minimum wait of 12 weeks for non-urgent elective procedures. It says that the policy will ensure “a one-off saving to the system in the current financial year”.
Derek Alderson, president of the Royal College of Surgeons, said: “We are concerned minimum waiting time policies may become commonplace. Longer waits simply make an already stressful situation even worse for patients and their families.” He added that the policy “merely kicks the cost further down the road”.
Professor Alderson said he was concerned that managers rather than surgeons would decide which patients were urgent, asking: “Will patients that are unable to walk now be forced to wait an arbitrary number of weeks for life-changing knee replacement surgery?”
Jonathan Dunk, acting chief officer of Cambridgeshire and Peterborough Clinical Commissioning Group, said that “emergency life, limb, sight or hearing treatment, or cancer diagnoses and treatment” would be excluded from the policy. However, he said: “As part of cost management for the local health system we are proposing that 12 to 18 weeks would be the expected waiting time for adult non-urgent cases.”
A spokeswoman for NHS England said: “The NHS has always had to live within the budget that parliament allocates and it is unfair if a small number of areas in effect take more than their fair share at the expense of other people’s hospital services, GP care and mental health clinics elsewhere in the country.”
The decision on assisted dying is to be welcomed, as is the news that diseases such as this could be edited out of society eventually using Crispr, but there is a cost, and patenting of the processes may mean costs are too high for many nations/systems. The news in the recent edition of the New Scientist is that a leukaemia gene can be edited for the price of $475,000 per patient. This blows NICE life – years valuation out of the water… But on the other hand, rich families will be able to afford the treatments… At last – common sense on the right to die with agreement of Dr and Family. But the cost implications of prevention, along with the ethical dilemmas and the religious rights objections, mean that helping the patient by “putting them at the centre of your concern”, will still be the main problem for doctors for decades to come. Even the insurers might object.
A judge has made a landmark ruling that legal permission will no longer be required by a court before life-supporting treatment is withdrawn from patients suffering from severely debilitating illnesses, lawyers say.
Mr Justice Peter Jackson ruled that a 50-year-old woman who had suffered from Huntington’s disease for more than 20 years should be allowed to die after a hearing in the Court of Protection, where judges analyse issues relating to people who lack the mental capacity to make decisions for themselves, in London.
The woman’s daughter plus doctors caring for her all agreed that life support treatment should end……
Sir, The crux of the debate on assisted suicide is whether it is possible to grant some people the right to assistance in suicide without exposing others to subtle, malicious pressure to exercise it.
In 2011 Lord Falconer’s commission stipulated that a safe assisted-suicide framework required, first, safeguards “to ensure that the choice of an assisted death could never become an obligation and that a person could not experience pressure from another person to choose an assisted death without the abuse being detected”. Second, there had to be provision of “the best end of life care available”, including staff who would fully investigate the circumstances and motivations of any person seeking an assisted death and alternative options for treatment and care”.
In her book about the treatment of the elderly, Not Dead Yet (2008), Baroness Neuberger reported that in the UK 500,000 elderly people were being abused, two-thirds by relatives or friends. The Stafford Hospital scandal revealed that abuse of vulnerable patients is not limited to amateurs but extends to healthcare professionals.
So, we have no reason to suppose that we can “ensure” the absence of undue pressure to opt for assisted suicide and the presence of compassionate staff. Indeed, there is good empirical reason to doubt that such things can ever be guaranteed.
Judging by his own commission’s criteria, then, Lord Falconer’s Assisted Dying bill is, while well meaning, dangerously imprudent.
judge in a specialist court has made a landmark decision that will affect the relatives of terminally-ill people, lawyers say.
Mr Justice Peter Jackson ruled that a 50-year-old woman who had suffered from Huntington’s disease for 20 years should be allowed to die after a hearing in the Court of Protection, where judges analyse issues relating to people who lack the mental capacity to make decisions for themselves, in London.
The woman’s daughter and her doctors all agreed that life support treatment should end.
