A consideration of current issues with particular reference to Cornwall.
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NHS on the proverbial 'rocks'?
If the BBC programmes of 'Question Time' and 'Any Questions' (TV BBC 1 and Radio 4 respectively) are any indication of the public mind, only two subjects dominate it: BREXIT and the NHS. For all the words spoken by panelists and audience members, nothing ever seems to be resolved and the caravan roles on unmolested.
Brexit will have to wait.
BREXIT as a topic of conversation will have to wait for another time and place. Here I wish to share a few thoughts on the thorny subject of Britain's National Health Service, which if we are to believe the Leader of the Opposition, and many others, is undoubtedly heading for the metaphorical and proverbial 'rocks', for want of money and a few other things.
The programmes mentioned above make a point of travelling the country so we may conclude that the topic is equally of concern no matter where. I suppose this is only to be expected as heath, or lack of it, is of concern to individuals wherever they reside or whatever they do. It is often difficult however to extract the topic from political point-scoring or indeed to differentiate between the realities of treatment and provision. What are slogans or by vested interests.
Only money matters?
There are innumerable specialist subjects but the discussion usually centres on just one: finance and its implications. Almost uniquely, the NHS finance comes only from Government because a founding principal and politically very difficult to change, is "free at the point of use or need". Government gets its money from principally two sources: taxes and loans. With a soaring National Debt and resistance to higher taxes, Government finds itself in a real bind that cannot be avoided.
The NHS web site states when the NHS was launched in 1948, it had a budget of £437 million (roughly £15 billion at today’s value). For 2015/16, the overall NHS budget was around £116.4 billion. NHS England is managing £101.3 billion of this. However the actual amount spent on health products and activities must be well in excess of this as it does not include private spend either on health insurance, private medicine or surgery, non-government funded nursing or social care, alternative medicine and treatments such as osteopathy, and the huge amount spent on non-prescription remedies, supplements and 'health clubs'. This works out roughly at several thousand pounds per every person living in the UK, every year!
Safe in Conservative hands?
West Cornwall Hospital, Penzance. c. 1935
https://www.picturepenzance.com/media/west-cornwall-hospital.36220/full
Despite vociferous assurances to the contrary, there is a prevailing belief in the country that the Conservatives cannot be trusted to protect the NHS as a publicly funded and run service. Everything in Conservative philosophy and practise suggests that it prefers privately run enterprises and to the idea that individuals should pay for what they get, when they need it.
The hospital today. Evidence of progress or decline?
http://s0.geograph.org.uk/geophotos/04/98/29/4982973_bdfa8ed4.jpg
Of course the obverse of this thinking, means that the poor and destitute cannot access treatment, a situation that is almost the norm outside the European block and no doubt one of the many reasons why there is such a tide of humanity trying to get here. Even in advanced America, without insurance, medical treatment is prohibitively expensive. People have to suffer in silence. Essential medical procedures literally result in bankruptcy and penury.
In Britain the Dental Service is a case in point, where it is now almost impossible to obtain anything other than private treatment and the cost to the individual has soared. Even if successful in finding an NHS dentist, a significant contribution is required, and I can state from personal experience a lower quality of service is provided across the board.
"Stuffing mouths with gold"?
https://upload.wikimedia.org/wikipedia/commons/thumb/e/e6/Anenurin_Bevan%2C_Minister_of_Health%2C_on_the_first_day_of_the_National_Health_Service%2C_5_July_1948_at_Park_Hospital%2C_Davyhulme%2C_near_Manchester_%2814465908720%29.jpg/1200px-Anenurin_Bevan%2C_Minister_of_Health%2C_on_the_first_day_of_the_National_Health_Service%2C_5_July_1948_at_Park_Hospital%2C_Davyhulme%2C_near_Manchester_%2814465908720%29.jpg
Aneurin Bevan's quote that he "stuffed doctor's mouths with gold" to persuade them to join the NHS is almost apocryphal. Of course it has been repeated to get them to adopt Government policy. Despite agreeing to be part of the NHS, doctors and dentists retained a semi-independent status which recent legislation has reinforced, making practices or groups of practices profit orientated businesses. A recent Times reports that at least one GP is remunerated with over £800,000 and more than 200 GP's are now paid more than £200,000. The old and familiar doctor/patient relationship has been undermined. Doctors are incentivised to make access and treatment more difficult and it has evidenced by greater difficulty in arranging appointments, whilst no longer obligated to carry out home visits.
Given these circumstances it is hard to see why General Practise nationally is said to be in crisis, or why in a city like Plymouth it is said to be at the point of collapse. Why given the long training period, do qualified doctors shun GP practise? Why are so many GP's giving up and insufficient doctors taking their place? Could it have something to do with the nature of the interaction and what is expected of them? Has the doctor/patient relationship been dehumanised and unpersonalised to such an extent that neither doctor or patient are satisfied?
Where are you Florence?
http://l7.alamy.com/zooms/11704280786048d684b144417a34e81b/in-scutari-florence-nightingale-attends-to-a-patient-date-1854-5-g388tk.jpg
Nursing has undergone parallel change, usually a direct result of government policy. Nurses have always had an ambivalent relationship to doctors both as regards activity and status, to say nothing of rewards. We would have to go back to Florence Nightingale to understand it fully. In large part it was a matter social status and gender. For the last forty years it has fuelled the move to graduate status.
