Tag Archives: British Medical Association

Does Atos stand for arrogance?

Or for ‘new’ politics?

Atos

Atos (Photo credit: Wikipedia)

 

Let’s hope the legscy left by the Olympics is to stand up to bullies.

Atos is being challenged

It has cost the Government £50 million to defend challenges against Atos-recommended withdrawals of Disability Benefit with 38 out of 40 cases going overturning Atos rulingd.

The Guardian  Newspaper recently commentet that they were surprised that Atos had chosen to sponsor the Paralympics. As a company tasked by the Government to carry out the controversial assessmentd of Disabled people, it semed a bizarre choice.

But this typifies the new way of running anything political and/or Government-run.  When a Government realises that reforming one of their institutions, such as the NHS, was what they thought was needed – thinking seems yo be to throw taxpayers money at this, then stand back and let the company that is going to make a fortune take flak from the public. 

Witness :  the massive amount  Olympic security was going to cost;  then get a company such as G4S to run the contract; when it all goes pear-shaped, stand back and let G4S take the flak.  And don’t worry, G4S will be offered other contracts to compensate.

The same principle applies with reorganising the Benefits system.  And re organising the NHS – instead of working hard with  those already working in the industry who must know where skeletons are buried, and what needs to be changed.  Doing it the sensible way, taking  time, and supporting those who have worked in the field for some time. Instead just grab a fistful of taxes, scatter them into some CEO’s pocket, and let them handle this.  They will be shamed into giving back some dosh as a sop, but nothing like the huge amounts they are going to make.

Good News

A HEALTH professional signed off work by her doctor in “excruciating pain” lost all her benefits and was judged fit to work following an assessment by Atos.

The mother – she lives in Camden but wants to remain anonymous – said she had been pushed to the limits of despair by the Government’s £100m contractor:  Atos Healthcare

Currently the agents of the Coalition’s welfare reform and Paralympics partner – is under intense criticism for assessments campaign groups who say they are forcing seriously ill people over the edge.

The mother has worked all her life until a serious workplace injury forced her to quit. She regularly sees a hospital pain management team for her pain but after being assessed by Atos she was told she no longer qualified for Employment Support Allowance (ESA).

Her child tax credits, housing, council and employment benefits were cut off in the same week.

She said: “I am in extreme, excruciating pain. But for three months I didn’t have any money at all. At first I thought this was a joke. I was asking for help from friends – but the worst thing was I couldn’t give my two children anything during the holidays.
How do you explain to a child about this sort of thing?

“I was so proud to work – I went to school, university, I have studied. Now the kids are crying for you and it makes you so upset. When they stop one benefit, the others also stop.”

She added: “These assessments – the trouble you have to go through – they are leaving people with mental illness.

“I cannot carry shopping bags. I can’t stand for long and cook so I sometimes buy ready meals. I told them this and they said: ‘Oh, because you can put things in the microwave you can go to work.’

“They score you on communication, sitting and standing, about whether you can read your email, can you talk on the phone, walk 200 metres?

“It is like speaking to a robot – they ask you what you can do, but not how you are. I was assessed by a nurse – fitness to work should be assessed by a doctor.”

Disability benefit assessments were formerly done by a registered GP.

Lost papers

After challenging the decision, she was told her appeal papers had been lost. With help from the Kentish Town-based campaign group WinVisible, some of her benefits have been restored.

Clare Glassman from WinVisible said: “One of the main problems is that Atos do not get penalised when they get things wrong.

Women are terrified and it is very, very serious. They don’t count pain levels or the difficulties of getting around. None of that. Being in a wheelchair is now classed as being mobile.

“The BMA [British Medical Association] has called for these assessments to be scrapped. We have got results for some people, but there needs to be a wholesale change because this is happening on a massive scale.”

She said she had spoken to women living in Camden who had physical disabilities but also “terrible psychological” injuries that were not taken into account under the new system.

She said “equality” – a principle championed by New Labour – was being used to argue that it was “patronising that the severely disabled cannot work”.

A week of protest ended when more than 400 protesters demonstrated outside the Atos headquarters in Triton Square, Euston.  Then George Osborne was booed by tens of thousands of Paralympic fans as he handed out medals in the Olympic Stadium.

A spokeswoman for Atos said: “We don’t make benefit decisions – we are small part of the overall process. We send a report off to the Department and they decide these are parameters set by the Government – that is all Government policy.

She added: “At Atos we have proudly supported the Paralympics Movement for a decade. We hope people will view the Games, as we do, as an opportunity to celebrate sporting achievements.”

“We fully respect people’s right to peaceful protest and we understand this is a highly emotive issue.

So who are they?

Go on the Atos Website and it is obvious they don’t want to publicise that they are a foreigtn-owned compay.  But the dead give-away is the telephone codes used.  But one wonders why they are so coy? When you go to Google, the UK website that comes up does its best to hide its origins.