Mr Justice Jackson said that judges should not be required to make rulings in similar cases, where relatives and doctors were in agreement and medical guidelines had been followed.
Mr Justice Jackson said he could understand why the woman’s mother and doctors had asked for a ruling. But, he said, in a written ruling : “In my view it was not necessary as a matter of law for this case to have been brought to court.”
He published the ruling on Wednesday and said the woman had now died.
Specialist lawyers at Irwin Mitchell had represented the woman’s mother. They described Mr Justice Jackson’s decision as a landmark.
Genetic engineers have eradicated disease-carrying DNA from human embryos in a breakthrough that heralds a new era in medicine.
The achievement could lay the groundwork for doctors to eliminate hundreds of inherited illnesses such as Huntington’s disease, cystic fibrosis and sickle-cell anaemia with a single, permanent change to a family’s bloodline.
While implanting altered embryos in the womb is against the law in the UK and many other countries, some scientists forecast that the technology will become acceptable if the benefits of preventing these conditions outweigh their practical and ethical problems.
There are about 10,000 diseases that are caused by individual mutations and could in theory be fixed with the treatment, which is known as germline gene editing because it involves using chemical scissors to snip harmful DNA out of an embryo’s genome.
Biologists in the US, China and South Korea used a powerful form of the technique called Crispr/Cas9 to cut out the gene that causes one of the most common of these conditions, hypertrophic cardiomyopathy (HCM), from sperm cells as they fertilised 52 eggs from a single healthy woman.
This incurable disease, which affects one in 500 people, thickens and stiffens the wall of the heart, sometimes leading to shortness of breath, palpitations or abnormal rhythms.
Findings published in the journal Nature show that scientists were able to get rid of the mutation that causes about 40 per cent of HCM cases by injecting a tailored version of Crispr/Cas9 into the woman’s eggs at the same time as they introduced the mutation-bearing sperm.
It is the first time that researchers have edited the genes of embryos and then seen them develop normally, partly because the embryos appear to be able to repair their DNA cleanly by using the egg’s genome as a template.
Attempts carried out in China over the past two years failed because they resulted in so-called mosaic embryos in which some cells had been fixed while others carried the gene.
There is a long way to go before the treatment can be used in IVF clinics. Ethical questions aside, the findings will need to be repeated in eggs from other women, while politicians and regulators will need further evidence that it is safe before they can consider legalising germline editing in the real world.
Even then, it will play second fiddle to pre-implantation genetic screening, where doctors examine the DNA of a couple’s embryos to see if any are free of mutations. In practice gene editing would be most useful for would-be parents who cannot produce enough healthy embryos, particularly if they carry dominant gene-linked disorders such as Huntington’s disease, HCM, Marfan syndrome and neurofibromatosis, which makes its carriers prone to cancers of the nervous system.
Peter Braude, emeritus professor of obstetrics and gynaecology at King’s College London, who was not involved in the study, said: “The possibility of germline genome editing has moved from future fantasy to the world of possibility, and the debate about its use, outside of fears about the safety of the technology, needs to catch up.”
Designer babies — the last taboo
Scientists heave a collective sigh when they hear the phrase “designer babies”. The words conjure up an elite race of children whose genes have been customised with methods that are as technically implausible as they are ethically fraught.
This is not what most experts fear. The real risk is that one of these days, in a fertility clinic beyond the intense scrutiny that attends every step of embryo research in most western countries, doctors will quietly slice an inherited disease out of a few embryos’ genomes and nine months later announce the birth of the world’s first gene-edited baby.
We know this because we have been here before. Last year John Zhang, a US doctor, used a different but scarcely less controversial technique known as mitochondrial replacement to create a “three-parent” baby in Mexico.
The global scientific establishment was appalled, particularly as the UK was still putting the finishing touches to a pioneering system for licensing this kind of experiment after more than a decade of thorough debate.
