tag:blogger.com,1999:blog-83162238835461715852024-03-29T04:02:34.756-07:00Dr David WrigleyMy thoughts on politics & the NHSDavid Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.comBlogger56125tag:blogger.com,1999:blog-8316223883546171585.post-16176455274607766212018-01-30T15:08:00.003-08:002018-01-30T15:32:21.130-08:00The serious implications of the case of Dr Bawa-GarbaA shockwave swept through the medical profession this week. The <span style="color: blue;"><a href="http://www.bbc.co.uk/news/uk-england-leicestershire-42816913" target="_blank"><span style="color: blue;">erasure from the medical register</span></a> </span>of Dr Bawa-Garba left many doctors thinking 'that could be me.....'.<br />
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Dr Bawa-Garba was a junior doctor working in a busy paediatric department in Leicester in 2011. She was just back from a years maternity leave and thrown straight back into acute paediatric care with doctors missing on the rota, faulty hospital equipment and far too much work/too many patients to remain a safe doctor.<br />
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Tragically, on that day a child died due to multiple failures and indeed the hospital itself admitted it had many areas it needed to improve on to prevent such an incident occurring again.<br />
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Dr Bawa-Garba was subsequently convicted of manslaughter in a court of law and given a 2 year suspended sentence. It is said the court did not take into account the serious pressures Dr Bawa-Garba faced that day.<br />
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Some time later she subsequently went through a process at the Medical Practitioners Tribunal Service (MPTS) - an independent panel who impose sanctions on doctors who have been accused of misdemeanours. That MPTS tribunal took all the evidence into account and spent hours analysing the information before them. They decided to suspend the doctor from the medical register for 12 months as an adequate penalty. She couldn't work or earn for 12 months and then had to come back to the MPTS in 12 months to give good reasons why she should be able to work again.<br />
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The General Medical Council (GMC) didn't like what the MPTS did. They now have a <span style="color: blue;"><a href="https://www.gmc-uk.org/news/28450.asp" target="_blank"><span style="color: blue;">new power</span></a> </span>where they can appeal a decision of the MPTS. This is what they did and the outcome from the High Court last week was that Dr Bawa-Garba should be erased from the medical register - 'struck off'. She could no longer work in any capacity as a doctor for at least 5 years, no longer earn an income and would have to live with the stigma of being 'struck off'.<br />
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This sent a shockwave through the whole medical profession who now worry that they may too be struck off if they make a mistake when under serious pressure in an underfunded and under staffed NHS. Doctors are told to speak up when they feel conditions are unsafe for them at work but if they do speak out this could be used against them if a mistake is made.<br />
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Doctors are now between a rock and a hard place and much anger has been directed at the GMC asking them exactly what doctors should do nowadays in the pressured NHS - speak out, walk out, keep quiet? The law of medical manslaughter may also need revisiting and this is down to Parliament to address.<br />
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As chair of Doctors in Unite we released <a href="https://docs.google.com/document/d/1CSRBDk1_xCj7Mc_t40xkDR7iL-9esSRzrzmcr3LsA3o/edit" target="_blank"><span style="color: blue;">this statement</span></a> on the issue which goes into more detail.<br />
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Many doctors are very worried now as they go to work every day wondering 'will it be me next?'David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com19tag:blogger.com,1999:blog-8316223883546171585.post-34005758491581827882017-12-13T09:25:00.005-08:002017-12-13T09:25:37.551-08:00General practice is on a cliff edge - and ACOs could tip it over<div class="MsoNormal">
The latest acronym to hit the NHS is ACO – Accountable Care
Organisations. You would be forgiven for sighing with disbelief at yet another
change to the way the NHS operates. It wasn’t enough for the Conservative led
coalition to push through the single biggest reorganisation of the NHS with the
Health and Social Care Act 2012 – a change so big you could ‘<a href="https://fullfact.org/health/end-nhs-we-know-it-guide-health-and-social-care-act/">see
it from space’</a> according to the then NHS chief executive David Nicholson.<o:p></o:p></div>
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ACOs are the latest reorganisation by <a href="https://www.england.nhs.uk/publication/accountable-care-organisation-aco-contract-service-conditions-1bii/">NHS
England</a> which Simon <span style="background: white; color: #333333; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Stevens expects to “deliver fast-track improvements,
such as fewer emergency hospitalisations and better care in people’s homes”. On
the face of it that sounds like a good plan but the potential seismic shift in
how the NHS runs under an ACO is frightening.<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">ACOs will
seek to bring together all organisations (providers and commissioners) offering
health and social care under ‘one roof’ in a geographical area. Social care is
now based on means testing so you have to pay if you have some savings. There
is a risk health care will go down a similar route within an ACO. All those in
an ACO will be jointly responsible for care – and crucially jointly responsible
for the multi million pound deficits run up by hospital trusts due to
government underfunding. GPs beware…. you could also be responsible for sorting
out that deficit within the ACO.<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Another
concern is that an ACO will be very much driven by secondary care given the
large budgets they have and offices full of lawyers, accountants and managers.
General practice is already in such a bad place with wholly inadequate funding,
inability to retain or recruit GPs and a workforce so ground down with work and
stress they haven’t got the time to speak out or stand up to such proposals.
LMCs have a vital role to play as the true advocate for GPs and they must be
central to any discussions on reconfiguration of services. <o:p></o:p></span></div>
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<span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><br />
ACOs have the potential to remove the list based general practice that has
served our patients well since 1948 and consume all patients into the ACO with
the role of the GP as yet being unclear. It may be that the GPs become salaried
in their ‘ACO practice’ or salaried to the local hospital trust. It is hard to
see the independent contractor model surviving such a shift in ethos of how the
NHS is configured. Private companies and insurance firms will be watching this
change with interest as they will see a big opportunity to profit by working
with ACOs by taking on lucrative contracts or offering insurance products to
patients in such a large health organisation. Government legislation will allow
this to happen.<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Practices
who are very large or have strong voices may be able to ride this storm but the
threats are clear. The NHS is in such a mess with massive underfunding, a
demoralised profession and politicians with no interest in preserving what was
once the jewel in the crown that was general practice. <o:p></o:p></span></div>
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<span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">There may be
some hope heading our way though. The government have singularly failed to
explain these changes or consult on them and this has angered many people.
