[Offwidth]

Some more news

https://www.theguardian.com/society/2016/jul/27/hospitals-overtime-payments-soar-freedom-of-information-request

[slackline]

Assisted Conception is free to a point* on the NHS, after that you have to pay for it.  A recent paper in the BMJ demonstrates the pernicious consequences of unregulated private treatments being sold to patients with little evidence to support their efficacy...

Heneghan et al. (2016) Lack of evidence for interventions offered in UK fertility centres BMJ : 355:i6925

Someone I share an office with is working on a study assessing the efficacy of the one promising adjunct intervention (endometrial scratch).


Looking at the US system I can only really envisage this spreading to other areas of care and pointlessly inflating the cost of healthcare in an already under-funded and strained system.






* The point varies between Clinical Commissioning Groups, some places you get one pop at IVF, others two.

[slackline]

Protect the NHS from Brexit trade deals (primarily with the US)

[Offwidth]

More shit news:

https://www.theguardian.com/education/2017/feb/02/nursing-degree-applications-slump-after-nhs-bursaries-abolished

[tomtom]

Sadly not at all surprising. Apparently here has been a halving of applications for nursing positions from non U.K. People since Brexit...

[webbo]

Some of the best and most experienced nurses in the NHS have recently retired which also adds to the shortage.

[mrjonathanr]

This does not make encouraging reading:

https://www.theguardian.com/society/2017/jun/20/leak-shows-devastating-impact-of-planned-nhs-cuts-in-london

[SamT]

Some of the best and most experienced nurses in the NHS have recently retired which also adds to the shortage.

My other half works 'behind the scenes' in a Lab for the NHS.  This is totally the case here, older, i.e. anyone over 50, with vast experience are just retiring early/quitting left right and center before they have mental breakdowns  They're being replaced particularly well if at all, leaving a raft of younger, less experienced staff who are now even more overworked/stressed, without the comfort blanket of older staff to lean on, but who are just about young enough to cope with the stress/long hours.. 

[mrjonathanr]

Posted in Guardian comments. I wonder if any knowledgeable posters could comment on the accuracy of the detai lin the letter below?

I'd like to ask everyone who's keen to protect the NHS's survival to read through the following letter. If they agree with it, please could they send the letter (email or print) to their own MP?

This letter was drafted by a KONP member (KONP is one of many groups working to protect the NHS), not by me. I think it's a superb letter.

Dear (MP name),

You will be aware that the state of the NHS continues to cause grave public concern .
The 44 Sustainability and Transformation Partnerships (STPs) are required to deliver a £22bn reduction in the NHS annual budget by 2020/21 - even though the UK already spends significantly less healthcare than comparable countries like France or Germany.

The Sustainability and Transformation Plans have been drafted in secret. They lack public support or any firm clinical evidence base. The swingeing cuts will be achieved through ‘new models of care’ that involve:
● closure of A&Es, beds, hospitals and local services despite lack of capacity
● rapid and unprecedented sell-off of NHS sites to plug funding gaps (as set out in the Naylor Review), resulting in lengthy, inconvenient and potentially unsafe journeys for patients and relatives and loss of sites for new NHS provision
● downgrading professional staff : replacing qualified doctors with 2-year trained Physician Associates; replacing nurses and other professional staff with unqualified care assistants,
● ‘care nearer home’ meaning impossible new demands on social care services that are already stretched to breaking point and family carers (predominantly women) caring for very sick people at home
● appointments conducted via Skype despite known difficulties this will create for many older and vulnerable patients
● health apps and remote monitoring used as a replacement for face-to-face engagement

We are horrified that the STPs are being imposed primarily as cost-cutting measures, in the absence of any reliable evidence-base to support clinical effectiveness, and without consultation with clinicians or with patients or local communities to determine acceptability.

This devastating STP programme flies in the face of the NHS’ proud tradition of evidence-based medicine to meet patients’ needs.

The latest phase of the programme is the creation of ‘ Accountable Care Systems’ , modelled on the US healthcare market, and we believe this is the intended future for the NHS.

We seek
● an immediate halt to the STP programme pending local review including full consultation and involvement of patients and community organisations.
● funding to bring the NHS into line with that of similar EU economies.
● a new NHS Bill that will end the NHS market and privatisation and will reinstate a publicly funded, publicly provided and publicly accountable NHS.
We look forward to hearing what action you, our elected representative, will take to support these aims.
Yours sincerely...
[\quote]

[powderpuff]

Posted in Guardian comments. I wonder if any knowledgeable posters could comment on the accuracy of the detai lin the letter below?

