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The Lansley Reforms?

Stafford Hospital: hospital or abattoir

Liverpool Care Pathway

Southern Health Deaths

 

 

 

 

 

 

 

 

 

 

 

 

 

By repackaging privatisation as ‘reform’, the government has tried to sell voters the idea of dismantling the health service.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Blast-It Home

Broken Home

 

 


The state of the NHS

The average annual rise has been just over 4%. During the Labour years under Blair and Brown this was closer to 7%. We are now spending 10 times more on the NHS than we did 60 years ago. Today 30p out of every £1 spent on services goes on health. The Budget for the NHS is £105bn in England, the budget was increased 4% in real terms in 2016. The increase in 2017 will be less than 1%.

The four-hour A&E target was last met in the summer of 2015. The fact it is not being met is sign of system strain, it tells us nothing about the quality of care provided. The fact is that more people are choosing A&E in place of going to the GP, we have a shortage of GPs, people find difficult to get timely appointments and hence go to the hospital A&E.

The strain on the health service is generally laid at the door of our ageing population. The service is a victim of its own success, medical and technical advances have improved life expectancy by an average of 13 years. However, this has led to the rise of more people with chronic diseases, i.e., diabetes, heart disease and dementia. This situation calls for a massive improvement in the care system beyond hospitals, that is just not there. Older people cost more to treat and care for, e.g., a 65 year old costs 2.5 times more than a 30 year old. Then there's obesity, eating up resources. We also have a growing population.

It's not just old people who are driving up the NHS budget. The government is currently considering a cap on spending for new drugs at £20m. And we not yet know what effect taking away bursaries from student nurses (from Sept' 2017) and replacing them with loans will have on nurse recruitment.

Serious mistakes by hospital staff that put patients at risk are on the rise, despite the government’s drive since the Mid Staffs scandal to make care safer. The last few years have seen more cases of delayed diagnosis, staff failure to act on patients’ test results, poor care of seriously ill patients and blunders during surgery. A health spokesman said the increase number of mistakes being identified did not indicate a decline in standards but rather better recording and reporting.

 

 

The Lansley Reforms?

A CQC’s report, from October 2016, State of Care, suggested that the system was at a ‘tipping point’; i.e. not broken yet but on a downward trajectory. In short we are at a point where deterioration is gathering momentum.

Waiting times in A&E beyond four hours. Non-emergency operations, up to 4 million people may be waiting for knee and hip replacements.

Cuts - Sustainability and Transformation plans

“There are 44 of them covering the whole of England and some are pretty radical - involving closures of A&E and maternity units and, in some cases, whole hospitals.” and community pharmacy cuts?

'We will cut the deficit not the NHS'

Cameron promised he would cut the deficit not the NHS but this turned out to be another lie. By October 2014, 66 maternity and A&E units had been closed or downgraded and 8649 beds had been lost. ‘Reconfiguration' has become a dirty word with the closure of A&E departments often the prelude to downgrading and closing of hospitals.  

The Lansley ‘reforms’ have plunged it into organisational chaos and financial instability, and the patients are the losers.

Inefficient and unaffordable

International studies have consistently shown the NHS to be one of the most cost-effective health services in the world. In 2014, the Commonwealth Fund study ranked the NHS the most cost effective overall. The US healthcare system was among the least efficient and effective.

Not privatising the NHS 

Politicians claim they are not privatising the NHS, but one tenth of GP surgeries are now privately owned, and contracts worth billions of pounds have been given to the likes of Virgin and Serco. Recently huge contracts have gone to private companies including one for £780 million to catch up on the backlog of patients waiting for surgery and diagnostic tests.

Politicians quote statistics showing a low percentage of the overall NHS in the hands of the private sector, but the private sector does not want to run much of the NHS because they can’t make a profit from it. In the areas in which they are interested – typically elective surgery, community health and mental health – they have a high proportion of the contracts (recent figures suggest up to 60% in community and mental health).

People also want accountable health care, while private contracts hide behind ‘commercial confidentiality’. Contractors may go on using the trusted and familiar NHS logo, patients may not even know they’re receiving treatment from a private company.