Health professionals including Professor Allyson Pollock and Dr Ben White (who
has already taken Jeremy Hunt to court over the junior doctor dispute) have
launched a </span><a href="https://www.crowdjustice.com/case/jr4nhs-round2/"><span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">crowdfunding appeal</span></a><span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> to take the government to the high court for a
judicial review over the ACO changes. It might make the government think twice
and I urge you to support them.<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">General
practice is on a cliff edge. ACOs pose significant threats and it is vital we
inform ourselves on these huge changes to the NHS and speak out about them
before it is too late.<o:p></o:p></span></div>
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<i>This article first appeared in <a href="https://www.gponline.com/general-practice-cliff-edge-acos-tip/article/1452411" target="_blank"><span style="color: blue;">gponline.com</span></a></i></div>
David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com8tag:blogger.com,1999:blog-8316223883546171585.post-26713792422241254862017-09-05T08:00:00.000-07:002017-09-21T06:00:32.331-07:00Second-guessing your GPs referralIt has become apparent that some parts of the country will see the NHS intervening and looking at your GPs referral if you need to see a hospital doctor or other specialist service.<br />
<br />
This made me consider a few issues and the implications of this. The excellent <a href="https://www.opendemocracy.net/" target="_blank"><span style="color: blue;">OpenDemocracy</span></a> published my thoughts and you can find them <span style="color: blue;"><a href="https://www.opendemocracy.net/ournhs/david-wrigley/second-guessing-your-gp-s-referral-nhs-denials-leave-big-questions-unanswered" target="_blank"><span style="color: blue;">HERE</span></a>.</span>David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com3tag:blogger.com,1999:blog-8316223883546171585.post-35870166034859477112017-07-19T08:31:00.000-07:002017-07-19T08:46:55.466-07:00Why are GPs considering closing their patient listsBelow is an FAQ composed and supported by the people named at the end of the document. The document is to be used to explain the reason why GPs are considering such a significant move. GPs are reaching breaking point and we must make the government sit up, listen to the professionals and fund and support the NHS and general practice adequately.<br />
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<br />
<div align="center" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;">
<b><u><span style="font-family: "calibri";">List closure FAQs<o:p></o:p></span></u></b></div>
<div align="center" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;">
<b><u><span style="font-family: "calibri";"><br /></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "helvetica";">We are aware that practices have started to receive their ballot
papers from the BMA asking you to vote as to whether you are willing to
consider collectively closing your list in response to the crisis in General
Practice, in line with the motion that was passed at LMC conference in May
which said:<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "calibri";">“That conference believes that the GP Forward View is failing to
deliver the resources necessary to sustain general practice and demands that
GPC ballot GPs as to whether they would be prepared to collectively close their
lists in response to this crisis.”</span><span style="font-family: "times";"><o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "times";">Many practices have approached us for more information. In
response we have compiled a list of FAQs which we hope are helpful. We urge you
to read this in conjunction with the FAQs sent out by the BMA and
stress that in this ballot you are not voting to close your lists but to give
GPC a steer as to whether you are willing to consider this action.
This initial vote is to strengthen the hand of GPC when
dealing with the Government. Only after a YES vote in this survey will GPs be
balloted on whether they will actually close.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "calibri";">Q: Why are we balloting for willingness
to take action?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "calibri";">A: It
is beyond doubt that General Practice is in meltdown with dangerous levels of
workload every day. The public sector pay cap has meant that doctors have
effectively taken a 22% pay cut in the last decade. In general practice this
means the small business we run to care for our patients rapidly becomes
unviable. Practices are closing across the county. All we have been offered is
the totally inadequate GP Forward View and a couple of other sweeteners such as
reimbursement of CQC fees. This is simply not enough
to be able to provide the care our patients need. </span><span style="font-family: "calibri";"><o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "calibri";"> </span></b><b><span style="font-family: "calibri";">Q:
Why are GPC proposing list closure?</span></b><b><span style="font-family: "calibri";"><o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "calibri";">A:
General Practice is governed by contract. Refusing to comply with many clauses
in the contract, such as refusal to cooperate with CQC, would risk a
breach notice. List closure however, if carried out on the grounds of patient
safety, is allowed under the contract.</span><span style="font-family: "calibri";"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "calibri";"><a href="https://www.bma.org.uk/advice/employment/gp-practices/quality-first/manage-inappropriate-workload/list-management" target="_blank">https://www.bma.org.uk/advice/employment/gp-practices/quality-first/manage-inappropriate-workload/list-management</a></span><span style="font-family: "calibri";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "calibri";">“A practice can decide not to register new patients,
provided it has ‘reasonable and non-discriminatory grounds for doing so’, (such
as protecting the quality of patient services.) In such cases, the regulations
allow practice to refuse to register new patients (Schedule 6, Part 2,
paragraph 17).”</span><span style="font-family: "calibri";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "calibri";">Any
action by medical professionals is only done with a heavy heart. In advising
practices to consider list closure, our representatives are clear that this is
a way of causing maximum disruption to the governments plans for the NHS,
registering our disdain at their failure to adequately fund general practice,
whilst causing no harm to our registered patients. </span><span style="font-family: "calibri";"><o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "calibri";">Q: What should I say to patients?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "calibri";">A: Be
honest. Tell them we regret taking this action and do not do it lightly, but
that the Government have not listened to years of warnings about the strain on
General Practice and that now it is on the point of collapse. We have to do
something to stop it breaking down altogether. We struggle to provide a safe
service due to our workload and that this is not good for patients. Ask
patients to support you, put a petition in the waiting room and ask them to
write to their MP.</span><span style="font-family: "calibri";"> </span><span style="font-family: "calibri";">Our patients are the strongest weapon we have in fighting
for general practice. Tell them what you are doing and why. </span><span style="font-family: "calibri";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "calibri";"><br />
</span><b><span style="font-family: "calibri";">Q: My practice has a high turnover, if
we close our list we will rapidly lose income. </span></b><b><span style="font-family: "calibri";"><o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "calibri";">A: For
practices like yours, consider deciding a minimum list size to sustain the
service, then temporarily close your list until patient numbers had dropped below
this. You could then re-open until your safe limit was reached, closing again
and so on. Remember the aim is to highlight the dangerous working conditions we
all face and the impact this has on patient care. You can still achieve
this. </span><span style="font-family: "calibri";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "calibri";"> </span><b><span style="font-family: "calibri";">Q: What about the patients who are not
registered with a GP?</span></b><b><span style="font-family: "calibri";"><o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "calibri";">A: GPs
will remain able to see patients as temporary residents in emergency
circumstances. We regret that this action will mean a delay in registering
fully with a GP, but failure to act will lead to the collapse of General
Practice which would mean a lack of access for all. As a profession we do not
do this lightly, but the risk to our patients is greater if we do
nothing. NHS England will still be able to allocate patients to closed
lists, as is the case currently in many areas where all practices have closed
lists. If this list closure happens nationwide however it causes a significant
increase in workload for NHSE, as well as public embarrassment to the
government. </span><span style="font-family: "calibri";"><o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "calibri";">Q: I understand the need to take action
but I am nervous.<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "calibri";">A: Of
course. We are a caring profession who are reluctant to do anything to hurt or