But ironically, their attempt to gain more clients by sponsoring the Paolympics may have highlighted the company’s failings, and given protesters a focus-point where to aim demonstrations.  The company weren’t helped by the heavy-handed policing of these protests, with media pictures of people in wheelchairs being manhandled.  Never good publkicity.

Meantime, now that Lansley and his pathetic team have been booted out, idn’t it time to go back to transparency, and awarding Government contracts to British companies who have a proven record, and can be held accountible?

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Quick guide to Interpreting NHS jargon

Useful phrases in Lansley-speak

 

LONDON, ENGLAND - APRIL 13:  Secretary of Stat...

He’s just been asked a question by a nurse

 

 

 

The revered Minister of State for Health, Andrew Lansley (this is him), seems a likely candidate for a bed in his ‘new’ reformed NHS, as he comes out with his pat phrases glossing over NHS shortcomings.

To prevent you going bonkers too when trying to understand what medics are spouting, here is my handy guide to what I think he actually means when he comes out with gobbledegook.

The British Medical Association and the Plain English Campaign have criticised the NHS’s use of words such as ‘service users’ and ‘clients’ to describe patients.  They said gobbledygook phrases were causing confusion for staff and patients alike.

I agree.  Nothing enraged me more whilst being treated for cancer than each time I was called a ‘customer’.  A customer is someone who goes into a shop and decides to buy something – not a patient who has woken up one day and found they have cancer.  But officials can’t understand that, unlike shops’ customers, I did not choose to pick cancer off the shelf.

Do you need an Interpreter?

No, I have finally realised they aren’t mistaking me for an immigrant.  They are being polite as they realise it is sometimes difficult to understand what medics say.

Interpreting Lansley-speak

You have to understand he is following the phrases his computer is programmed supply phrases when writing his  speeches.

One of his favourites is 5000 fewer managers, 4000 more doctors: (and similar misleading phrases). By the time you manage to Google this to try and confirm where he gets his figures from, ask a Dept. Health Press Officer (where do they pick them from?)  or contact your MP, the translation will be lost in mists of time (with any luck for LaLa).

But despair not – this and similar phrases are just plucked out of thin air to sound good in TV sound bites.

Baffled by opposition (stock reply when your MP manages to ask a sensible question…) translation:
I have not been listening to any other views but mine for the last 18 months

Care provided by the NHS will remain free at the point of use:
That’s provided you can work your way through the minefield and actually find someone to deliver this before you are carted off to the old people’s home and won’t need it any more.

Alternatively, for those of you whose nerve has crumbled and you bought health insurance, of course your care is free (to the NHS) because the insurance company will pay

Cutting management costs:
When you phone your hospital for an appointment, most will offer an option to ‘press button No. X for private appointments’.  With any luck you will get so fed up with waiting for the call centre to answer that you will press this option – thereby cutting NHS costs

Doctors tell me they want these reforms:   Translation: I once met a doctor who told me he supported part of my Bill

Evidence shows:  translation: Er – I’m making this up.  Please don’t ask where I got my evidence because you will be fobbed off by different departments until you give up.

Hand more control to patients:
Well, we can’t manage this so with any luck we are hoping you will all go privately and sort out your own care.

Health and social care integration:
(misleading phrase)  cutting budgets for both health and social care

No decision about me without me:
this misleading phrase was set to be Lansley’s signature cry – but rebounded.  Means you do have a choice :  either stay in system and wait – or go privately

No top-down re-organisation:
We can’t ask senior management because they have all taken redundancy and negotiated higher pay packets working for the new quangos we are setting up.

Biggest re-organisation since 1948    With any luck no-one is around from that time, so doesn’t remember the days when Matron managed the hospitals more efficiently

Ploughed back into patient care:
In the Dept. Health we are becoming experts at robbing Peter to pay Paul.. We can constantly play the game of announcing ‘new funding…..’ and with any luck we won’t be around once they have worked out what we are cutting to pay for this.

Liberate NHS from bureaucracy:
get rid of layers of Administration such as PCTs, and replace with two layers for every one we close down

Let’s take the politics out of this
The opposition are getting too near the nitty-gritty

The bill enjoys the support of all the clinical professions:  there are fairies living in the Dept. Health’s massively expensive collection of plants in their indoor garden

Those who are against the bill just don’t understand it:
1) everyone is out of step but Lansley
2) almost nobody understands the Bill, especially MPs, but luckily the Coalition has more MPs than the opposition, and the Whips make sure they vote the way Lansley wants them to vote.  Who mentioned Democracy?

doctors/clinicians are already (…):
We have bribed some medics near retirement with lovely Quango posts to get them to carry this out

Patients will be involved                                                                                                                                                                                    We 1) We just make sure we don’t ask any of them in the first place;  then by the time they find out we have closed the Enquiry down and no-one is around to answer questions.                                                                                                                               2) Copy the Future Fandango (Forum) format.  Announce patients are going to be involved, then make sure there is no contact address so we don’t have to answer questions asking who are patient reps. 

If all else fails, LaLa can copy his revered Boss and only invite those backing him to tea at Downing Street – or Richmond Towers.

