Saturday, 9 July 2016

A Quiet Time for the NHS

400 doctors recently gathered in Belfast for their annual meeting to discuss issues affecting the whole profession. It is a 4 day event and a very busy week discussing issues affecting everyone from medical students up to retired doctors covering medical politics as well as the professional, scientific aspects affecting our day to day work.

GPs were angry this year. Angry at how their branch of practice has seen yet more cuts to their budgets and angry with politicians who make out things are OK when those of us working on the front line of the NHS know it isn’t.

GP surgeries are closing across the country now. GPs can no longer keep going and are handing their keys back to NHS England. What a shocking indictment on our politicians when their policies and funding cuts bring about the closure of much loved and well respected community surgeries. Patients are the ones who lose out and once a surgery closes it will never come back again.

The workload in intolerable with upwards of 60-70 patient contacts a day, 30-40 blood results a day, 20-30 hospital letters to deal with, numerous telephone consultations and a few home visits thrown in for terminally ill patients whom we increasingly care for at home now in their dying days.

Much of this was discussed in Belfast and the profession has demanded a rescue package that will go some way to save our profession from collapse. If nothing comes about by the autumn, then the BMA has been given the go ahead to ask GPs whether they will consider industrial action. This is how bad things have got. General practice used to get around 12% of the NHS pie to fund its work and this has been gradually eroded by our politicians to around 7% now. That is nearly a 50% cut when workload has rocketed and the complexity of the work we do has increased significantly. We now see patients with up to 8 co-morbidities such as diabetes, heart failure, renal disease, hypertension and COPD. Often they are on 10-15 different medications and juggling all of this in a 10 minute appointment is nigh on impossible. The chair of GPC, Dr Chaand Nagpaul, said in his conference speech this was ‘not possible, not sustainable, not safe’.

Dr Napgpaul went on to say how shameful it was that when we are the worlds 6th richest economy that we have some of the lowest number of hospital beds in Europe and very low numbers of doctors and nurses. He accused politicians of ‘savagely slashing NHS funds under self-proclaimed austerity’.

Another big issue at the moment is the junior doctor dispute. We recently saw a ballot of junior doctors and medical students reject the contract by 58% to 42% on a 68% turnout. On the day this was announced the chair of JDC Dr Johann Malawana resigned as he had recommended the contract to his colleagues and given they had rejected it he felt he had to leave. Dr Ellen McCourt was elected chair the next day. Ellen is an A&E trainee from Hull and has a lot of work ahead of her. JDC have decided to survey its membership over what steps they might be prepared to take next. You will have seen that Mr Hunt got up in Parliament days after the result was announced and announced he would be imposing the contract. This has led to a group of junior doctors (Justice 4 Health) consider legal action against the actions of Mr Hunt. We will have to see where all this gets us over the summer.

All this is at a time when the major political parties in turmoil and the country has voted to leave the EU. It is hard to think of a time when so many momentous events have come together at once like this.

One thing we must remember is that our patients must come first in all we do. Despite the savage cuts to the NHS and the dwindling workforce we must do all we can to ensure patients receive safe, high quality care. We must hold to account those who put this aim of ours at risk and speak out on behalf of our patients when we believe we see injustice occurring.

No doubt there will be many more interesting times ahead of us!

Wednesday, 13 April 2016

Thoughts from the Picket Line

I arrived at the picket line at Royal Lancaster Infirmary at 8am on Wednesday just as the photographer was arriving to take some pictures for his latest story. There is still significant media interest in the strikes - which are the first set of doctors strikes in 40 years.

The junior doctors had arrived and were getting their banners ready and it was fantastic to see some local teachers turn up to support our doctors. The rain didn’t dent our spirits and we spoke to many passers by who supported us and hundreds of cars honked their horns in support as they drive by.

As a GP I support our junior colleagues 100% in this fight for a safe and fair contract and what is in effect a fight for the NHS. I know they don’t want to be on strike but they have been forced into this by Cameron and Hunt who now see doctors as their enemy and are trying to crush them.
A consultant came out to the picket line and brought coffee for us and I had a chat with him. He said the consultants were showing huge support for the junior doctors and would continue to do so during the next escalation to a full walk out in late April.

In most democracies if a Health Secretary had handled the situation so badly that junior doctors had gone on strike he would have ben sacked. But not in this country. We have a government prepared to bully doctors and force through and implement a contract that is manifestly unsafe, unfair and what we have recently seen is actually discriminatory – to women on the whole.
Junior doctors have been left with no choice as Cameron and Hunt refuse to talk. The doctors are livid at how they have been publicly vilified by politicians prepared to lie about statistics in order to justify their misplaced ideology.

