Category Archives: Uncategorized

Extreme inequality leads to extreme health outcome differences…

Inequality in wealth is not the only inequality. Opportunity, education, political involvement and awareness, health and life expectancy are all changing. The economist also argues for sticks as well as carrots in Welfare Programme – Spilling over, 9th May 2019:

Talking about penalties (school exclusion and removal of benefits) for a child not being vaccinated “The papers find that such penalties have wide-ranging effects. They encourage compliance not only by the family that is directly affected, but also by their neighbours, and by the families of classmates and siblings’ classmates.”……


Delphine Strauss in the FT reports: Britain risks extreme inequality, says Nobel Prize winner

Angus Deaton-led review urges UK to ‘change the rules’ to avoid excessive disparities

The UK needs to “change the rules” to avoid the damaging extremes of inequality seen in the US, according to Angus Deaton, the Nobel prize-winning economist. Britain has not yet experienced anything like the wage stagnation and rising mortality seen among less educated Americans, but on recent evidence, it risks following the US example, Sir Angus will say at Tuesday’s launch of a review that aims to identify the forces driving UK inequality and propose solutions. The five year exercise, led by Sir Angus and initiated by the Institute for Fiscal Studies, a think-tank, is one of the most ambitious attempts yet to understand and address the economic disparities that are often blamed for the surge in populism and decline of mainstream political parties across the developed world. It comes amid a ferment of intellectual activity in both the UK and US, with new think tanks on the left advocating radical remedies to capitalism’s perceived shortcomings, ranging from a universal basic income to a four day working week. Politicians across the political spectrum have been searching for a response to the sense that the UK’s economic and social structures do not give all of its citizens a fair chance. The IFS review, funded by the Nuffield Foundation, a charitable trust, will harness academic heavyweights from several disciplines, with a panel including experts in sociology, demography and philosophy, as well as the World Bank’s chief economist Pinelopi Goldberg and the Nobel-winning economist Jean Tirole. Paul Johnson, IFS director, said the first goal was to understand the interaction between different forms of inequality — of income, work, health or family structures; and between generations, genders or regions — and identify those that matter most.

A report by the IFS, to be published on Tuesday at the review’s launch, noted that while UK income inequality had been stable, this was largely because tax credits had offset worsening earnings inequality. “Benefit income received from the government may feel quite different, in terms of the dignity and security it brings, from income earning in the labour market,” said the report. But inequality “is not just about money”, added the report. Among other examples, it called attention to a rise in the UK of middle aged “deaths of despair”, from suicide, drug overdose or alcohol-related disease.

The IFS report also noted diverging family structures: high earners have become more likely to live with a partner, while those on low wages have become more likely to live alone. As well as mapping out changing patterns of inequality, the IFS review will draw on international experience to examine the underlying causes. It will look at frequent scapegoats, such as technological change and globalisation, but also at the decline of trade union membership and the widening gap between the most successful companies and the rest, which could point to failures in competition policy. The aim is to design an overarching response — ranging from changes in taxes and benefits to reforms of labour markets, education, competition policy and ownership structures — so that measures complement each other.

“If working people are losing out because corporate governance is set up to favour shareholders over workers, or because the decline in unions has favoured capital over labour . . . we need to change the rules,” Sir Angus will say.


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

Lets get this clear: this is NOT about emergencies. It is about cold planned care. Since the “money moves with the patient”, and since Wales has not got enough money to pay up, Chester Hospital’s accounts will suffer. This is the reality. The whole situation represents the thin edge of a very large wedge. Health care as arranged today is unaffordable. We need to ration health care overtly so that everyone knows what part of the “wedge” is not available. It may be different parts to different people with different means. Should deserts based rationing apply? IS the large wedge being taken from the 4 health services similar to that the Americans have taken to Obamacare?

Image result for thin end wedge health cartoon

Kat Lay reports 6th April in the Times 2019: Welsh patients no longer welcome at English hospital

An English hospital will no longer treat patients from Wales except for in emergencies amid a row over funding.

Local doctors and officials expressed “disappointment” at the announcement, while the Welsh government said that it was “not acceptable” to limit access on financial grounds.

The Countess of Chester NHS Foundation Trust said that it had reluctantly decided to stop taking any patients living in Wales for planned care because of a gap between the work it was doing and the payment it was receiving. The hospital is only a ten-minute drive from the Welsh border, and many of its staff and about 20 per cent of its patients live in Wales.

Responsibility for the NHS in Wales is devolved to the Welsh government. Cross-border protocols are in place to govern how patients who live in one country but require treatment in the other should be dealt with, but payment arrangements are not always the same between the English and Welsh systems.

In October Sir Duncan Nichol, the Countess of Chester’s chairman, said that treating Welsh patients cost the hospital up to £4 million each year. Susan Gilby, the trust’s chief executive, said: “This is a national issue related to the highly complex NHS internal market. Discussions are ongoing between national leaders and we are hopeful that we will be able to return to accepting new referrals from our Welsh commissioners once national agreement has been reached.