 

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What do today's GPs think of Health Bill?

 

Abetternhs’s Blog

This is a fascinating Blog (obviously written by someone or some people who work in the NHS)

Up on the screen today is ‘Brief notes before the Battle of Ideas 2011 debate

and asks what is a GP’s role today?

The answer depends on who is defining the role.

The answer (as always) should not come from GPs, (or those pesky meddlers the Kings Fund, or the Dept of Health) but patients.

And not the pushy, entitled, ‘fix my sore throat before I interview Sir David’ journalists (that’s obviously aimed at me!) , that cannot understand why GPs don’t keep the same opening hours as Tescos (do they think Tescos could afford 24hour opening if it took 10 years of training to operate a checkout?) – but in my defence I want better service than I get in most supermarkets, so realise I have to wait.

Nor the people who run think-tanks who imagine what they would want from a GP if they were a patient, only they’re not actually chronically sick or worried half to death that they might be; these are healthy people, not patients.  Hear hear – am always saying the Dept. Health must go out and ask genuine patients what we want.

No, the answer is that GPs are defined by, moulded by, stretched, pummelled, weighed down and held up, worked over, leant on, wept on, bled, spewed and even pissed on by their patients, who beat them into shape over years.

Studies have shown that at the start of medical school, GPs are in fact normal people, capable of blending in at any social occasion. After 5 or 6 years we are turned out of the sausage machine that is medical school unable to speak the same language as our parents; after a few years in hospital we are a different species entirely, harder to understand than teenagers. Entering General Practice we soften a little, but being unused to conversing with conscious patients who ask difficult questions, we’re like pubescent Dr Spocks trying to cope with the emotional turmoil that our patients, (yes, our-own patients) lay on us. After painful years, we unlearn most of what we have learned and replace it with what our patients have taught us. How to interpret stories and relate them back, how to recognise unspoken signals, appreciate hidden strengths, uncover silent symptoms, and be a part of the narrative of our patients’ lives.

The commonest question my patients ask me is, “Will you be my doctor?”

How can we say no? In spite of decades of incentives to make us all attachment-free, autonomous consumers, to be somebody’s GP is to make a committment, a committment in many respects like that of a marriage. To stand firm in sickness and in health, to be consistent and honest at all times, to take abuse and shoulder blame without judging, to bear witness to suffering and personal tragedy and always maintain confidentiality. To be fair and compassionate, professsional and competent no matter how we ourselves are feeling.

The commonest reason for visiting a GP is ‘fear’.

Fear that the lump is cancer, that the chest pain is another heart attack, the headache a stroke, like the one that tragically disabled Maureen. Fear that I may die before my children grow up, fear that I may lose my sight, my balance or my mind. Fear that I cannot cope, that I am a failure or that I will be judged unfairly and blamed for my suffering. To be a patient is to be unfamiliar with oneself, to inhabit an unfamiliar shell, barely in control and in need of help. The world and our relationships are radically aletered when we are patients.

What an extraordinary job it is we do. Grounded in a therapeutic relationship, everything we do depends on trust. What an extraordinary responsiblity to be charged with caring for people when they are at their most vulnerable and most easily exploited.

Because of this it is absolutely vital that we are not led into temptation. Just as monks and nuns need to be protected from the distractions of the world so that they can dedicate themselves to God, so we need to be protected from mammon and the perverse incentives of the market-place, so that we can dedicate ourselves to our vocation and our patients, and be the doctor that they need, not the doctor the market makes us.

The above was shamelessly lifted from http://abetternhs.wordpress.com/2011/10/28/role/

To see more, log on and have an interesting browse.

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Are you waiting for NHS treatment?

Philips MRI in Sahlgrenska Universitetsjukhuse...

Image via Wikipedia

Is NHS Restricting scans

and tests?

 

All over Britain people are waiting – and waiting – for referral letters for tests, scans and treatment.

Are these delays a cynical way to extend payment times?

By the time you get your long-awaited appointment, the fee for this will  probably be charged to next year’s budget.

Surveys

Recent press articles show a quarter of PCTs are looking at ways they can reduce the numbers of patients GPs send for extra investigations. Several are also setting upper limits for “excessive” use of tests, while others have blocked GPs from directly referring patients for tests.

Looking at the mass of emails I receive,  showing results of surveys, etc.  extracts from the deluge showed that

  • of the 116 Primary Care Trusts contacted, 28% said they had either started looking into how many referrals GPs carried out across their area, or were planning to do so
  • A quarter are helping practices reduce ‘inappropriate’ access
  • Nine Trusts said they had found surgeries that either sent too many or too few patients for tests
  • Two Trusts are considering introducing upper and lower targets
  • Five PCTs have scrapped direct access altogether to at least one type of test.

If you want evidence, Google the above lines – and you will get it in spades.

Royal College of GPs are worried

Dr Claire Gerada, Chair of the Royal College of General Practitioners (RCGP) criticised the move saying, “This is about money and finances driving behaviour by the PCT – not about putting patients first.”  And yet isn’t it their members that stand to gain if GPs have access to commissioning?

