“Brexit a major risk to almost every part of NHS, report warns”. We did vote to be poorer it seems, both in body and mind

Update 16th October: Jack Maidment in the Telegraph reports: No deal Brexit could place £500m a year added strain on NHS, health chiefs warn  – so “remaining” is a lot cheaper..

The Evening Express reports 29th Sept 2017: Brexit a major risk to almost every part of NHS, report warnsWe did vote to be poorer it seems, both in body and mind.

Leaving the European Union could be “potentially catastrophic” for the NHS, the authors of a hard-hitting report have warned.
Even a “soft” Brexit that retains access to the single market while restricting the free movement of people is likely to have a big impact on healthcare in the UK, they claim.
A total break with Brussels was expected to have far worse consequences

Leaving the European Union could be “potentially catastrophic” for the NHS, the authors of a hard-hitting report have warned.

Even a “soft” Brexit that retains access to the single market while restricting the free movement of people is likely to have a big impact on healthcare in the UK, they claim.

A total break with Brussels was expected to have far worse consequences.

Nationality of NHS hospital and community staff in England
(PA graphic)

Professor Martin McKee, a member of the team from the London School of Hygiene & Tropical Medicine, said: “Our analysis of how Brexit will affect the NHS, although the UK’s desired outcome remains unclear, is that Brexit in any form poses major risks to almost every part of the NHS, with a ‘no deal’ scenario potentially catastrophic.

“The EU has shown that it recognises many of these threats, and we hope that our paper encourages the UK negotiating team to make health issues a priority.”

Writing in The Lancet medical journal, the seven authors examined the effects on the NHS of three possible Brexit scenarios: a “soft” departure that allows the UK to remain a member of the EU single market, a “hard” Brexit providing a free trade agreement between the UK and EU, and a “failed” Brexit that results in the UK falling back on World Trade Organisation rules.

Proportion of all NHS hospital staff in England who are non-UK EU nationals
(PA graphic)

Even the soft option raised serious issues for policymakers, including workforce recruitment and retention, NHS financing, public health legislation, and the licencing of medical products, the report said.

After Brexit it will be increasingly difficult for the UK to recruit sufficient NHS and social care staff, according to the research.

Estimates for 2017 suggest that 60,000 people from the EU work in the NHS and 90,000 are employed in adult social care, with a concentration of staff in London and the South East. These regions would be especially vulnerable to labour shortages, said the authors.

Another risk highlighted in the report was the loss of funding to the NHS, both as a direct result of the European money stream being cut off, and indirectly from impacts on the UK economy.

The NHS was said to have received 3.5 billion euros (£3 billion) from the European Investment Bank since 2001, which helped fund various public-private partnerships.

In addition the NHS soaked up so much public expenditure it was likely to be especially sensitive to any damaging impact of Brexit on the UK economy.

UK science was likely to suffer post-Brexit since EU direct funding accounted for 17% of research contracts held by British universities, the report said.

Lead author Nick Fahy, from Oxford University, said: “Health is often thought to be a purely national matter, relatively insulated from the consequences of Brexit.
“That is not the case; as this analysis shows, leaving the EU will have wide-ranging impacts on health and the national health service. These must be addressed now if the consequences of Brexit are not to be borne by the sick and the vulnerable.”
A Government spokesman said: “We are committed to a world-class NHS, which is why we’re backing it with an extra £8 billion investment by 2022 and are focused on getting a Brexit deal that is in the best interests of business, citizens and patients.
“We’ve made clear that the future of EU nationals should be a priority in Brexit negotiations so their valued contribution to the NHS can continue, but the NHS also needs more home-grown staff, so we’ll be training an extra 1,500 doctors and 10,000 nurses, midwives and allied health professionals a year by 2020.”