“My first concern is patient safety. In order to ensure this the trust must be financially sustainable. To accept referrals without the appropriate funding would place our services and our patients at great risk.

“I and the trust board are not prepared to let this happen. This decision only affects patients who require planned consultations and who are not already on our waiting list. We will of course continue to provide high-quality care to all emergency and maternity patients.”

Mark Tami, MP for the Welsh constituency of Alyn and Deeside, said that he was “very concerned” about the hospital’s announcement. “The Countess of Chester was built to care for patients within its proximity, which included people in Flintshire. It’s very important that this continues to be the case,” he said.

Doctors at the Marches Medical Practice in Broughton, Wales, about seven miles from the hospital, told the BBC that they were “extremely disappointed that our patients could be adversely affected by this policy”.

A spokesman for the Welsh government said that it was engaging with health officials “to discuss cross-border payment arrangements”.

The spokesman added: “In the context of ongoing engagement, any actions taken by English providers to limit access for Welsh patients on financial grounds are unacceptable and not in the spirit of reaching a cross-border agreement with English NHS representatives.”

Image result for thin wedge health cartoon

The Health Service is no longer National, and there is blatant financial rationing because Wales has not paid up!

Local Taxpayer Powers for MPs/Mayors – who else? What is National about breaking up the Health Services? 2015 NHSreality

What is National About the Health Services in the UK? I have thought of 10 areas…2015 NHSreality

Image result for thin wedge health cartoon

A new West Wales Hospital – an inevitable utilitarian decision. Today’s children are going to live shorter lives than their parents. Todays West Wales adults could also live shorter lives than their parents.

The decision to commit to a new hospital in West Wales has been inevitable – since the WG has no intention of combining Hywel Dda and Abertawe Bro Morgannwg (ABMU) and providing a sensible solution, a mistake is being made. Recruitment to West Wales has been poor at the best of times, and now that the rationing of medical school places over the last 30 years is coming home to roost, the Hywel Dda board have no other option. There are not enough professionals ready and willing to work in West Wales, and not enough money to fund them if there were. There is an ethical argument, from a population perspective, that rationing covertly )whereby nobody knows what is not available until they need it) is better than rationing covertly (whereby citizens know in advance what is not available in their post code). But from a liberal and individual perspective, this is unethical, as it discourages autonomy and choice. It seems some choices have to be planned for by saving money, and of course this option divides us into the haves and the have nots. Exactly what Aneurin Bevan tried to avoid. Medical professionals accept that the pace of advance of medical technology is faster than any states’ ability to pay, and that rationing is inevitable and endemic already. Politicians deny the need to ration, and until this becomes honest and overt, the hearts and minds of the caring professions will be disengaged from the politics.

It has been a “least harm for the greatest number” decision that Hywel Dda has been asked to make. It will please nobody. It will satisfy nobody. It may lead to more emergency deaths. As the population ages and the demographic suggests this will be for several decades, the problems of type 2 diabetes and dementia will become worse. The Welsh Health Service costs more per capita than the English because of poverty, and yet the WG takes more from the overall budget by top slicing. When dealing with a population as low as 3 million, this really matters and adversely affects the options in devolution. That is just one of the reasons devolution has failed.

Aberystwyth finds it even harder to attract staff, and the longer term prospects for their people are worse. Llanelli and Carmarthen citizens have speedy access to Swansea, and NHSreality, and most GPs in Pembrokeshire, feel that joining the two boards would be best. The decisions to build relatively new A&E and Renal units at Withybush in the last decade now seem very strange.

Is the fact that every county wants the new hospital the opposite of NIMBYism?

Image result for nimby cartoon

Today’s children are going to live shorter lives than their parents. Todays West Wales adults could also live shorter lives than their parents.

…Babies of both sexes in Scotland and Wales and baby boys in Northern Ireland are even projected to live shorter lives than their parents do after average longevity dropped slightly in parts of the UK.

Experts said that the government must investigate the reasons behind the stalling of life expectancy, which some have blamed on cuts to public services.

Between 2015 and 2017 the average life expectancy remained at 79.2 years for men and 82.9 for women, the Office for National Statistics said. There were falls in Scotland and Wales for both men and women, and among men in Northern Ireland, averaging 0.1 years.

Greg Hurst September 26th in the Times: Today’s children set to live shorter lives than parents

Nicola Davis in the Guardian 25th September: Children becoming physically weaker found team who measured handgrip, arm-hangs and sit-ups in Essex children

Western Mail (Walesonline) 26th September: Hywel Dda Board in shake up decisison

May 4th 2018: The agony of Damocles sword hangs over West Wales..

The fourth option for West Wales? Do we want “soft lies and gentle indifference”, until we realise the safety net is failing for us personally?

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

January 2018: The West Wales options.

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

Leimyoscarcoma treatment options unfair…. in west Wales where choice is anathema.