Call me naive, but when I can’t even get an appointment with my usual GP, and end up seeing a Locum who tells me that they are going to have to cut down on drugs, etc – yet are spending a huge amount of senior GP time bidding for the new consortia – it does raise questions in my mind.

Dr Chaand Nagpaul, a senior member of the British Medical Association (BMA) has also commented saying that restricting access to scans risks “turning back the clock” on plans to diagnose disease early. He said, “An intelligent approach would be to have guidelines for appropriate use of diagnostics and incorporate them into the pathway.”

Patients should have tests needed

Yet more evidence that the cuts to NHS funding are beginning to have a detrimental effect on services for patients. GPs should not have to be in the business of rationing out referrals for tests. If patients need tests, they should be able to access them when they need them and not be forced to wait while the GP’s referral quota is renewed. Early diagnosis is important for many diseases including cancer, and delaying diagnosis could have dire consequences.

It happened to me

Last winter I might – just might – have had a return of cancer.  I was OK in my mind, but all signs pointed to needing a rapid diagnosis.  But delays, missing letters, doctors not available, referral letters not sent, and most important of all – the ommission of the word ‘cancer’ (for which my doctor spent half an hour apologising) meant a wait from October to January.  So if it happened to me – what about others?

I still haven’t been able to get my head around the fact that when I complain, I am told that “not to worry, we can deal with it” is supposed to reassure me.  But I don’t want to end up as another statistic trotted out by La La Lansley when he tries to blame us for not coming forward early enough for cancer disagnosis.  Cynical manipulation I call it.

The Department of Health must ensure that tests are not rationed, and that funding and resources are in place to ensure all patients have access to the care they need.

For more information, please visit http://www.telegraph.co.uk/health/healthnews/8748093/NHS-managers-restricting-access-to-crucial-scans-and-tests.html

 

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Could The Apprentice do a better job running NHS?

The Apprentice

NHS needs Sugar's straight talking Flickr

Latest on Un-Healthy Bill

Go on the web, turn the sound down and re-watch The Apprentice.

Management speak is rife, and substitute an NHS manager for an Apprentice and you begin to see where they are coming from.  Scary!’

More layers – not less

Administration levels are beloved of Health Ministers since the 1960.  Doctors started to go on management courses, and came away with lots of buzz words.  They were quick to see the courses could help them build empires, and rule over plebs who didn’t go on courses, but just got on with their work, looking after patients.

Today’s Health Bill is compounding the awful layers, and the latest blog from Abetternhs says it brilliantly:  www.abetternhs.wordpress.com :

The government’s intention to privatis,the NHS continues unabated after a so called ‘pause-and-listening’ exercise in which the rarely spotted ‘future forum’ gathered opinions from carefully selected stakeholders and reported back to No.10.  (There was ONE patient included in the 46 great and good).

Of greatest significance is that the duty of the secretary of state for health, enshrined in the NHS act since 1948, ‘to provide and secure the effective provision of services’ has been delegated to an unaccountable quango called the NHS Commissioning Board. Withdrawing the duty leads to the abolition of structures and functions that follow from that duty, meaning that eligibility and entitlement to a comprehensive range of NHS services will no longer be assured.

The other significant non-change after the pause is the role of competition, which was widely reported to have been watered down, but emerges intact and probably more central than before the pause, with the Competition and Cooperation Panel (CCP) taking on the role of preventing anti-competitive behaviour. They have made it clear that they regard existing NHS hospitals as ‘vested interests’ and that competition is an unmitigated good.

Hostility to the bill is widespread in the medical and nursing professions, with the British Medical Association voting for the bill to be withdrawn at their ARM this month, and protests taking place outside hospitals throughout the country.

The question that remains more than a year after the publication of the health bill is what problems the bill is supposed to resolve. It has never been the opinion of significant numbers of either patients or professionals that the NHS was in need of more choice or competition.

From my perspective as a GP the main problems that need reform are listed below. It is important to note that the health bill fails to address any of them, and in almost every case will make the problems worse.

Collaboration. Both hospital specialists and GPs are aware of huge variations in clinical practice, but without good communication and collaboration, little or nothing is done. Evidence from the US Mayo clinic and others shows that when clinicians collaborate rather than compete, costs and clinical errors are reduced and quality increases. In the last few years we have set up historically unprecedented close working relationships between GPs and our local hospital. We have improved the quality of GP management, reduced unnecessary referrals and made sure patients are seen by the appropriate specialist without the need for repeating investigations. By introducing a range of providers to compete with NHS hospitals with the Cooperation and Competition Panel enforcing competition, the health bill will allow private providers to challenge us for colluding unfairly with each other and will fragment and disintegrate patient care. GPs should be federated so that they have to take responsibility for their peers to ensure uniform quality of care in a geographical area. The health bill encourages GPs to collaborate by setting up commissioning consortia but allows them to exclude underperforming practices and challenging patient populations allowing the creation of ‘sink consortia’ and very small consortia with an unsafe risk pool.

