Posts Tagged ‘“National Health Service”’

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-debateEngland is in the midst of two of the biggest scandals this century.

First we have the scandal affecting the National health Service (NHS); and now the escalating scandal involving the use of horse meat, for which there is a sufficient opinion in the newspapers being offered up under various sensationalist headlines. 

Why am I writing this?

Because I want to convince myself that there is nothing to get wound up about, and putting it down in a post is sort of catharsis.

Question…Would you know what horse meat tasted like if it was in a burger, lasagne or kebab? I know I couldn’t, and if told it was a beef burger or beef lasagne then that is what it is. It is funny that no-one questions the flavourings, preservatives and other chemicals put in these dishes. The French have eaten horse for years with no ill effect (some may disagree with that statement). Put a beef steak and a horse steak next to one another, cooked in different pans, then I might be able to tell. It’s said that frogs legs taste like chicken, I wonder what the contents of “chicken nuggets” are?

Question…Is horse meat cheaper than beef? I believe horse meat is up to 40% cheaper than beef in some countries, so is it any surprise we find it in some cheaper brands of food. For example if you want to by the “ten burgers for a £1” do you really expect to find 100% beef; wonder how much crushed bone and offal could be in there.

Question…What about “Bute” (Phenlybutazone) getting into the food chain? I have yet to be convinced that if “Bute” is present, that it is of a such significant amount that one would succumb to the documented side effects of the drug. May be if you ate an entire horse or two, which had received long-term treatment of Phenlybutazone I would seriously consider it a risk.

What is the real issue…I guess for me the real issue is probably the deceit, labelling the product as beef when it contained horse; but then who would have bought it?

I am glad that I gave up buying meat products from the supermarkets a long time ago now. Despite paying a little more, I use the local butchers who buys his meat locally sourced and when you see him making the burgers from the meat he has just minced you know what you are buying.

So forget the sensationalist head lines, put down your pitch forks and just forget what you read in the media. It’s all tripe!

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.

A friend introduced me to the thoughts of Jared Diamond, during a conversation at work, in particularly to a  lecture he presented titled “Why societies collapse“.

In his lecture he presented an interesting analogy describing contributory factors associated with the collapse of societies; an analogy relating society, to bacteria in a Petri dish.

As bacteria grows within the confined space of a Petri dish there comes a point where there is a balance between “resources” within the Petri dish (nutrition) and “resource consumption”.

Diamond suggests, to prevent collapse within an evolving society, a balance between resources and their consumption; as much as a balance between economic outlay and economic potential to prevent collapse.

“Mismatch between available resources and resource consumption” will bring imbalance due to continuing growth of bacteria. As society expands beyond the available resources and systems of economy available, as with the bacteria, society collapses.

Taking Diamonds bacteria analogy to macroscopic level in everyday life, brought me to the state of the health service in the United Kingdom (UK). Taking this to microscopic level (that is hospital level) one can begin to appreciate why hospitals are failing.

It is clear that boundaries have been reached when the “Petri dish” represents the confines of the hospital. Attributable to an ageing, expanding, population available resources are not keeping up with consumption nor is the required economic outlay to maintain the service provision being met by the economic potential available. Simply there are not enough people contributing enough to the pot.

Resources in this instance means service provision within the hospital.

Accident and Emergency departments failing to meet the four-hour targets set by Government, where-by “no-one should wait more than four hours in accident and emergency from arrival to admission, transfer or discharge“. Or the increase in waiting times for operations due to the availability of level two and three facilities and ward beds.

In order to address the collapse of this micro-society one has to look at resources and resource consumption in tandem with economic outlay and economic potential.

What can be done to delay, if not prevent the collapse of this society?

As the Government of the day used public funding to save the banks from collapse, the health service is employing private companies. And whether this is liked or not, there is little that can be done about it.

Some hospitals are having to utilise facilities at private hospitals because they do not have the resources available within their “Petri dish”. We are already seeing private companies investing in health services. Richard Branson’s “Virgin Care” investing in community health services: Circle Partnerships investing in “Hinchingbrooke Hospital“, are providing the economic outlay.  This investment is bringing back an equilibrium to resource availability against resource consumption.

Whether one agrees with the thought that these companies have entered the market to make a “quick buck” or not; the question do we want healthcare or not, needs to be asked. There will never be enough people contributing to the pot, so we will all have to pay more in the long run no matter how healthcare is provided.

