The Budget 2017: three and a half ways it will impact healthcare

If you’re more sensible and more interesting than me, you probably haven’t looked through the thrilling contribution to world literature that is the Spring 2017 Budget.

For those who might still be interested in what our Government plans to do to healthcare spending but don’t have the time or inclination to read all 68 pages of figures, here’s a quick summary of the three healthcare related bits.

(1) £2 billion more for social care

While the NHS is struggling at the moment, social care currently looks like a Curly-Wurly being stretched between two hungry toddlers. Given that, the extra £2bn pledged over three years by Philip Hammond is welcome.

However, it’s estimated social care will need £2.8bn by 2019-20 so unless some more money can be found, or radical new policy solutions are found, social care is likely to be struggling for a while.

(2) £100 million for new facilities in A&E

A&E is in a perpetual state of just about managing, with January 2017 the worst month on record for waiting times. 15% of people had to wait longer than 4 hours to be seen, while the government target is 5%. Whether or not new facilities will stop people waiting longer, having £100 million of new buildings is nicer than not having £100 million to spend on new buildings.

Luckily, the idea proposed by the chancellor – having facilities for GPs to work in A&E – is not mandatory. While in principal having GPs in A&E to help triage patients is not a terrible idea, we don’t currently have enough GPs to fill jobs in GP practices. Transferring some of them to A&E and further exacerbating a community shortage doesn’t seem like the smartest move.

(3) £325 million for locally proposed capital investments.

The Department of Health’s latest wheeze is to get local NHS organisations to restructure themselves using ‘Sustainability and Transformation Plans’. Essentially, this means the NHS has been divided into 44 areas each with it’s own plan for how to make local services address local needs.

While local solutions are great and I’ll advocate localism as a solution for most things, they do allow Jeremy Hunt to say ‘well it’s your own plan’ when something goes wrong, which is probably the main reason they exist. Whatever the motivations, there’s going to be £325 million for local teams to bid for to build new facilities.

However, part of the criteria to receive the money is whether ‘the local NHS area is playing its parts in raising proceeds from unused land to reinvest in local services’. So effectively the policy is ‘sell some of your land, we’ll give you some money’ – which is an interesting way to encourage local creativity.

(3.5) 850 PhDs in Science, Technology and Maths

Not strictly a healthcare related bit, but additional funding for science PhDs is always a welcome thing. Investing in science and engineering always results in future benefits, and the Government has frequently said how much it values scientific research, so its good to see them putting their money where their mouth is.

 

That’s your lot. Nothing too horrendous, but nothing that’s going to radically change health or social care. Though Phillip Hammond has repeatedly said he’s going to make autumn the time when big money changes are made, so perhaps we’ll some more exciting things then.

Slower 999 responses and longer waits in A&E – and it’s not even the winter crisis yet!

Slower 999 responses and longer waits in A&E – and it’s not even the winter crisis yet!

More people are waiting over 4 hours to be seen in A&E than ever before, according to government statistics. Only 84% of people were seen within 4 hours in October 2016, the worst performance ever recorded in October, and 5% worse than last year.

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12 hour waits in A&E tripled between September October in 2016  Credit: John Ferguson

Not only did A&E have its worse October on record, so did 999.  Only 69% of patients who stopped breathing, or had no pulse, had an ambulance arrive within the recommended 8 minutes. This number fell to 63% when other types of life-threatening calls are included (e.g. severe bleeds, strokes).

To top off a truly disastrous triad for the NHS as it approaches the annual ‘winter crisis’, delayed transfers of care took up more time than ever before. Patients spent over 200,000 days in hospital in October, not because they were ill, but because they couldn’t be moved out of hospital. Delayed transfers (horribly known as ‘bed blocking’) occur for  many reasons, the commonest being unable to find spaces in either care homes or other NHS facilities.

