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Jim Mackey, Chief Executive of NHS Improvement, a government appointee, said last week that the NHS has seen "five years of decline on all of the things that people would worry about".

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One of the MANY advantages of being in the EU, was the Working hours directive. Now every trust in the NHS will be able to ignore that law & force our NHS Staff to go back to working until the are so tired that they make mistakes, get struck off by their registration body, & their trust won't back them up, as usual.

Pea nus head NHS Managers.

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Spent a few early morning hours in Conquest A&E during the week.

 

Not sure if it was an official directive but it's a good job we drove as ambulance crews weren't able to drop off cases as they were beyond capacity.

 

The inspiring part was watching some dedicated staff trying to help people all over the place.  The less than inspiring part was everything else.

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Why the NHS has the winter blues in summer - http://www.bbc.co.uk/news/health-37159254

The hospitals in Essex, Suffolk and Norfolk were in a state of admission emergency in June that would have ministers informed and action plans imposed if it were December. Unfortunately, that nice Mr Hunt changed the rules so that they only got reported publicly from November to February. That meant the hospitals got zero extra assistance and had to suck it up.

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Another example of why the NHS should remain a public company with strict protocols over deals with private companies.  In the US, an Epipen (the emergency self-administered anaphylaxis treatment) costs US$608.81 for a two pack having gone up every year from the 2007 price of US$57.  The price the NHS pays for a two pack is £52.90.

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I am going to sound a bit like Hunt now, but some of the NHS's problems do stem with our (the public's) obsession with hospitals and, particularly, our own local hospital. This has stopped strategic decisions being made and meant far too much money being pumped into acute hospitals instead of primary care and community care where it is more urgently needed and ironically would reduce the pressure on acute hospitals.

A bit of consolidation into larger hospitals would not only save a few bob, but more importantly improve the care people receive, even if it means travelling a bit further. We have hospitals where surgeons are only doing a handful of hip replacements a year - all the evidence is that you get far better results (and fewer complications/infections) if your surgeon is doing that same operation 60/70 times a year. Yes, a bit factory-like, but it is how it works in our best institutions. Likewise, we have dozens of pathology departments across the country when in the 21st century you could do all the work in a couple of places if you gave it a bit of thought.

We don't put nearly enough money into the NHS and we get by on half the amount (as %age of GDP per capita) of many comparable countries. The Health and Social Care Act, as ckn has eloquently explained and shown many times on here, makes the whole thing even more difficult with different bits of the NHS fighting and competing with one another. But our national obsession with 'my local hospital', where the nurses are lovely but often the rates of poor practice and MRSA not quite so impressive, is a factor that prevents the NHS making informed decisions. We should let Stevens get on with his job.

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I am going to sound a bit like Hunt now, but some of the NHS's problems do stem with our (the public's) obsession with hospitals and, particularly, our own local hospital. This has stopped strategic decisions being made and meant far too much money being pumped into acute hospitals instead of primary care and community care where it is more urgently needed and ironically would reduce the pressure on acute hospitals.

A bit of consolidation into larger hospitals would not only save a few bob, but more importantly improve the care people receive, even if it means travelling a bit further. We have hospitals where surgeons are only doing a handful of hip replacements a year - all the evidence is that you get far better results (and fewer complications/infections) if your surgeon is doing that same operation 60/70 times a year. Yes, a bit factory-like, but it is how it works in our best institutions. Likewise, we have dozens of pathology departments across the country when in the 21st century you could do all the work in a couple of places if you gave it a bit of thought.

We don't put nearly enough money into the NHS and we get by on half the amount (as %age of GDP per capita) of many comparable countries. The Health and Social Care Act, as ckn has eloquently explained and shown many times on here, makes the whole thing even more difficult with different bits of the NHS fighting and competing with one another. But our national obsession with 'my local hospital', where the nurses are lovely but often the rates of poor practice and MRSA not quite so impressive, is a factor that prevents the NHS making informed decisions. We should let Stevens get on with his job.

 

 

I can't disagree.  However I would say that I would prefer that clinical need/effectiveness should be the driver, not saving money.  By that I mean, if a larger central unit will save lives/increase life expectancy, then that should be the reason to do it, even if it costs the same as multiple smaller ones.  

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I can't disagree. However I would say that I would prefer that clinical need/effectiveness should be the driver, not saving money. By that I mean, if a larger central unit will save lives/increase life expectancy, then that should be the reason to do it, even if it costs the same as multiple smaller ones.

