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Its a lack of trust in politicians and experts that is stopping us … We need PR for a good health system to evolve from the ashes of this one.

I was reflecting on what stops us having a good health service in Wales, and on the 72nd birthday of the original truly National Health Service that seems reasonable. Last week i answered a questionnaire on Survey Monkey, and was directed into a national survey of opinion on politics afterwards. I decided to help, and clicked the yes button.

The question that got me thinking (for half an hour) involved a long list of topics, and the reader was asked to say which was most important in the next election for the nation. I ran down the list with Health at the top, and of course Education, Environment, Business, Food production etc below.

And there was a box underneath … “OTHER”, which I eventually ticked. Of course I was asked to expand and I replied that the biggest issue …

Its a lack of trust in politicians and experts that’s the biggest issue in the country. If I tell a friend that a “source” seems reliable, most would believe me, but my younger friends, who get their news and opinions from U tube, Facebook, the Daily Mail, the Sun, and from social media, rather than a respected broadsheet, denounce me for saying that any source seems reliable.

They are expressing the “despair” that is prevalent in USA more than EU and the UK so far, but is spreading. Without a form of Proportional Representation that lets all people feel their vote matters we will not get the engagement of youngsters.

We need Proportional Representation for a good health system to evolve from the ashes of this one.

 

Tribalism at its worst. Rationing by region, and post code. Bring back a National health service please, and unify all apps..

Apps are different in different diverged dispensations. How can it be “National”? Philip Hayward for Walesonline 11th April reports: New app created to track coronavirus in Wales and Philip Sim in BBC Scotland  5th May asks “Will Scotland have its own coronavirus app?”

How can we still call this a National System? Just like the EU, and the World, our different “countries” are acting differently to each other, and in an uncoordinated way. Tribalism at it’s worst.

Reverse the devolution of health.. Now is the time to combine the 4 health services to give us efficiency, equality and unity.

Poor state of Welsh health. The experiment with devolution has failed….

Wales is bust, and cannot pay for its citizens care. Devolution has failed. This is the thin end of a very large wedge..

Theresa May – Avois Nationalism

Medical Nationalism

Chris Whitty’s recent Gresham College lecture on CV19

 

We need to shift from a culture of me to we. Maggie was wrong. There is such a thing as society.. and it will be our local support groups that get us through this crisis.

We need to shift from a culture of me to we. Matt Chorley opines in the Red Box in the Times 19th March 2020.

Maggie was wrong. There is such a thing as society.. and it will be our local support groups that get us through this crisis. Lets show her ghost that she was wrong.. But makeshift mortuaries in London could be replicated across the country.

He tried asking nicely. Despite the crude caricature drawn by his opponents (and the gaffes which gave them the outline), Boris Johnson is a liberal at heart.

Repeatedly when pressed on why he has not adopted more draconian measures, he has insisted: “We are a mature, grown-up and liberal democracy.”

This is not, he doesn’t quite add, China, where the containment of the coronavirus has been achieved with extraordinary levels of authoritarian control.

And yet. This only works if people do as they are asked. There is growing concern at the top of government that too many are ignoring the advice to stay at home, stop socialising, avoid pubs, cafés and restaurants.

This is especially true in London, where the outbreak is thought to be a few weeks ahead of the rest of the country, and the close proximity of its nine million inhabitants means it is spreading fast: a third of all recorded cases have been in the capital.

makeshift mortuary was constructed in the heart of London yesterday to boost the storage capacity for bodies of coronavirus victims.

Earlier this week Johnson pleaded: “It is important that Londoners now pay special attention to what we are saying about avoiding non-essential contact and to take particularly seriously the advice about working from home and avoiding confined spaces such as pubs and restaurants.”

As Sky News’ Beth Rigby told the PM at yesterday’s press conference, London isn’t listening.

So plans are being drawn up in Whitehall to put London in lockdown. It could see all shops closed, except for supermarkets and pharmacies.

Restrictions are coming into force, though. From today up to 40 London Underground stations that do not interchange with other lines will be closed until further notice. Services will be scaled back, the Waterloo and City line will close altogether.

The formation by the Ministry of Defence of a new “Covid support force” to assist public services across the UK has fuelled talk of the army being drafted in to help the police clear the streets. This is what is happening already in many other countries.