Intellectual capacity and medical knowledge may be valuable but the overall effect for the patient and health care system may have been negative. Basic principles introduced by Nightingale that professionalised and raised the status of nurses, nevertheless placed the caring arts above everything, and this may have been jeopardised by modern nurses seeing themselves as junior doctors, rather than specialised carers.
The horrors of Scutari when Nightingale arrived are beyond imagining.
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The practical effect has been to lower the education and skills of the people actually doing the caring in institution or home. Cut-backs to local authority budgets and the privatisation of care homes has resulted in closures, ever shorter contact time and derisory pay, besides increased private contribution if cash or property is owned.
Doctors and dentists paid more. Nurses paid the same, carers paid less.
The change may also increased expectation of financial reward, achieved either by working for Agencies or by changing career or employer completely.
Private Eye (No. 1462) reports that more than 33,000 nurses gave up working in the English NHS last year alone, an increase of a fifth since 2012/13 alone. In each of the last five years more than a tenth have departed each year.
This is clearly unsustainable and results in the employment of agency nurses at hugely increased cost to the budget and recruitment from overseas that may result in increased communication problems and lower standards. Needless to say this may also engender resentment and dissatisfaction that cannot be good for either nurse or patient.
The academic approach has resulted in student nurses having to pay full university fees and running up huge student loans before they qualify, whilst paid virtually nothing whilst on the wards. This must act as disincentive to join and reason to leave prematurely. Any savings are probably negated by the huge additional cost of hiring agency nurses that cost twice as much.
Reorganisation
http://www.livingmemory.org.uk/images/ThreeandSixpenny/output/OutPatients.jpg
"Top down' changes seldom work and make no sense whatever to the 'customer' or 'consumer'. In fact I doubt even one in a thousand would have the faintest idea what they meant in practise or be able to describe the difference before and after. All it did I would suggest, was seed confusion, disrupt existing relationships, create a plethora of acronyms and hierarchies, and waste a ton of money that could have been spent more wisely on much needed services.
Nor has it stopped local reorganisation of this or that aspect of the service. A hospital closed here, an A&E unit transferred there. Meanwhile operations are postponed to allow for "winter peaks" and waiting times targets are missed. Significant numbers of people actually die as a result of ambulances or doctors taking too long to get to them.
Isn't just incredible that our system of representation permits this huge waste of public money, whilst the government pleads poverty for everything it doesn't want to do?
Government waste of public money.
Government seems very good at wasting public money and it has to be asked if the NHS is exempt from this general rule? The following are just a few recent examples.
The government is well known for inefficiency and waste. We need only cite:
- two rather useless non-aircraft carriers (£6.2 billion plus),
- the HS2 Rail link (£60 billion plus),
- the cost of military campaigns in the Middle East, Libya (£320 m) and Afghanistan (£34.7 billion in total),
- refurbishing Buckingham Palace (£369 m)
- the Palace of Westminster (£4 - 8 billion!)
- not to mention a billion pound bung to the DUP.
As far as the NHS is concerned, the following are a few notable examples of mismanagement and huge waste:
Reorganisation 2012
The most recent Conservative reorganisation in the 2012 "Health and Social Care Act", said to have cost about £3 billion, is now apparently accepted as its "biggest mistake" by the party and government itself. I therefore do not even have to persuade you that it was - it's official!
IT Systems
For example at least ten BILLION pounds was wasted on a computer system that has been ditched. Current stories suggest there is general confusion and a plethora of systems that don't 'talk' to each other.
This report dates from 2014:
"An abandoned NHS patient record system has so far cost the taxpayer nearly £10bn, with the final bill for what would have been the world's largest civilian computer system likely to be several hundreds of millions of pounds higher, according a highly critical report from parliament's public spending watchdog."
"MPs on the public accounts committee said final costs are expected to increase beyond the existing £9.8bn because new regional IT systems for the NHS, introduced to replace the National Programme for IT, are also being poorly managed and are riven with their own contractual wrangles."
"Richard Bacon, a Conservative member of the committee, said the report was further evidence of a "systemic failure" in the government's ability to draw up and manage large IT contracts. "This saga is one of the worst and most expensive contracting fiascos in the history of the public sector.
Source: https://www.theguardian.com/society/2013/sep/18/nhs-records-system-10bn
Private Finance Initiative (PFI) contracts
PFi's, first introduced by John Major and continued by Tony Blair, were designed to use private capital to fund major projects which were then leased back to the government at high interest rates. It took the capital sum off the government books but has cost the country far more in the long term, not least because government could have borrowed the money at much lower rates. The recent collapse of Carrilion and failures in rail franchises have proved that private businesses cannot always be relied on and are prone to fail. If and when they do, it is the taxpayer who must pick up the tab. However in the process Executives of the Companies and investors extract large sums. They may also lose.
In 2016 the Independent reported as follows:
"The NHS has more than 100 PFI hospitals. The original cost of these 100 institutions was around £11.5bn. In the end, they will cost the public purse nearly £80bn. The total UK PFI debt is over £300bn for projects worth only £55bn. This means that nearly £250bn will be spent swelling the coffers of PFI groups." See:http://www.independent.co.uk/voices/nhs-funding-pfi-contracts-hospitals-debts-what-is-it-rbs-a7134881.html
Exorbitant pay of some GP's and Consultants
On the face of it Consultants are paid much less (between about £40,000 and £105,000) which seems strange given the level of expertise and responsibility, although these can be significantly enhanced for specialisms and private practise. More than half the total NHS staff employed are clinically qualified. (See: http://www.nhsconfed.org/resources/key-statistics-on-the-nhs)
As can be seen bill for GP's and doctors is huge and may well have got out of hand. Clearly there is huge disparity between top and bottom and between the medical and other professions alligned to it. It is also complicated by the market forces at work at both home and abroad.