The trouble is that no matter how carefully we try to control the science, there will always be places where even the best-laid laws cannot reach. There is not much that experts can do to hold back their colleagues if they are determined to defy international convention, particularly if they are prepared to do so in countries whose regulations are vaguer or more permissive than those in Britain and the US.
This is true not only of gene editing but also of many ethical frontiers that are being challenged by the breakneck pace of biological discovery.
Sandy Starr, of the Progress Educational Trust, a biomedical charity, said the technology needed to be considered alongside projects such as the creation of animals that contain human cells and the generation of sperm and eggs in a dish.
“All of these are potentially exciting areas of research,” he said. “They all require careful regulation, and they certainly require the widest public and international debate before we consider permitting any clinical applications.
“Of course it’s always possible that someone unscrupulous will jump the gun, go jurisdiction-shopping, and travel somewhere to use an experimental medical technique in an unethical way. Even if they do, and even if they evade legal judgment, we can still subject them to our own moral judgment and find them wanting. Indeed, it becomes all the more important for us to do so.”
The problems in Wrexham are going to spread. BBC News today reports: Wrexham patients protest about GP staffing levels. The rationing of medical school places, midwifery places, physiotherapy places and nurse training places has led to severe under capacity. Patients will be asked to see nurses for “diagnosis”; something they are not trained for, and the result will be no living with uncertainty, or letting the natural course of disease run, over investigation and over referral to defend their litigation risk. We have the evidence here than we have destroyed the goose that laid the golden egg … Its NOT funny..
Mr Jones told BBC Radio Wales: “We know how important health is and we have got to the point where it takes most of our expenditure.
“But we have experienced austerity since 2010 and it is taking more of a decreasing budget.”
Speaking to BBC’s Good Morning Wales programme, he called on the UK government to support public services, saying finances were being “squeezed”.
Newport council leader Ms Wilcox said health boards could do more to reduce their spending.
“I think there has to be a question asked about further reform,” she said, pointing to management costs in the NHS.
“If the cuts keep coming, as this report has shown, local government is going to fall over.
“I think there is a responsibility on the NHS to sit down and talk to us and engage with us.
“We have made huge cuts. We have managed tremendously well. We can teach the NHS the ways in which to do that.
“We need to collaborate more and show them better ways of managing our limited resources.”
Finance Secretary Mark Drakeford will set the next budget on 3 October.
The NHS currently receives 48% of the Welsh Government’s revenue budget – up from 39% in 2009-10.
The two Cardiff University-based think tanks said under current UK government plans, the Welsh Government should expect another 3% cut to its budget for day-to-day spending by 2021-2022, on top of a 11.5% cut since 2010.
Welsh ministers have promised to protect the NHS, schools and adult social care, meaning local authorities take a bigger hit.
The share of the Welsh Government’s revenue budget the NHS receives could rise to 56%, if ministers find the money needed to keep up with a predicted growth in demand, the report has warned.
Cuts to Welsh councils have been smaller than in England, but spending on unprotected services – such as libraries, roads and culture – could reach 50% by 2021-2022, the study estimated.
It added: “There may not be a single tipping point but continued attrition would call into question whether the full range of services we have now is affordable.”
For the first time, Mr Drakeford has the option to raise some taxes.
But those powers are “likely to have only a limited impact” on spending during the next four years, the report said.
Ministers will have control over landfill tax and land transaction tax – formerly stamp duty – next year.
They will also get powers to vary income tax in 2019.
But Labour has promised there will be no changes to income tax, leaving spending heavily dependent on a shrinking block grant from the Treasury in London.
The Welsh government said the report illustrated the difficult budget decisions it faced.
“We have repeatedly called on the UK Government to end its unnecessary austerity agenda, which has resulted in ongoing real terms cuts to our budget since 2010,” a spokesman said.
But the Conservatives said the problems facing the Welsh NHS were “the product of nearly two decades of Labour mismanagement”.