The private sector

There is not a scrap of evidence that the price goes down and efficiency increases when private companies deliver NHS care. The evidence points the other way. Costs increase and services may well get worse as the private sector typically cuts and/or downgrades staff and reduces the services on offer .

The fiasco of hospital cleaning has shown the reality of privatisation: apparent short-term savings, but at the expense of lower hygiene standards, higher rates of hospital-acquired infection, the break-up of established ward teams and casualisation of the workforce.

Companies such as Serco have been heavily criticised for the poor standard of the service they have delivered. Serco has now withdrawn from clinical services, preferring to concentrate on the more lucrative work of providing admin' for the NHS market.

Other recent failures have included a contract for cataract surgery that had to be terminated after a few days because of disastrous outcomes, and the discovery of unexplained deaths in private hospitals delivering care to NHS patients

Bureaucracy 

Today we have a bigger bureaucracy that consumes more time and resources.

The 150 primary care trusts have morphed into 211 ‘clinical commissioning groups’ (CCGs). Much of the CCGs’ work is outsourced to ‘commissioning support units’ (CSUs), to be performed by people the NHS does not call employees, and who are not subject to the Freedom of Information Act. By 2016 these services will have been put out to competitive tender.

CCGs and CSUs are monitored by a new national bureaucracy, NHS England, which employs 4,000 people and has 27 local area teams that don’t meet publicly or publish papers.

Among the other tiers of bureaucracy are the health and wellbeing boards, Healthwatch England, toothless local Healthwatch patient groups (which are forbidden to conduct any ‘political’ campaigning), citizens’ panels, clinical senates and dozens more.

The new bureaucracy is less accountable and the Royal College of GPs has described the new lines of accountability as looking like ‘spaghetti junction’.

Accountability

Jeremy Hunt is the Secretary of State for Health but he is not responsible for happenings within the health system, the Lansley reforms removed any notion of accountability from the Secretary. The buck of accountability has been passed to hospital trusts and clinical commissioning groups. However the private companies feeding on the NHS will be harder to hold to account because they can claim commercial confidentiality, their business is none of your business - even if you are paying their wages.

NHS reforms waste money

As a direct result of the ‘reforms’ the NHS is now less cost effective. Money is being wasted on running the English NHS as a market, in which hospitals have to compete rather than cooperate and GPs (contrary to the promises that were made by Lansley) are legally required to spend money on expensive and lengthy tendering processes.

The proportion of the NHS budget spent on administration has increased dramatically, rising from around 6 per cent to around 15 per cent (the government won’t tell us exactly how much). Running the English NHS as a market is estimated to cost between £5 and £10 billion a year.

Large amounts of money are being lost through PFI, with tax payers getting about £11bn infrastructure for an eventual cost of over £70b. These PFI debts are crippling many of the hospitals involved.

Meanwhile the Treasury has clawed back about £5b from the NHS at the same time that the service has suffered rationing, bed closures and staff cuts. If we abandoned the costly and unnecessary market and dealt with the outrageous and unfair PFI debts, we would save billions for frontline care.

Patient choice

Patients have less choice now than they did 20 years ago, when a GP could send a patient to any part of the NHS anywhere in the country.

Now GPs may be constrained by the contracts they have with providers.

Many GPs are now given targets to lower their referrals to hospital. Referrals may pass through a management centre where they are checked and may be redirected by people with little or no clinical training and no knowledge of the patient.

One in eight referrals is rejected altogether. Operations once available from the NHS, such as joint replacements and hernia repairs, are increasingly being rationed or withdrawn.

‘Choice’ has been used as a Trojan horse to introduce the market, but market ‘competition’ is unlikely to result in diversity.

Large companies have the resources and expertise to win expensive tendering processes for NHS contracts, crowding out NHS workers and small social enterprises.

67% of contracts have been won by non NHS providers since 2013.

If this continues we face the possibility of quasi-monopoly private providers, who have more talent for winning contracts than for running clinical services. The private sector also has no obligation to provide a full range of services, so it cherry picks the ones it sees as profitable. Any replacement of local NHS providers by private companies can result in reduced services and gaps in care for vulnerable patients. 