I'd like to ask everyone who's keen to protect the NHS's survival to read through the following letter. If they agree with it, please could they send the letter (email or print) to their own MP?

This letter was drafted by a KONP member (KONP is one of many groups working to protect the NHS), not by me. I think it's a superb letter.

Dear (MP name),

You will be aware that the state of the NHS continues to cause grave public concern .
The 44 Sustainability and Transformation Partnerships (STPs) are required to deliver a £22bn reduction in the NHS annual budget by 2020/21 - even though the UK already spends significantly less healthcare than comparable countries like France or Germany.

The Sustainability and Transformation Plans have been drafted in secret. They lack public support or any firm clinical evidence base. The swingeing cuts will be achieved through ‘new models of care’ that involve:
● closure of A&Es, beds, hospitals and local services despite lack of capacity
● rapid and unprecedented sell-off of NHS sites to plug funding gaps (as set out in the Naylor Review), resulting in lengthy, inconvenient and potentially unsafe journeys for patients and relatives and loss of sites for new NHS provision
● downgrading professional staff : replacing qualified doctors with 2-year trained Physician Associates; replacing nurses and other professional staff with unqualified care assistants,
● ‘care nearer home’ meaning impossible new demands on social care services that are already stretched to breaking point and family carers (predominantly women) caring for very sick people at home
● appointments conducted via Skype despite known difficulties this will create for many older and vulnerable patients
● health apps and remote monitoring used as a replacement for face-to-face engagement

We are horrified that the STPs are being imposed primarily as cost-cutting measures, in the absence of any reliable evidence-base to support clinical effectiveness, and without consultation with clinicians or with patients or local communities to determine acceptability.

This devastating STP programme flies in the face of the NHS’ proud tradition of evidence-based medicine to meet patients’ needs.

The latest phase of the programme is the creation of ‘ Accountable Care Systems’ , modelled on the US healthcare market, and we believe this is the intended future for the NHS.

We seek
● an immediate halt to the STP programme pending local review including full consultation and involvement of patients and community organisations.
● funding to bring the NHS into line with that of similar EU economies.
● a new NHS Bill that will end the NHS market and privatisation and will reinstate a publicly funded, publicly provided and publicly accountable NHS.
We look forward to hearing what action you, our elected representative, will take to support these aims.
Yours sincerely...
[\quote]

Just emailed my local MP ☺

[mrjonathanr]

The ACS are a new concept to me. Kings fund explains this:
https://www.kingsfund.org.uk/topics/integrated-care/accountable-care-organisations-explained

The relational challenges centre on the need to develop trust between the organisations and leaders involved as well as an ability to collaborate in a legal context that was designed to promote competition. 

Sounds like quite serious organisational change. It seems to me that news of what is occurring within the NHS is not that well publicised.

[Offwidth]

Latest bad news:

https://www.theguardian.com/society/2017/jul/03/more-nurses-and-midwives-leaving-uk-profession-than-joining-figures-reveal

Also Roy Lilley did a concerned comment piece on the likely new chair of NHSI; an extract:

"The time is right to get back to one head-office; straddling primary and secondary care.  Commissioning is all-but finished.  Providing, service level agreements, ACOs, population-based, capitated budgets... they're the future. Time to dump NHSE and NHSI and have NHSA... NHS All-together.

However, if the gossip is right and it usually is, it looks like we are set for more of the same.  Perhaps I should say, the worst of the same. A key appointment will be the chair of NHSI.  For months everyone's known it will be Dido Harding, aka; Baroness Harding of Winscombe.  You may not have heard of her?  If you had a Talk-Talk phone you will.  She came spectacularly unstuck with a data breech. Having been accused, by the press, of naivety, she left saying she;  '... wanted to focus more on her public service activities.'  Jerusalem, jam and the NHS.  She probably knew then, she had a job in the bag. She's worked at McKinsey, Thomas Cook, Woolworths, Tesco, Sainsbury's, Car-Phone Warehouse, British Land and Cheltenham Racecourse... a great pedigree.

But there's a problem... She's a conservative life-peer, went to uni with David Cameron and The Tinkerman and married a conservative MP.  For the role of chair of an independent regulator... totally unsuitable. No one seems to have had much of a say in her appointment and it will be a test for the chair of the Health Select Committee to say no.  NHS do not elect their bosses and they should.  Staff should have a say. In the public sector favouritism, cronyism and nepotism undermine confidence and the common good.  No one I've spoken to sees Dido as an independent regulator.  The fear; everything confided in her will go straight back to mates at DH. In the US there would probably be a law against this appointment. 