Completely. But for 95% of people, it will be primary and social care which has the greatest effect on life expectancy and quality of life - what happens once you're blue-lighted into a hospital is less important to that than we tend to think.

Utopian perhaps, but it is easy to construct an argument that better quality care leads to less waste. Fewer corrective operations, fewer drugs to combat infections and more specialisation.

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I am going to sound a bit like Hunt now, but some of the NHS's problems do stem with our (the public's) obsession with hospitals and, particularly, our own local hospital. This has stopped strategic decisions being made and meant far too much money being pumped into acute hospitals instead of primary care and community care where it is more urgently needed and ironically would reduce the pressure on acute hospitals.

A bit of consolidation into larger hospitals would not only save a few bob, but more importantly improve the care people receive, even if it means travelling a bit further. We have hospitals where surgeons are only doing a handful of hip replacements a year - all the evidence is that you get far better results (and fewer complications/infections) if your surgeon is doing that same operation 60/70 times a year. Yes, a bit factory-like, but it is how it works in our best institutions. Likewise, we have dozens of pathology departments across the country when in the 21st century you could do all the work in a couple of places if you gave it a bit of thought.

We don't put nearly enough money into the NHS and we get by on half the amount (as %age of GDP per capita) of many comparable countries. The Health and Social Care Act, as ckn has eloquently explained and shown many times on here, makes the whole thing even more difficult with different bits of the NHS fighting and competing with one another. But our national obsession with 'my local hospital', where the nurses are lovely but often the rates of poor practice and MRSA not quite so impressive, is a factor that prevents the NHS making informed decisions. We should let Stevens get on with his job.

The problem with the hospital obsession is that it's right in quite a way.  The first point gives an example of why the patients can't be blamed for it though.

 

Emergency/urgent care.

If you're feeling very ill, but not 999 ill, out of hours you're going to get seriously substandard care unless you go to hospital in most areas.  A few areas, very few, have an out-of-hours system that works.  Take Suffolk, once you hit a certain time all out-of-hours work is done by Care UK, you're more likely to win the lottery than get a Care UK GP to turn out to see you at home.  A personal example, my wife took very ill at night a few months ago, she was in real pain, her temperature was up and she was breathing more rapidly than normal, I called 111 as I didn't think it was 999, they tried to get a Care UK GP to come out, Care UK refused and told her to take paracetamol to lower her temperature, 111 then sent out paramedics.  The paramedics didn't know what to do, that's fine they're not doctors, and called another Care UK GP for advice, he was annoyed that they were called again and reiterated the advice to do nothing but paracetamol.  The next morning my wife was blue-light rushed to hospital with double pneumonia and sepsis and ended up on a non-invasive ventilator for 10 days in intensive care and then a general hospital ward hospital for a further 30 days. 

 

Out-of-hours care is utterly broken in most areas with all of the load being put on ambulance trusts and hospitals because the out-of-hours private company primary care lot just want the money, to "demonstrate savings" and do nothing.  So, if I get concerned with my wife again I'll be taking her straight to A&E and screw that I know it's the wrong way to do it; the outcome of that is that Care UK will still get their money for doing nothing and they've convinced one patient and her carer to go direct to hospital in future, thereby reducing their costs even further.  And you know what the government's view is?  Care needs to be provided in the most cost-effective way possible.  But then they refuse to police, or censure, these private companies doing nothing but leeching money and pushing yet more patients to overstretched A&E.

 

This is one of the biggest reasons why we're seeing all the stories about A&Es being overwhelmed, unfortunately hospitals are now starting at-door triage in most areas where consultants turn away non-emergency patients.  The hospitals get pats on the head for getting back within their targets, the hospital pressures reduce but then you have a whole core of patients who are so ill they can't wait until the next working day to get to a GP (good luck with that in most areas) being sent away into a system that genuinely doesn't care and won't treat them.  It's an abysmal and shameful destruction of the previously good emergency and urgent healthcare system.  For this alone, Hunt and Lansley deserve to be banned from ever holding public office again, among other punishments.

 

General hospital services

The centralisation of hospitals into specialisations is fine, I do support it when it has genuine benefits for patients as mentioned in the quoted post but way over half of these centralisations I've seen are all about money and have little patient benefit, if any.  I'd even support them if the patient impact were neutral in order to help financial efficiency.  Where it gets silly though is when the centralised hospital radius is 100-150 plus miles away from patients.