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 Delays in providing mobility equipment can delayed people going home, leaving them at risk to infections and other illnesses  Credit: Matt Sawyers

These three indicators (999 waits, A&E waits and delayed transfers) act as a proxy measure for the slack in the NHS. Good numbers in each mean patients are flowing in and out of hospital in a timely manner. Bad numbers mean the NHS is becoming increasingly bottlenecked, and pressure is building up with the system.

Given that all of these indicators typically worsen over the winter, it seems unlikely we’ll be seeing any improvements in the data in the upcoming months. In all likelihood, we’ll see the most pressurised winter in the NHS since records began. Maintaining quality of care in such an environment will be a Herculean task.

 

Jeremy Hunt meets with media execs 7 times in 3 months – but doesn’t find time to see the BMA

Jeremy Hunt had meetings with 7 senior media figures between January and March this year, a period that includes 4 days of industrial action by junior doctors.

Jeremy Hunt, the UK Secretary of State for Health and Dr. Mark Davies, Director of Clinical and Public Assurance at the Health & Social Care Information Centre, visited the Kaiser Permanente Center for Total Health for a tour, given by Bernadette Loftus, MD, Mid-Atlantic Permanente Medical Group, Kim Horn, President, Kaiser Permanente, Mid-Atlantic States, and Phil Fasano, Chief Information Officer
UK Secretary of State for Health Jeremy Hunt and Dr. Mark Davies visit the Center for Total Health. Credit: Ted Eytan

These included James Kirkup, Executive Political Editor at the  Telegraph; Hugh Pym, the BBC’s Health Editor and Alastair McLellan, Editor of the Health Service Journal, the trade magazine popular among NHS management.

These meetings follow on from eight meetings he had with media figures between October and December last year, including with the editors of the Sun, Daily Mail and the Telegraph. Hunt met both Amol Rajan, Editor of the Independent, and Tony Hall, Director-General of the BBC, twice in a six month period.

During this period, Hunt has met a grand total of zero times with the Junior Doctor Committee of the BMA, though junior ministers have met with the BMA to negotiate the new contract. Hunt has also met with other sections of the BMA including the Chair of the General Practice Committee, Chaand Nagpaul.

The full list of media figures Hunt met with from October 2015 to March 2016 is as follows:

  1. Fraser Nelson, Editor, The Spectator, October 2015
  2. Amol Rajan, Editor, The Independent, October 2015 and January 2016
  3. Tony Gallagher, Editor, Sun, 27th October 2015
  4. The BBC News editorial team, November 2015
  5. The Daily Telegraph editorial team, November 2015
  6. Tony Hall, Director-General of the BBC, November 2015 and January 2016
  7. The Mail on Sunday editorial team, November 2015
  8. The Daily Mail editorial team, December 2015
  9. Janine Gibson, Editor-in-Chief, Buzzfeed, January 2016
  10. Jim Waterson, Political Editor, Buzzfeed, January 2016
  11. James Kirkup, Executive Political Editor, The Telegraph, February 2016
  12. Alastair McLellan, Editor, Health Service Journal, March 2016
  13. Paul Goodman, Editor of Conservative Home, March 2016
  14. Hugh Pym, Health Editor, BBC, March 2016
  15. Fiona Godlee, Editor, British Medical Journal, March 2016.

Previous attempts to find out the content of these meetings were unsuccessful, with the Department of Health refusing to release details under the ‘development of public policy’ clause allowed under the Freedom of Information (FoI) Act. The BBC declined to release details of the meetings under the exemption granted to it to protect its journalism operations.

Yorkshire and Humber School of Radiology to be ran by a radiographer; a bottle of red with lunch blamed

In very specific, but very silly news, The Yorkshire and Humber School of Radiology and Health Education England have chosen a non-radiologist, supposedly Dr Anne-Marie Culpan, as its head. She has no experience of radiology and isn’t medically qualified. She is in fact, a highly capable academic radiographer who has a PhD and is a senior lecturer in breast imaging at the University of Leeds. So no slouch, but definitely not a radiologist – a fact so concerning to the Royal College of Radiologists (RCR) that they are trying to urgently meet with the school to ‘explore how the damage caused by this ill-informed and ill-conceived decision can be limited’.