Drug over-pricing and over-prescribing
Apart from the exorbitant pay to some GP's and Consultants, the recent news has been full of stories about the NHS being ripped of for drugs and other medicinal supplies. For example one High Street giant charged £1,579 for a tub of moisturiser that was sold elsewhere for £1.73!
In another example according to the Competition and Markets Authority (CMA) one firm Actavis UK, ramped the price up of hydrocortisone tablets, after the patent expired, to eye watering levels - equivalent to12,000 per cent - from 70p in 2008 for a 10mg pack, to £88 by 2016!
Before April 2008, the NHS spent around half a million a year on hydrocortisone tablets. By 2015, this had soared to around £70m a year. Clearly these are only a few examples it illustrates how limited resources are wasted and why funding never seems sufficient.
Here is a list of their published products which makes a far more general point maybe? Activis UK is of course one of many drug manufactures world-wide.
Products manufactured by Actavis UK Ltd
- Actelsar (Telmisartan/Hydrochlorothiazide)
Cardiovascular System >> Hypertension - Beacita (Orlistat)
Nutrition >> Obesity - Cacit Tablets (Calcium carbonate)
Endocrine >> Osteoporosis, other bone disorders - Cyclogest (Progesterone)
Obstetrics and Gynaecology >> Premenstrual disorders - Delmosart (Methylphenidate)
Central Nervous System >> ADHD, narcolepsy - Diazemuls (Diazepam Rectal Soln)
Anaesthetics, Muscle Relaxants and Premeds >> Premedication - Electrolade (Sodium chloride,Potassium chloride,Sodium bicarbonate,Glucose,Electrolytes)
Gastrointestinal Tract >> Diarrhoea - Floxapen (Flucloxacillin)
Infections and Infestations >> Bacterial infections - Glidipion (Pioglitazone)
Diabetes >> Oral and parenteral hypoglycaemics - Hapoctasin (Buprenorphine)
Pain >> Pain, fever - Lecaent (Pregabalin)
Central Nervous System >> Anxiety - Lotprosin XL (Galantamine)
Central Nervous System >> Alzheimer's dementia - Lynlor (Oxycodone)
Pain >> Pain, fever - Nebusal 7% (Sodium Chloride)
Respiratory System >> Cough, congestion, respiratory distress - Nemdatine (Memantine)
Central Nervous System >> Alzheimer's dementia - Politid XL (Venlafaxine)
Central Nervous System >> Anxiety - Preblacon XL (Tolterodine)
Genito-urinary System >> Incontinence, nocturnal enuresis, nocturia - Raponer XL (Ropinirole)
Central Nervous System >> Parkinson's disease, parkinsonism - Raporsin XL (Doxazosin)
Cardiovascular System >> Hypertension - Reltebon (Oxycodone)
Pain >> Pain, fever - Salipraneb (Salbutamol/ipratropium)
Respiratory System >> Asthma, COPD - Sastravi (Levodopa + carbidopa + entacapone)
Central Nervous System >> Parkinson's disease, parkinsonism - Stesolid (Diazepam Rectal Soln)
Anaesthetics, Muscle Relaxants and Premeds >> Premedication - Stronazon MR (Tamsulosin)
Genito-urinary System >> BPH, urinary retention - Tenprolide XL (Quetiapine)
Central Nervous System >> Depression - Trangina XL (Isosorbide Mononitrate)
Cardiovascular System >> Angina - Trolactin (Dipyridamole)
Cardiovascular System >> Thromboembolic disorders - Vascalpha (Felodipine)
Cardiovascular System >> Angina - Victanyl (Fentanyl)
Pain >> Pain, fever - Vitile XL (Gliclazide)
Diabetes >> Oral and parenteral hypoglycaemics - Zeridame SR (Tramadol)
- See: https://www.mims.co.uk/manufacturers/actavis-uk-ltd?sortBy=A-Z
Over-prescribing of medicines
Over £16 billion is paid by the NHS drugs. That equates to about £250:00 for every person living in the country every year. In 2010/11, in England, £450m was raised through prescription charges. In 2016, 1.10 billion prescription items were dispensed in the community. An increase of 1.89 per cent from 1.08 billion in 2015.
The question emerges to what extent drugs are prescribed unnecessarily? We are now very aware that anti-biotics have been prescribed in this way for decades with very dangerous consequences for their efficacy where they are actually needed. Statins and other popular drugs have been prescribed when the medical justification is questionable, often with adverse side effects that require further different medication.
There has been a huge increase in the prescription of anti-depressants and similar with questionable results. Drug firms are continuously seeking new possibilities and opportunities and doctors appear enthusiastic supporters as for example the use of Ritilin for child over-activity when changes in diet and past-times would be far more effective.
Over £16 billion is paid by the NHS drugs. That equates to about £250:00 for every person living in the country every year. In 2010/11, in England, £450m was raised through prescription charges. In 2016, 1.10 billion prescription items were dispensed in the community. An increase of 1.89 per cent from 1.08 billion in 2015.