upset our patients. Having considered many options, we genuinely believe this
is the best choice to cause maximum disruption for Government, but minimal harm
to patients. The risk of continuing to provide care at this unsafe
workload outweighs the risk of carrying out this action. </span><span style="font-family: "calibri";"><o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "calibri";">Q: Why
are we balloting for “collective” list closure?</span></b><b><span style="font-family: "calibri";"><o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "calibri";">A:
Because together we are much stronger and can have a much bigger impact. If we
stand united across the profession, supporting each other we can make rapid
gains. Uniting GPs across the country means we can deliver a stronger message
and hopefully achieve our aims quickly. </span><span style="font-family: "calibri";"><o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "calibri";">Q:
What do you want the Government to do?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "calibri";">A: There are many things that Government could do. These are
some suggestions:<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraph" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "calibri";">1.<span style="font-family: "times new roman"; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "calibri";">Enact BMA policy and fund the NHS to the level of
comparable countries and at the same time increase the proportion of NHS
funding which is allocated to General Practice to at least 15%. </span><span style="font-family: "calibri";">In 2015 the UK spent 7.3%
of GDP on the NHS. This is lower than most other European countries and is set
to decease to 6.6% by 2020. The UK has fewer hospital beds per head at 2.8/1000
than the OECD overage of 3.3 and has fewer doctors and nurses per head than
comparable developed nations</span><span style="font-family: "calibri";">. Despite this the NHS is regularly
found to be the most cost effective health care system in the developed world. </span><span style="font-family: "calibri";"><a href="http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror" target="_blank">http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror</a></span><span style="font-family: "calibri";"><br /></span><br />
<br /></div>
<div class="MsoListParagraph" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "calibri";">2.<span style="font-family: "times new roman"; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "calibri";">Take responsibility for GP indemnity in the same way that they do
for hospital doctors.</span><span style="font-family: "calibri";"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoListParagraph" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "calibri";">3.<span style="font-family: "times new roman"; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "calibri";">Allow
patients to directly refer themselves for services such as antenatal, terminations
of pregnancy, podiatry, physiotherapy, weight management programmes etc, to
remove needless administrative burden from general practice.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "calibri";">4.<span style="font-family: "times new roman"; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "calibri";">Remove all of the hoops that we have to jump through to for
example obtain the tiny pots of money in the GP Forward View. Funding must be
made directly available for all practices. <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoListParagraph" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "calibri";">5.<span style="font-family: "times new roman"; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "calibri";">Deal with the incompetence of companies such as
Capita and NHS Property Services whose failures cause such time wasting in
surgeries.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraph" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "calibri";">6.<span style="font-family: "times new roman"; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "calibri";">Sort out NHS Property Services so that they stop wasting
practices time with repeated premises surveys and sending unjustifiable service
charge bills.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraph" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "calibri";">7.<span style="font-family: "times new roman"; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "calibri";">Attract doctors and nurses into General Practice, both young
doctors and those who have left. Increasing doctors and nurses will help
decrease the workload which 84% of us have said undermines our ability to
provide safe patient care and enable us to provide a safe service for patients.</span><a href="https://www.bma.org.uk/news/2016/november/workload-strain-compromises-patient-safety-finds-survey"><span style="font-family: "calibri";">https://www.bma.org.uk/news/2016/november/workload-strain-compromises-patient-safety-finds-survey</span></a><span style="font-family: "calibri";"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraph" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "calibri";">8.<span style="font-family: "times new roman"; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "calibri";">Confirm the residency status of all non British born doctors
and nurses immediately so that they remain here making their vital contribution
to our health service.<span style="font-size: 9pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
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<span style="font-family: "calibri";"><b>Dr
Rachel Ali, GP.<o:p></o:p></b></span></div>
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<span style="font-family: "calibri";"><b>Dr
Jackie Applebee, Tower Hamlets GP.<o:p></o:p></b></span></div>
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<span style="font-family: "calibri";"><b>Dr
Susie Bayley, GP Derbyshire.<o:p></o:p></b></span></div>
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<span style="font-family: "calibri";"><b>Dr
Naomi Beer, Tower Hamlets GP<o:p></o:p></b></span></div>
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<span style="font-family: "calibri";"><b>Dr
Naureen Bhatti, Tower Hamlets GP.<o:p></o:p></b></span></div>
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<span style="font-family: "calibri";"><b>Dr
Kambiz Boomla, Tower Hamlets GP<o:p></o:p></b></span></div>
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Russell Brown, GP <o:p></o:p></b></span></div>
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Prit Buttar GP Oxfordshire.<o:p></o:p></b></span></div>
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<span style="font-family: "calibri";"><b>Dr
Stephanie de Giorgio, GP<o:p></o:p></b></span></div>
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Louise Irvine, Lewisham GP and Chair Save Lewisham Hospital Campaign.<o:p></o:p></b></span></div>
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Matt Mayer, GP.<o:p></o:p></b></span></div>
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<span style="font-family: "calibri";"><b>Dr
Ben Molyneux, GP.<o:p></o:p></b></span></div>
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<span style="font-family: "calibri";"><b>Dr
Gerard Reissman GP Newcastle and North Tyneside.<o:p></o:p></b></span></div>
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<span style="font-family: "calibri";"><b>Dr
David Wrigley, GP in Lancashire.<o:p></o:p></b></span></div>
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<!--EndFragment--></div>
David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com7tag:blogger.com,1999:blog-8316223883546171585.post-869888476628630472017-06-30T08:23:00.000-07:002017-07-19T08:26:14.230-07:00Charges to see a GPOn June 29th 2017 at the annual BMA meeting of UK representatives I proposed a resolution that stated -<br />
<br />
<br />
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<b><span style="font-family: Calibri; font-size: 11pt;">Motion </span><span style="font-family: 'Calibri'; font-size: 11.000000pt;">by NORTH WEST REGIONAL COUNCIL: </span></b><br />
<b><span style="font-family: 'Calibri'; font-size: 11.000000pt;"><br /></span></b>
<b><span style="font-family: 'Calibri'; font-size: 11.000000pt;">That this meeting opposes charges for
patients:-
</span></b><br />
<b><span style="font-family: 'Calibri'; font-size: 11.000000pt;"><br /></span></b>
<span style="font-family: 'Calibri'; font-size: 11.000000pt;"><b>i) to see a GP;<br />
ii) if an appointment is missed. </b></span><br />
</div>
</div>
</div>
<br />
The resolution was passed with a significant majority and now becomes BMA policy. It was an important moment at a time when many commentators and some politicians are saying 'we need an honest debate about what the NHS can afford' which is doublespeak for 'lets bring in some charges to use NHS services'.<br />
<br />
This was the speech I gave......<br />
<br />
<br />
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<b><i>Chair<o:p></o:p></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><i>The BMA has clear policy supporting
the 1948 founding principles of the NHS – comprehensive care free at the point
of access available to EVERYONE funded from general taxation<o:p></o:p></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><i>We see a growing call to introduce
charges to see a GP. <o:p></o:p></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><i>This will introduce a consumerist
approach to healthcare. A consumerist approach will become part the doctor
patient relationship. That will corrode the relationship we have with our