Listening to my usual radio station in the car this morning, having just dropped my children off at school, there came a discussion about the National Health Service (NHS) providing thirteen year-old girls contraception without their parents knowledge, let alone consent.

An interesting debate.

It is important to remember that at 13 years-old our children are starting to develop and are still, without being disrespectful, children.

The promotion of contraception, particularly implantable, encouraged by our Government and supported in action by the NHS.

The literature appears to discuss issues with the use of implantable contraceptive devices in adults and not children.

My main point to raise is that in England, Scotland, Northern Ireland and Wales the age at which it is legal to have sex is 16 years; also referred to as the age of consent. I believe this is an important point to raise. It is my opinion that any agency involved in the promotion, implicit or explicit, of sexual intercourse in under 16 year-old children are morally and ethically questionable; moreover, considered culpable in their act of promoting a breach in the law.

The discussion on the radio included a little on how it is acceptable for health-care practitioners to prescribe and implant contraceptive devices with the consent of the 13 year-old child: without any formal involvement of the child’s parents; using “Gillick Competency and Fraser Guidelines” by health professionals. If the child meets the criteria laid down in the these standards, the child is capable of giving consent to treatment; and for the healthcare professional to provide the treatment without the involvement of the parent or guardian.

However, what was not discussed was the fact that in England the current age of criminal responsibility, that is the age at which a child becomes criminally responsible for their actions, is 10 years-old. So are these children aware of the fact that they are breaking the law and consequences of their actions?

The moral and ethical debate surrounding this subject is immense. I am of the opinion that the Government in the stance it has taken on sex education, and the use of contraceptive devices in our children has exacerbated an issue that has been with us since time immemorial. This is not a remedy.

The Fraser Guidelines have simply provided a “get out of jail free” card for healthcare professionals in promoting the Government drive in the use of implantable contraceptive devices; to whose advantage? Not our children’s.

It is the parents responsibility to educate and raise children, not the states.

I do acknowledge that not all parents have the skills to raise and educate their children and in this instance society, as a whole, has a role to play in helping.

I apologise now for any referencing errors contained within this article.

On July 5th, 1948, the National Health Service (NHS) was established by the Labour Party. The central principle, a health service available to all: provided free at the point of delivery; financed entirely from taxation. However, it did not take very long before flaws were identified in Labours grand plan, in fact only seven months.

In an article published in the British Medical Journal (BMJ), February 19, 1949, titled, “The cost of the National Health Service”: Ffrangcon Roberts, M.D., [Roberts] clearly identified why the NHS was flawed; the areas identified, being as relevant today, some sixty three years later.

. Ageing population
. Expansion of hospital practice
. Misconceptions about the nature of disease

Other areas of relevance identified by Roberts include:

. Social and economic conditions
. Disease and working capacity
. Standard of living
. Moral implications
. Medicine considered as a commodity

Perhaps the NHS would be far different today if his points had been taken seriously in 1949.

The central principle of a health service available to all, provided free at the point of delivery, is how we would wish to see the NHS maintained. Having worked with many international staff involved in the provision of healthcare, the principle of the NHS is envied the world over.

The question of how this ideology can be financially maintained is one that divides the political spectrum. Roberts made reference to “The Beveridge report”: that full prevention and curative treatment must be available “without economic barrier at any point”; (P.162). How can this be possible with a system based on taxation? “Without economic barrier at any point”, suggests taxation would provide infinite funding for the NHS; yet in 1948, as now, there was and never would be sufficient numbers contributing to the health care coffer.

Roberts concludes,

“I believe that through ignorance and miscalculation in its preparation the cost of the Health Service has been grossly underestimated, that when in full operation it will be not less than £500 million, and that in future years it will rise to an even higher figure. Whatever the exact figure, I am firmly convinced that at the present rate of expenditure it will involve us in national ruin.” BMJ (1949).

“The alternative is hardly less comforting. It is that a limit will beset by shortage of personnel and materials. This means (mark it well!) that medicine will be rationed and controlled, and there is no reason for supposing that nationalized medicine possesses any moral superiority rendering it immune from the vices which rationing and control invariably bring in their train.” BMJ (1949).

Sixty-five years on and Ffrangcon Roberts words ring true; and the implications to the resolution of the health care crisis remain obvious…