The NHSI chair will have influence... that can be the invisible poison that pollutes public life. As the Talk-Talk advert used to say; 'This stuff matters'. Dido, the NHS matters.  It matters that public life is not an extension of mates, alumni and the Carlton Club.  Transparency matters; it matters that appointments look like a fit-up.  It matters they look tribal. In my view this appointment is contrary to the Nolan Principles, undermines public confidence in the recruitment process, is naive, lacks judgement and waves two fingers at the NHS. Appointment by whisper. This appointment undermines the purpose, tone and texture of good government. It matters that this is a bad, bad, bad appointment, that will play badly in the NHS, she will become the story and it matters that the NHS is the story.

Dido, 'This stuff matters', do the right thing; give it a miss."

[Offwidth]

When do we think someone is going to do something about the nursing crisis? Brexit consequencies, the demographic pension bulge, supercharged by austerity and a shortage of required training numbers were all fairly predictable. The reality is turning out even worse than the "doom mongers" predicted from two years back.

The latest on the DH press office response to this from Roy Lilley:

"Honesty

News and Comment from Roy Lilley

I don't know why I let them upset me but they do.  They irritate me beyond belief.  I've tried everything.  Deep breaths, counting to ten, think-calming-thoughts, relaxation, calamine tea... but they still drive me BARMY! I'm talking about the Department of Health Press Office. Why don't we dump them?  We could have one of those press-button, dial yer-own-answer, premium phone lines; dial-a-quote.

Press one for; 'The NHS has had more money than any time in the history of coinage... there is more money than ever before'.

Press two for; 'The NHS is expected to provide more care, better care... whatever... there will be more care in the NHS than ever before.'

Press three for; 'The NHS has commissioned a report on this and it will be published when it is published and it will address these issues, or not... there are more reports in the NHS than ever before.'

Press four; 'Although you may think today is Thursday, actually, because yesterday was Wednesday and tomorrow is Friday, does not guarantee you have got the day of the week correct.  There are more days in the week than every before....'

... and there is the latest.  Infuriating.  But first some context from the BBC;

The NHS is "haemorrhaging" nurses with one in 10 now leaving the NHS in England each year. More than 33,000 walked away last year, piling pressure on understaffed hospitals and community services.... a rise of 20% since 2012-13... there are now more leavers than joiners. In up-sum: more than 10% of the nursing workforce have left the NHS in each of the past three years; leavers would be enough to staff more than 20 average-sized hospital trusts; more than half of those who walked away in the last year were under the age of 40. Leavers outnumbered joiners by 3,000 last year.

The DH press office; what did they say?  Brace yer-self... here it is;

'There are 11,700 more nurses on our wards since 2010...'

Reach for the calculator;

11,700 in 7 years = 1,671 nurses a year

There are roughly 157 trusts;

1,671 new nurses divided by 157 Trusts

= 11 new nurses per Trust.

Less than one new nurse a month...

Does the Press Wallah think we are all stupid.  Can't add up?  Is this careless or Machiavellian?  Dissembling, misleading an attempt at being smart.  Is this good ethical press management?

As the BBC say;

'They (the DH Press office) have picked 2010 and nurses on wards.  If you look at the entire nursing workforce, the numbers have only risen by 1%... demand across health care has gone up between ten and twenty percent...'

It is the role of the DH press office, funded by the taxpayer, to be truthful, accurate, objective and impartial.  They are accountable to us all.  They are not accountable to Tory Central Office; to gift wrap, polish or present the facts sunny-side up.  We want stripped pine facts. And the facts are nursing is a great profession, a wonderful vocation but a rotten job.
It's a rotten job because the DH have got the numbers wrong, training wrong, funding wrong, safe staffing wrong.  On any measure they are on the wrong side of right. Three days a week twelve hours a day, understaffed wards, getting through a shift with fingers crossed there isn't a disaster.  It's not a job it's torture. Car-parking charges, child care, flat-line pay increases, patients in the corridors.  No breaks. To make ends meet a couple of shifts in a care home.  Exhausting.

All the nurses I have met love nursing.  None of them leave a job they love.  They leave management, bureaucracy, bullying, anxiety, rehearsing for CQC inspections, daft policy and unnecessary pressure. What's not to like about working for an agency; work the shifts you want, where you want, no management hassle.  I'm surprised the whole of the workforce isn't agency.

Organisations get the workforce they deserve.  Nothing changes anything faster and quicker than honesty.

The Health Select Committee report on nursing next week.

