The best result for the Health Services – Liberals and SDP holding balance of power

From both Brexit and Health Services point of view: The best result for the Health Services – Liberals and SDP holding balance of power. It is Liberal Idologies which could save the Health Services.

Even the city traders are nervous. A hung parliament would achieve the opposite of what Mrs May hoped for. The markets will remain nervous until a stable government is formed.

GB needs a general election and a clear choice between a “remain” and a “brexit” party – Liberals v the Rest?

 

Liberal beliefs need to be modified pragmatically to create a sustainable health service – especially in Wales

Join the Liberal Democrats now. Change the future for the UK Health Systems!

“Mediocre’ NHS has fewer nurses and beds than other rich nations. You wont get rationing, but vote Liberal for a regional, rational, and propitious approach to government.. The PR debate should follow.. boasting at the Olympics seems like black humour now..

The Liberals could save your health services – give them a chance. None of the others could do this.

Why Liberal philosophies are better for the UK. Who will be the first party to re-invent a truly National Health Service?

Wales Liberal Democrats wish to change Health Funding formula – Wales compared with Gaza?

Specific tax rises are short term, not enough and ignore the big issue.. Honesty.

The inconvenient truth: NHS faces £20bn funding hole whoever wins  (£30m-40m if Brexit worst case is factored in)

 

 

The “big issues” have not been addressed. Today we get the government we deserve – because of media failure. The Health Services are political footballs kicked around in a desert sandstorm.

The “big issues” have not been discussed. The media has failed us, but not their owners’ bank accounts. Leaders, CEOs and Trust Chairmen have also failed us. The austerity and the pain which citizens voted for is now a certainty. The parties’ policies are all equally impotent in the face of a poorer population. A lack of honesty and investigative reporting, a lack of nuanced argument, the language of the “Sun” and the “Mail” is equally responsible, but so is every one of us. We do get what we deserve in a democracy.

Just because we are financially poorer does not mean we have to be socially poorer. Wales and Scotland have socially based societies, and are better equipped to cope than England. The social and geographical divide in England and the UK as a whole will be evident after the election. Anyone who fails to vote should be banned from complaining in the years ahead: they have disenfranchised themselves. (Deborah Ross in the Times 8th June). The Latest contribution from Dennis Campbell in the Guardian 7th June 2017 reads: How May and Hunt constituents’ hospitals are struggling to meet targets.   

Are the politicians brain damaged former footballers? 20 years ago you could ask any minister of health in the world what was most impressive about the NHS and they would have said access and primary care. Now look at it! A political football kicked around in a desert sandstorm.

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Roy Lilley tweets today (and it is worth repeating in full):

You’ll know I’ve popped up early this morning.  I wanted to catch your attention.

I hope you’ll be thinking about how to fit-in a visit to the polling station.
A couple of thoughts, if I may…
This is election is not about Brexit.
Election strategists will tell you it is.  They want attract the votes of the leavers by talking tough, assuring them; there will be no back-sliding and strong leadership will deliver a deal to die for.
For the retainers they want to give the impression that skilful negotiations will give us a deal that doesn’t kill us.
The fact is, there are 27 countries who will decide what the deal is.  For them a cohesive European project is at stake.  We’ll get the deal France and Germany want.
Our future will be bound up in the fortunes of China, India and the US.
If you are reading this on the way to work you might be thinking exactly what is this election all about?
In the age of fixed-term-parliaments this early election has been engineered.  The government knows, full-well, negotiation will play a small part in our exit.  Every tiny gain will be hailed as huge success and poor terms dismissed as insignificant, hidden in the spin doctor’s lexicon.
A big majority and a cushion of backbench support will keep the engine of government ticking-over and The Maymite in Number 10… come what may.
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If you are reading this at work, you may have already voted.
You might be thinking, what to expect next.  Austerity is the answer.  None of the main political parties have anything like the policies needed to turn us into an enterprise economy.