The question emerges to what extent drugs are prescribed unnecessarily? We are now very aware that anti-biotics have been prescribed in this way for decades with very dangerous consequences for their efficacy where they are actually needed. Statins and other popular drugs have been prescribed when the medical justification is questionable, often with adverse side effects that require further different medication.
There has been a huge increase in the prescription of anti-depressants and similar with questionable results. Drug firms are continuously seeking new possibilities and opportunities and doctors appear enthusiastic supporters as for example the use of Ritilin for child over-activity when changes in diet and past-times would be far more effective.
More reorganisation.
https://www.facebook.com/PeterStefanovicJuniorDoctors/photos/a.160601644322466.1073741828.156333781415919/546345255748101/?type=3&theater
I have lived long enough to experience several reorganisations of the Heath Service after its creation in 1948. The first was in 1974 when the health function of local government was significantly downgraded with the loss of preventive services under the direction of the 'Medical Officer of Health'. To some extent the 2012 changes reverted the situation but within the context of huge cut backs.
Of course if the number of Health Visitors is reduced, it is reasonable to expect greater demands elsewhere in the doctor's surgery or A&E or need for intervention by Social Worker and even criminal system. Sadly Governments see only possible savings and not the costs that arise elsewhere. (Can we overlook the health implications of the historically high prison population (about 90,000) despite all the non custodial sentencing?)
So those at the head of government and the NHS are faced with an huge unwieldy organisation with limited room for manoeuvre, once described by one expert as "squaring the circle" - the need to reconcile uniform standards of management and clinical practice, with local involvement and accountability. High technology and expertise inevitably result in local hospital and facility closure.
I am unconvinced by this trend that results in long journeys in non urban areas either in response to accidents or courses of treatment. The 'magic' hour following an accident or major health incident before specialist attention is available is often compromised with fatal consequences. If an ambulance is delayed or if the journey to hospital takes too long, what is the point of vastly superior facilities provided there?
A recent non-fatal incident to a young person I happened to 'stumble' on was attended by two ambulances and two helicopters (air ambulance and coastguard) besides several police vehicles. In a way it illustrates the modern situation: In the past the injured person would have been carried just a couple of miles to the local hospital by ambulance. The ambulance personnel would probably have been less highly trained and the equipment at the hospital less sophisticated but it is unclear whether the final outcome would have been any worse.
Now the distance of about 25 miles to the A&E centre increases the justification for air transport and highly trained personnel. Because the hospital covers a much larger area we might expect the facilities and medical staff to be more specialised yet far busier with longer waits often in ambulances.
How are we to judge how this all balances out for the injured person? However there is one clear conclusion: the present system is much, much more costly. The air ambulance is stated to be seven times as expensive as an ambulance but can do the job of seventeen - a rather dubious claim as presumably it is in addition to the ambulance fleet. It costs about £3 m a year, much of it covered but public subscription, so this is not a cost for the NHS apparently. As of 2007 (WIKI) it cost £350:00 a flying hour which presumably has increased. Two para-medics are employed and paid for by the NHS. The coastguard helicopter will doubt have similar operating costs.
It is a truism that you cannot put a value on saving a life and that helicopters offer advantages to accident victims, but just this aspect of the health service illustrates why it is so much more costly as it once was and why Government funding is never enough.
Unhealthy statistics.
Returning to the issue of 'heath' and the service that has theoretically to ensure it, all the indicators it is coping are not good. In fact they are very unhealthy. Almost every indicator of provision and performance - hospital beds, operation waiting time, A&E waiting times, ambulance response times, death rates and life expectancy - show significant decline.
Meanwhile the discrepancies in vital statistics between regions and social classes are as wide as they have ever recently been. Life expectation has for the first time dropped by a year and a person in the North West can expect to live ten years less than someone in the South East.
The gulf is much greater of course if we were to compare the lot of the homeless drug taker on the street and the affluent retiree. And this nearly forty years after the 1980 Black Report assessment of "Inequalities in Health". These facts impose an obligation on us to view the topic of health and the NHS in a much wider context.
The Socialist Health Association observed as follows, "It was clear that the Government would have preferred to suppress the whole thing, and it is greatly to the authors’ credit that this did not happen. However you do not need to read very much to see why the Conservatives wanted to suppress it."
That was at the beginning of the '80's. The underlying reason for the inequalities in heath remain and in some respects have worsened but this is something that government and society at large refuse to acknowledge or address. How can we consider the problems faced by the NHS unless we look at causes as part of a wider context?
Societal obligations v. Personal responsibility.
Seldom is the NHS issue addressed in terms of personal responsibility. Much of ill heath (a majority?) is down to behaviour and choice. This has huge health and cost consequences. How do you get people to adopt reasonably healthy life styles that tend to be inversely proportional to education, class and wealth. Is this because the poorly educated want to be ill and lead shorter lives or because they can't or don't know how to avoid it? Often healthy options are more expensive options but this is not always the case. Fashion, peer pressure and convenience all play a part.
Obesity alone has the potential to bankrupt the NHS unless drastic steps are not taken to prevent it which has to start in the Primary School. Being overweight, relatively uncommon in Britain fifty years ago, is now a major issue with implications going far beyond the obvious visual and social ones. Many diseases are correlated besides the much talked about diabetes including a range of malignancies. As overweight people age it can be expected to place an ever increasing burden on NHS facilities and finances unless the trend is reversed.