Contact Roy - please use this e-address  roy.lilley@nhsmanagers.net  "

[Oldmanmatt]

Jeremy has got this!
Using advanced technology, like spread sheets (not sure what I was using, circa 1999. MS Project must have been far inferior); staff are ensuring safe staffing.
Because Red is good right? The Chinese think it’s lucky, so it must be, because they’re good at business and controlling their population.
This does not in anyway indicate a chronic staff shortage that not merely strays, but leaps like a startled Gazelle with a firework up it’s arse, into dangerous territory daily...
No, not at all.

[Jim]

someone has obviously shown him how conditional formatting works

[mrjonathanr]

I get Roy Linley’s regular bulletin. (thanks Offwidth for advertising it). Very down to earth,an  interesting if slightly disturbing read at times, from a well informed perspective.

I’ve never read a message from him like this one. Worrying.
https://myemail.constantcontact.com/No-way-back.html?soid=1102665899193&aid=NFCkOLV0AaE

[stone]

I get Roy Linley’s regular bulletin. (thanks Offwidth for advertising it). Very down to earth,an  interesting if slightly disturbing read at times, from a well informed perspective.

I’ve never read a message from him like this one. Worrying.
https://myemail.constantcontact.com/No-way-back.html?soid=1102665899193&aid=NFCkOLV0AaE

Yesterday one of the leaders of the consultants' strike was on BBCRadio4 Today. He said that their demand was for the pay review body to be genuinely independent rather than being constrained under government directed
affordability limits as is now the case. That seemed to make a lot of sense to me as an achievable "way back" to having a decent NHS.
If we want an NHS (which I do), we have to (and should) pay the staff. It won't save us any money if we end up reverting to a private system.
 
Whenever there is grumbling about paying people who do well paid jobs such as doctors, train drivers or whatever, I remind myself that a huge slice of our national income (50%ish) goes to share and bond holders and landlords etc. The political choice we have made was to increase that share from the 30%ish that it was a few decades ago. That's the choice I question.

[Offwidth]

I get Roy Linley’s regular bulletin. (thanks Offwidth for advertising it). Very down to earth,an  interesting if slightly disturbing read at times, from a well informed perspective.

I’ve never read a message from him like this one. Worrying.
https://myemail.constantcontact.com/No-way-back.html?soid=1102665899193&aid=NFCkOLV0AaE

I think Roy is really good on constructive NHS management issues and is incredibly well informed but he has always had a blind spot on trade unions. His analysis is very simplistic on the BMA failures on pay,  given such failures are shared by every major trade union and are mainly down to an increasingly difficult legal environment for industrial action in times of austerity. He does at least recognise the NHS workforce planning (and motivation to remain working in the NHS) is falling apart but somehow refuses to link that to one of the key ideological drives causing medical staff to strike, despite deep care for their patients: most genuinely think they are trying to save the NHS.

[spidermonkey09]

Well informed he may be, and that email was an "interesting" read, but am I alone in finding the rhetorical style of it intensely irritating? So many ellipses, unnecessary bold type, repetition. Really annoying.

Pretty unimpressed by his inference that the GMC should threaten strikers with deregistration. That sort of rhetoric belongs in the Mail. Also pretty tedious is the inference that doctors are bad people for going on strike, coupled with the predictable recourse to the 'do no harm' line. The delusion that doctors are all Florence Nightingales is nonsense. It is a job, nothing more nothing less, for many, and they are striking accordingly (with a gigantic mandate as well). He should consider why 13,000 doctors trained in the UK have left (his reference), and then consider again why they are striking.

[stone]

Pretty unimpressed by his inference that the GMC should threaten strikers with deregistration. That sort of rhetoric belongs in the Mail. Also pretty tedious is the inference that doctors are bad people for going on strike, coupled with the predictable recourse to the 'do no harm' line. The delusion that doctors are all Florence Nightingales is nonsense. It is a job, nothing more nothing less, for many, and they are striking accordingly (with a gigantic mandate as well). He should consider why 13,000 doctors trained in the UK have left (his reference), and then consider again why they are striking.

Especially since the key demand by the consultants is for genuine independence for the pay review body -ie taking their pay out of the realm of being something they need to strike for.

[webbo]

 The delusion that all doctors are Florence Nightingales is nonsense.
You have your professions a bit muddled there.

[spidermonkey09]

Ha I realised that after I posted it but hopefully the gist came across!

[monkoffunk]

Yeah wow, what a mad suggestion.

I don’t believe the 35% will stand, and the BMA would have to put an offer of less than that to its members. I suspect members might vote in favour of significantly less. But the government do have to negotiate something.

[spidermonkey09]

I think they'd be happy to vote for anything in double figures really. I don't think anyone seriously thinks they'll get 35% but it's an opening gambit. The government appear to have forgotten how negotiation works and are just taking their ball home.