Government to introduce ‘state-backed’ indemnity scheme for GPs

Jamie Kaffash in Pulse announces 12th October 2017: Government to introduce ‘state-backed’ indemnity scheme for GPs

Why for GPs and not other doctors? What is the governments attitude to “No fault compensation”? This is good news, but it looks like a reaction to the threat of losing General Practice as a speciality rather than a planned change in policy which could open up other opportunities. And its not just GPs who need cover. Hospital trusts and Regions are in deep financial do-do as their projected losses for litigation exceed annual budgets. Cleaning fluid included..

The health secretary will today announce plans for a new ‘state-backed’ indemnity scheme for GP practices that will see them paying a membership fee to have their fees covered.

As Pulse reported this week, Jeremy Hunt will tell delegates at today’s RCGP Conference in Liverpool that he is discussing plans to include the option of a new membership scheme into the 2018/19 GP contract.

Pulse understands that details around the cost of the scheme for practices and who it will cover are still being worked out.

It follows pressure from the profession and Pulse to tackle the problem of rising indemnity fees.

GP leaders gave the announcement a cautious welcome, but said more details on funding and who it will cover was needed.

No fault compensation postings in NHSreality.

Jo Wadsworth in the Brighton and Hove news 12th October 2017: Investigation launched after elderly woman dies ‘after drinking cleaning fluid’

David Williamson reports 30th December 2016: More than £600m allocated to pay for clinical negligence and personal injury claims against the Welsh NHS in the future – In the last financial year £74.6m was paid out and £682m has been set aside for future payments

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An infected UK health service – its beyond self remedy now, and needs radical surgery for the septicaemic contagion to be removed.

Never mind the news that antibiotics will be ineffective in a few year’s time. We have an infected UK health service – its beyond self remedy now, and needs radical surgery for the septicaemic contagion to be removed. Politicians continue to duck and weave, and none of them will face up to the measures needed. We are the only country in the world to pretend that we can have Everything for everyone for ever….

BBC News 13th October 2017: Antibiotics ‘may be lost’ through overuse, says chief medical officer

England’s chief medical officer is urging global leaders to tackle the growing threat of antibiotic resistance.

Medical experts say these drugs are being used too much, and that 25,000 people die across Europe each year because of drug-resistant infections.

Professor Dame Sally Davies says she is “really worried” that without effective antibiotics, common medical procedures such as caesarean sections and cancer treatments could become too risky.

The Nuffield Trust has published a new report on “Collaboration in General Practice”, which shows that not much is moving forward. GPs are set up as independent practitioners, who compete for patients. There is little incentive to collaborate, although as numbers fall the temptation to become salaried will be greater.

Thomas Mackie reports in The Express 30th September 2017: NHS failed to adapt to population growth and RADICAL action needed, hospital chief warns – THE NHS is not fit for the 21st century and has failed to adapt to population growth in the UK, the new chief inspector of hospitals has warned.

There are so few doctors and so few of those in training come from or aspire to work in rural and poor areas that the Express reports the bribes as “Doctors get £20k to go where needed”. This is to try to stave off the civil unrest which NHSreality has predicted for some time now.

The New Statesman reported 11th August 2017: It’s official – there’s a £200m hole in the Brexit bus NHS promise – The UK contribution to the EU budget was £156m a week in 2016-17 so the money is not there and the sums don’t add up.

Admitted in the Independent: 

Philip Hammond admits Brexit ‘no deal’ will mean less money for NHS and social care – Warning comes one day after the head of the NHS said cuts will be necessary without a bailout in next month’s Budget

and this is supported by Prof Max Exworthy of Birmingham University: The scale of re-couped EU membership costs is relatively marginal in the overall NHS finances.”

On 21st September and reported in the Guardian: Almost 10,000 EU health workers have quit NHS since Brexit vote – Staff losses will intensify recruitment problems at health service, which now has 40,000 vacant nursing posts

There are more and more trusts/hospitals in trouble.


Norfolk and Suffolk Mental Health Trust repeats the mistakes of the past.

Tayside may qualify as the first “civil unrest”…. as the citizens protest. The Evening Express: NHS Tayside faces ‘extremely challenging position’ of £50m funding gap

and Waiting times for NHS treatment are rising, figures reveal

Treatments are approved rather too late to help, and of course some such as  A A Gill will always be caught in the funding trap.