Low taxes, incentives to innovate, take chances in an Uber world… all too risky at a time when no one can really predict how the economy will behave.  Stress-testing for Brexit

 is not a barrel of laughs.  The safe option; move the HQ to Frankfurt.
If you are reading this and you are an EU national with a family, expect a stress-testing time.
If you are reading this at lunchtime… you may be popping off to the polling station.
You might be thinking what it means for the NHS?  None of the parties propose policies that will fix the damage done by flat-line funding since 2010.
The King’s Fund have a fabulous quick-look-comparator.
The NHS costs £2bn a day to run.  A focus on eye-watering efficiency and effectiveness, reshaping where services are provided and by whom, is inevitable.
In the medium term; nothing like the staff numbers we need, primary-care unprepared for any significant shift in service redesign.
STPs, without sorting out better communications plans, will implode under the weight of squabbles and interminable arguments with a vocal and an informed public and their lawyers, over closures, cuts and relocations.
Another five years of getting by, struggling on and occasional flashes of brilliance to remind us how fortunate we are.
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You may be reading this in the afternoon.
TV and radio stations will be reporting turn-out and hopefully not about an attempt to disrupt the election.  You might be thinking about who will keep us safe?  More guns, more laws…
If you are reading this on the way home… 
… your day may have been full of trying to find work-arounds to keep services going.  You may have been trying to plan reconfigurations, filling rota gaps, battling regulators, working short-staffed and muddling through.
Making the NHS work as only talented managers and staff can.
If you are catching up with the day and are at home reading this; I hope you made it to the polling station.  Or, if not, there is still time.
Elections are a time for economists, strategists, sociologists and investors.
That means you…
You are an economist.  You manage a budget, if not a work, at home.  You have an instinctive grasps of money and know you can’t spend a pound twice and you can’t make one pound do the job of two.
You are a strategist; you plan, you think things through, you decide what good looks like and how to get it.
You are a sociologist; you are a people person, knowing what makes people tick and how to get the best from them.
You are an investor; at home and at work.  You invest your time and love and attention and your taxes, knowing small investments will only give you small returns.  You get what you pay for.
General elections have become an exercise for the mass media.  Ignore them.  The fact that elections are possible is the important thing.  
 
There is never a good time for a tough decision.
I just hope, today, you’ll find the time to make one.

 

Jenni Russell in the Times 8th June 2017: The Brexit catastrophe is only just beginning

 

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State funded media asks the right question – at last

Hugh Pym reports for BBC news 7th June 2017: Is NHS rationing a possibility?

State funded media asks the right question – at last. Will they provide the right answer in our lifetime? The BMA is already on record as willing to debate the motion “Is NHS rationing a possibility?(Bournemouth in July) and in Wales has asked for an “honest language” in health. (and Exit interviews) More importantly, why have our intellectual elite, and the public health experts, media and politicians, failed to open the debate years ago, and continue even this week, before the  professions became disengaged and demoralised? Now that many have retired early, emigrated or changed career, it will take years to recover.

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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.

Spending control

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.

Specific tax rises are short term, not enough and ignore the big issue.. Honesty.

 

Medical papers published or on-line should legally be obliged to reveal which journals refused publication..

An interesting headline in the Times ( and in NetDoctor ) says “Want to beat cancer? Move to the country and get to know your GP”. Most of the papers covered this but the research is questionable to say the least. The numbers are small, so the power is low, and the confounding factors of social class and education probably account for the observed differences. Was the paper presented to the BMJ or the Lancet before the Journal of the RCGP? Legislation is needed to make explicit who has rejected any paper. It may be that the right conclusion is the one drawn by the media, but there is no real evidence to support this. Training GPs in rural areas is good for their independence and broad based clinical skills. More of this training, rather than less please…

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The paper: Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer: a cross-sectional cohort study in primary care by Peninah Murage, Peter Murchie, Max Bachmann, Michael Crawford and Andy Jones ()

Chris Smyth in The Times reports: Rural patients less likely to die from cancer under the headline “Want to beat cancer? Move to the country and get to know your GP”.