But we need also accept that many disease or accident inducing factors are largely beyond the control of the individual. For example the parameters of our accommodation, of the air we breath and the food we eat are set by others and by organisations that may not be responsive to our concerns, indeed motivated to the opposite. The many who die or suffer injury from transport and other accidents may be totally innocent parties.
"Informed consent"
Much of heath treatment is taken on trust that it is the best available without much in the way of personal choice. "Informed consent" may be an established and fundamental principle of treatment, but more in theory than practice. The unconscious patient cannot make it and a patient suffering from mental or debilitating illness may be less able to. The 'average' person is in no position to question medical knowledge,
Academic qualifications may be important but leading a fulfilled and healthy life is more important. Ageing is not preventable unless by early death, but there is no reason why people should not stay healthy longer, as many now do. Effort must be directed towards providing decent physical and social environments to enable older people to remain independent. This is not beyond the wit of man. If not people remain in hospital longer because they cannot be discharged. With the breakdown of traditional family ties this becomes a bigger problem.
Penzance Public Meeting (Friday 26th January, 2018)
https://www.cornwalllive.com/news/health/fears-over-future-nhs-cornwall-1134800
The meeting arranged by former Helston MP and Health campaigner Andrew George included panel speakers Dr Malcolm Stewart (clinical director at RCHT), Dr Neil Walden (local GP and Penwith CCG locality lead), Marna Blundy (West Cornwall Healthwatch), Stuart Roden (Unite union regional officer) and Cllr Rob Rotchell (Cornwall Council) Health and Care Cabinet lead). It should be noted that the current Conservative MP for St Ives, Derek Thomas, had been invited but did not attend.
(For information and reports on it see the following:
- https://www.facebook.com/photo.php?fbid=1918187845177106&set=a.1486666811662547.1073741830.100009577272672&type=3
- https://www.cornwalllive.com/news/health/fears-over-future-nhs-cornwall-1134800.amp
- https://www.andrewgeorge.org.uk/hospital-trust-chiefs-criticised-large-nhs-public-meeting-penzance/
- https://cornwallreports.co.uk/nhs-consultation-at-penzance-ends-amid-chaotic-scenes-as-angry-crowd-demands-investment-in-health-not-cuts/
- http://www.falmouthpacket.co.uk/news/15904004.Save_Our_NHS_meeting_attended_by_over_200_people/
- An earlier meeting:https://cornishstuff.com/2017/01/11/penzance-is-revolting-public-stp-consultation-descends-into-shambolic-chaos-video/)
Today (3rd February, 2018) it is reported that "thousands" were marching in the rain in London in support of the NHS and against planned hospital closures in Lewisham and other cut-backs and privatisations. The demonstration began at Gower Street in Central London at midday, and marched to Downing Street at 1pm.
Meanwhile back in Penzance similar fears were expressed in response to the news of the government’s plans to cut £264 million pounds from Cornwall’s NHS budget. It is difficult to reconcile the Government's position that its funding is keeping pace with inflation when faced with the reality of these substantial cuts to an already pressed service.
At the second meeting (the first attended by three Cornwall NHS officials broke up in rancour and confusion apparently) I attended the subsequent one with about 200 others. Significantly the local Conservative MP, declined an invitation. It was a better organised and well run affair, including microphones that worked even! There appeared to be a consensus that if the proposed cuts were carried through it could only result in further deterioration of the service provided.
One pressing issue of concern was the planned closure of the "Sunrise Centre" for the treatment of cancer resulting in patients having to travel to Plymouth or Exeter, the practical implications of which were movingly described from the floor.
(See: http://www.cornwallcancercare.co.uk/sunrise.htm)
It is only fair to note that Cornwall MP's have made representations on this matter to the Minister of Health. In fact two, including the St Ives MP Derek Thomas, raised the matter at a recent Prime Minister's questions. Sadly for him, he rather muffed his lines and called it the "Sunset Centre" which some might think was something of a Freudian slip. Derek Thomas of all people has much to be thankful to the National Heath Service, one of his children having suffered a long and fatal disease.
Ever member of the panel expressed an opinion from their own particular perspective, although I doubt anyone was much the wiser about the organisation or realities of this complex system by the end of it. There was far more heat than light and emotion than fact. Apart from the closure of the Sunrise Centre, no one was really clear what the practical consequences would be other than less money must entail a worse service for those in need of medical intervention.
People were clearly attached to the NHS founding principle of "free at the point of use" and against cuts and prepared to demontrate in force, as they had done fifteen years before, but to what practical effect? In the intervening period Penzance has seen its cherished local hospital and A&E steadily down-graded to effectively a geriatric hospital and minor accident centre, whilst services have been concentrated at Truro Treliske.
It comes as no surprise to locals that Treliske is over-stretched, whilst ambulance costs and response times must have increased as a result of increased travel distances. As far as I am aware no study has ever been undertaken to determine if outcomes have improved or deteriorated as a result. If inconvenience and stress are indicators, the latter is far more likely I would say.
As usual the underlying complicated issues were hardly addressed. How could they be? A very frail-looking Dr Malcolm Stewart said he had suffered a serious medical condition since his appointment as Clinical Director at the RCHT requiring intensive NHS treatment and six months off work. It was not entirely clear - to me at least - what his job entailed or what he had achieved. I don't think I was alone in that regard. Ever since the Hippocrites, medicine has been surrounded by a certain aura of mystery and inviolability, that certainly Dr Stewart was going to do nothing to change. He left early to catch a train, to attend an important meeting elsewhere the next day, so was unable to answer any questions. This drew some adverse comments from the audience and panel.