 

Overall hospital financial status

Here's an article in that well known left-wing rag, the Telegraph, on a forthcoming glut of hospital ward closures.  We're only five years away from when the NHS was in permanent surplus, the NHS had more money than it could spend in 2012 and it was in this state since the mid 2000s, that was chipped away again and again and again to help fund corporate tax cuts.  There is absolutely no defence against this from the government, they're overseeing the mass dismantling and financial bankruptcy of the NHS in an atrociously short time and all to suit narrow political dogma that even their own voters would rebel against if they were honest about it.

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And the moral of all this is?  YOU CAN'T TRUST THE TORIES WITH THE NHS.  It happened in the fifties and it happened in the eighties.  They fought tooth and nail to prevent  the NHS and every time they get into power they run it down.  I know this, why doesn't everyone else?  Why did they believe Cameron?  In fact how could anyone looking and listening to him  believe a word he ever said?

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You may have heard how the government are investing record amounts of money this financial year into the NHS.  Well, the capital approvals for this financial year (yes, four and a half months into the year) have finally been released and they're showing approximately 60% reductions on last year in many areas.  This is the capital money not for normal day-to-day running but for repairs, replacements, new builds, updates of obsolete equipment and so on.  In the past, this money has been fairly steady, realistic bids go in, they're properly assessed and they're granted at roughly the same value each year, the idea of year on year similarities is to give local bodies an idea what they'll get from future bids and stop them putting fantasy requests in.

 

We've helped a whole pile of NHS organisations with their capital bidding and it's just shocking what's come back from NHS England and the DoH.  So much for "record investment".

 

Lies, damned lies and Jeremy Hunt.

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Sorry for hogging this thread but another one released today.  Fridays before a bank holiday weekend during the summer Parliament recess is such a positive time to do so.

 

Two separate government funded independent reviews on NHS training have recommended that investment in quality training is dangerously low and that there is an easy and solid positive return on investment for even small increases in these budgets.  So... onto today's news.  NHS providers (the hospitals and community trusts mainly) that employ NHS clinicians will see a 2% cut in their central training grant this year (£48m cut) following a 1.6% cut last year.

 

Oh, and yesterday, I read about Trusts being put in Special Measures officially because of poor training investment.  It really is a farce.

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The actual proposals sound like they could be good but, as is so often the case with the NHS, how they are managed and whether the outcomes are actually implemented are another matter.  If the collaboration suggested by the STPs is borne out in reality then there could be a positive turning point in the overall delivery of health and social care services in England: https://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2016/aug/26/nhs-plans-bring-benefits-barred-telling-public-sustainability-transformation-plans

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The Tories were warned in 2010 & 2011 that the NHS under the Lansley reforms was heading for a car crash. Well it appears to be here.  As someone who's 70 in a couple of months, I must say I find it very frightening indeed.  I said I was scared when the brought in these "reforms," I'm terrified now.

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The actual proposals sound like they could be good but, as is so often the case with the NHS, how they are managed and whether the outcomes are actually implemented are another matter.  If the collaboration suggested by the STPs is borne out in reality then there could be a positive turning point in the overall delivery of health and social care services in England: https://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2016/aug/26/nhs-plans-bring-benefits-barred-telling-public-sustainability-transformation-plans

They're actually a step backwards in time.  One of the very few good things that the Lansley reforms brought in was a legal duty for Clinical Commissioning Groups (CCGs) to consult with the public over major changes to commissioned services, these STPs have no such duty and are essentially a large grouping of CCGs attempting to fix a local health economy's failings behind closed doors.  They have zero public accountability, the plans will be signed off and capital approved before the plans are made public and they'll be responsible for the lion's share of the £22bn of cuts that are coming in the next three years.

 

Two of my services have been working full-time on the STP IT plans for a number of these STP footprints and the potential is genuinely there if they can batter their way through the pride, obstinance and outright idiocy of some local NHS leaders who refuse to collaborate towards helping the patient.  The problem is that there was a letter sent to all STP heads yesterday telling them that "capital funding will be severely constrained" meaning that the investment won't happen now to fix these problems, it'll all be done by the goodwill of teams like mine that have to prioritise either this work or other patient-critical work.

 

So, the STPs were a good idea poorly implemented in a hurry to fix a problem that needs solid investment but has now been told it's getting none.  Yay for our government.

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They wouldn't dare make cuts like this if there was even a chance of Labour being elected.  The fact that Labour are a joke at the moment is giving the Tories carte blanche to cut public services.  It's a damned disgrace.

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