Management. There is a long history of animosity between clinicians and managers and between NHS managers and the public. This pariah status of managers is unwelcome and unjustified. The promise to increase clinician involvement in the planning of services in the health bill was initially welcome, but any good has been blown apart by the unjustified demonization of NHS bureaucrats, the arbitrary 45% cuts to management, the destruction of existing NHS structures at huge cost, and the replacement of 163 statutory bodies with 521 new ones.

The purchaser-provider split. The purchaser-provider split rewards hospitals for doing more and GPs for referring less. Consequently it damages relationships between GPs and specialists and hinders rather than facilitates joint responsibility for patient care because GPs suspect hospitals of over investigating and over treating patients for profit, whilst hospitals suspect GPs of holding onto patients who need specialist attention to save money. The purchaser-provider split needs to be abolished, but it is central to the market-driven health bill.
Guidelines. The National Institute for Clinical Evidence assesses the cost-effectiveness of treatments. The potential benefits are enormous. Clinical guidelines are all too often not followed because of lack of familiarity rather than clinical reasoning and there are unwarranted variations in the quality of care. IT needs to be improved to aid clinical decision making. Guidelines need to be available instantly so as not to interrupt workflow or consultation time. The health bill has lurched back and forth over its position on NICE.[3] Social policies such as a minimum price on alcohol and banning smoking have much bigger health impacts than medical interventions, but worryingly what remains cut is NICE funding for a number of important public health projects including studies into reducing harm from alcohol. Instead the government have entered into public health partnerships with the food and drink industries which have clear conflicts of interest.

Inflation. Health care costs are rising because of a number of factors including the costs of new treatments and widening diagnostic and treatment thresholds. Ageing, surprisingly makes little difference, no more than 1% per year. The health bill has no analysis of why costs are rising or what to do about it. By introducing competition and converting health care to a commodity the evidence is that costs will increase much faster than before.

Data. The outcome of health care is health gain. It is very difficult to measure health gain because of the huge numbers of variables, the social determinants of health, the subjective nature of health, the variable time-lags between interventions and outcomes and more. If we are to become more efficient, then we need also to agree on how to measure efficiency. For all the emphasis on outcomes and efficiency in the health bill there is nothing in it about how to improve the measurement of outcomes or efficiency.

Inequalities. Having worked in deprived and affluent areas I know that general practice in deprived areas is far more clinically challenging and less financially rewarding. There are serious inequalities in the resources available, the quality of care and the incentives for GPs. There is nothing in the health bill to reduce inequalities, indeed the evidence is that competition in healthcare creates, ‘islands of excellence in a sea of misery’

Accountability. There is and always has been a democratic deficit in the NHS. From the secretary of state to the GP commissioner, at every level there will be less accountability as a result of the health bill.

The specious separation between health and social care. For general practitioners and patients it is obvious that there is a continuum. When the social care of a vulnerable patient fails too often they end up in hospital where they remain at great cost until appropriate care in the community is found. There are enormous cuts to social care and the NHS will remain the refuge of those with nowhere else to go.

The opportunity to address the problems the NHS faces has been wasted by this coalition government on a neoliberal project to hand a cherished public service over to commercial interests. If the government were seriously interested in preserving a comprehensive NHS, making it more fair and ensuring it is affordable and sustainable for future generations they would be listening to people who spend every day working in it and being treated by it instead of those who see it as a business opportunity.

Could anyone persuade Lord Sugar to shoot the next Apprentice series in a hospital, and set the contestants the enormous task of cracking down on money-wasting that is rife in the NHS – from 1,000 different types of rubber glove to Gluten-free loaves costing 1000% more than in supermarkets.

 

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What happened to the old doctor – patient relationship?

LONDON - MAY 01:  Workers take calls at a Nati...

Call centres replace GPs. daylife

One doctor’s view of what is happening to his job

 

There is an NHS doctor blogging anonymously on abetternhs – and this week he comes up with very, very sensible comments on today’s patients and their relationship with their GP:

‘The myth of the ‘trivial consultation

“Despite the best efforts of a modern, scientific medical education, most GPs realise that when a patient presents, the pathological process is only one of several processes, (social, psychological, economic, environmental, spiritual, etc.) that contribute to the patient’s sense of illness or well-being.

The nature of general practice, by which a doctor gains, over time, a knowledge of their patients lives enables them, through the development of a therapeutic relationship, to act as a holistic practitioner, understanding their presenting symptoms in the context of a broad range of contributing factors.

Increasingly we complain about ‘trivial consultations’, and eager to support us, politicians, policy makers and managers help us think up creative ways to ease the burden of the General Practitioner so that someone (or something) else; a nurse or pharmacist, or their assistant or deputy, or perhaps a receptionist or NHS Direct, an Internet site, in fact, anyone – or anything- paid less, can deal with them so that the overworked, over qualified and over-paid GP can concentrate on the type of complicated, high risk consultation that their expensive years of education and indemnity premiums justify.