In Italy, as Tom Kington explains on the Red Box podcast this week, dogs are in high demand as exercising a pet is one of the few reasons to be out of the house. Exhausted hounds are being loaned for endless walking by those going stir-crazy indoors.

In France people now have to download and print off a form to go out. Charles Bremner describes how, in classic French style, the form is complicated and confusing. It is, as the French call it, “usine à gaz”, or gas factory, where the government comes up with something unnecessarily complicated.

Why does all this matter? Because every person who stays at home, who keeps their distance, is helping to save lives.

“The more closely, the more strictly, the more ruthlessly we can enforce,” Johnson said yesterday before adding a liberal caveat “upon ourselves, our families”, emphasising that this is a choice not an instruction. But he insisted that the more strongly we all follow the “advice we are getting about avoiding unnecessary gatherings, about staying at home when we have symptoms, then the better we will be able to protect the NHS, the fewer deaths we will have and the less suffering there will be in the UK population, and the faster we will get through this”.

With mass gatherings cancelled, public movement restricted, and now schools shutting from tomorrow, this is the message which will keep getting hammered home. That everyone must take responsibility and do the right thing.

Anyone not worried about the level of take-up should read the Mumsnet thread entitled: “Anyone else’s Parents swanning about as if they are immortal?”

This post about two parents in their seventies gives you the idea: “Just had a chat with my Mum, she then asked if I want anything from B&Q as they are popping in there tomorrow! This is after they went shopping to Sainsbury’s this morning and then said they are going again on Friday.”

James Johnson, the former Downing Street pollster, writes for Red Box today on some research for ITV’s Peston which highlights the scale of the challenge for the government nationwide.

Just 18 per cent say they are no longer meeting people outside of their immediate family. More than half (56 per cent) say they have no intention of doing this in future. Asked about limiting trips to the shops for essentials, again half are not planning to do this.

Across the board, men, and especially young men, are less likely to take all of the key actions: more hand washing (78 per cent of men, 89 per cent women); not shaking hands (56:62:); stopping using public transport (26:33); working from home (16:20).

According to Johnson, the wealthiest people are taking the least action: a quarter of people in the poorest households were already no longer meeting anyone outside their immediate families at the start of this week, compared with less than a fifth (16 per cent) of those in the richest households.

Too many people think that although the situation is bad, they personally will be OK. Only about a third of men and half of women are very concerned about the impact of the virus on their own health; but half of men and two thirds of women are concerned about the health of the country as a whole.

This is no time for “I’m alright Jack”. This is time for younger people, especially, to disprove the claim that Millennials and Gen Z-ers are too selfish and Insta-obsessed to think of society as a whole.

Of course it is upsetting not seeing friends, not celebrating, not partying, but it will be more upsetting when a close relative dies because you, or someone like you, couldn’t sacrifice a night out for the national effort.

The Most Rev Justin Welby, the Archbishop of Canterbury, spoke in the House of Lords yesterday, calling for the huge financial commitments made by the government to be matched by a bold vision “that recovers ‘us’ and ‘we’ from the era of ‘I’ and ‘me’. In short, a vision to recreate the notion and reality of society”.

It is a bold ambition, but one upon which lives depend. The time for asking nicely might be over.

Australia bekons

Many young doctors will be wondering where they can go to be trained, and looked after, properly, whilst in their formative years. You could do much worse than go to Australia.

GP-Australia Connect shared a post: WANTED DOWN UNDER ⇨ Series in which British families are given a look at life in Australia ahead of possible migration ⇨ Available on BBC iPlayer Link in comments box below #australia #health #careerdevelopment

The site is: “Health Jobs in Australia”.

The undervalued workforce. Option: reduce, resign, retire or emigrate. Its going to get worse still..

NHS for sale – property assets are the “family silver”. Staff may leave/emigrate/retire, and are doing so, but the property, once gone, is no use, and selling it just delays addressing the ideology.

Changing a culture of fear, bullying and gagging…… Start again with local pride….

The shortage of diagnostic and filtering skills is costing us dear. GPs retiring especially.

 

NI chief asks for an “society-wide conversation on budgetary priorities”, which means rationing..

Marie-Louise Conolly in N Ireland BBC reports 9th October 2019: NI health chief Richard Pengelly warns ‘something has to give’

He will be aware of the denial and the lack of the honest debate asked for by the chief of NHS England (Mr Stevens) in 2014.  The NI chief is asking for an “society-wide conversation on budgetary priorities”, which means rationing..