Move to the countryside if you want to beat cancer | Daily Mail Online

Jenny Cook of NetDoctor reports: How living in the countryside could reduce your risk of dying from cancer – According to a couple of studies

Abstract of  Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer in the JRCGP

Background Several studies have reported a survival disadvantage for rural dwellers who develop colorectal cancer, but the underlying mechanisms remain obscure. Delayed presentation to GPs may be a contributory factor, but evidence is lacking.

Aim To examine the association between rurality and travel time on diagnosis and survival of colorectal cancer in a cohort from northeast Scotland.

Design and setting The authors used a database linking GP records to routine data for patients diagnosed between 1997 and 1998, and followed up to 2011.

Method Primary outcomes were alarm symptoms, emergency admissions, stage, and survival. Travel time in minutes from patients to GP was estimated. Logistic and Cox regression were used to model outcomes. Interaction terms were used to determine if travelling time impacted differently on urban versus rural patients.

Results Rural patients and patients travelling farther to the GP had better 3-year survival. When the travel outcome associations were explored using interaction terms, the associations differed between rural and urban areas. Longer travel in urban areas significantly reduced the odds of emergency admissions (odds ratio [OR] 0.62, P<0.05), and increased survival (hazard ratio 0.75, P<0.05). Longer travel also increased the odds of presenting with alarm symptoms in urban areas; this was nearly significant (OR 1.34, P = 0.06). Presence of alarm symptoms reduced the likelihood of emergency admissions (OR 0.36, P<0.01).

Conclusion Living in a rural area, and travelling farther to a GP in urban areas, may reduce the likelihood of emergency admissions and poor survival. This may be related to how patients present with alarm symptoms.

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Specific tax rises are short term, not enough and ignore the big issue.. Honesty.

The charade of the election is upon us. Medical professionals know that the debate is dishonest and that all the parties are in denial. 1p on tax from my party is a gesture, but hardly enough if the whole health service is not to be rationed. Whilst most medics and nurses would like to vote Liberal (if it counted in their area) they may be so disengaged they fail to vote. The big issue is honesty – and all parties are lying. Even the Economist thinks that the Liberals have the best manifesto, but even the economist has failed to lead on rationing health care.

( The middle has fallen out of British politics – The leaders of both main parties have turned away from a decades-old vision of an open, liberal country )

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James Gallagher reported 6th May 2017: Lib Dems pledge 1p income tax rise to fund NHS

Hugh Pym for BBC News 18th May opines: Whose election promise adds up for the NHS?

“Billions more for the NHS,” is a familiar election battle cry.

This time, the pledges from the main political parties have been much anticipated because of the warnings about mounting pressures on the service.

Those commitments have now been made and, perhaps unsurprisingly, comparing them is like apples and pears.

BBC News on 17th May 2017 reports: Lib Dem manifesto summary: Key points at-a-glance

A programme providing voters with an “opportunity to change Britain’s future – by changing the opposition” – a choice between “the extreme and divisive Brexit that Theresa May has chosen for Britain” and a Labour Party “that has given up on opposition”.
Tim Farron’s foreword says: “I want the Liberal Democrats to be the party that holds Theresa May to account over spending on the National Health Service; our young people’s education, skills and opportunities; the protection of our precious environment; and our future relationship with Europe.”……

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The Guardian analysis: Liberal Democrat manifesto: the key points and analysis

Fighting hard Brexit takes centre-stage but manifesto also promises significant new investment in health, social care and education

The Telegraph today reports: Liberal Democrat manifesto for General Election 2017: Key points …

Reality Check by BBC News 5th June 2017: Reality Check: How would Lib Dems fund NHS plans?

What’s the policy?

The Liberal Democrats say they would increase NHS and social care spending in England by £6bn a year by 2022. This is money on top of the government’s existing plans.

Out of that £6bn, £2bn has been earmarked for social care – leaving an additional £4bn for the NHS.

Extra money would start to go into the health service from 2018, with the full increase taking effect from 2022.

Outside of England, it will up to the devolved governments in Wales, Northern Ireland and Scotland to choose whether to spend the money on health or elsewhere.


How would it be funded?