patients and would paradoxically increase demand. Charging to see a GP would discourage
patients from seeking both necessary and unnecessary treatment.<o:p></o:p></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><i>It would be penny wise but pound
foolish.<o:p></o:p></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><i>What do charges do – they
discourage the poor and disadvantaged from getting the care they need<o:p></o:p></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><i>In Germany they introduced a
charging system in 2004 called Praxisgebuher. Studies have shown that fewer
patients received the treatment they needed. There was a subsequent increase in
non evidence based treatment and those with a lower consultation frequency were
particularly affected. <o:p></o:p></i></b></div>
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<br /></div>
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<b><i><span style="background: white; color: #333333; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">One U.S. study published in
the </span><span style="border: none windowtext 1.0pt; color: #333333; mso-bidi-font-family: "Times New Roman"; mso-border-alt: none windowtext 0cm; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB; padding: 0cm;">New
England Journal of Medicine</span><span style="background: white; color: #333333; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"> involving fairly healthy
adults showed that patient charges led to a 20 per cent increase in risk of
death for people with high blood pressure because people were less likely to
see a doctor and get their blood pressure under control.<o:p></o:p></span></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><i><span style="background: white; color: #333333; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Faced with charging, the evidence
shows that people often do without preventative care and chronic disease
management. Patient charges means they have to decide whether or not symptoms
warrant medical attention. For example, when a child has a fever, most parents
don't know whether it's the flu or the onset of meningitis. Do we really want
parents to make the decision about whether to take their child to the doctor on
the basis of whether these very charges will leave enough money to pay the
rent?</span><span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><i>Charging patients is a ZOMBIE
policy <o:p></o:p></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><i>It’s a policy that is killed off
repeatedly by scientific evidence but, just like zombies, it keeps bouncing
back to try and wreak havoc on our NHS. <o:p></o:p></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><i>We must not punish our patients for
political failure. <o:p></o:p></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><i>Please send a strong message to
politicians, policy makers and those who wish to turn our NHS into a
marketised, consumerist, insurance policy driven health care service.<o:p></o:p></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><i>Please vote unanimously for this
motion. </i></b><o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
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David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0tag:blogger.com,1999:blog-8316223883546171585.post-40054165040835394352017-04-13T09:43:00.002-07:002017-04-13T09:43:43.637-07:00A Porsche or a Ventilator?We've seen the government announce they want to borrow money from City hedge funds to prop up the NHS finances. In effect this means taxpayers will be funding a hedge fund dealers new Porsche rather than buying a neonatal ventilator. Tax payers will be fleeced and huge interest payments on this deal will go to the hedge fund meaning less funds are available to the NHS for direct patient care.<div>
<br /></div>
<div>
I've written an article in the BMJ on this and you can read it here...</div>
<div>
<br /></div>
<div>
<a href="http://blogs.bmj.com/bmj/2017/04/13/david-wrigley-financing-the-nhs-through-hedge-funds/">http://blogs.bmj.com/bmj/2017/04/13/david-wrigley-financing-the-nhs-through-hedge-funds/</a></div>
<div>
<br /></div>
<div>
Do leave a message on the BMJ website on how you feel about this. </div>
<div>
<br /></div>
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David </div>
David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com161tag:blogger.com,1999:blog-8316223883546171585.post-45831274967508420382017-04-09T09:24:00.001-07:002017-04-09T09:24:22.682-07:00A new low?A new low seems to have occurred with the government publishing a form that has to be filled out by women who have been raped.<br />
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The government recently pushed through <a href="http://www.entitledto.co.uk/help/Exemptions_to_2_child_limit" target="_blank"><span style="color: blue;">changes to child support</span></a> so that any family having a 3rd child cannot claim this support. This was hugely controversial and was voted through due to the Tories having a Parliamentary majority.<br />
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One aspect was around a woman who had been raped and thus had a 3rd child due to the rape. The government felt they needed to check women were not making the rape up so came up with this form for women to fill out.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOar2x5LpueyBgsltKmIGRwLob90F15sN7QmaMrJctF5Dt83Iotpln0yjasd4RyzoRlNv0gFwzqLnLtb2lwx4OuG7g4b6cWjhNEHXX1Tk_BZEI-PsgR9NxrPkq1YSHHfkHBe-ZJygXJiY/s1600/Screen+Shot+2017-04-09+at+16.36.11.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOar2x5LpueyBgsltKmIGRwLob90F15sN7QmaMrJctF5Dt83Iotpln0yjasd4RyzoRlNv0gFwzqLnLtb2lwx4OuG7g4b6cWjhNEHXX1Tk_BZEI-PsgR9NxrPkq1YSHHfkHBe-ZJygXJiY/s320/Screen+Shot+2017-04-09+at+16.36.11.png" width="223" /></a></div>
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What they have failed to grasp is that many rapes occur within a relationship yet they ask of the woman to declare if they are not living with 'the other parent'.<br />
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How will this make the woman feel? How many are likely to own up to this and fill the form out?<br />
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It is so heartless and despicable of this government to do this.<br />
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Even if you agree with the fact that a 3rd child is not deserving of any child benefit (many do not agree with this) it has come to something when your own government seeks information like this and a formal declaration of the rape and residential status of the alleged rapist.<br />
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Words fail me and I wondered how you feel about this?David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0tag:blogger.com,1999:blog-8316223883546171585.post-36304227544125353662016-12-20T14:54:00.003-08:002016-12-20T14:54:52.186-08:00STPsThis is the latest issue to hit the NHS and it is very worrying. I wrote this for the Huffington Post. Have a read and see what you think about STPs.....<br />
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<a href="http://www.huffingtonpost.co.uk/david-wrigley/stps-are-no-justification_b_13647056.html?"><span style="color: blue;">http://www.huffingtonpost.co.uk/david-wrigley/stps-are-no-justification_b_13647056.html?</span></a><br />
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<br />David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0tag:blogger.com,1999:blog-8316223883546171585.post-38663544355750617252016-10-16T09:43:00.000-07:002016-10-16T09:43:22.248-07:00Could private top-up insurance help fund the NHS?<div class="teaser" style="border: 0px; box-sizing: border-box; font-family: interfaceregular, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 20px; line-height: inherit; margin: 0px; padding: 5px 0px 10px; vertical-align: baseline;">
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<span style="color: #333333;">This article first appeared in the </span><a href="http://www.bmj.com/content/355/bmj.i5424" target="_blank"><span style="color: blue;">BMJ</span></a></div>
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Current tax revenues cannot maintain healthcare standards, writes <strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-variant-caps: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Christopher Smallwood</strong>, but <strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-variant-caps: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">David Wrigley</strong> worries that introducing inequity sounds the death knell of a service free for all who need it</div>
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Yes—Christopher Smallwood</h2>
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It is hardly controversial to suggest that standards of healthcare in the NHS are declining. A stream of recent reports has shown the strain the NHS is under, drawing attention to a near universal failure to meet the target of four hours’ waiting time in emergency departments,<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-1" id="xref-ref-1-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">1</a> the longest waiting times for operations since 2007, and unprecedented staff shortages. </div>
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The principal cause of this lamentable state of affairs is unquestionably underfinancing of the system. In 2012-13, few trusts were in deficit but by 2015-16 the proportion had reached 85%.<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-2" id="xref-ref-2-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">2</a> As the King’s Fund has said, we are “facing a health system buckling under the strain of huge financial pressures.”<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-2" id="xref-ref-2-2" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">2</a></div>