In the Belfast Telegraph October 17th he warns: Health service faces difficult decisions on budget 

The man in charge of Northern Ireland’s health service has said he cannot afford to pay for lifesaving treatments and pay rises for staff while also tackling hospital waiting lists.

Richard Pengelly, the Department of Health’s Permanent Secretary, said the health service in Northern Ireland is facing a £20m black hole in its budget.

As a result, he said he is unable to adequately fund a range of crucial NHS services.

Speaking at a Chartered Institute of Public Finance and Accountancy conference in Belfast, Mr Pengelly said: “I have stated that my department does not have the money to do everything we are being asked to do.

“It’s now in the public domain that our health and social care trusts are facing a projected £20m deficit this financial year.”

He restated the need for a debate to establish the public’s spending priorities in the face of budgetary pressures.

“While intensive work will continue to ensure their books are balanced, the reality is that the projected deficit represents only a small part of the escalating pressures and demands we are facing in the months and years ahead,” he said.

“Currently these are presented to me with frustration – the argument being that because I don’t do something, it means I don’t want to do it. That is certainly not the case.”

Mr Pengelly said that he had been left with difficult decisions to make and could not please everyone.

“Why wouldn’t I want to reduce waiting lists, increase pay for hard pressed staff and reduce the pressure on those staff by recruiting and training more colleagues?  Why wouldn’t I want to improve mental health provision and focus on suicide prevention, commission new drugs for patients with cancer and other serious conditions?,” he said.

“The truth is I simply can’t afford to do all these things – in fact, I can’t afford to do all the things we currently do.

“And with a fixed budget, I can only do more in some areas by doing less in others. And that is the key challenge.

“It is why we need a society-wide conversation on budgetary priorities and how best to use the limited resources we have.  In the next year alone, the competing demands and pressures could between them add hundreds of millions to an already very stretched health budget.”

Belfast Telegraph Digital

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

Image result for denial cartoon

More deaths in Wales. More attempts at unreal solutions… Across the nation standards are falling…

No amount of cultural change can occur without changing the ground on which the health services are built. Any moreover, to attempt to do this internally, and without outsider help the attempt, like most previous reorganisations, is doomed.

Leah Powell in the South Wales Argus reports: Relative of Nye Bevan – founder of the NHS – died after “life-threatening” mistakes from two trusts.

Mark Smith on 26th June in the same paper June 26th reports that “Huge numbers of patients are dying due to mistakes made by the Welsh NHS” and that Thausands of others may have suffered harm.

Whether as a result, or not, on 21st June the Health Service Journal reported: The Welsh NHS has embarked on a fundamental change of culture and services. Nesta Lloyd-Jones tows the line…

Lizzie Parry –  Sebbastian Hibbard’s death is reported in the Sun: NHS 111 handlers “missed numerous opportunities” to save boy aged 6 with blocked bowel says coroner.

Laura Donelly in the Telegraph  17th June reports on “Eight NHS Hospitals hit by Listeria deaths”. Hancock plans to restore catering services “in house”.

Hundreds of villages lose their GP services across the country… The Telegraph

 

 

 

 

 

 

 

From 40 hospitals to six: how the Tories’ NHS numbers don’t add up

The Liberal Party missed a great opportunity to use basic liberal principles to reconfigure the 4 UK health services in their recent conference. Once Brexit is over they have no differentiating or sustainable policy on health.

Conservatives:

In the Guardian today Sarah Boseley reports: From 40 hospitals to six: how the tories ‘ NHS numbers don’t add up. Experts say it is hard to know how much new money Boris Johnson’s government intends to put into the NHS

Labour: In the Guardian again reports: Labour’s NHS policies risk replacing one dogma with another

 

 

As seen from USA Nationalisation of Health gives worse outcomes…… than the G7 excluding USA!

The idea that nationalised health care is worse than no health care, which applies to 40% of working American citizens is laughable. Yes, for those with cover the US system is better, especially for the elderly on retirement incomes, but it excludes so many. But against Australia, Canada, Denmark, Ireland, New Zealand, and Norway, the UK has worse outcomes. A pity the whole of the US population was not included in the study.

The UK system is failing, badly, and needs to change its rules. No other country tries to emulate any of the 4 UK health systems. But we don’t need to emulate the USA.