The Lib Dems say they want an extra penny on each existing income tax band – that’s the basic, higher and additional rates. The party says this would raise £6.3bn a year.


Table shows the 1% income tax increase proposed by the Liberal Democrats

*This excludes Scotland, which has different income bands


Rather than all going into the Treasury’s coffers, this extra money would be ring-fenced so that it’s only spent on NHS and social care. This is known as a hypothecated tax.

In the longer-term, the party would replace its income tax rise with a “health and care tax”, possibly based on a reform of National Insurance contributions.

Under this new system, deductions would appear on workers’ pay-packets, setting out the proportion of tax going to the NHS and on social care.


What does it mean for pay packets?

As the independent Institute for Fiscal Studies (IFS) observes, the tax plans would affect all the 30 million adults who pay income tax in the UK.

That still leaves a considerable number who won’t be affected.

The IFS says 45% of adults currently pay no income tax at all, as their incomes are below the personal allowance, which currently stands at £11,500 a year.

The Lib Dems says their plans will mean that someone earning £15,000 would pay an extra £33 a year in tax, with someone on £50,000 paying an extra £383.

According to party leader Tim Farron, the policy will mean an average person paying an extra £3 a week.

“A pint of beer a week to pay for a health and social care service that will last us from cradle to grave,” Mr Farron said.

Those towards the bottom of the income scale may still stand to benefit, despite the increase in the basic rate of tax.

That’s because the Lib Dems are also planning to cancel a number of welfare cuts that are planned over the next few years.

The IFS believes the £6bn the Lib Dems expect to raise is much more certain than the extra revenue forecast by Labour’s income tax rise.

The reason, according to the IFS, is that the Lib Dem plans are less dependent on the income group at the very top.

This group is more likely to take measures to avoid paying extra tax (eg putting more money into their pension pots, leaving the country).


Previous 1p pledges

It’s not the first time that the Lib Dems have called for a 1p tax rise.

In their 1997 and 2001 manifestos, the Lib Dems pledged to put an extra penny on the basic rate of income tax to pay for their education plans.


Is this a lot of money in the context of health spending?

According to the Nuffield Trust, health spending in England – after being adjusted for inflation – is currently set to rise from £123.7bn this year to £126.5bn in 2021.

This works out, according to Nuffield Trust analysis, at an average increase of 0.75% a year above inflation.

By comparison, the Lib Dem plans work out at a 1.4% increase a year above inflation, according to separate IFS calculations.

While this is certainly more than the current spending plans imply, it is still less than the historical average.

According to the Office for Budget Responsibility (OBR), since 1978 UK health spending has grown at an average of 3.8% a year after inflation is taken into account.

Going forward, the OBR also says that pressure on the budget will grow at 4% a year as a result of a growing and ageing population.

The inconvenient truth: NHS faces £20bn funding hole whoever wins

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The inconvenient truth: NHS faces £20bn funding hole whoever wins

Whilst the media discusses terrorism without any evidence of what might be successful, the health service is ignored, despite evidence that refinancing is urgently needed, and in the long term the ideology is unsustainable. A letter from the three leading health think tanks in the Times fails to mention the need to ration health care overtly, but rationing is the unspoken thought behind all three… (CALL TO STRENGTHEN NHS FINANCES). Could it be that Mssrs Dixon, Edwards and Ham are effectively gagged from using the “R” word by threats to their funding? And they seem to include all the different health jurisdictions, and ignore that, as far as patients in Wales are concerned, there is no NHS any longer.

The Times’ Chris Smyth reports 6th June 201,7: NHS faces £20bn funding hole whoever wins

The NHS faces a £20 billion hole whoever wins the election, according to three leading think tanks.
They warn that services will worsen and patients will wait longer and be denied new drugs because no political party is offering enough for the NHS to cope with an ageing Britain. The main parties’ plans will give the NHS less than half the money it needs to avoid getting worse over the next parliament.
The King’s Fund, Nuffield Trust and Health Foundation say that politicians must come up with a long-term answer to rising health spending or be forced into wasteful emergency bailouts.

