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Deceitful verbal obfuscation. Prioritisation, limiting, restricting, reducing, cutting, delaying, (de-)commissioning: it’s all “rationing”

It is deceitful verbal obfuscation. Prioritisation, limiting, restricting, reducing, cutting, delaying: it’s all rationing and it needs to be discussed openly and honestly as such. Until it is the professions will remain disengaged. Since there is no honesty in our politicians, the response of the professionals in the UK’s 4 health services is entirely predictable. Meanwhile the disparity in services for the rich (private) and the poor (state) will become greater.

Paul Frances for Kentonline 14th September 2017 reports: West Kent Clinical Commissioning Group forced to cut services

An on-going cash squeeze on NHS budgets could see further restrictions on non-urgent operations and other treatments for patients in west Kent, it has emerged.

The West Kent Clinical Commissioning Group (WKCCG) says “significant cost savings” are needed to balance the books and rationing additional services will have to be considered.

Earlier this year, the CCG – which serves 463,000 people – delayed non-urgent operations for four months to save £3.2m, affecting 1,700 patients….

Dennis Campbell in the Guardian 12th September reports: NHS waiting times ‘driving people to turn to private treatment’Report says private providers have seen 15 to 25% annual rise in ‘self-payers’ as patients resort to using savings or loans

Chris Smyth in the Times 14th September reports: Elderly patients with broken hips wait too long for treatment

Four in ten elderly patients who break their hips suffer delays in vital treatment that increase their risk of ending up in a care home, a report says.
Seven patients a day also break their hips while in a hospital bed and the number appears to be rising, with some hospitals failing to do enough to keep patients safe, the study found.
Broken hips are a common injury among frail elderly patients and dealing with the aftermath is estimated to cost the health service £2 billion a year.
While death rates from the condition are falling, analysis of records of 65,000 patients, almost all those admitted to NHS hospitals over a year, found thousands not getting the care they should.
Almost one in ten patients were still immobile four months after an injury with “enormous variation” in rehabilitation rates at hospitals, the National Hip Fracture Database reported.

Patients are meant to get standardised care, most importantly surgery within 36 hours and a prompt review by a geriatrician. However, the review found 40 per cent of patients were not getting the treatments they should. “It’s truly terrible not to have early surgery. If you have to get on a bedpan with a broken hip there’s no dignified way of doing that and people just unravel,” Antony Johansen, clinical lead for the project, said.
“If 40 per cent of patients are not receiving this care — usually because they miss out on just one or two elements — this could compromise their rehabilitation and recovery.”
He said that while some hospitals had 80 per cent of patients back in their own homes a few months after injury, elsewhere it was “a tiny little number”. Hospitals are paid extra for good care and Dr Johansen said that there was no good reason for poor treatment.
“With care of frail older people, doing it well is cheaper than doing it badly. I know if I fail to rehabilitate someone and they go into a care home that’s a bill of £70,000 for them or the taxpayer.”
The audit also found that 4.1 per cent of all fractures happen while older people are in hospital, up from 3.9 per cent last year. Accidents peak during staff changeover times, it said.
“Seven people every day are breaking their hip in hospital and the slight trend for that to go up is concerning,” Dr Johansen said. “It’s something we need to challenge. It’s very easy not to have enough staff on the ward or have staff doing paperwork rather than being with patients.”
While saying that hospitals should not be overcautious and confine patients to bed, he said that some hospitals had only one fracture for each 700 beds each year, while others have as many as one for every 16 beds.
Patients in England are also spending a day longer in hospital than last year, at an average of 21 days.
Caroline Abrahams, of Age UK, said: “We are dismayed that 40 per cent of those who go under the knife don’t benefit from the best practice available. She added: “The numbers of hip fractures in hospitals are unacceptably high.”
• Elderly patients face becoming sicker if they are rushed out of hospital in an NHS drive to empty beds, say local councils. Simon Stevens, chief executive of NHS England, has given hospitals six weeks to free up thousands of places after saying flu was likely to hit the UK harder than usual. The Local Government Association said the plan would backfire as patients were taken back to hospital at the busiest times.