Sally Pipes (President of the Pacific Research Institute ) for Forbes 30th September 2019 reports : Across The Atlantic, Nationalized Health Care Is Failing Cancer Patients

The United Kingdom’s National Health Service is failing cancer patients. That’s the grim conclusion of a new study published in the Lancet, a medical journal.

Researchers examined five-year survival rates for seven types of cancer in seven “high income” countries. The United Kingdom came in dead last in five of the categories—and near last in the other two.

These dismal results have a simple explanation. The National Health Service is woefully short on doctors, nurses, and other healthcare personnel. Long waits and poor care are the result.

These are the stark realities of any government-run healthcare system. If the United States implements Medicare for All, British-style rationing is sure to follow.

There are few places in the developed world worse for those with cancer than the United Kingdom, per the Lancet study. From 2010 to 2014, just 16% of patients diagnosed with cancer of the esophagus survived five years. Less than 8% of those with pancreatic cancer and 15% of those with lung cancer lived that long.

Those results can partly be attributed to the country’s shortage of cancer care providers. About one in ten diagnostic posts is vacant, according to 2018 data from Cancer Research UK, a research and awareness charity. By 2027, the government must add 1,700 radiologists to its workforce to accommodate demand. It must also hire over 1,800 oncologists and 2,000 therapeutic radiographers—professionals who administer radiotherapy to patients with cancer.

“We don’t have nearly enough radiologists in the UK right now,” noted Gils Maskell, Cancer Research UK’s radiology expert. “And far too many patients are waiting too long for scans and results.”

In some cases, hospitals are so strapped for resources that they’re getting rid of crucial cancer services. Last year, for example, a London hospital announced that it would nix chemotherapy because it had too few qualified nurses to continue providing it. One health official called it a “serious blow to patient care.”

As a result, patients experience dangerous treatment delays. Data from the NHS revealed that nearly 58,000 patients didn’t see a cancer specialist within two weeks of getting an “urgent” referral from their doctor between April and June 2019. More than 18,000 didn’t see a specialist within three weeks.

These delays often mean missing tumors at earlier stages, when patients have a better chance of survival. In 2017 alone, 115,000 cancer patients in England didn’t get a diagnosis until the cancer had already reached stage 3 or 4, according to a recent Cancer Research UK report.

The results are often tragic. For example, while more than 90% of patients with bowel cancer survive for at least five years if it’s detected at its earliest stage, only 10% do so if it’s not discovered until the latest stage.

The statistics are similar among women with breast cancer. Eighty percent of lung cancer patients will live five years if the disease is diagnosed early, compared to only 15% if it is discovered in its most advanced stage.

And then there’s the outright rationing. The NHS simply denies patients treatments if it decides that they’re not worth their price. In 2017, for example, the NHS’s “rationing bodies” decided to reject a drug that could have extended the lives of hundreds of women with breast cancer.

Cancer patients fare far better in the United States than in the United Kingdom, according to 2005-2009 data from the Centers for Disease Control and Prevention. Here, 89% of female patients diagnosed with breast cancer survived for at least five years. In the United Kingdom, only 81% did so. Among patients with colon cancer, 65% of Americans survived five years, compared to only 54% of Britons. And U.S. lung cancer patients were about twice as likely to survive five years as those in the United Kingdom.

These stark differences show that the last thing the United States should do is import government-run health care—if we care about saving the lives of cancer patients.

As a GP, I know there is a huge void for patients where the NHS used to be

Zara needs to realise that all health systems ration care and services. Because we cannot get our politicians to admit this, we ration covertly and by post code, easy targets, and without reference to severity of symptoms or means, or cost and volume. The result is an unofficial two tier system whereby the richest pay for those rationed services, and the poor do without. Zara also needs to recognise that there are 4 UK health services, and no NHS.

In The Guardian Zara Aziz reports 1st October 2019: As a GP, I know there is a huge void for patients where the NHS used to be

Rationing means that hernia repair, hip or knee replacements and removing tonsils or a gallbladder are no longer routinely funded

….Did you know that hernia repair; hip or knee replacements; removal of cataracts, tonsils, haemorrhoids or a gallbladder; injections for back pain; and referral to specialised pain clinics are among the growing list of treatments that are no longer routinely funded by the NHS?