Archive for the ‘Health’ Category

skeletal-debate

Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.

Aneurin Bevin

The ability to provide safe, cost effective health and social care, across the National Health Service (NHS) England, and other recognised agencies, is continually being driven further into an abyss.  Contribution to this situation is seen through numerous factors: the change in societal expectations of what treatments should be available on the NHS; the historic failing of successive governments to create mechanisms within general taxation, and additional charging to facilitate the continuing demands on these services; poor leadership by the Department of Health-a direct result of short-termism and political ideology-cascading down to hospital management teams.  The private funding initiative (PFI) projects that have been demonstrated have a phenomenally catastrophic impact on patient care.  Outsourcing of services to the private sector which are integral to patient care, for example portering, and domestic services.  And more recently a drive, initiated through a shared myopia of government, and hospital managers, to blindly follow a culture of “more for less”, to name but a few.

Making savings ad infinitum with the objective of maintaining the same standards, is detrimental to an organisations ability to be efficient and sustainable.  Savings are a tool used by accountants to achieve short-term gains.  Whilst “Lean” working is a viable proposition in health care “lean” is not anorexic.  The long term effects of short term savings are to drive down standards, to force errors through the cutting of corners, and to cost the organisation dearly in the future.  “Speculate, you can’t accumulate, if you don’t”: true leaders in the NHS will see the value in this proverbial saying.

Hospitals are finding themselves in such financial dire straits, that with no apparent means of raising capital for investment, in the very basic infrastructure to make them viable propositions, under any  other circumstance they would be bankrupt.  It is possible to put a plug in the bath, even if it is a round(ish) plug in a square hole; and to at least turn the flow of the, money, taps down so they are running at a steady flow and not gushing.  But this requires long term policies, more freedom from government control, and leadership: not crisis managers.

It is time for hospitals to look at becoming shrewd financial investors; to speculate wisely.  If £25million in the red, to continue saving will only drive debt.  Speculate and invest to drive productivity over the long term, bringing the debt down.  If it is a system allegedly good enough for the government to implement, then why not Hospitals?

Managers do not inspire doctors or clinical staff but good leaders do. NHS needs good clinical leaders.

Dr Umesh Prabhu

It is true, managers do not inspire doctors or clinical staff; it is also true that the NHS needs good leaders. 

However, even good leaders will fail to inspire the diversity of professional groups within healthcare, even though they share common objectives. Professionals, who with their own opinion toward hierarchical importance within the organisation, are but a barrier to progress.

Recognition needs to be given to the real and present danger within health care. One [danger] so great that the power it wealds will lead to the conclusion of the self fulfilling prophecy, based on the negative implications, of a failing NHS. This danger to healthcare, and leadership within healthcare, is the short-termism afforded to financial savings imposed by accountants, on the behest of others.

What is required, is for NHS Trust boards to be represented by members of all parties with intrinsic and extrinsic vested interested in the provision of healthcare, each with parity of voice. 

NHS Trusts must be empowered to raise funds: but not held captive by the shackles seen imposed through Private Funding Initiatives (PFI); to facilitate long-term investment. There is real truth in the addage, “speculate to accumulate”.

NHS Foundation Trust Hospitals are in a position whereby they no longer have the facility, ability, to progress.

Dear Mr Hunt

Let us not beat about the bush.

Your attempt to save the National Health Service (NHS) £1 billion over three years, by way of capping agency spending bills, to re-invest in frontline patient care, is nothing but bravado in the face of a public who knows no better; and intimidation of hard working professionals who have to tread daily through sludge of government induced bureaucracy in order to deliver high levels of patient care.  To implement this aggressive policy at a time of year when individuals are at their most vulnerable clearly demonstrates the disdain this government has toward public sector workers.