Tory finance spokesman Nick Ramsay said: “Successive Labour administrations have singularly failed to get a handle on worsening public health, long-term workforce planning, and wasteful practices – all of which have been compounded by chronic underfunding.”
Legalising the production, purity, distribution, and sale of drugs makes sense. By controlling the processes above the criminals will need to stop or change into a different field. We as citizens stop spending on prevention and punishment in a system that produces more criminals in training schools (prisons). The savings from both prison and police can be spent on providing a better health service. Wales might even find the money for Cancer Cervix victims..
It is a debate that has divided society for decades, with libertarians, hippies and the state of Colorado on one side, and conservatives and anxious parents on the other. Now the Duke of Cambridge has raised the question: is it time for drugs to be legalised?
He spoke out as he visited a charity in east London that helps people with addictions.
Prince William, 35, told a group at the Spitalfields Crypt Trust in Shoreditch who had all been helped by the charity: “Can I ask you a very massive question — it’s a big one. There’s obviously a lot of pressure growing on areas about legalising drugs. What are your individual opinions on that?
“You seem like the key people to actually get a very good idea as to what the big dangers here are.”
Heather Blackburn, 49, from Hackney, said: “I think that it would be a good idea but the money is kind of wasted on drug laws that put people in prison . . . of the people I’ve known in recovery, 95 per cent have massive trauma and terrible stuff happen to them and using drugs to cope and then you get put in prison, you don’t get the facilities and actual help you need.
“ You get punished — which is not going to stop anyone taking drugs.”
William asked: “So there needs to be more of a social element to it?. . . So prison doesn’t tackle the root cause of why someone is taking drugs?” Ms Blackburn replied: “No, it just punishes.”
A royal aide said that while William had been careful not to proffer an opinion, “he has long taken a keen interest in the issue of homelessness and is not immune to the fact that addiction can play a big part in this”.
The aide added: “If there is a social issue then he believes it is important not to talk about it in the abstract but ask questions of and listen to those who are affected.”
A spokesman for Transform, the think tank pressing for a change in drug laws, said: “Transform is delighted that Prince William has the courage to ask one of the most crucial questions of our time . . . legalisation would better protect the most vulnerable people by putting government, not gangsters in control of the drug trade.”
Plymouth Hoe gave us a national hero, and another is needed. This time it will be the first politician who persuades his party to be honest about the UKs 4 health services. It follows through into care of the elderly….
With surgeries closing their doors and providers handing back contracts, what does the future hold for our city’s GPs?
….It is not just Ocean Health who have experienced difficult times in Plymouth – Cumberland, Hyde Park, St Barnabas and Saltash Road GPs all shut on March 31 – the surgeries were being run up until that date also by Access Health Care, which stepped in last year after previous providers pulled out.
Freedom Health Centre will be shutting its doors on September 30 after the current provider resigned too.
The surgery, which has about 1,800 patients and deemed “not fit for modern healthcare” will stay open until that date.
Ernesettle, Mount Gould and Trelawney, which serve around 10,000 patients also need to find a new provider by March 2018 to ensure they stay open……
Many elderly and vulnerable people who receive care in their own homes are having levels of support cut because of funding pressures, despite ministers’ injection of extra money, social workers say.
Cuts include reducing home calls from 45 to 30 minutes, withdrawing help to wash at home or prepare hot meals and fewer visits to help them use the lavatory, according to a report.
Home care is also being more tightly defined in many areas, with local authorities refusing to pay for activities to help people go out and focusing on physical needs, it said.
The reports of squeezed budgets come despite the announcement by Philip Hammond, the chancellor, in March of an additional £2 billion over three years for adult social care.
A report by the Social Care Alliance said that the system was buckling under the strain of too few resources and rising demand, based on 469 responses from social workers to a survey conducted online by Community Care magazine.