Where exactly is the State Safety Net? What state is it in? Will you fall through a hole when it’s your turn to need it?


Jeremy Hunt to unveil state-backed GP indemnity deal. Bribery is an admission of perverse recruitment and education processes..

GPonline reports 12th October (Jeremy Bostock): Jeremy Hunt to unveil state-backed GP indemnity deal

Health secretary Jeremy Hunt will reveal plans for a ‘state-backed scheme for clinical negligence indemnity for general practice’ at the RCGP annual conference in Liverpool on Thursday.

This “Bribery” is an admission of perverse recruitment and education processes over many administrations. Rationing of training places and recruiting from overseas 6 years later….

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The anxiety about indemnity is evident in GP Frontline – Raging against the rising costs of medical indemnity (Author unknown) ,and in numerous recent publications.

Anu Patel on 23rd March: Indemnity: Rising indemnity costs are a threat to general practice

David Millett on 9th October: Thousands of GPs urged to write to MPs about indemnity

It is no wonder that bribes have been offered, and in Wlaes this has helped fill some GP Training posts, but as predicted, England has, in a competitive market, offered to march the inducement fees of £20K.

Alex Matthews-King in March Pulse: £20,000 GP ‘golden handshake’ scheme to be expanded this year

BBC News today 12th October: Jeremy Hunt to pledge £20,000 ‘golden hello’ for rural GPs

Newly-qualified GPs are to be offered a one-off payment of £20,000 if they start their careers in areas that struggle to attract family doctors.

The £4m scheme, to be announced by Health Secretary Jeremy Hunt, aims to boost the numbers of doctors in rural and coastal areas of England.

Mr Hunt will also pledge to “secure general practice for the future”.

The Royal College of GPs backed the plan saying there is a “serious shortage” of family doctors.

The one-off payment will be offered to 200 GPs from 2018.

As of September 2016, there were 41,985 GPs in England.

Mr Hunt is due to speak at the Royal College of GPs’ annual conference in Liverpool, where he will offer something for those already in the profession too, by announcing plans for flexible working for older doctors – to encourage them to put off retirement.

He will also confirm plans for an overseas recruitment office which will aim to attract GPs from countries outside Europe to work in England.

“By introducing targeted support for vulnerable areas and tackling head-on critical issues such as higher indemnity fees and the recruitment and retention of more doctors, we can strengthen and secure general practice for the future,” the health secretary will say.

The Royal College of GPs said the package must be delivered in full and welcomed the commitment to incentivise working in remote and rural areas.

NHS England has already pledged an extra £2.4bn a year for general practice in England – part of which will fund plans for 5,000 extra GPs by 2020.

But Dr Richard Vautrey, chairman of the British Medical Association’s GP committee, said the government was not on course to reach that target.

“General practice is facing unprecedented pressure from rising workload, stagnating budgets and a workforce crisis,” he said.

“‘Golden hellos’ are not a new idea and unlikely to solve the overall workforce crisis given we are failing badly to train enough GPs to meet current demands.”

In 2016, the BBC learned that there were some practices in England offering a bonus of up to £10,000 to attract new doctors.

But The Nuffield Trust think tank said recruitment was “only half the battle”.

“The NHS is struggling to hang on to qualified GPs, with surveys showing 56% plan to retire or leave practice early. Many trainees also drop out when they finish,” said senior policy fellow Rebecca Rosen.

Why won’t anyone in power talk about rationing? “We need to talk about NHS rationing”…

The downside of honesty must be greater than the upside – what an indictment of our media led society. Why are our leaders and administrators, trust chairmen and CEOs so afraid to speak out?

In Pulse 10th October 2017 David Turner opines: We need to talk about NHS rationing

A woman requesting breast reduction.

A child with severe behavioural problems in need of psychological assessment

A seventy year old brought to tears daily with knee pain, waiting for physiotherapy.