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Current problems are set to intensify at an alarming rate. The budget for NHS England is planned to rise by 1.4% next year, then by 0.4% and 0.7% in the following two years, compared with an expected rise in demand and cost pressures of between 4% and 5% a year.<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-3" id="xref-ref-3-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">3</a></div>
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Muddling through</h3>
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If we try to go on “muddling through,” a steady erosion of standards is inescapable. Trusts under ferocious pressure to balance the books leave vacancies unfilled, cut the ratio of staff to patients, slash capital spending, defer operations, increase waiting times, cut training, and restrict the treatments they are prepared to offer.</div>
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The only hope of reversing this process is properly to debate how to bring more money into the NHS. The NHS will not be adequately financed as long as it relies exclusively on tax revenues. Given budgetary constraints, it is inconceivable that the government will approve NHS budgets rising more rapidly than gross domestic product to match rising demand.</div>
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The choice is stark: either we find new sources of finance to supplement tax revenues or we accept the prospect of declining standards for years ahead.</div>
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French model</h3>
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Lessons can be learnt from some other European countries that provide excellent healthcare and are financed differently from our system. If we moved towards the French model, for example, mainstream healthcare could continue to be mainly financed from public funds, but the proportion of treatment costs covered would vary depending on the service provided.<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-4" id="xref-ref-4-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">4</a> Treatment for catastrophic events would be paid for entirely by the state, with more minor treatments requiring a contribution from individuals. People on benefits would be exempt from such charges so that everyone could receive the care they needed.</div>
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The government could negotiate with insurance companies the premiums chargeable to provide cover for this menu of charges, as in Switzerland and the Netherlands, and also for the treatments which the NHS is likely to withdraw from as the financial squeeze continues. Without such a scheme, poorer people may lose access to these treatments.</div>
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Far lower premiums</h3>
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A French style scheme would make top-up insurance readily affordable for most people. The premiums would be far lower than for private insurance at present because the bulk of costs would remain covered by the state.</div>
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The French experience is that people opt for top-up insurance in large numbers—95.5% of people have it and the rest have their healthcare paid for from social funds<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-5" id="xref-ref-5-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">5</a>—so it is not easy to describe this as a two tier service. Over time, it is possible to envisage that a quarter of healthcare in the UK would be paid for from these supplementary funds, as it is in France, enabling us once again to deliver international standards.</div>
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People on low incomes would be treated for free, with better-off people making contributions well within their means. We’re rich enough to drop the “free at the point of use” principle for the pragmatic “no one should be denied the healthcare they need for financial reasons.” How else can we reverse the decline in standards that now looks inevitable?</div>
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No—David Wrigley</h2>
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The NHS is going through one of the toughest periods of its life.<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-6" id="xref-ref-6-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">6</a> Every day we hear of general practices closing,<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-7" id="xref-ref-7-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">7</a>hospitals at full capacity,<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-8" id="xref-ref-8-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">8</a> patients waiting in pain in emergency department corridors, ambulances queuing up with patients outside hospitals, and a social care system cut to the bone.</div>
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Politicians, commentators, and think tanks often say that we need a serious conversation about NHS funding.<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-9" id="xref-ref-9-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">9</a> This usually means, “Let’s start making patients pay.” And because of the huge pressures the NHS is under some of them think that soon this will happen<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-10" id="xref-ref-10-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">10</a>: private companies will offer “fee-for-service” appointments or care, and private insurance companies will help write new “NHS policies” to give patients access to their GP or to pay for some operations or procedures.</div>
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Any appointments above a threshold, or more complex procedures, would be funded by patients “topping up.” This is common in the United States, which has one of the best healthcare systems—if you can afford it—but also some of the most iniquitous healthcare in the world.</div>
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Envy of the world</h3>
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That is why the model of the NHS from 1948 onwards has been the envy of the world. It is paid for from general taxation, free at the point of use, and available to all no matter what your background, bank balance, or location in the UK. </div>
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We must ask why we are in such a dire financial situation when in 2010 the NHS had the highest ever satisfaction rating and shortest ever waiting times.<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-11" id="xref-ref-11-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">11</a> Since 2009 funding has increased by just 0.9% on average a year,<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-12" id="xref-ref-12-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">12</a> and this is set to continue until 2020. Many economists think that the NHS needs a 3%-4% increase a year just to keep pace with demand.<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-13" id="xref-ref-13-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">13</a></div>
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This 0.9% increase has allowed governments to say, “We have increased NHS funding year on year,” because inflation has been low.<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-14" id="xref-ref-14-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">14</a> However, it does not make up the 3%-4% shortfall and has led to this disastrous financial situation throughout the NHS.</div>
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Cuts in funding</h3>
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An explicit decision was made at the highest political levels to offer the NHS these paltry amounts. The economic policies of the 2010 and 2015 administrations have led to many cuts in funding for public services. The NHS was “protected” but only against inflation. The blame for the current state of the NHS lies firmly at the door of our politicians. This allows talk of “top-up insurance” as the answer to the NHS’s woes.</div>
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Having a budget for a package of care, say for one year’s treatment for diabetes, sounds attractive. But what happens when that money runs out? People who could afford it could top this up for extras such as diabetic retinopathy. But people with no insurance or savings would be unable to do this and lose out. We should be working hard to ensure that everyone has equal access to all the care they need.</div>
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Politicians could decide to fund the NHS adequately if they were to end their obsession with cutting public services. Governments can borrow at all-time low interest rates, and investment in healthcare has been proved good for the economy.<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-15" id="xref-ref-15-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">15</a></div>
</div>
<div class="subsection" id="sec-8" style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-variant-caps: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">