I am still asked “how should I choose my GP practice”, and I usually give a guarded reply which amounts to “It depends what functions/services you value most”. Continuity of care is a rarity these days, and with more and more part time GPs the problem will get worse. Patients are not “ill” on days that suit a Dr working 2-3 days a week. Children are ill suddenly, and so practices where partners offer a daily surgery, albeit with a different doctor, are valued. One thing to consider is whether there is an “individual list” system, or a “shared list” system. In the former it can be harder to see your doctor, but it may be worth waiting especially for older patients with chronic conditions. In the latter system patients are often fitted in quickly but usually see a different Dr each time if it is an emergency (as defined by the patient)! Mothers of young children usually prefer this type of system, but not always. Does the practice have an active Patient Participation Group?Other things to consider are whether the practice is a teaching practice, what the turnover of staff is, and whether they have a QPA (Quality Practice Award) which is in date. If you know a family who have had a death recently, the quality of any palliative or terminal care is pertinent, but remember “dead patients don’t vote“. Despite all this, and the Care Quality Commission report, most patients will still ask their neighbours…
It’s a pity that we don’t know the quality of care for comparison in the other 3 UK health regions, thus emphasising that there is no NHS. Rather than reporting the bad news, the Times could report that 90% of GP care is good quality, and ask “Are you lucky enough to be in a post code with good GP care and good choice?” as many areas have reduced choices, even in cancer care.
Seven million patients are treated at GP surgeries with serious safety problems, according to the first comprehensive review.
Inspectors urged patients to switch to better performing surgeries after finding that one in seven had issues with safety and one in ten was not good enough overall.
They uncovered “pockets of persistent poor care” including out-of-date medicines, a failure to follow up on test results, delayed cancer diagnoses and a lack of checks on the medical qualifications of staff.
Smaller surgeries were more likely to do badly, the review showed, with the worst half the size of the best. They have been ordered to end “professional isolation” by linking with neighbouring surgeries to share resources and expertise.
The Care Quality Commission (CQC) has finished inspecting all 7,365 GP practices that existed when it started its revamped regime three years ago. Nine in ten were good or outstanding, significantly better than hospitals or care homes. It initially found that one in three was not safe enough, forcing inspectors to take action including shutting dozens of surgeries. One in seven still had safety problems, however, covering seven million patients, with 13 per cent “requiring improvement” and 2 per cent, with almost a million patients, “inadequate” for safe care.
“Safety is the one clinical area that we worry about,” Steve Field, chief inspector of GPs, said. “You find surgeries where they have lots of [test] results that haven’t been acted on, they might have out-of-date medication, their fridges might be at the wrong temperature so the vaccines might not work. It’s really poor leadership.”
Professor Field recently had to intervene to replace out-of-date emergency adrenalin that could have led to the death of a patient, he revealed. He urged patients to use ratings on the CQC website to switch to a better surgery. “I was in a surgery two weeks ago where they said they’d had 300 patients move to them because they were rated outstanding,” he said.
The average “inadequate” practice has 5,770 patients compared with 10,126 for the average “outstanding” one. Professor Field said that smaller places often found it harder to stay up to date, manage services well and employ nurses to help patients with long-term conditions. He said that most should be linked to other family doctors and social services. “I suspect that if you’re a weak leader but a good clinician and you’re part of a larger group, the quality of care will be better,” he said.
Ministers have promised GPs £2.4 billion as they struggle with rising patient numbers and Professor Field said that this had to get through before a “winter crisis”. Richard Vautrey, chairman of the British Medical Association GP committee, said: “These positive results are undoubtedly down to the hard work of GPs and practice staff, but many are in an environment where they are increasingly struggling to deliver effective care.”
The union has clashed with Professor Field, insisting that his inspections were not fit for purpose. Dr Vautrey insisted that the process “remains overly bureaucratic and continues to result in GPs spending time filling in paperwork when they should be treating patients”.
Jeremy Hunt, the health secretary, said: “Nearly 90 per cent of GP surgeries in England have been rated as ‘good’ or ‘outstanding’ — and that is a huge achievement for GPs given the pressures on the front line.”