The Conservatives, Labour and the Liberal Democrats have all promised to increase the NHS England budget, which is currently £124 billion. Analysis of manifesto pledges suggests that by 2022 spending will increase to £132 billion in real terms under Tory plans and £135 billion under Labour.
However, projections by the Office for Budget Responsibility (OBR) suggest that the ageing population, rising cost of new drugs and other pressures mean the NHS will need £155 billion a year by then to maintain services.

“A real-terms funding increase of about £30 billion a year is needed in five years’ time to enable the NHS to deal with these pressures,” Chris Ham, Nigel Edwards and Jennifer Dixon, heads of the King’s Fund, the Nuffield Trust and the Health Foundation respectively, write in a letter to The Times.

“Our analysis shows that none of the main political parties has pledged enough in their manifestos to cover even half of that, while the share of our national wealth spent on healthcare would fall under all of their plans.

“Failure to provide sufficient funding and improve efficiency will result in longer waiting times for patients, poorer access to cost effective treatments and a decline in NHS and social care.”

Siva Anandaciva, chief analyst of the King’s Fund, said the OBR figures assumed the NHS would make further savings of the sort they had managed in the past, with bigger ones unlikely.

“You can certainly have that aspiration. But what the OBR does is take historical productivity that the NHS has achieved and bake that in,” he said.

By 2022 the population is expected to rise by 3.7 per cent, over-65s by 9.2 per cent and over-85s by 14.5 per cent.

CALL TO STRENGTHEN NHS FINANCES)

Sir, A strong NHS is vital for a thriving population, workforce and economy. Public spending on healthcare accounts for just over 7 per cent of our national wealth. That is not enough to cope with the ageing population and other cost pressures.

Projections by the independent Office for Budget Responsibility suggest that a real-terms funding increase of about £30 billion a year is needed in five years’ time to enable the NHS to deal with these pressures. None of the main political parties has pledged enough to cover even half of that, while the share of our national wealth spent on healthcare would fall under all of their plans.

The next government must act quickly to strengthen the health service’s finances in the short term, as well as developing a sustainable, long-term approach to funding the NHS, to put an end to the cycle of feast and famine. This should include establishing an independent body to assess and advise on health and social care funding needs.

The NHS must also focus on improving efficiency and use additional funding to reform care to meet changing population needs. Failure to provide sufficient funding and improve efficiency will result in longer waiting times for patients, poorer access to cost-effective drugs and treatments and a decline in NHS and social care.
Jennifer Dixon, CEO, the Health Foundation; Nigel Edwards, CEO, Nuffield Trust; Chris Ham, CEO, the King’s Fund

Mandator NHS service plan for new doctors…..? Run, Doctors, Run! (While You Still Can)

The European Convention of Human Rights is going to be ditched when we leave the EU. Brexit could exclude much needed overseas talent, but also chain our own down. Getting experience abroad has been part of development for many doctors, most of whom return home. The undercapacity in medical staffing and manpower, and the more attractive “shape of a job” abroad do tempt many to stay. One answer is to remove performance management, improve morale by “showing care” (for staff) and training an excess for delivery in 10 years time. Juniors with ambitions to expand their horizons are incensed. Narrowing their experience will only help to reduce standards further. The time for feedback to the administration and the Hunt style “jack Boots” is gone, but below is article by Dr Evgenia Galinskaya, and I can only apologise for missing the deadline for consultation (June 2nd). Run, Doctors, Run! (While You Still Can)Image result for run away cartoon health

European Human Rights – The UK May Lose ECHR Human Rights‎

Neil Roberts reported in October 2016 in GPonline: Doctors face four-year mandatory NHS service as Jeremy Hunt expands medical training

David Millett reports for GPonline 13th March 2017: Doctors could face more than five years mandatory NHS service under DH plans

The Westleyan Insurance Society posted 30th March 2017: Doctors could face more than five years mandatory NHS sertvice under …

Pulse Magazine May 29th 2017: Run, Doctors, Run! (While You Still Can) by Dr Evengia Galinskaya

 

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