<h3 style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: 1.9rem; font-style: inherit; font-variant-caps: inherit; line-height: 3rem; margin: 0px; padding: 0px 0px 10px; vertical-align: baseline;">
Exorbitant interest payments</h3>
<div id="p-22" style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-variant-caps: inherit; line-height: 1.5; margin-bottom: 15px; padding: 0px; vertical-align: baseline;">
We should be investing in front line staff instead of “management consultants” of dubious value.<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-16" id="xref-ref-16-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">16</a> And we should find a way to end the exorbitant £2bn a year interest payments for private finance initiatives that could be spent on caring for patients.<a class="xref-bibr" href="http://www.bmj.com/content/355/bmj.i5424/rapid-responses#ref-17" id="xref-ref-17-1" style="border: 0px; box-sizing: border-box; color: #2a6ebb; font-family: inherit; font-size: 10px; font-style: inherit; font-variant-caps: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: 0.4em;">17</a></div>
<div id="p-23" style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-variant-caps: inherit; line-height: 1.5; margin-bottom: 20px; padding: 0px; vertical-align: baseline;">
Without more money we are just a short step away from the introduction of NHS health insurance or demands that the public supplement out of their own pockets. That would be a sad day for patients, and the NHS as envisaged—free for all at point of need—will be gone.</div>
</div>
</div>
<div class="section fn-group" id="fn-group-1" style="border: 0px; box-sizing: border-box; clear: both; color: #333333; font-family: interfaceregular, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 16px; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">
<h2 style="border: 0px; box-sizing: border-box; color: #1c497d; font-family: inherit; font-size: 2.2rem; font-style: inherit; font-variant-caps: inherit; font-weight: inherit; line-height: 3rem; margin: 0px; padding: 0px 0px 5px; vertical-align: baseline;">
Footnotes</h2>
<ul style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-variant-caps: inherit; line-height: inherit; list-style: none; margin: 0px; padding: 0px; vertical-align: baseline;">
<li class="fn-conflict" id="fn-1" style="border-bottom-color: rgb(200, 200, 200); border-bottom-style: solid; border-width: 0px 0px 1px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-variant-caps: inherit; line-height: inherit; margin: 0px auto; padding: 0.5em 0px; text-align: left; vertical-align: baseline; width: auto !important;"><div id="p-24" style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-variant-caps: inherit; line-height: 1.5; margin-bottom: 0.5em; margin-top: 0.5em; padding: 0px; vertical-align: baseline;">
Competing interests: Both authors have read and understood BMJ policy on declaration of interests and declare that DW is deputy chair of BMA Council.</div>
</li>
</ul>
</div>
David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com1tag:blogger.com,1999:blog-8316223883546171585.post-26730738756306572302016-07-09T13:39:00.001-07:002016-07-09T13:39:39.281-07:00A Quiet Time for the NHS<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="font-size: 14.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="font-size: 14.0pt;">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. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="font-size: 14.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="font-size: 14.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="font-size: 14.0pt;">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, <a href="https://www.bma.org.uk/collective-voice/committees/general-practitioners-committee/gpc-latest-news/arm-chair-speech" target="_blank"><span style="color: blue;">said in his conference speech</span></a> this was ‘not
possible, not sustainable, not safe’.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="font-size: 14.0pt;">Dr Napgpaul went
on to say how shameful it was that when we are the worlds 6<sup>th</sup>
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’. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="font-size: 14.0pt;">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 (<a href="http://www.justiceforhealth.co.uk/" target="_blank"><span style="color: blue;">Justice 4 Health</span></a>) consider legal action against the actions of Mr Hunt. We will have to see
where all this gets us over the summer. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="font-size: 14.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="font-size: 14.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
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<span lang="EN-GB" style="font-size: 14.0pt;">No doubt there
will be many more interesting times ahead of us!<o:p></o:p></span></div>
David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0tag:blogger.com,1999:blog-8316223883546171585.post-61075172549349408602016-04-13T10:50:00.001-07:002016-04-13T10:50:59.914-07:00Thoughts from the Picket Line<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
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<br /></div>
<div class="MsoNormal">
<span lang="EN-GB">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. <o:p></o:p></span></div>
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<span lang="EN-GB"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-GB">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-GB">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. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">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. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-GB">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. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">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. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-GB">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. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-GB">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB">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. <span style="mso-spacerun: yes;"> </span>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. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-GB">It is a national scandal. It should see a
government fall. It should see millions of us on the streets.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">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. <o:p></o:p></span></div>
<div class="MsoNormal">
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<!--StartFragment-->
<span lang="EN-GB" style="font-family: "calibri"; font-size: 12.0pt;">They are fighting for your NHS. An NHS that
might not be around much longer. </span><!--EndFragment-->David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0tag:blogger.com,1999:blog-8316223883546171585.post-46311888414933528002016-02-21T09:49:00.000-08:002016-02-21T09:55:47.055-08:00Cameron treating doctors and NHS with contemptDavid 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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg76YRM5o728wQPqG6XFlUpLVSyLkkeoASL2czTjQoEJKiAnxRTgOYVx-JJfOZ4DHBGAAMh1Nrr55ZGWR5_oUemMHQXMl6I00TbfBnQg4CYScUl_fBvCDqU0363lCK-U8ASZDQYyCux_EE/s1600/Lansley+promise.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg76YRM5o728wQPqG6XFlUpLVSyLkkeoASL2czTjQoEJKiAnxRTgOYVx-JJfOZ4DHBGAAMh1Nrr55ZGWR5_oUemMHQXMl6I00TbfBnQg4CYScUl_fBvCDqU0363lCK-U8ASZDQYyCux_EE/s640/Lansley+promise.png" width="616" /></a></div>
<br />
The full letter can be read <span style="color: blue;"><a href="http://offlinehbpl.hbpl.co.uk/NewsAttachments/PGH/Lansley%20CCGs%20-%20e-mail%2016%20Feb.pdf" target="_blank">HERE</a></span><br />
<br />
Specifically Lansley said <b><i>'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.'</i></b><br />
<br />
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<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiU3elK_bp7yc2ob7tcKJUNApisMTmXFbJSUoigeWXijsfSNGTWJnUoJEPHfmuvGxkoU7yKDU_DpNc3rlgFTsho9wr7_2AuQfA5LE3MvYQnDIBbCI0C38F7-ByTAe1GpawFXQa3hvRS76U/s1600/Virgin+win+legal+case.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="112" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiU3elK_bp7yc2ob7tcKJUNApisMTmXFbJSUoigeWXijsfSNGTWJnUoJEPHfmuvGxkoU7yKDU_DpNc3rlgFTsho9wr7_2AuQfA5LE3MvYQnDIBbCI0C38F7-ByTAe1GpawFXQa3hvRS76U/s640/Virgin+win+legal+case.jpg" width="640" /></a></div>
<br />
<b><i><br /></i></b>
The full article can be found <span style="color: blue;"><a href="http://www.healthinvestor.co.uk/ShowArticle.aspx?ID=4643" target="_blank">HERE</a></span><br />
<br />
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.<br />
<b><i><br /></i></b>
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.<br />
<br />
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.<br />
<br />
Write to your MP. Quote this article and challenge them and tell them you don't want this happening to your NHS<br />
<br />
<br />
<br />
<br />David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0tag:blogger.com,1999:blog-8316223883546171585.post-58557756108013092772016-02-16T13:58:00.002-08:002016-02-16T13:58:17.869-08:00Cameron is doing what Thatcher never daredHistory tells us many things.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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 <a href="http://www.telegraph.co.uk/comment/columnists/charlesmoore/8555607/To-change-the-NHS-you-have-to-sound-like-a-true-believer.html" target="_blank"><span style="color: blue;">Nigel Lawson wrote</span></a> 'the NHS is the nearest thing the English have to a religion'.<br />
<br />
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.<br />