And outsourcing the profitable work to private companies destabilises the local NHS which may not be able to continue to deliver the expensive and complex work which the private sector doesn’t want. We have already seen this with the contracting out of dermatology and musculoskeletal services

GPs in the driving seat?

Polls show 73 per cent of GPs now believe they have been set up to take the blame for rationing health care. Far from being in charge, GPs are effectively rubber stamping decisions imposed by NHS England and commissioning support services. Only a third of GPs are actively involved with the work of CCGs, and of those who are involved, more than a third have links with or shares in private medical companies and insurers.

There has been an unprecedented collapse in morale in general practice, with 6 out of 10 GPs considering retiring early. According to Dr Maureen Baker (chair of the RCGP) general practice is ‘on the brink of extinction’

Power and voice to local people 

Local consultations have been consultations in name only. Petitions with thousands of signatures have been ignored. After Lewisham’s local hospital was sacrificed – to bail out a nearby trust crippled by a massive PFI debt – community members had to take Jeremy Hunt to court to overturn the decision. When he lost he changed the law to make it easier in future to close hospitals without consultation.

The government’s willingness to go against local people is deeply undemocratic, and the more rhetoric there has been about patient voice the less genuine engagement there has been. The proliferation of NHS campaigns and local action groups is an indication of the fact that many people feel they have little option but to take to the streets to be heard.

‘Health tourism’ is bankrupting the system? 

The most reliable figures suggest that unrecovered costs from treating foreign nationals account for less than 0.2 per cent of the NHS budget. The government has encouraged scaremongering as a useful distraction from the real problem of £20 billion in cuts to the service.

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Stafford hospital

Stafford Hospital: hospital or abattoir

Back in January 2013, a report into the tragedy that was Stafford Hospital, indicated that patients were "routinely neglected ". It's said that between 400 and 1,200 more people died than would have been expected in a three-year period from 2005 to 2008.

The report cost £11m and it was money well spent, it identified complaints against 41 doctors and 29 nurses Their so-called professional bodies tok no action. Mad cap funny man, ex-culture secretary, and now health secretary, Jeremy Hunt, said the NHS needed a "change of culture". He, of course, blamed New Labour for imposing a culture of targets and performance management on hospitals. This culture can hardly be considered to have taken much of a hold or else operatives performing poorly would have been shown the door.

Stafford hospital had the misfortune to employ a load of rubbish doctors and nurses, and a management team recruited from Toys-r-Us, all overseen by an inspection process that failed to notice patients drinking the water from the flower vases. The Healthcare Commission (predecessor to the Care Quality Comminssion) told us in 2009 that "appalling standards" were putting patients at risk. Four years on and no action had been taken, we were waiting for yet another report to be published. Jeremy Hunt needed to take some action, send all the monkeys masquerading as doctors and nurses back to the banana plantations and zoos where they came from, get rid of the Toys-r-Us chancers and get Defra to pitch their tent in the Stafford Hospital car park until the place is run like a hospital and not an abattoir.

Of course, taking action is not part of the Health Secretary's brief since the Lansley 'reforms' removed accountability and responsibility for all and any actions from the Secretary. No, his job is policy, not action

 

The man from Abattoirs-Are-Us

 

Sir David Nicholson, who was head of the Midlands regional health authority, said sorry in February 2012 for the 1200 unnecessary deaths at Mid Staffs but what exactly was he apologising for. Was he apologising for his abject uselessness as a manager, a fawning puppet, working at the behest of an antisocial diseased political mindset that thinks that healthcare can be run like a Brillo factory. Now, he's chief executive of NHS England but not so long ago he had clinical oversight for the Shropshire and Staffordshire SHA, you know, where the patients at the Mid Staffs abattoir were drinking the water from the flower vases because the nurses couldn't be bothered to give them a drink.

The Francis Inquiry into Mid Staffs told us that the target driven culture of the NHS must change but so must the indifference and ignorance of the politicians who feign astonishment when mass murder occurs on their watch. These are the people who publicly claim to know nothing about gagging orders and huge pay offs to those who wont toe the line but privately they condone the culture of silence - Andrew Lansley, Alan Johnson, Andy Burnham are all guilty.