Image result for rich and poor cartoon

Let us charge patients for extra services, GPs urge – is this “decommissioning”?

Cynical de-commissioning bringing back fear.. Dying patients waiting hours for pain relief in NHS funding shortfall.

We need to be talking de-commissioning and not commissioning….. Fewer doctors and higher occupancy mean more deaths – in Hospitals..

The Training of doctors…. unfortunately it is too late to recover in even the 5 years promised by government… Decommissioning of operations



There is no nothing National about abortions if you live in N Ireland..

The Times’ Law reports 19th June:  Court rejects appeal over free NHS abortions in Northern Ireland. 

This case will be decided in the European Court of Human Rights and if the word National is to apply at all the women of N Ireland will win out. If we have left the EU and the decision is taken away from this court by Brexit, we are shamed. The judges may have been divided here in the UK but NHSreality expects a clear decision from Europe.

The Supreme Court has rejected an appeal for women from Northern Ireland to have abortions paid for by the NHS.

The Supreme Court has rejected an appeal for women from Northern Ireland to have abortions paid for by the NHS.
The justices announced the decision by a vote of three to two in London today.
At the centre of the case are a woman and her mother, who cannot be named for legal reasons, who travelled from Northern Ireland to Manchester only to be told that she would have to pay hundreds of pounds because she was excluded from free abortion services.
They lost their original action in the High Court in London in May 2014, when the judge concluded that the health secretary was entitled to adopt a residence-based system, and lost an appeal in 2015.

Announcing the Supreme Court’s decision, Lord Wilson said that the judges had been “sharply divided” about the outcome.

The majority concluded that the health secretary was entitled to reach the decision he did.
He said that it was not for the court to “address the ethical considerations which underlie the difference” in the law regarding abortion in Northern Ireland and England.
Lord Wilson added: “But the fact is that the law in Northern Ireland puts most women in unwanted pregnancy there in a deeply unenviable position.”
Lawyers for the mother and daughter said that women and girls from Northern Ireland were being treated as “second-class citizens”.
The women, referred to as A and B, said in a statement after the hearing: “We are really encouraged that two of the judges found in our favour and all of the judges were sympathetic to A’s situation.
“We have come this far and fought hard because the issues are so important for women in Northern Ireland. For this reason, we will do all that we can to take the fight further. We have instructed our legal team to file an application with the European Court of Human Rights in Strasbourg, to protect the human rights of the many other women who make the lonely journey to England every week because they are denied access to basic healthcare services in their own country.”
Angela Jackman, a partner at the law firm Simpson Millar, who has represented the two women, said: “All five of the judges concluded that my clients were discriminated against (on the basis of their status as UK citizens, present in England and usually resident in Northern Ireland). Whilst a slim majority decided the discrimination was justified, I am heartened that Lady Hale and Lord Kerr, the two most senior judges on the case, gave strong dissenting judgments and would have allowed the appeal in full.
“This provides A and B with a firm basis for taking their case forward to the European Court of Human Rights.”

May 23rd: People ‘should have their say on abortion’

May 14th: Abortion for health reasons backed by 75% 

April 24th : Detractors proved wrong with mix of calm and fury Ellen Coyne

Nobody predicted this. When the citizens’ assembly was announced to widespread disdain from both the pro-choice and the anti-abortion campaign groups last year, the notion that it would recommend full legal access to abortion in Ireland was beyond comprehension for those on both sides.

May 24th: Politicians are out of touch with the public on abortion

Support for abortion has become a mark of orthodoxy among the political elite. But politicians, especially in Scotland, are seriously out of touch with the general public on this matter, as a new opinion poll has revealed this week. With abortion devolved to the Scottish parliament since last year, MSPs now have power to address this issue.

Image result for abortion cartoon

Lets ration back fear, inequality and lower standards… Lets create a two tier service, and scapegoat the GPs on the way… How could we have done this better?

The NHS crisis deepens. Simon Stevens admits to instructing dramatic rationing decisions on Radio 4 today programme 31st March 2017. We could have done this so much better, with honesty, planning and pragmatism. But our politicians have left it too late. It is bound to get worse, and the dishonest language and lack of engagement by politicians bodes ill for the future.