Dr Neil Walden, a local GP endeavoured to present a more positive and optimistic impression including the fact that West Cornwall Hospital was to have up-graded diagnostic (Magnetic Resonance Spectroscopy ?) technology. Details of how this would impact treatment were not forth-coming but presumably can only be positive.
Marna Blundy (West Cornwall Healthwatch) was clearly a dedicated campaigner to retain high quality treatment and care inside Cornwall. How this was to be achieved within government policy and financial guidelines was not so clear.
Stuart Roden (Unite union regional officer) was perhaps the most pessimistic. He said that in his long career he had never known a time when the NHS had been under greater threat from Government "initiatives".
Cllr Rob Rotchell (Health and Care Cabinet lead at Cornwall Council) He generally supported the previously announced position that Cornwall Council was facing less funding from central Government, as well as increased pressure as a result of rising demand for services. This means that despite the £300 million savings we have already made, we still have considerable savings to find in the years to come. One practical consequence appears to be a December decision to cut £400,000 from its health promotion budget affecting heath visitors and school nurses.
Andrew George, for many years the sitting (Lib Dem) MP, said he supported Lib Dem Norman Lamb MP and 90 MPs calling for an NHS and Care Convention to be set up in the NHS' 70th year. He added "There is no doubt that more money is needed. However, it is untrue to claim that NHS Kernow faces £270 million cuts. He stressed that over the same period Cornwall and the Isles of Scilly are set to receive a £142 million increase in their allocation. As well as this, he said, that Cornwall received more than £1.5 million to assist with winter pressures.
So we may ask are the scare stories accurate? Are the reported cuts in service such as paying for huge transport costs, currently in the region of £6 m true or false. In fact this is a problem issue nationally. Trying to distinguish between truth and hype.
NHS Privatisation in Cornwall
The practical implications of pending changes in Cornwall that would translate aspects of the NHS into an 'ACO' or 'Accountable Care System' were hardly explained or discussed despite its potentially dramatic implications. I doubt if more than a handful of the audience could explain what it entails - apparently a transfer of functions aimed at better integration of treatment and social care.
What this means for the patient - or should we call them 'victims'? - remains to be seen. I suppose it all depends on whether you are a 'glass half empty' or a 'glass half full' sort of person? Opponents say it is privatisation and 'Americanisation' by the back door. Others see it as better and more integrated management of services and limited resources.
Cornwall Council has said: "An ACS does not change each organisation's statutory and legal responsibilities. Instead it describes a way of working together that allows for a one strategy, one budget and one plan approach which puts the person not the organisation first.
"As well as being in agreement about the approach, all are signed up to making progress and testing out the practicalities by working in shadow form during 2018/2019.
"The shadow ACS will operate within the existing statutory framework which means that the Councils, NHS England, the CCG and provider trusts will remain the statutory accountable bodies in the system.
"Work will be supported by an accord which describes the principles of collaboration agreed by all partners involved in the ACS".
Any the wiser?Dr Iain Chorlton, Chairman of Shaping Our Future's Clinical Practitioner Cabinet, has said: "Our plans to transform health and care detail the need for greater integration between health and care services. The results of our ongoing engagement with the public, clinicians, health campaigners, and people working across health and care, show support for a more joined-up delivery."
See: https://www.piratefm.co.uk/news/latest-news/2454737/anger-over-new-health-care-plans-for-cornwall/
Seventy Years of Health?
https://static.guim.co.uk/sys-images/Guardian/Pix/pictures/2016/1/8/1452265364635/Guardian-6-July-1948-001.jpg
Had the initial philosophy been sound seventy years ago, all disease would now be cured and everyone would be 'healthy' presumably. Sadly that is not and never will be the case as long as humans are humans and society is society as we know it.
The NHS, beside being a gargantuan organisation and the biggest employer in the country, needs to be all things to all people that it manfully strives to do, but the question emerges how much money is 'enough' or put another way, will there ever be 'enough'?
The supply of money is only one side of the 'supply and demand' equation. If we create an environment that causes disease, or if people continue to make themselves unwell, can we expect an organisation to forever provide free treatment whenever required?
Just taking one example, diabetes has the potential to bankrupt the NHS on its own, yet as a society we have allowed the known precipitating factors to proliferate in a reckless negligence. As someone once famously said, "We are so busy pulling people out of the river, we don't have time to ask who is pushing them in up-stream."
Norms of behaviour and expectation underlie everything. The 'magic bullet' seems to have been the prevailing philosophy for decades that has turned GPs into 'pill pushers'. This is also a problem rooted in the philosophy of medical practitioners themselves and is now coming home in job dissatisfaction. People don't want to be told to change their way of life as the only permanent cure and doctors don't want to tell them.
Besides the facilities are not there because chemical cures have been chosen over more difficult options. Recent television programmes have proved the largely ineffectual nature of chemical and other prescriptions. The adverse effects of Statins; the over-prescribing of anti-biotics and bacterial resistance; the contribution of anti-depressants to suicide risk, are just three examples of many. Information on the relationship between inoculation and a huge surge in child autism has been energetically suppressed.