It made me think once more how GPs have it bad at the moment too. With a crushing workload, no time to think or take stock of the 50-60 patients we see at 10 minute intervals each day, the GP profession is on its knees and many are walking away because they can’t continue. 12-14 hour non stop days are the norm and it is killing my specialty. I am so angry at what is being done to what was once the jewel in the crown of the NHS. Many GPs say they no longer feel safe in their day to day work given all the government has piled on us.

In a way I would like GPs to be on strike side by side with our junior colleagues to show the dreadful state the NHS is in due to the neglect of this government. Year on year real cuts to the NHS budget has left the service close to collapse. When the NHS needs 4% increases each year to keep up with the care needed it has been getting 0.9% for the past 6 years.

When the junior doctors change jobs in August (as they do each year) there will be huge gaps in rotas as doctors will have gone abroad or just left medicine. Their morale is so low they do not want to work under this imposed contract.  I think some hospitals will seriously struggle to fill rotas leaving doctors to care for ever increasing numbers of patients overnight and making it less and less safe.
The government should be ashamed of itself having brought the service to its knees but they continue to ply us with their lies about the NHS doing well and care improving – when every NHS staff member knows the exact opposite is true.

It is a national scandal. It should see a government fall. It should see millions of us on the streets.
The only way to stop what is happening is to get angry and get active. Join campaigning groups, get family & friends to write to their MPs, write to the local press, oh and above all support your junior doctors and tell them you stand shoulder to shoulder with them.

They are fighting for your NHS. An NHS that might not be around much longer. 

Sunday, 21 February 2016

Cameron treating doctors and NHS with contempt

David Cameron has been the Prime Minister since 2010. Every policy has his authority stamped on it.  He is ultimately responsible for the policies of government.

In 2010 his government introduced one of the most controversial pieces of legislation in the history of the NHS. It was so unpopular it saw every type of NHS worker oppose that piece of government NHS policy - which is unheard of. Called the Health and Social Care Act the government eventually got their way because of the voting support of the Liberal Democrats.

Back then the Secretary of State for Health Andrew Lansley (eased into the House of Lords now as Lord Lansley) knew his legislation was in trouble so he wrote a letter to all GPs on 16th Feb 2012 to try and smooth the way to the looming vote in the House of Commons.

An extract can be seen here on a vital point of allowing GPs control over who they wish services to be run by - something the profession was very concerned about with many private companies seeking to win NHS contracts.

The full letter can be read HERE

Specifically Lansley said 'I know many of you have read that you will be forced to fragment services, or to put services out to tender. This is absolutely not the case. It is a fundamental principle of the Bill that you as commissioners, not the Secretary of State and not regulators, should decide when and how competition  should be used to serve your patients interests.'

Roll the clock forward to 2016. Virgin Care have just driven a cart and horse through the promises of the Prime Minister and Secretary of State in that important letter and over ridden the desire of a local GP led CCG. They have successfully challenged Hull CCG who expressly stated they wanted local NHS GPs to provide general practice from eight of their surgeries. Virgin didn't like this and went to the courts to challenge the CCG desire for local GPs to run the surgeries. They won. The whole process will now follow a costly and time consuming tendering process which Virgin Care will be at the forefront of bidding for. The letter from Lansley isn't worth the paper it is written on. Cameron's promises are worthless. An extract from the article is here

The full article can be found HERE

This quite clearly shows how the profession was misled and how subsequent legislation passed by Cameron allows private companies to challenge decisions of local GPs on CCGs.

It is a disgrace and shows once more how the Conservatives treat the NHS and medical profession with contempt - much like they are doing with the junior doctors at the moment.

There will be more of this to come under the Conservative's NHS which is being slowly parcelled up and sold off to the big corporate companies of the City.

Write to your MP. Quote this article and challenge them and tell them you don't want this happening to your NHS

Tuesday, 16 February 2016

Cameron is doing what Thatcher never dared

History tells us many things.

When it comes to the Tory Party their action in the 1980s should present a clear warning to us now in 2015. Back in the 1980s the Tories spent most of the decade selling off public services. Tory belief is that the 'state should be kept small' which actually means selling off the assets we owned as a country to the private sector.

In the 1980s we saw British Gas, British Steel, Water, Electricity, British Rail (1990s), British Airways, Rolls Royce and British Airways sold off very cheaply to the City investors, large pension funds and a small percentage of shares sold to the public (who owned all the assets beforehand!). We got the crumbs from the table where the corporate beasts were feasting.

In the past 6 years the Tories have sold off RAF Search and Rescue to an American firm, the Royal Mail has gone to the City investors, East Coast Rail (profitable and giving millions back to the Treasury) handed over to Richard Branson and banks that we bailed out with billions of our taxes and actually making profits sold off at a loss to the taxpayer. We actually give tax payers money (called 'subsidies) to Virgin Trains to run the service and they also get to keep all the profits too. You couldn't make it up.