Josh Boswell and Jon Ungoed-Thomas report in the Sunday Times 2nd April 2017: NHS threatens GPs with closure – Doctors hit by increases of up to £100,000 in service charges

Ban on nurses working agency shifts is dropped after protests


A reminder from 2015. BMJ. All main political parties’ pledges for NHS will prove inadequate, says former chief executive

All main political parties’ pledges for NHS will prove inadequate, says former chief executive  (BMJ 2015;350:h2081 ) Gareth Iacobucci

The NHS faces a “substantial financial problem” this year that will require significant upfront investment to maintain current services, the former chief executive of the NHS in England has warned.

David Nicholson, who led the service from 2006 to 2014, said that it would be “helpful” for the NHS if Labour joined the Conservatives and Liberal Democrats in committing to his successor Simon Stevens’s call for an additional £8bn (€11.1bn; $11.8bn) of funding above inflation by 2020.

But he said that the current pledges from all main political parties would prove inadequate in the short term and said that £8bn should be made available this year to help shore up the service and in particular the financially stricken hospital sector.

Speaking in an interview with BBC Radio 4’s Today news programme, Nicholson said he was concerned that politicians were promising additional services in the run up to the general election when there was already a huge financial gap to fill.1 “What politicians will be talking about is all the great extra things they want to do with the £8bn they want to put in, but actually there is a serious short term financial problem to solve here,” he said.

“We need to institute proper financial discipline in the system . . . and make some short term decisions to enable us to be in a position where we’re not building on sand, that actually there is a stable financial base on which you then can take forward the big changes that are needed.”

Nicholson highlighted that the £8bn projection first outlined in NHS England’s Five Year Forward View was based on the NHS’s ability to meet a hugely ambitious efficiency target of £22bn by 2020,2 which he said would be “a big ask” to achieve.

“In the history of the NHS it’s never delivered savings of that scale over the time that’s been described. There is no healthcare system in the world that’s delivered this scale.

“You could get close [with additional funds to support service delivery changes] but it means actually a united political, clinical, and managerial leadership in the NHS, with a proper debate and discussion with the population about what this all means in practice,” he said.

He said that in his view taxes should be increased to fund the NHS. He said, “There are not simple solutions to this. We do need to pay more money for the NHS. There is support among the public to make that happen.

“If we spend more money on health we can boost economic growth.”



Inside Health changed from 7th to 14th Feb BBC Radio 4 21.00 – listen to questions and answers in a public debate

Inside Health is broadcast on the BBC 14th Feb:

Image result for no hope service NHSJoin the BBC Radio Theatre in London on 14th February 2017!

BBC Radio 4’s Inside Health is hosting a special debate on the current state of the NHS. Dr Mark Porter and guests discuss what needs to give.

The last few months have seen the service creaking under unprecedented demand, and there is likely to be worse to come.  Something needs to give. Is it simply a matter of more resources, or do we also need to change our expectations of what the NHS provides? Is rationalisation and rationing the way forward?

Mark is to discuss the issues with a panel including regular contributor Margaret McCartney GP, Claire Marx, president of the Royal College of Surgeons, and Chris Hopson, chief executive of NHS Providers.

Tickets will be available from the BBC website soon

email Questions to:

NHSreality questions:

Would the panel like to pre-determine their interpretation of the current ideology and philosophy of their NHS, and whether it coincides with Aneurin Bevan’s original article?  

In view of this ideology (if they all agree) is it sustainable, given that technology and demographics are advancing faster than our ability to pay, for best and universal health care? 

The WHO does not intend to report on the NHS but rather on 4 different systems when it next reports and compares outcomes. In what ways are the Regional Health services, from a patient’s perspective, (in  a patient centred NHS) (England, Ireland, Scotland and Wales) still “National”? 