There is even a word for medical or surgical complications: "Iatrogenesis". Wikipedia states: "Globally, as of 2013, an estimated 20 million negative effects from treatment occurred. It is estimated that 142,000 people died in 2013 from adverse effects of medical treatment up from 94,000 in 1990. Clearly not a minor issue.
There are so many other issues not confronted or addressed that has a direct effect on the NHS:
- Addiction or over indulgence in illegal drugs, alcohol and smoking, primary amongst them.
- Family break-up and homelessness.
- Poverty and unemployment generally as a factor of economic policy and activity.
- An ageing population.
- An increasing population because people live longer and net immigration, often with their own unique health issues.
- Sexual activity norms and related disease.
- New expensive procedures and drugs.
- Accidents generally and particularly linked to transport and other activities.
- Mental illness and depression itself caused by the above
- And as I have said, the ever increasing expectation that medical intervention will cure the problem or lead to longer life.
We need to realise that the philosophical underpinning of a society is absolutely fundamental to what can be expected of a heath service - more properly described as a National Disease Service.
At this meeting who mentioned strategies of prevention? That no one did, highlights a major part of the problem.
Waiting in corridors, people sick in a bed
Some not so poorly, some look half dead
Doctors and Nurses all rushed off their feet
Clocking more miles than a professional athlete
Some not so poorly, some look half dead
Doctors and Nurses all rushed off their feet
Clocking more miles than a professional athlete
Angry guy at reception, thinks he's fractured his arm
Screaming "get me seen now and then I'll keep calm"
"The staff are all busy" Is the receptionists answer
"Trying to save a man's life who's dying from cancer"
Screaming "get me seen now and then I'll keep calm"
"The staff are all busy" Is the receptionists answer
"Trying to save a man's life who's dying from cancer"
The girl who's hungover after way too much wine
Could have just slept it off and you would have been fine
But you came to the emergency department as you felt you were dying
Now the really ill wait for the bed you're occupying
Could have just slept it off and you would have been fine
But you came to the emergency department as you felt you were dying
Now the really ill wait for the bed you're occupying
People's tempers are fraying, after hours of waiting
Patients slagging off staff, who can hear all the slating
But they turn a deaf ear, as they have work to do
Carry on with a smile as they look after you
Patients slagging off staff, who can hear all the slating
But they turn a deaf ear, as they have work to do
Carry on with a smile as they look after you
A mother says they should hang their heads in shame
For the wait she's endured, but who's really to blame?
On his own in the street, when your kid took a fall
But' we'll patch up your child and we won't judge at all
For the wait she's endured, but who's really to blame?
On his own in the street, when your kid took a fall
But' we'll patch up your child and we won't judge at all
Your name gets called up and you're finally seen
Yet you carry on moaning about how long it's been
The nurse says she's sorry, all watery eyed
She was comforting a parent whose child had just died
Yet you carry on moaning about how long it's been
The nurse says she's sorry, all watery eyed
She was comforting a parent whose child had just died
Some folk are there, through no fault of their own
They've fell down the strairs or broken a bone
Some just have a cut or a graze to their head
Some OD'd on drugs, which one first gets a bed?
They've fell down the strairs or broken a bone
Some just have a cut or a graze to their head
Some OD'd on drugs, which one first gets a bed?
Ten hours into shift, staff not yet had a break
Hungry and thirsty and every limb has an ache
And the patients keep coming, though some needn't be there
But they won't turn you away, they'll continue to care
Hungry and thirsty and every limb has an ache
And the patients keep coming, though some needn't be there
But they won't turn you away, they'll continue to care
So next time you're all moaning about our HSE
Just remember it's not staffs fault it's in such a mess
They are doing a job that a lot couldn't do
Often working for pittance to help folk just like you
Just remember it's not staffs fault it's in such a mess
They are doing a job that a lot couldn't do
Often working for pittance to help folk just like you
And remember if this was some other country
That don't get free treatment, then where would we be?
In times of an illness or when we feel in distress
We should all be so grateful for our HSE
That don't get free treatment, then where would we be?
In times of an illness or when we feel in distress
We should all be so grateful for our HSE
A recent case study added 18.10.22
A letter to me: "Hi Tim.
Thanks for your letter. I think it took me around a week to smell the very fishy smell coming out of the covid narrative. I haven't conformed since and as you know, once you see it, you can't unsee it.
Around me, within a few hundred yards, we have several people collapse onto their faces. They don't even have time to put their hands out to protect themselves. In roads, their houses and public spaces. Most have been badly injured with broken noses and arms. And brain bleeds which cause lasting damage. None of them have connected the fact to their recent receipt of a mRNA shot.
The ward in St Austell hospital (24 beds) that is for people recovering after surgery is now almost entirely full of people who have collapsed. Hospitals and hospital staff know this and yet, it's a well kept secret amongst them.
I believe I may have been one of the earlier victims of selected DNR here in this country. On March 4th 2020 (the day before anyone had died of c19 in the country and before any announcements of lockdowns, I was found unconscious with a serious case of CO poisoning. (I had been unconscious for 4hrs and was in a very bad state). Paramedics turned up (after an hour and a quarter on a slow night), put me in the ambulance and then stayed park in a quiet country lane for an hour. No treatment. Nothing. Just chatter.