<br />
Of course the Tories will say they are not privatising the NHS but the <a href="https://www.opendemocracy.net/ournhs/clive-peedell/cameron-lied-to-country-says-clive-peedell" target="_blank"><span style="color: blue;">World Health Organisation is clear</span></a> that the involvement of the private sector in providing and financing health care to patients is most definitely privatisation.<br />
<br />
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.<br />
<br />
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.<br />
<br />
Support your doctors and fight for the NHS before it is too late.David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0tag:blogger.com,1999:blog-8316223883546171585.post-72675587631956113542016-01-25T16:26:00.003-08:002016-01-25T16:26:52.961-08:00A Commission Could Spell Disaster for the NHS<div class="MsoNormal">
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 <a href="http://www.pulsetoday.co.uk/political/political-news/dh-to-hand-over-billions-of-pounds-underspend-to-treasury/20004042.fullarticle"><span style="color: blue;">been
in surplus</span></a> 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 <a href="http://www.kingsfund.org.uk/press/press-releases/nhs-set-miss-%C2%A320-billion-savings-target"><span style="color: blue;">cuts
to the NHS</span></a> 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 href="http://www.theguardian.com/society/2015/apr/07/ae-waiting-times-england"><span style="color: blue;">A&Es</span></a>,
hospitals and <a href="http://www.telegraph.co.uk/news/nhs/11583896/Average-GP-waiting-times-will-hit-two-weeks-family-doctors-predict.html"><span style="color: blue;">GP
surgeries</span></a> are bursting at the seams.<o:p></o:p></div>
<div class="MsoNormal">
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. <a href="http://www.libdems.org.uk/norman_lamb_calls_for_a_commission_into_the_health_and_social_care_crisis"><span style="color: blue;">Norman Lamb MP</span></a> 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 <a href="http://www.bbc.co.uk/news/health-35233346"><span style="color: blue;">Stephen Dorrell and Alan
Milburn</span></a>. <o:p></o:p></div>
<div class="MsoNormal">
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 <a href="http://www.telegraph.co.uk/news/politics/conservative/11264425/Stephen-Dorrell-MP-faces-calls-to-resign-over-conflict-of-interest.html"><span style="color: blue;">took
a role</span></a> with the firm KPMG whilst still an MP and at a time when KPMG were
bidding for NHS contracts worth £1bn. <o:p></o:p></div>
<div class="MsoNormal">
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 <a href="http://www.bridgepoint.eu/en/our-team/alan-milburn/"><span style="color: blue;">Bridgepoint Capital</span></a>
and <a href="http://www.pwc.co.uk/industries/healthcare/meet-the-team.html">PriceWaterhouseCoopers</a>
– both of which have taken substantial contracts from the NHS. Sometimes they even leave
patients high and dry <a href="http://www.chroniclelive.co.uk/news/north-east-news/private-company-exiting-newcastle-gp-7067521"><span style="color: blue;">when
the profits dry up</span></a>.<o:p></o:p></div>
<div class="MsoNormal">
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.<o:p></o:p></div>
<div class="MsoNormal">
Governments of the day can choose the remit of a <a href="https://en.wikipedia.org/wiki/Royal_Commission"><span style="color: blue;">Royal Commission</span></a> and
influence the choice of chair for the Commission. Governments can also
completely ignore the report findings if they don’t like the outcome. <o:p></o:p></div>
<div class="MsoNormal">
This is a real danger. We have a Conservative majority
government hell bent on reducing spend on public services to <a href="http://www.theguardian.com/uk-news/2014/dec/03/autumn-statement-2014-george-osborne-spending-cuts"><span style="color: blue;">1930s
levels</span></a> - 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’. <o:p></o:p></div>
<div class="MsoNormal">
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 <a href="http://socialinvestigations.blogspot.co.uk/p/key-facts-of-lords-and-mps-connections.html"><span style="color: blue;">for
whom politicians work</span></a> for and profit from will rake in many more millions
and it will be patient care that suffers and the NHS will be doomed. <o:p></o:p></div>
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<div class="MsoNormal">
I urge you to write to your MP to oppose a commission
for all the reasons I give. <span style="background-color: white;"><a href="http://www.theyworkforyou.com/"><span style="color: blue;">You can
write to your MP here</span></a>.</span> This may be the last chance saloon for the NHS.<o:p></o:p></div>
David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com2tag:blogger.com,1999:blog-8316223883546171585.post-7081885726943206922015-12-14T16:07:00.001-08:002015-12-15T00:25:10.047-08:00A Letter to Professor Steve Field14th December 2015<br />
<br />
<div class="MsoNormal">
Dear Professor Field<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I noticed the Daily Mail printed your latest comments on a
Monday – what is usually a crushingly busy day of the week for UK GPs.<span style="mso-spacerun: yes;"> </span>I am not sure if you work as a GP on a Monday but if
you did you would see what pressure GPs and their staff work under due to the
failings of those working from comfortable offices in London – politicians and
senior managers like yourself.<o:p></o:p></div>
<div class="MsoNormal">
The <a href="http://www.pulsetoday.co.uk/your-practice/regulation/cqc/professor-steve-field-says-gps-have-failed-as-a-profession/1/20030685.article?PageNo=5&SortOrder=dateadded&PageSize=10#comments"><span style="color: blue;">commen</span>t</a>
that hit the headlines was that ‘GPs have failed as a profession’ and you were 'ashamed to be a GP'. My jaw
dropped when I read this. I just couldn’t believe someone who had once led the
profession as Chair of the Royal College of General Practitioners could say
this. I had to read it again for it to sink in properly.<o:p></o:p></div>
<div class="MsoNormal">
UK GPs saw this comment you made and their morale sank even
lower than the subterranean depths it is now at. As they battled with their 12-14 hour day seeing around 60-70 patients or more they wondered why you were beating them with a stick again. <o:p></o:p></div>
<div class="MsoNormal">
General practice is on the verge of collapse Professor Field.
Our workload is unsustainable. It is not safe and we have had enough. We have
seen politicians cut the funding to our once world renowned profession year on
year. Once we had around 13% of the NHS pie. Now it is down to <a href="http://www.rcgp.org.uk/news/2014/april/funding-for-general-practice-set-to-plummet-by-fifth-by-2017.aspx"><span style="color: blue;">around
7%</span></a>. To see such a dramatic drop provides one reason why GPs are leaving in
their droves to retire early or work abroad. It explains why young doctors are
running a mile from GP training schemes. It explains why GPs are having to lock
up and close their surgeries for good as they cannot recruit new GPs and have to give up or they will crack up (who would have ever thought we would see GP surgeries closing down across the UK). It explains why GPs are suffering mental illness due to
the pressures and stress of working in the current NHS. We have seen cuts to
services by politicians which directly impact on the care we provide. Social
care has been cut to the bone and this directly impacts on the lack of hospital
beds and inability for us to treat our patients effectively. <o:p></o:p></div>
<div class="MsoNormal">
Another reason we see general practice on its knees is down
to the ever increasing burden of over regulation and micro management of our
day to day work by the likes of the organisation you work for – <a href="http://www.cqc.org.uk/content/professor-steve-field-cbe"><span style="color: blue;">CQC</span></a>. We are
one of the most regulated and monitored professions in the world and we spend
weeks on end filling out forms and endless paperwork of dubious value when we
could be seeing patients and dealing with ill people. <o:p></o:p></div>
<div class="MsoNormal">
I accept UK general practice is not perfect and there are
parts of it that need to dramaticially improve their standards. All GPs wish to
support and encourage colleagues to provide high quality care but why do you
label all of us as failures? Have you any idea of the damage you do when you
say such things. Aspects of the media, political classes and think tanks who wish to see a
privatised general practice service will lap up your comments because you are
the Chief Inspector of General Practice - the man who should be listened to. GPs who work such long hours they can
hardly drive home safely will just wonder whether it is all worth it. Many will
give up when they hear you say such things.<o:p></o:p></div>
<div class="MsoNormal">
I have met you a few times Professor Field and we have
discussed issues around training in general practice. I was openly critical
when you accepted the role offered to you by former Conservative Health
Secretary Andrew Lansley to chair the NHS Future Forum. That Forum allowed the
disastrous Health and Social Care Bill to have more legitimacy and you played a
crucial role for the coalition government in 2011 by helping it become an Act
of Parliament. This was at a time when every part of the NHS opposed that piece
of government legislation.<o:p></o:p></div>
<div class="MsoNormal">
As a GP yourself I hope you will now do what all GPs should
do – reflect on their actions and think whether you have done the right thing.