Jeremy, the ignorance to the true potential of damage to health care demonstrated through your action is incomprehensible.  It is evident that there is already considerable loss of income across the NHS through the inability of hospitals to meet, in a timely manner, contracts with commissioning trusts.  On-the-day cancellations attributable in part to the inability of NHS hospitals to staff substantive vacancies with permanent staff; and a reluctance to employ short term agency staff, compound loss of income with the addition of  fines imposed by the commissioning trusts for failing to meet standards.  The perceived cost to prevent the cancellations, through the employment of short term agency, is an additional expenditure of small significance in the grand scheme of overall patient experience and outcome.

It must be asked Jeremy whether National Health Service Professionals (NHSP) ltd, an agency for healthcare professions set up by the Secretary of State for Health Alan Milburn in 2001; which was still owned in whole (all though not centrally funded) by the Secretary of State for Health in 2011, is included in your harsh opinion of, “agencies ripping off the NHS“?  In the very own words of NHSP:

We typically recruit more than 1,000 flexible workers every month, making NHS Professionals the largest recruiter in the NHS. http://www.nhsprofessionals.nhs.uk/nhsp/Pages/default.aspx

Is NHSP Ltd going to flourish through your anti-competitive attack on the private companies supplying agency staff?

Based purely on empirical data there is sufficient, substantive, evidence to be able to be explicit in saying the ratio of permanent staff (doctors, nurses, Operating Department Practitioners (ODP)) in post, on any one day, is far greater than that of agency.

Jeremy, if you are serious about making substantive savings in the NHS, remove the barriers of the internal market implemented by Thatcher post the Griffith Report.  Healthcare in silo’s creates financial waste.  Put some meat back on the carcass of a health care system made too lean by the blind followings of an inappropriate management system.

Regards

Richard

 

skeletal-debateIt is ironic that despite all the negative press given to the abuse of controlled substances, illegal or not, figures produced by the Office of National Statistics (ONS) suggest drug poisoning involving both illegal and legal drugs is on the increase.

Misuse of illicit drugs is not a new phenomena, we just have to listen to the tales from those who were present at Woodstock and the “Summer of Love”. The question that needs asking in relation to that era is, were the drugs cleaner in those days? How many celebrities from the music world have appeared to defy death through substance abuse. In fact, how many bankers, stockbrokers, and barristers partake in illegal drug use ( as reported in the press) and manage to lead relatively normal lives? Is it always the base drug which kills or the additives used to make it go further, and make the drug dealers richer.

Referencing data from the ONS (acknowledging their disclaimers), whilst drug related deaths in the UK are on rise in both male and female populations, the deaths represent an insignificant percentage on a whole. Though the loss of life is not insignificant.

Unlike the change in law to make not wearing of seat belts illegal, changing the law and misuse of drugs act will not, I believe, save lives.

It is long over due that society must take a step back, draw a deep breath, and ask where the heck are we going?
And for the time being we have to accept that people are not averse to risk taking. Children and adults today have enough information and sources of reference to make informed decisions; we should accept that is life.

skeletal-debate“Horse meat scandal: cancer causing horse drug has entered food chain, minister announces” By 

Dominiczak provides no evidence in his article to corroborate the sensationalist headline  that Phenylbutazone causes cancer. And for me, if he [Dominiczak] was writing responsibly, to do so would have made for more informed reading.

Whilst I do not particularly like using Wikipedia, here is what they have to say on the potential carcinogenicity of Phenylbutazone.

Prof Alastair Hay, Professor of Environmental Toxicology at the University of Leeds, said:

“According to the International Agency for Research on Cancer (IARC), phenylbutazone is not classifiable as to its carcinogenicity.  There is no convincing evidence of its carcinogenicity in humans because in the individuals studied many other drugs had also been taken and any one of these might have caused the cancers seen.  And there is no animal evidence either that it is a carcinogen.

“The reason the chemical is not for human consumption appears to be rare and idiosyncratic responses in humans to the chemical.  These include aplastic anaemia and some other disorders of the bone marrow.  But these are not cancer events.”