There can be little doubt that education can inform and empower patients to manage many health matters without the interference of their GP, or for that matter anyone else, just as there is no doubt that the other sources of advice and treatment listed above can offer an excellent service -many as good, and some -for some patients with some conditions in certain circumstances, better than a GP. Patients have always made use of a wide range of advice and treatment options and the majority of ailments have always been managed without the ministrations of the GP. This will always be the case. What is changing is the range and number of options that come with our approval and encouragement, increasingly also assessed as being ‘quality’, ‘sensible’, ‘official’ or best of all, ‘evidence based’.

Under pressure, either implicit or more direct, patients are encouraged not necessarily to deal with problems themselves, but by exploring a plethora of other alternatives, to avoid bothering their GP unless absolutely necessary. The GP is increasingly being marketed as a last resort, rather than a first line. Once the patient has tried the advice of friends and family, taken some over the counter medicines, searched for advice on the Internet, seen the herbalist, read the practice leaflets and made a case for their need to see a doctor to the interrogatory receptionist, passed the triage nurse and taken the course of antibiotics prescribed by the nurse practitioner, they finally see the stranger whose name is on their NHS card. At this point they are faced with a stranger, a doctor in name who knows nothing of their lives, their relationships or their experiences of illness and health, hopes, fears or expectations, someone who they have been deprived of the opportunity to grow to know and trust.

Continuity of care is being increasingly devalued and undermined, not only by the factors outlined above, but by the loss of personalised lists, subcontracted out-of-hours work, reduced home visiting, and increasing amounts of management and administrative responsibility. As we lose continuity we will lose the ability to form therapeutic relationships and act as holistic practitioners.

Increasingly patients are turning to alternative models of healthcare that attempt to integrate a more holistic approach. Whilst offering varying degrees of holism, none of these view the patient from such a range of perspectives as offered by a GP with the knowledge gained over years.

If we believe in treating patients rather than conditions and see each consultation as an opportunity to develop a relationship with our patients, then we will become more effective and more satisfied with our work. To do so involves a change in attitude towards each patient consultation and the right conditions to allow us to develop relationships with our patients”.

http//abetternhs.wordpress.com

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Update on NHS fiasco

The Department of Health headquarters in Whitehall

DH HQ Wikipedia

Cameron and Lansley are facing massive opposition to NHS changes

Latest ‘Initiative’ is two month wait – then they are going out to consult with patients

 Considering Lansley had his mega-expensive tour of UK last summer, then there was a ‘consultation’ – one wonders what on earth they do with their time? 

Perhaps they need to have their ears syringed?  Or, as the decal goes in souvenir shops – “what don’t you understand about NO?

 It’s all thanks to good old People Power – petitions and letters to MPs are making them tell their masters to call a halt to the senseless roller coaster of NHS reform

and make the Government plan much-needed changes in a slow, methodical and thought-out manner.

My dream to reform NHS

The NHS desperately needs local avisory boards of local business people, to award contracts and hire and fire administrators as needed in their area.

Get locsl CEOs / reps from local branches of John Lewis (who give workers a stake in their own firm), and reps from Sir Terence Leahy (late CEO of Tesco and one of most successful businessmen in UK), Edward de Bono (famous for Lateral Thinking – and the NHS needs this), Gerry Robinson (who famously asked why the NHS almost closes down on a Friday), and a few other heads of successsful companies,  to join an NHS board as non-Executive Directors.

I would love to see Alan Sugar spend five minutes in my local Foundation hospital – his beady eyes would spot where money is being wasted in a nano-second.  Walking through this hospital, one can see where cuts could be made, and contractors should be told to honour contracts.  But if you have had a medical training – when did your tutors have time to give you a crash course in Business Administration?

The NHS should take advantage of some of the good private sector health services;  but how can a politician know which companies provide good value for money?  Often it seemed to get an NHS contract you had to know Tony Blair, and produce beautiful balance sheets – but no-one cared about the appalling service some of these companies gave patients.  Hence the private sector got a bad name – when it was the fault of NHS administrators choosing the wrong companies.

Then, if it is decided we need one,  the Government could appoint a Minister of Health to go round the country shaking hands and buttering people up – but tell these Ministers to take their amateur hands out of the till.  How can we expect MPs, who today seldom have any background in business, to understand balance sheets, contracts, etc?

Leave the medical profession to get on with running its own service, free from worries about apportioning budgets. 

And bring back Matron.

David Cameron talks about the Big Society – but I reckon Mr. and Mrs. Average are so fed up with the way Government (of whichever party) is wasting their hard-earned money, that they are now making voices felt;  Big Society or no.

No-one would deny the NHS is drastically in need of reform.  Doctors tell me they are waiting for the whole service to  collapse; patients see waiting times climb again, cancer patients find the promised Two Week wait for diagnostic tests is cycnicaly swept aside – now it applies to the FIRST alert – after that further tests are delayed and delayed;  and reports are coming in from all over the country about lack of care, lack of resources and operations being postponed or even denied.