Large companies conduct exit interviews on their staff who leave or retire, or get promoted. Is the panel aware that there are very few (if any) Exit Interviews conducted in the Health Trusts (which are much larger organizations)? It is BMA policy (In Wales) to ask for these – would the panel support this? How would you give feedback from these interviews so that it made a difference? 

What does the panel think of the language of health? Trusts describe prioritization, restriction and limiting, but not rationing. Is this language honest in a “patient centered” health service? 

Do the panel members feel that covert rationing is preferable / more ethical to overt rationing or vice versa?  Would it be fairer if patients knew what services they were not entitled to? 

The Medical profession believes that the language of health care should be more honest with regard to rationing: do you agree? 

If rationing were to be allowed to be debated, where would the panel begin the debate? 

How would the panel set about changing the culture of fear in the Health Services of the UK? 

Does the panel think that it is right to reject 9:11 applicants to medical school, and then recruit the shortfall from overseas, and countries that can least afford to lose doctors? 

Does the panel believe we as taxpayers would get better value from graduate medical students as opposed to undergraduates (as in many other countries)? 

In view of the litigation bills: Does the panel believe a “no fault compensation” system would give a payback over time (longer than one term of office)? 

How would the panel de-politicize health so that it was not a political football? 

Does the panel feel hypothecated taxation, allied to rationing could be a way forward? 

What are the arguments against providing patients with the true cost of every good or service they receive, even if there is no charge? 

How would the panel design a system that encouraged patient autonomy rather than a paternalistic state?

In a “free” health service (cradle to grave) why is neonatal and maternal health fully funded and yet palliative and terminal care depends on charities?

Are there any goods and services which are so cheap that everyone, whatever their means, should pay for them?

How would the panel address the disengaged, cynical and angry professionals in the medical professions? Given that these real people are in the majority, and they will not be the ones sending questions in to you, and will not be listening to your answers how will you get your new and inspirational message across to them?

Do you think all ministers and health board members should let their citizens know annually whether or not they have Private Medical Insurance?

Would the panel members know of any other country whose funding is open ended? What is their opinion of the New Zealand system which used to be similar to ours? Is there any other country whose system they would hold up as equivalent or better than our own?

How would the panel like to change the dental contract so that, once there are enough Dentists, they will be tempted to have Health Service patients?

Does the panel agree with the 1982 report by Prof Robert Duthrie (1925-2005) of Oxford University: to reduce complications, lower waiting lists and raise standards we need a national network of cold orthopaedic centres. This would reduce infections and complications.

Does the panel think that cold orthopaedic centres should be an option/choice for everyone in the UK Health Services? 

Does the panel feel that, with increasing bacterial resistance and cross infections, associated with over occupancy of hospital beds, that patients are more or less likely to choose the private option if they can afford it? What effect does this have on equality?

If you had the power to act, what would the panel members first actions be; in the short term, and then in the long term, to address staff shortages?

Are there some goods and services which are so cheap that everyone, whatever their means should pay for? Eg: 10 paracetamol. Paracetamol liquid. Suppositories for piles.

Health Services (England) dentistry “for sale”.

We all know dental care is becoming less and less equitable, and private care is dominant in many areas. Eagle Radio News reports 26th December 2016: Southern Dental tycoon launches fresh effort to sell NHS supplier

The tycoon behind the third biggest provider of NHS dental services has launched a fresh effort to sell his business months after abandoning an earlier auction.

Sky News understands that Dr Mazdak Eyrumlu, who founded Southern Dental a decade ago, has asked bankers at DC Advisory to find a buyer for the company, which he values at up to £100m…..

…”Our overall revenue mix of 74% NHS and 26% private has enabled us to grow our NHS commitment and at the same time maintain and grow our private income,” the company said.

“The group’s income continues to be principally from long-term fixed NHS contracts with NHS England.”

Private equity firms including Capvest and Graphite were among the parties with which Southern Dental held talks during its aborted auction in 2014.

A number of the UK’s biggest dentistry providers have attracted private investment over the last decade, including Oasis Healthcare, which was backed by the investment firm Bridgepoint before its recent sale, and its larger rival MyDentist, which is owned by Carlyle.

Southern Dental could not be reached for comment on Friday