Prof Hay has also provided a research paper for background.  It refers to the identifiable drug in horsemeat and the need to have proper screening processes in place to pick up the drug. (JANUARY 24, 2013)”

And for you more technically minded there is “The Carcinogenic Potency Project“.

I would think twice about eating 500 horse burgers in one sitting, as the figure suggested to increase the risk to the side effects of Bute; but I would still eat horse meat if prepared properly.

Will there ever be a time when reporters stop acting irresponsibly with unsupported sensationalist headlines?

My eldest daughter (of 13-years) is, to say the least a young lady who under certain circumstances can and will work her self up into a bit of a lather over nothing.

Okay, when I say nothing what I actually mean is over those little things that most people ignore or shun: spiders, flies, the sight of blood, the sound of a grisly tale to name a few. Oh and the dentist!

Now early last year we found out that “M” needed a brace, which to M was fine because her friends had them; they were cool. But M needed to have four teeth removed to facilitate the brace. Too many teeth for such a dainty (he notes with a sarcastic smile) mouth.

The options available to us, or so we thought were twofold. Either M could have them out awake with local anaesthetic or not have them out at all. The National Health Service (NHS) in my area, had in their wisdom, decided that it was too expensive to continue a service of full general anaesthetic to facilitate the removal of teeth for braces as this was a cosmetic procedure.

You could, and I tried, arguing that the psychological impact upon my daughter being awake would have scarred her for a long time; and could have effected her attitude toward dentists quite strongly. But still no give…

Then one day I heard a colleague mention that Manchester University Dental Hospital had a Consultant in Paediatric Dentistry who ran a sedation service to help kids like M. The sedation drug of choice, administered by a Consultant Anaesthetist in a suitably equipped environment, with trained assistance, was propofol (Michael Jackson juice). So I took this information to M’s Orthodontist and asked for a referral. Considering he was unfamiliar with the service and did not usually refer to this hospital, he sent the letter and necessary paperwork; and we waited.

Well, as you’d expect when waiting for a hospital appointment it seemed to take an age; but in reality it wasn’t that long.

The big day came and we arrived in plenty of time. Unfortunately, fate dealt a nasty hand of cards and the extractions were not to be. Genuine events outside of any-ones control dragged the day out and we (a joint decision all round) eventually called it a day.

Four months later and we received a new appointment.

On this occasion the gods were smiling up on us and the procedure went ahead.

It is rather quite amusing watching your daughter succumb to the effects of a sedentary does of propofol; knowing that she was in extremely safe hands in a secure environment.

Well all four teeth are out and M is as happy as Larry having leapt such a large hurdle.

And we have the utmost praise for the service and the staff who run it.

It would be great to think that such a service as the one run at the University Dental Hospital in Manchester, could be available through out the country. It truly would make a great number of young adults happier; and healthier.

I have reflected hard as to whether I should pass comment on this highly emotive news article, written by Sam Marsden and Martin Beckford, in The Telegraph, about a 32-year-old woman referred to as “E”. If it were not for the comments laid down by Dr Peter Saunders, the campaign director of Care not Killing I probably would not have.

On this occasion, Mr Justice Peter Jackson took a most difficult decision but got it wrong.

In getting it wrong Mr Justice Jackson has not only prolonged the agonies of “E”: but also the agony of her family, who have obviously morally and ethically deliberated (in some depth) to how best support their daughter. He has also provided campaign groups such as Care not Killing yet another stick to bang their drum with.

Dr Saunders inferring that “E” was lacking capacity, “…that acting in the best interests of people who are lacking capacity does not always mean acceding to their demands” is an insult to “E”.

The implication of Saunders comment could suggest that Mr Justice Jackson was acting appropriately.

However, as his [Mr Justice Jackson] decision was against that of an individual with capacity – the article clearly, identifies “E” as “…a highly talented and intellectual woman…” – was this so?

Clearly, “E” has been striving to keep control of her life and her destiny, as is her right. It would appear that this whole case is about protecting the authorities position and not “E’s”.

I hope “E” finds what she is looking for.

Peace…