A new cancer drug costing thousands per month that has just received NICE approval.

What have these patients got in common? They all have a legitimate claim on the NHS pot of money for funding.

The recent announcement that NICE has approved nivolumab for treating patients with certain types of advanced lung cancer is fantastic news for those patients and will add valuable months to their lives.

There is, though, a rather large pachyderm in the room, which sooner or later needs to be faced. I’m afraid all of us – doctors, patients, managers and politicians – seem reluctant to address the rather obvious reality that NHS coffers are not infinite. Funds for healthcare are always going to be finite and even with the best political will in the world (and we certainly don’t have that at the moment) we cannot pay for everything.

Funding an expensive cancer treatment to give someone extra time on earth will impact on other aspects of healthcare. Increase funding to one area and others will suffer with reduced services and longer waiting lists.

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Do we say only disorders that can be fatal go to the front of the queue?

Many will say we should prioritise the most serious illnesses which can kill quickly such as heart disease or cancer. Nobody dies from osteoarthritis, but thousands suffers tremendous pain every day while waiting joint replacement surgery. It’s also not unheard of for people with mental illness to kill themselves while waiting to see a psychiatrist.

Name virtually any condition or disease and there will be individual sufferers and support groups making their case as to why more taxpayers’ money should be spent researching into or treating their disorder.

The reality is everyone’s health matters to them more than anything else and few people will be altruistic enough to say public money should be spent treating others before themselves and their loved ones.

I don’t claim to have the answers, but unless we start to talk more openly about the very real issue of rationing in the NHS we are just postponing some very serious questions for the future and they are not going to get any easier to answer.

Dr David Turner is a GP in west London

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Worried there may be an epidemic – of deaths, many alone at home… A precarious health service..

Niall Dickson opines in the Times 9th October 2017: This will be one of the NHS’s toughest winters and flu is not the only epidemic professionals fear. Mental health (Elderly, middle aged and teenagers), Diabetes from Obesity, staff bullying, staff attacks, drug addiction  and almost any other service you like to name.. The future of the whole NHS is precarious..

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It is becoming hard to overstate the perilous state of the health and care system in England. We have just polled our members — 92 per cent of healthcare leaders are “concerned” about their ability to cope this winter and 62 per cent of those are “extremely concerned”.
Last year the NHS managed well in difficult circumstances. Yet the impact on patients was evident. In early winter, waiting times in the big emergency departments rose sharply, with nearly one in five patients waiting longer than the four hours that is supposed to be the maximum. And there were ten hospitals in which less than 70 per cent of patients were seen within four hours.
This year there is an even greater sense of foreboding. There is much activity in central NHS bodies and an understanding of the political sensitivity of this issue — in part this is because of the obvious damage and distress that such delays cause patients and their families, but it is also because emergency departments are seen as a litmus test for the rest of the system. If the health service cannot cope at its front door, what lies behind it will also be struggling.
The causes are well known — we have a rising population. We have not invested enough in the services in the community that take pressure off hospitals, and we have a problem recruiting skilled staff. Emergency admissions are continuing to rise — in the first quarter of this year there was a 25.9 per cent jump in responses to life-threatening ambulance calls — so the ambulance service too is under increasing strain.

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The current levels of concern are heightened by fears that we may not escape a flu epidemic this year. Simon Stevens, CEO of NHS England, has pointed out that hospitals in Australia and New Zealand have been hit by the worst flu season in years; there is a good chance the same H3 strain is heading our way. A lot of work is underway not just to improve the flow of patients through hospitals but to relieve pressures elsewhere in the system. At the heart of all this will be effective planning and good co-operation across the entire health and social care system, but there is only so much that can be done.

A cash injection at this stage is unlikely to solve the winter pressures, but the chancellor must revisit the pencilled-in figures for 2018-19 and 2019-20, which if left as they are would guarantee more crises ahead and further delays to the reforms that are needed. For the longer term, the budget in November will be an opportunity for the government to underline its support for the NHS and to make sure it is deternot preside over a deteriorating service.