In the case of Mid Staffs, Nicholson's behaviour was criminal beyond doubt and his reward, a better job with a bigger pay packet. The most important part of NHS England is the commissioning board, the body that supervises the spending of tens of billions by GP-led commissioning groups and Nicholson's the man in charge - he must know where all the bodies are buried to receive such a pot of gold.

Nicholson stepped down from his role in March 2014, as chief executive of NHS England, heavily criticised in the media and by some health campaigners following the publication at the height of the failings between 2005 and 2006 Francis Report,

Professor Malcolm Grant, chair of NHS England, said Sir David's leadership through the radical changes in the NHS of the past two years had been "absolutely fundamental to their success".

Health Secretary Jeremy Hunt also praised Sir David's leadership.
"NHS waiting times have fallen, infection rates reduced, and mixed sex accommodation is at an all-time low. His job has often been incredibly complex and very difficult, and yet he has always had a reputation for staying calm, and maintaining a relentless focus on what makes a difference on the NHS frontline."

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Liverpool Care Pathway

The pathway, designed to ease the suffering of patients in their last hours or days of life, has come under intense scrutiny in recent months. It can involve the removal of drugs, nutrition and hydration if they are judged to be of no benefit to the patient.

But a number of families have complained that their loved ones were put on the pathway without their knowledge, while some doctors have claimed it can hasten death. A national audit recently disclosed that almost half of dying patients who were placed on the controversial pathway were not told that life-saving treatment had been withdrawn.

The Health Secretary insisted the protocol was far better than alternative arrangements and allowed those close to death to be comfortable and to spend their last hours with their families. Hunt told LBC radio:

 

“It’s a fantastic step forward, the Liverpool care pathway, and we need to be unabashed about that."

And............

“It’s basically designed to bring hospice-style care to terminally-ill people in hospitals. Inevitably people do die in hospital but they weren’t getting the quality of care in those final few hours.”

Mr Hunt said many patients did not want to die “with lots of tubes going in and out of their body” but would prefer their final moments with their families to be “dignified”. How does he know these things?

The Pathway was developed with Marie Curie, with Macmillan, with Age UK and a number of other charities to try and bring dignity to people in their last moments. Last moments, now there's an interesting phrase, lingering moments, is a better one. How would you like to linger for days without food and water and medication? Well, there's nothing diginified about dying in pain and it's about time all these agencies of good intentions grew up and, instead of killing people on the sly, just passed the dying person a Mickey Finn.

About 57,000 patients a year are dying in NHS hospitals without being told that efforts to keep them alive have been stopped, also thousands of dying patients were not given drugs to make them more comfortable.

And the idiot, Hunt, now in charge of the nation's health, says he hopes that one or two bad reports do not end up discrediting the concept of the Pathway.

Forlorn hope....

The Pathway was discontinued due to poor implementation, the practitioners were not trained properly. The Pathway was introduced to provide palliative care options for patients at the end-of-life but it ended up as a means to free up hospital beds a bit quicker.

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Southern Health Deaths

January 2016

An NHS England report, published last month, found that Southern Health NHS Foundation Trust had failed to investigate hundreds of deaths over a four-year period. Health Secretary Jeremy Hunt described the trust's failings as "totally and utterly unacceptable". Really Jeremy, and what have you done about it, apart from nothing. Chair of the trust Mike Petter said at a meeting no-one would resign over the issues but the trust has apologised for failings.

The families of the dead want the leadership of the trust to resign or be sacked by regulators. But they must know that they will just be reemployed elsewhere in the labyrinth of NHS England and continue to do damage elsewhere.

Many of the deaths that occurred were not investigated and when they the were, the quality of investigation was shoddy. Mr Hunt presided over the whole period covered by the Report, April 2011 to June 2015; he perhaps should consider his own failures.

The chief executive of Southern Health, Katrina Percy, said she would not be resigning.

August 2016

Katrina Percy did resign from her £180,000 a year chief executive role. She kept her salary, they gave her a new job 'providing strategic advice on the transformation of local health services'.

October 2016

Percy was asked to leave the Trust and received £190,000 in get lost money. Another example of 21st century silliness, rewarding tragic failure.

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