Eventually I was taken to Treliske. The A&E dept was like the Marie Celeste. No people waiting and empty beds. Then I was abandoned more or less. No doctor attended, no pain assessment (the pain in my head and spine was extraordinary) and most important of all, still no oxygen. I literally begged for oxygen but none came. My partner turned up and asked again for gas to the chattering nurses. Still none came. Eventually a doctor stood in the doorway and told me to go. My partner had left to go to work so I had no way of getting home. I was covered from hair to feet in vomit and faeces (this happens when you're dying) but told to sit in the waiting room with other people for hours until I could get someone to collect me.
I wrote to the hospital after two days about this. They investigated and eventually replied that 'A doctor should have attended. A pain assessment should have been done. I shouldn't have been left for hours in filthy clothes. I should have been given oxygen. For we apologise. We will learn from this'.
From that time I have had permanent throat ulcers, burning lungs, kidney disfunction, broken teeth, mouth lesions, many teeth extracted due to ulcers, hair loss, anaphylaxis etc etc. Signs of an autoimmune disease. Of course, the gassing could well be the cause but the negligence of the hospital contributed. They have admitted negligence but block me getting a diagnosis and therefore treatment at every turn.
My thoughts are that they took one look at my age (63 at the time) and DNRd me. I didn't die so they sent me home. Clearly the emptying of the hospitals had already started and the policy of no treatment too. I may well have been labelled as a covid death had I not survived. Possibly the first one in the UK. Not and honour I aspired to.
We know there is oppression of anyone who speaks against the narrative. I see bullying in your case with people 'ganging' up on you. I despise this mob mentality and only have admiration for anyone who speaks up. I learnt that challenging those with cognitive dissonance is pointless as their reaction is hostility and ad hominem attacks. I changed my approach to what I call 'sowing seeds' and use humour whenever I can to pre-empt the following anger or annoyance. This drip feed gives people the chance to go away and maybe, think a little.
As for the rest, they'll never wake up.
Anyway, all the best. "
Thanks for your letter. I think it took me around a week to smell the very fishy smell coming out of the covid narrative. I haven't conformed since and as you know, once you see it, you can't unsee it.
Around me, within a few hundred yards, we have several people collapse onto their faces. They don't even have time to put their hands out to protect themselves. In roads, their houses and public spaces. Most have been badly injured with broken noses and arms. And brain bleeds which cause lasting damage. None of them have connected the fact to their recent receipt of a mRNA shot.
The ward in St Austell hospital (24 beds) that is for people recovering after surgery is now almost entirely full of people who have collapsed. Hospitals and hospital staff know this and yet, it's a well kept secret amongst them.
I believe I may have been one of the earlier victims of selected DNR here in this country. On March 4th 2020 (the day before anyone had died of c19 in the country and before any announcements of lockdowns, I was found unconscious with a serious case of CO poisoning. (I had been unconscious for 4hrs and was in a very bad state). Paramedics turned up (after an hour and a quarter on a slow night), put me in the ambulance and then stayed park in a quiet country lane for an hour. No treatment. Nothing. Just chatter.
Eventually I was taken to Treliske. The A&E dept was like the Marie Celeste. No people waiting and empty beds. Then I was abandoned more or less. No doctor attended, no pain assessment (the pain in my head and spine was extraordinary) and most important of all, still no oxygen. I literally begged for oxygen but none came. My partner turned up and asked again for gas to the chattering nurses. Still none came. Eventually a doctor stood in the doorway and told me to go. My partner had left to go to work so I had no way of getting home. I was covered from hair to feet in vomit and faeces (this happens when you're dying) but told to sit in the waiting room with other people for hours until I could get someone to collect me.
I wrote to the hospital after two days about this. They investigated and eventually replied that 'A doctor should have attended. A pain assessment should have been done. I shouldn't have been left for hours in filthy clothes. I should have been given oxygen. For we apologise. We will learn from this'.
From that time I have had permanent throat ulcers, burning lungs, kidney disfunction, broken teeth, mouth lesions, many teeth extracted due to ulcers, hair loss, anaphylaxis etc etc. Signs of an autoimmune disease. Of course, the gassing could well be the cause but the negligence of the hospital contributed. They have admitted negligence but block me getting a diagnosis and therefore treatment at every turn.
My thoughts are that they took one look at my age (63 at the time) and DNRd me. I didn't die so they sent me home. Clearly the emptying of the hospitals had already started and the policy of no treatment too. I may well have been labelled as a covid death had I not survived. Possibly the first one in the UK. Not and honour I aspired to.
We know there is oppression of anyone who speaks against the narrative. I see bullying in your case with people 'ganging' up on you. I despise this mob mentality and only have admiration for anyone who speaks up. I learnt that challenging those with cognitive dissonance is pointless as their reaction is hostility and ad hominem attacks. I changed my approach to what I call 'sowing seeds' and use humour whenever I can to pre-empt the following anger or annoyance. This drip feed gives people the chance to go away and maybe, think a little.
As for the rest, they'll never wake up.
Anyway, all the best. "
Theresa May’s secretive plans to replace NHS in England with private US healthcare system Kaiser Permanente
ReplyDeletehttps://tompride.wordpress.com/2017/04/23/theresa-mays-secret-plans-to-replace-nhs-england-with-private-us-healthcare-system-kaiser-permanente/
Senior managers pocketed £166million in bonuses and other extras last year – as the Tory-led Coalition slashes £20billion in costs from the beleaguered service.
ReplyDeletehttps://www.mirror.co.uk/news/uk-news/nhs-bonuses-chiefs-pocket-116-3553527#ICID=sharebar_facebook