Banal and sanitised Drakeford interview shames the local press in West Wales

Image result for nimby cartoon


The best and the worst hospitals in Wales

If you believe these superficial reports you might like to think whether you want to go to your local DGH in all circumstances? Do you have much choice? Waiting hours in A&E is going to become routine. Don’t forget money, a good book, drink and food, and possibly a camping stove if you have to go.

Walesonline reports on the comparisons by looking “at how long it would take if you need an ambulance, a visit to A&E or planned treatment in hospital.” (Mark Smith 22nd August)






RCGP Wales asks GPs to take action, and write to their WAMs…. The crisis in out of hours (OOH)

This e-mail received today from RCGP Wales. GPs are asked to write to their WAMs. \But how did this happen, and why was so little done over decades? OOH and locum doctors in Pembrokeshire can earn prodigious sums and be put up in a hotel for working in Fishguard.

GP out of hours services are in crisis. The Wales Audit Office recently highlighted the decade of neglect of these services. Health boards are unable to fill hundreds of out of hours shifts, leaving some areas without cover in the evenings and at weekends.


This is unacceptable. We need to ensure that patients can receive high quality care when they need it

Patients’ needs don’t stop when GP practices close, but evidence shows that patients are finding it difficult to access care.


GPs are going above and beyond to try and make things work, but health boards are not providing the resource or support needed to deliver their own services, and patients are feeling the effects.


However, the problem can be fixed.


We’ve launched a plan to turn around out of hours services.  We’re asking the Welsh Government and health boards to follow our five essential steps to fix patient care.


Our asks are achievable – but we need your help to ensure that local health boards and the Welsh Government listens and makes patient care a priority.


Mr madam’s approach to a national shortage of diagnostic skills is understandable, but only partly truthful.

Arvind Madam, head of primary care for England, obviously lived in a city. Whilst it is good to raise standards in denser populations, and large teams can offer more, the problem in our rural and deprived areas is simply access. A friend tried to get an appointment in my old surgery this week, and was told there were none for 6 weeks. My old practice does not suffer from a recruitment problem, unlike many others in the area, but it is the holiday season…. several doctors are absent and access is difficult. I advised my friend to drop a written letter in and await a phone call. The letter with symptoms will have to be scanned and put into her notes, and the doctors will need to “safety net” ! She will get a response but she is articulate, literate, reasonable, and informed. What would the average patient do and feel? Mr Madam is like my patient, and his approach to a national shortage of diagnostic skills is understandable, but only partly truthful. In Pembrokeshire more and more practices are under special measures, and manned by expensive locums, some earning over £1700 per day, and accommodated in local hotels. The post code differential in quality and access is becoming clearer daily.

Kat Lay reports 2nd August in the Times: Demise of small GP surgeries helps patients, says health chief

The end of small GP surgeries could be good for patients, NHS England’s head of primary care has suggested.

Arvind Madan said that the amalgamation of small, independent practices into bigger groups should be welcomed.

Dr Madan told the GP magazine Pulse: “There are too many small practices struggling to do everything patients now want for their families in a modern era of general practice.”

Earlier this year the magazine found that 1.3 million patients had been forced to move surgery over the past five years after their own had closed. Many GPs are struggling because of recruitment and funding problems. Dr Madan said that “a rationalisation of providers” would make the remainder more viable.

He said: “General practice here is built on a foundation of 7,400 small and medium-sized businesses. In all markets there is some degree of difficulty for a proportion [of them]. But I think we would all like modern, thriving general practice available to us and our families.”

He said that practices should take up the opportunity created to be part of new primary care networks covering 30,000 to 50,000 patients, which were made up of larger teams that included nurses, pharmacists and mental health workers.

“I think it is our job to help every practice on this journey. There is a degree to which the central national team can create the environment in which all practices can thrive,” he added.

“But there is also a degree of responsibility within practices, which I am sure they will accept, to take up the opportunity because I am not clear that passively waiting for the system to change around them is sufficient.”

His comments were criticised by GP union leaders. Mark Sanford-Wood, the British Medical Association’s GP committee deputy chairman, said: “Small practices are often delivering the best standards of care to patients, who are seeing the same doctor who is embedded within the community and has a detailed knowledge of individuals’ medical history.

“While the BMA believes there is a benefit in practices working together across an area, this needs to be done in a positive, mutually beneficial way, in which full support is provided to practices. For such systems to thrive, all parties, not least patients, must benefit.”

Michelle Drage, chief executive of Londonwide local medical committees (LMCs), said: “For general practice to do ‘everything you would want for your family’ it shouldn’t be placed in a market. Market success or failure should not be the measure by which we judge it.”

Rachel McMahon, chairwoman of the England Conference of LMCs, claimed that many practices simply did not have the resources available to change the way they worked. She said that all the efforts of the surgeries were going into “just keeping the doors open” and to suggest that they were able to drive a big transformation was being naive to the issues they faced.

“I am in the privileged position of being able to speak directly to patients at a variety of practices,” she said.

“My personal opinion is that the highest levels of patient satisfaction seem to be from patients who are registered with smaller practices, as they are able to experience a more personalised service.”