Niall Dickson CBE is chief executive of the NHS Confederation, a membership body for NHS health and social care organisations

Kat Lay reports: NHS straining at the seams as our bad habits add to pressure and Cash boost can’t save NHS from another winter crisis and Mental health staff attacked ‘on daily basis’

Chris Smyth: NHS is given six weeks to empty beds in flu alert

and Financially the lunatics running the asylum have run out of ideas in reigning in the cost of locums. Experience is very valuable in medicine and the most experienced radiologists, anaesthetists ans surgeons command high prices in their market, one created by politicians.

A perverse incentive epidemic, especially in mental health – both for GP’s pay/workload in UK and increased organ donors in the US, or dying, means that the systems are likely to get worse ..

An epidemic of nationwide bullying. In most dictatorships this precedes dissolution or breakdown….

Rosemary Bennett 10th October : Half of expelled pupils are mentally ill

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BBC News reports “peanuts” spending: Scottish government announces mental health funding boost

Nick Triggle for BBC News: NHS future precarious, says regulator

Performance related pay schemes, such as QOF, are not suitable for professionals.

Management courses have taught for a long time now that Performance Related Pay (PRP) has a short half life. The box ticking production line style of management is not for professionals. The QOF (Quality Outcomes Framework) is another form of PRP and has been in existence for far too long. Elderly multi-pathology and terminal care patients are the future of primary care, and their care will mostly have to be at home. Hospital at home projects are the future, and they will need staffing…… Lets hope we can train them up from our own population, because we have alienated the immigrant labour force. NHSreality agrees that there may be a sudden surge in deaths from epidemics such as flu, and most of these will have to be at home. Commissioning groups need to abolish QOF, remove the perverse incentive to ration those services that pay less, and trust the overstretched GPs to ration their care appropriately.

Kat Lay reports 10th October in The Times: Cash incentives for GPs do not make care better

A financial incentive programme for GPs may not improve the quality of care, according to researchers.
The quality and outcomes framework, introduced as part of the 2004 GP contract, means that up to a quarter of a surgery’s income is linked to targets on areas such as heart disease, diabetes and smoking.
Researchers from University College London and Imperial College London reviewed a series of studies evaluating the worth of such financial incentives.
They found that although a number reported initial improvements in the treatment of a range of chronic diseases such as hypertension, diabetes and asthma, these were often not sustained. Any positive effects were not consistent across ethnic, gender and age groups.
There was also a suggestion that patients whose conditions were outside the framework “experienced higher mortality and poorer quality of care”.

The study, published in the British Journal of General Practice (BJGP) will add weight to calls to scrap the scheme. NHS England has said it supports such a move in principle but failed to make any changes in the latest round of GP contract negotiations. A year ago, Simon Stevens, the chief executive of NHS England, said: “For the most part it has descended into too much of a box-ticking exercise.”

Last month a review commissioned by NHS England concluded that the framework did not improve care and should be replaced, but cautioned that removing it could have a severe impact on GP practice incomes and patient care. The study’s authors warned that any new incentives should be looked at carefully. “Despite uncertainly about their effectiveness, financial incentives receive widespread political attention and are increasingly being implemented,” they said.

A spokesman for the British Medical Association said that the framework had “helped deliver substantial improvements to patients across the UK” and had raised detection rates.

•A survey in the BJGP found GPs were concerned about the introduction to the NHS of physician associates, graduates without traditional medical training. Patients, however, had fewer fears.


Tears, tantrums and no pay – my life on a zero-hours contract in the NHS

You get what you pay for — which, for most NHS users, is nothing

NHSreality response to the RCGP Questionnaire into the future of Welsh health and social care

A fearful anonymous consultant tells it as it is… “the NHS is in crisis”.

Fighting for the NHS’s moral life: There are 4 Chernobyl’s waiting for meltdown..

Getting to see a Health Service physio – like getting to see a health service dentist