Now I don’t seriously believe the interview panel didn’t know the difference between the two, but according to the RCR, there was no radiologist on the interview panel, and an experienced and qualified radiologist did apply for the job, so it’s in play. For those unaware, here’s a simple guide that works for most situations –  radiographers use the scanners to do the test; radiologists look at the images to see what’s wrong.


As Anthony points out in the comments, the line between radiography and radiology can get a bit blurry. Some radiographers give radiotherapy treatments; others report on the results of tests in the same way as radiologists. The description above is not to be conclusive.


Now for why this appointment was exceedingly dumb.

  1. Head of Schools are responsible for delivering the training set out by the Royal College of Radiologists. Anne-Marie Culpan cannot even be a full member of this college as she is not a radiologist, leaving her outside of the loop when discussing clinical training.
  2. They are responsible for pastoral and training support of all radiologists in the Yorkshire and Humber area, including those in higher specialty training. Anne-Marie Culpan has not done even foundational medical training, leaving a question open about how much understanding and empathy she will have with complicated training problems.
  3. Anne-Marie Culpan would be responsible for any concerns raised about doctors. While I generally don’t hold much of a candle to the argument that only doctors can pass judgement on other doctors, I quite like those in senior positions to understand what the juniors should and should not be doing. It’d be extremely inappropriate for a radiologist to be in charge of supervising radiographers in training, it is no different the other way around.
  4. I do not know much about Dr Culpan, but her academic and radiographic work seems to have been very focused on breast imaging.  It seems hard to visualise how someone will go from being a very specialist research and teacher in one sub-speciality of a profession, to supervising 125 trainees going through generalist and sub-specialty training in a totally different profession.

While just one appointment, it does seem to part of a trend that doctors aren’t quite necessary under the people running the NHS. To expect a radiographer to understand what its like to be a radiologist and do so well enough to train consultants in that area is a ridiculous idea. It’s the equivalent of having a doctor train nurses or pharmacists, or in the non-medical world, a mainstream school teacher trying to train special school teachers. Let’s hope Health Education England don’t try such a dumb appointment again.

Corbyn and McDonnell join protesters near Downing Street in support of junior doctors

Corbyn and McDonnell join protesters near Downing Street in support of junior doctors

Jeremy Corbyn and John McDonnell joined hundreds of demonstrators who rallied around junior doctors on the day of the first ever full-walkout by doctors in the history of the NHS. They spoke to the crowd outside Richmond House, home of the Department of Health (DoH), having marched across Westminster Bridge from St Thomas’ Hospital.

During his four-minute speech, Jeremy Corbyn described a free health service as a human right, and said the Government were ‘more interested in attacking those who work in the NHS’. The Leader of the Opposition said Jeremy Hunt’s behaviour was ‘utterly contemptible’ and that the NHS was not safe in his hands. Other speakers included John McDonnell (Shadow Chancellor), Caroline Lucas (Green Party MP for Brighton Pavilion) and Johann Malawana (Chair of the BMA Junior Doctor Comittee (JDC)).

Dr Jayne Lim, who stood to be the Labour candidate in the upcoming Sheffield Brightside and Hillsborough by-election, said she was pleased to see her party leader join the demonstration and said: “This dispute has seen a lot of doctors realise they are in the same boat as other public sector workers.”

Dr Jeeves Wijesuraj, a member of the JDC, spoke from a picket line outside St Thomas’: “I think today is very sad. I, and my junior doctor colleagues, have never contemplated striking before. We’ve been forced into this position by a health secretary who is not listening to his own doctors, the Royal Colleges or the Patient’s association when they say the contract is not safe.”

Doctors have been maintaining a vigil outside the DoH for two weeks, offering Jeremy Hunt the chance to come and speak to them about the contract. Dr Carrie Thomas, an A&E registrar from a South London hospital, said she’d received unanimous support from the DoH employees she’d spoken to. “I think it’s horrendous in 2016 that Jeremy Hunt has introduced a gender pay gap into a profession where previously it didn’t have one.”