When Andew Lansley announced he was going to get rid of many of the Administrators in the NHS, everyone was happy – except cynics like myself.  Realising that any Administrator on a six-figure salary wasn’t that stupid to sack themselves, we wondered how the administration was going ensure that the cuts didn’t  affect their cosy inflation-proof salaries and pensions.

In our neck of the woods it soon became obvious.  Senior physios, OTs, Community Nurses, etc. who, having worked in their jobs very efficiently for years, were probably now in charge of a team.  Bingo – they were classed as ‘administrators’ – and easy to get rid of.

But People Power might just have done enough to convince David Cameron that the NHS reforms could be his ‘Poll Tax’ downfall.  Currently the papers are full of reports, comments and high-powered letters – telling the Government they MUST think again.  So much so that Cameron is having to climb down.

38 Degrees

The people behind some very successful recent petitions are scenting victory.  After previously getting a very good response, they are asking the public again to “Click here to send your MP a message re NHS reforms. Over 30,000 38 Degrees members already have, but as the decision approaches each message that comes in could be the one that tips the balance:
http://www.38degrees.org.uk/NHS-email-MP

Who’s agin’ Lansley’s proposed reform of NHS?

Lansley’s co-workers in Whitehall are distancing themselves – a sure sign that things aren’t going well.  When you get to talk to the workers in the Dept. Health’s press office, they don’t even bother to hide the fact that he is very, very unpopular.  At least the message has got through that journalists were getting fed up with the constant press releases we found in our email, lauding another ‘Lansley initiative’.  Whitehall now resounds with the sound of these being dropped – hard.

The Liberal Democrat spring conference voted overwhelmingly to reject the Government’s health reforms.

The British Medical Association (BMA) held an emergency meeting in London to vote on a motion “to oppose the [Health and Social Care] Bill in its entirety”, and sent a message to the Department of Health highlighting the concerns of the medical profession.

Do politicians lose touch with reality – whilst they build their little Empires?

The public are getting angry, and so are major health organisations and associations, with the way the Government has promised so much, without actually working out who or what is going to pay for this.  The consequence is there is a huge round of ‘robbing Peter to pay Paul’ going on in the Dept. Health, now that the financial wizards have told Lansley what’s what. 

The Department of Health  (DH) seems to be going back on Cancer Drugs Fund pledge.  The Patients’ Association say the DH is being accused of going back on this initiative by clawing the money back from Primary Care Trusts by cutting their budgets.

Lansley can’t even get it right – after years of planning in opposition

He had seven years in the Health seat in Opposition – one questions what on earth he was doing with his time  not working out what is needed, that’s for certain.If he had bothered to work things out before, he could have saved a lot of paper, hot air and broken promises.

Two more health organisations are refusing to sign up to the government’s “responsibility deal” on public health, increasing the pressure on Lansley over his strategy of allowing the food and drinks industries to help form health policy.

Diabetes UK and the British Heart Forum, members of the panel looking at food and obesity, said they would not sign up to the deal which is being launched by the government. Their decision follows a walk-out by six leading health organisations who had been sitting on the alcohol panel.

As the Patients’ Association say, “the refusal of eight mainstream health organisations to participate in Lansley’s public health agreement is an embarrassment for the health secretary. Shadow health minister Diane Abbott said the government’s approach was “a favour to their friends in big business … The truth is that you cannot conflate corporate responsibility with public health”.

Royal College of Physicians, the Institute of Alcohol Studies, the British Liver Trust, the British Medical Association, Alcohol Concern and the British Association for the Study of the Liver wrote to Lansley telling him that they could not support the alcohol deal, which would not help reduce illness and deaths from drinking.

Bring in the Big Boys

How on earth politicians, with no knowledge of business finance, expect to be catapulted behind a massive Whitehall  desk, then run a ‘firm’ with an annual budget of over £20 billion, beggars belief.  Before they have even had time to count the square footage of their carpet, and learn the name of their drivers, they have to face allocating millions of pounds for different services.  No company would last long with this type of ridiculous administration.

Those that do understand finance, the House of Commons public accounts committee, had bad news for Lansley in its  latest report showing that NHS productivity has been declining for the last 10 years in spite of increased pay for doctors and other staff.

Whilst the last Government was throwing money around on glitzy new ‘health centres’, no-one set up a solid foundation to provide working capital to keep all the ‘toys for boys’ and their big machines, actually working once past the unveiling and celeb promotion stages.

So sign the petition – and get the Government to think rationally (if it can).

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Long wait for medical referral? It's all up to you to get faster attention

Postcodes and other Lotteries

When I first started these web pages, I was going to write about the nice things that help  us recover;  massage therapies;   skincare products; short breaks with TLC from top health centres, etc.

But sadly, events have overtaken this website.  Instead of writing about nice things, it has become obvious that health care in Britain is going through a crisis.  Often medical treatment becomes ‘survival of the fittest’,  and it is up to patients to fight for the best care.  We have to keep an eagle eye on what is happening, to ensure that those entrusted with NHS (our) money, spend it wisely, and not on things like ‘Away day outings for managers’, etc.