What do we know?
Every GP practice has an overall rating shown on the CQC website
Each practice is also given sub-ratings assessing whether it is safe, clinically effective, caring, responsive and well-led
The NHS GP patient survey assesses whether people would recommend their surgery, whether GPs give them enough time and whether they see the same doctor
There is little other official data on GPs
Patients can post ratings on websites such NHS Choices
All health systems are rationed. The political decision is whether to t=ration overtly (Most of the world0 or covertly (UK Health systems). Patients need not be in pain, and high cost treatments may be available if we accept that citizens have a need to provide the high volume and low cost treatments themselves. Rationing in this way will not offend big pharma or deny patients expensive cancer treatments. Rationing is not a possibility its a certainty. It’s just whether politicians continue to lie about it, and we are gullible enough to believe their lies.
Money, money, money – it’s a familiar background theme across the NHS in England, but the volume is increasing.
Campaign funding promises have been made but whoever forms the next government will find some challenging financial issues highlighted in their ministerial red boxes.
This week, reports of a tightening of the financial thumb screws have emerged. There is talk of rationing and, as one source told me, “unpalatable things” being contemplated by hospital managers and local health commissioners.
Under what’s been billed as a “capped expenditure process”, NHS England and the regulator NHS Improvement are telling some trusts to stick within spending limits even if that means tough decisions on the provision of non-urgent care.
The new pressure on hospitals and local health commissioning groups in England comes after some trusts overshot agreed spending targets during the last financial year.
Since the start of this year, from the beginning of April, it has become clear that the biggest over-spenders have been unable to agree their so-called “control totals”. They have now been told to take firmer action to keep a grip on spending.
The Health Service Journal (HSJ) reported that NHS officials have contacted health managers in 14 areas of England with a series of proposals for controlling budgets. These include extending waiting times for routine procedures and treatments, downgrading certain services and limiting the number of operations carried out by the private sector for the NHS.
HSJ first revealed the tougher spending regime in April, quoting from a letter sent to those local health leaders who could not agree their budgets.
They were asked to decide “from which areas further expenditure reductions will be made”, including reviewing the range of medicines prescribed.
Interestingly, the letter and subsequent dialogue has been with both commissioners, who can limit what they are prepared to pay for, and trusts who might save money by curbing the volume of non-urgent care provided to patients.
There was a clue to this tougher approach in the update to the NHS Five Year Forward View plan, published at the end of March. The finger is pointed at those organisations which had historically substantially overspent their “fair shares of NHS funding”.
Put a lid on it
They are accused of “living off bail-outs” taken from other services. They are then told to confront “difficult choices” and if necessary “scale back spending on locally unaffordable services”.
An NHS England spokesperson said no final decisions had been made and when final choices were made locally they would need to be approved nationally. But there was no denying the fact that in some areas hospital managers and commissioners were being told to go further than before to keep a lid on spending.
The background to this is that NHS England is receiving a much smaller budget increase this year than in 2016/17 which, though originally billed as a generous “frontloaded” settlement, appeared to only just cover what the service needed. Patient demand will continue to outstrip the money available with the financial pressure even more intense this year.
Those who see the NHS as a bottomless pit always requiring more money to be poured in will call for more efficiency savings before another bailout is contemplated. Those who argue that the NHS has been underfunded for some years, with the share of national income devoted to health lagging behind other leading economies, will say the only answer is higher levels of government funding.
It’s a familiar debate and one which won’t go away after polling day.
Not enough money
The three main health think tanks, The King’sFund, Nuffield Trust and the Health Foundation, wrote a joint letter this week arguing that no political party was offering enough extra spending to cope with the demographic and demand pressures on the NHS.
They estimated that an extra £20 billion annually would be needed by 2022 over and above the most generous manifesto pledge.
The think tanks argue that failure to provide sufficient funding will result in longer waiting times for patients and a decline in levels of care.
Recent reports indicate NHS chiefs are already planning for that to happen.