Dr Thomas was referring to the DoH own equality analysis that admits the contract ‘indirectly discriminates against women’ but that this is acceptable because is is for a ‘legitimate aim’. When asked about the safety concerns some have raised about the junior doctor strikes, Dr Thomas pointed out that her hospital today had 19 fully-trained consultant doctors in A&E when there would normally be 3 or 4.

Doctors were not the only people making their voices heard in the demonstration against the Government. Paula Peters, a Disabled People against Cuts (DPAC) activist, was concerned about how the contract would be yet another change for the worse in the lives of disabled people. “For us, [DPAC] it’s personal. Jeremy Hunt has voted for every cut and attack on disabled people. An unsafe, unfair contract that produces tired doctors at risk will put my services at risks. I’ve lost 22 friends [to suicide] as a result of these cuts”

 

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Disabled People Against Cuts activists attended the march alongside doctors

The actions of Jeremy Hunt comes as no surprise to Aine Hall who campaigned  with the National Health Action party against Jeremy Hunt in the 2015 general election. “I was grief-stricken when he increased his majority. I have relatives who are junior doctors, and it’s so upsetting how this dispute is making them feel.”

The Department of Health was asked for comment on the story but did not respond. Two of its employees were spotted wearing BMA badges.

Junior doctor strike called off

The BMA have announced that the 48 hour strike by junior doctors, due to begin at 0800 on 26th January, has been cancelled.

The BMA have stressed that this does not mean that they have reached an agreement with the government and will continue talking through ACAS.

In a statement on their website the BMA said: “Our aim has always been to deliver a safe, fair junior doctor contract through negotiated agreement.  Following junior doctors’ clear message to the Government during last week’s action, our focus is now on building on early progress made in the current set of talks.”

The BMA have not ruled out strike action on Wednesday 10th February, which would include withdrawing emergency cover.

Any deal that is agreed on by the BMA and governments will have to be approved by a ballot of junior doctors.


 

Click here to read the full BMA press release

Glasgow bin man hid his medical history before last year’s tragic accident

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Mourners for the victims of last year’s bin lorry tragedy in Glasgow.   Credit: Michel (Flickr)

 

A Glasgow bin lorry driver could have avoided the deaths of six people if he had: “told the whole truth” about his medical history.

Harry Clarke, 58, lost consciousness at the wheel of his vehicle on 22 December 2014. It then careened out of control into 23 people, leaving six dead.

At a fatal accident inquiry (FAI) at Glasgow Sherriff Court, Sherriff John Beckett pointed out eight ways the tragic accident could have been avoided, all of which related to his hidden medical past.

Clarke was found to have suffered: “an episode of neurocardiogenic syncope”, one of the commonest causes of fainting.

Syncope is just one of a long list of conditions that drivers may need to inform authorities about including diabetes, epilepsy and anorexia.

Drivers are supposed to notify the Driver and Vehicle Licensing Authority (DVLA) if they have a medical condition which could cause them to: “become incapacitated at the wheel.”

Matthew, a 21 year old with Type 1 diabetes described dealing with the DVLA: “It’s pretty easy, it’s just a case of sending a form off and getting a new license a few weeks later. Though it’s frustrating to need someone else’s permission to drive.”

Sherriff Beckett suggested that doctors could be given greater freedom to tell the DVLA about patients who may be driving unsafely. He even suggested that Parliament could give doctors a legal obligation to tell the DVLA.

The General Medical Council (GMC) said that their guidance already allowed doctors to breach patient confidentiality if they felt their patient posed a risk to the public, without fear of disciplinary action.

Niall Dickson, Chief Executive, said: “Doctors carrying out their duty will not face any sanction.”

The Crown Office responded to the report by saying: “There are no findings in the determination that undermine the decisions not to prosecute the driver.” The DVLA said they are: “carefully considering the recommendations in the report.”


This piece originally appeared on Westminster World