The latest information from the Patients’ Association gives one food for thought – and perhaps ammunition if you are caught up in increasing delays for treatment.

A report published by the health think tank, the Kings Fund, has found that some patients are having to wait longer for referrals than others. The review was led by a panel of experts over the course of two years.

The report has shown that in some areas some patients were waiting 8 times as long for a referral compared to patients at other nearby practices. The report has also found that just over a quarter of patients were unable to see their preferred doctor and that there were wide variations in the number of patients who had been admitted to hospital for conditions that could be treated outside hospital.

Chris Ham, chief executive of the King’s Fund, said there was no room for complacency, even if general practice in England remained “the envy of the world. While many practices have been at the vanguard of innovation and quality improvement, too many GPs remain unaware of significant variations in performance and do not give priority to improving quality.”

Dr Laurence Buckman, Chair of the GP committee at the British Medical Association said “Increasingly practices are working more closely together meaning they will be able to offer the wider range of service that patients expect. However, we should not assume that bigger always means better. Many patients value smaller practices and, as they consistently perform well clinically, it is important that this choice remains.”

Katherine Murphy, Chief Executive of the Patients Association said, “As the government hands responsibility for commissioning services to GPs, it needs to make sure that it offers support to those GPs who are struggling to perform and make sure that these practices are not allowed to fall further behind. Patients should be receiving a quality service regardless of the GP practice they attend. It should not be a lottery of care with your postcode determining the level of service you receive.”

For more information, please visit http://www.telegraph.co.uk/health/healthnews/8401157/Gaps-and-variations-in-GP-care-revealed-by-study.html
 

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This says it all!

NHS logo

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Proposed cuts to the National Health Service

 Sent in by a reader:

The British Medical Association has weighed in on Prime Minister David Cameron’s Health Care Proposals.

The Allergists voted to scratch it, but the Dermatologists advised not to make any rash moves.

The Gastroenterologists had a sort of a gut feeling about it, but the Neurologists thought the Administration had a lot of nerve.

The Obstetricians felt they were all labouring under a misconception.

Ophthalmologists considered the idea short-sighted.

Pathologists yelled, “Over my dead body!” while the  Paediatricians said, “Oh, Grow up!”

The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it.

The Surgeons were fed up with the cuts and decided to wash their hands of the whole thing.

The ENT specialists smelt “a rat”, didn’t swallow it, and just wouldn’t hear of it.

The Pharmacologists thought it was a bitter pill to swallow, and the Plastic Surgeons said, “This puts a whole new face on the  matter….”

The Podiatrists thought it was a step forward, but the Urologists were pissed off at the whole idea.

The Anaesthetists thought the whole idea was a gas, but the  Cardiologists didn’t have the heart to say no.

In the end, the Proctologists won out, leaving the entire decision up to the arseholes in London!

(With many apologies for the obscenity, but I feel so strongly about the way that the NHS is being mucked around, I couldn’t think of a more polite word).

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How to qualify to work in today's NHS

A patient having his blood pressure taken by a...

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FREE CPD ACCREDITATION AT NAIDEX EXHIBITION


The press release made no bones about it:

Healthcare professionals attending the UK’s largest disability, homecare and rehabilitation show Naidex National (Birmingham NEC, 5 – 7April) will once again have the opportunity to enhance their CPD (Continuing Professional Development).

This means 5,000 healthcare professionals who attended the last exhibition to “benefit from and experience the latest new products, learn about the issues facing the profession”, could gain CPD certificates to “demonstrate their commitment to finding out about cutting edge changes to their profession”.

It’s like Engineering students being awarded brownie points towards their engineering degree, if they attend the Motor Show.

Day out

Attend an exhibition – have a day out being chatted up by sales staff, sit in the chairs – the old faithfulls that one used to see at the Ideal Homes Exhibition and others – visit the Taiwanesse, Danish and other national pavilions to see what their countries are making to sell to NHS and disabled – and attend a seminar (if you have time).  Oh – and don’t forget the ‘Product Launches’ that are promised by manufacturers eager to sell their goods.  As the Taiwanese etc. have been promised, this will be a showcase for ‘increasing their business in the UK’.

Once you have done this, you get CPD more brownie points towards your qualification.

And to think I used to think healthcare staff were there to look after patients, and spent their training learning how to look after us.

Recently professional conferences aimed at nurses and NHS staff have offered CPD points to those attending;  but each conference has been in the form of lectures by professionals – even though advertised by some title such as “What do patients need?”  or “How to attend to patient’s needs in the re-structured NHS” or something equally vague.

When I phone to ask which patients will be speaking, the answer – when it comes – is always “our speakers are chosen by a committee/panel/the association, etc.”  And never is anyone a genuine patient of today – although they might have been patients years ago.  Consequently they have no experience of what patients actually need.

But it is very obvious when one comes across today’s health professionals they are experts at ticking the boxes and following the latest mantra – but TLC?  Forget it.  They’ve got their CPD certificates – that’s all they think they need in order to work with patients.