Often we hear the refrain 'but these were dreadful services in the 1980s and thank goodness the private sector was brought in'. The reason they were struggling services was precisely because they had been starved of funding and allowed to wither on the vine. British Rail was a fine example of this. Starved of investment for over a decade it became a national joke. This then allowed the Tories to justify the huge sale of public assets to 'rescue the service' and thus handing millions of pounds in profits to the City bankers overseeing the sale and further profits for City investors.

One thing Margaret Thatcher didn't try and privatise though was the NHS. She had a shrewd mind and knew this was one privatisation too far which could seriously damage her electoral chances. As Nigel Lawson wrote 'the NHS is the nearest thing the English have to a religion'.

The sale of the NHS is now going full steam ahead though in 2015. It was enabled by New Labour and the likes of Alan Milburn who eased the private sector into the NHS but it has been allowed to occur much more widely with the passage of the Health and Social Care Act in 2012 and the desire for Tory politicians to parcel up the NHS and sell it off. Many MPs and Lords have interests in private health care companies so it suits them that more of the NHS is sold off.

Of course the Tories will say they are not privatising the NHS but the World Health Organisation is clear that the involvement of the private sector in providing and financing health care to patients is most definitely privatisation.

We see our Junior Doctors fighting for a safe and fair contract. They see the erosion of their contract to bring in more weekend working as a way of syphoning off easy, profitable routine operations to the private sector. The City investors will be swooping in on these contracts like vultures round a decaying carcass. Junior doctors see the erosion of the ethos of the NHS as one final nail in the coffin and they are standing up and saying NO.

Leopards don't change their spots. The Tories despise public services. They sell them off to their friends in the City and they are now doing the same with the NHS.

Support your doctors and fight for the NHS before it is too late.

Monday, 25 January 2016

A Commission Could Spell Disaster for the NHS

There has been much debate in recent times that the only thing to save the NHS is a 'cross party commission'. The constant refrain that the NHS is bust belies the fact that the NHS has been in surplus in recent years with the leftover funds sent back to the Treasury and not used for healthcare. What is also forgotten is that there is a set of government imposed cuts to the NHS of over £20bn. This is why the NHS is struggling, waiting times are increasing, beds are never freed up, doctors struggle to properly care for patients and A&Es, hospitals and GP surgeries are bursting at the seams.
A commission has been backed by some well known people who have some very worrying hidden facts about themselves that they are not keen to broadcast. Norman Lamb MP has spearheaded the campaign for a commission. Here is a politician who was at the heart of health policy in the Tory led coalition from 2010-2015 – a period of time that pushed through the disastrous Health and Social Care Bill on the NHS in England and forced huge cuts to the service leaving it in the parlous state it is today. In cahoots with Lamb calling for a commission are Stephen Dorrell and Alan Milburn.
Dorrell stood down from Parliament in 2015 after 36 years at the heart of the Tory machine. He was chair of the influential Health Select Committee and most notably recently took a role with the firm KPMG whilst still an MP and at a time when KPMG were bidding for NHS contracts worth £1bn.
Milburn was a Labour MP and as Secretary of State for Health he was the architect of New Labour’s warm welcome of the private sector into the NHS. He subsequently left Parliament to ‘spend more time with his family’ and his since taken lucrative roles with the firm Bridgepoint Capital and PriceWaterhouseCoopers – both of which have taken substantial contracts from the NHS. Sometimes they even leave patients high and dry when the profits dry up.
The point I am making is that all these individuals have been involved in many aspects of English NHS privatisation – a process that has destabilised and fragmented the service wasting billions of pounds that could have been spent on patient care.
Governments of the day can choose the remit of a Royal Commission and influence the choice of chair for the Commission. Governments can also completely ignore the report findings if they don’t like the outcome.
This is a real danger. We have a Conservative majority government hell bent on reducing spend on public services to 1930s levels - and making a very good job of it up to now. A commission is the perfect vehicle for them to ‘discuss’ NHS funding and embrace their hoped for outcome requiring charging for NHS services or an insurance based health care system. And the beauty of it is that the Conservatives can say it was all decided upon by an ‘independent commission’.
So the project that Margaret Thatcher contemplated but never dared go near could be completed by her protégé David Cameron in the next year or two. The NHS as we know will cease to exist. Private healthcare firms, health lobbyists and insurance companies for whom politicians work for and profit from will rake in many more millions and it will be patient care that suffers and the NHS will be doomed.

I urge you to write to your MP to oppose a commission for all the reasons I give. You can write to your MP here. This may be the last chance saloon for the NHS.