This latest action by you was not, I feel, your finest hour. I hope you will
apologise to the tens of thousands of GPs and surgery staff who deal with a
million patients a day under the most testing of circumstances. They don’t
deserve being criticised yet again with your comments which too often are ill
thought through and hugely damaging.<o:p></o:p></div>
<div class="MsoNormal">
I did wonder what the RCGP thought about all this themselves
what with you being a Fellow of their College, Chief Inspector of General
Practice and former Chair of the RCGP and feeling that GPs have ‘failed as a
profession’. <o:p></o:p></div>
<div class="MsoNormal">
Please don’t make any more comments to demoralise and
depress my colleagues any more. We really don’t need it. We want to do our very
best for our patients but you are making that really really hard for us to do. Please direct your critical comments to those who deserve them and who are responsible for the mess the NHS is in - the politicians. They are the ones who have truly failed our profession Professor Field.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Yours sincerely<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Dr David Wrigley<o:p></o:p></div>
<div class="MsoNormal">
GP, Carnforth, Lancashire<o:p></o:p></div>
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@davidgwrigley<o:p></o:p></div>
David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com8tag:blogger.com,1999:blog-8316223883546171585.post-56077265751289189832015-09-24T11:49:00.000-07:002015-10-01T05:59:14.801-07:00A World Leading Hospital Fails - why is thisWe have just seen a world leading hospital fail according to the NHS regulator <a href="http://www.cqc.org.uk/" target="_blank"><span style="color: blue;">CQC</span></a>.<br />
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I co-wrote the article below to explain why - there is more to this than meets the eye. Please do read it and see what you think</div>
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<a href="https://www.opendemocracy.net/ournhs/david-wrigley-caroline-molloy/5-reasons-addenbrookes-really-%E2%80%98failed%E2%80%99-%E2%80%93-and-what-it-means-for-" target="_blank"><span style="color: blue;">Click here</span></a> for the article </div>
David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com1tag:blogger.com,1999:blog-8316223883546171585.post-49387790347048695702015-07-14T07:34:00.000-07:002015-07-31T07:35:27.059-07:00Panorama and the NHS - the perfect missed opportunity<div class="MsoNormal" style="font-family: Helvetica, Arial, 'Liberation Sans', FreeSans, sans-serif; font-size: 13px; line-height: 19px; margin-bottom: 20px;">
Last night’s <a href="http://www.bbc.co.uk/programmes/b05y3fcb" style="color: #0061bf; text-decoration: none;">Panorama </a>on the problems facing the NHS was public service broadcasting at its most disappointing.</div>
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The programme - ‘NHS – The Perfect Storm’ had been due to air in early June but was postponed at the last minute by the BBC, prompting speculation that the politicians needed a look at the final edit before it was aired.</div>
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When it did surface last night, the programme undoubtedly packed an emotional punch. How could we not be moved by patients’ touching stories and the dedication of our NHS staff?</div>
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But – lacking any real insight into what’s really going on in the NHS - the overall effect was sensationalist, with the narrator's fatuous comments adding nothing.</div>
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There was just one brief mention of the situation I see many of my patients struggling with - left ‘stuck’ in hospital or struggling on at home in worsening health, hit by <a href="http://www.communitycare.co.uk/2015/01/28/council-cuts-threaten-viability-adult-childrens-social-care-mps-warn/" style="color: #0061bf; text-decoration: none;">40% cuts</a> to the home support they used to receive from care assistants and social workers.</div>
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The programme's talk of 'care in the community' glossed over how the bits of the NHS that always have supported patients in the community are being cut to the bone. There’s been no investment in General Practice for the past five years. Community services such as district nursing, occupation health and physiotherapy have been amongst the hardest hit by cuts – with a <a href="http://www.bbc.co.uk/news/health-22623872" style="color: #0061bf; text-decoration: none;">40% fall in the number of district nurses in the last 10 years</a>, for example – so again, patients become sicker and more vulnerable in their own homes.</div>
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And the programme-makers then appeared to muddle up ‘social care’ with ‘community services’ – not leaving the viewer much faith that the <a href="https://opendemocracy.net/ournhs/osborne-hides-his-fiscal-secrets-under-hospital-bed" style="color: #0061bf; text-decoration: none;">hype about the benefits </a>of ‘integrating’ health and social care, and delivering it ‘in the community’, would be critically examined. As indeed it wasn’t.</div>
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Instead, most of the hour was indeed given over to how patients being old, demented, unemployed and obese were the main reason for the NHS crisis.</div>
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It was as if these problems had just begun in recent years and the NHS was only now struggling because of them. </div>
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But the world shown in the Liverpool slums is a world Jeremy Hunt and David Cameron will never visit or acknowledge. They have no understanding of the reasons behind these patients chaotic and unhealthy lifestyles. And even less interest – not much profit for 'insurers' and 'healthcare providers' in these people, after all; they're more interested in cherry picking the state cash to treat the cheap and easy patients and procedures.</div>
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So the answer we were presented with for the fat, old, unemployed or simply poor, was more ‘<a href="https://opendemocracy.net/ournhs/shibley-rahman/doing-more-with-less-low-paid-and-unpaid" style="color: #0061bf; text-decoration: none;">self-care</a>’. But there was no mention of how public health services which focus on preventing ill health are being decimated, with a further £200million being stripped from their budget. No evidence from public health professionals, who are decrying ‘austerity’ as worsening health outcomes and leaving people <a href="http://www.bbc.co.uk/news/health-28883892" style="color: #0061bf; text-decoration: none;">malnourished</a>, <a href="http://www.theguardian.com/society/2015/apr/17/austerity-and-a-malign-benefits-regime-are-profoundly-damaging-mental-health" style="color: #0061bf; text-decoration: none;">over-stressed</a>, and little able to focus on ‘healthy lifestyles’.</div>
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The smiling GPs in ‘leadership’ roles on the local Clinical Commissioning Group were presented to us as the last chance for the NHS. The programme ignored how Lansley’s Health Act wrote hospital consultants out of planning local healthcare – a shortsighted move that has led to many of the unproven, untested and unevidenced ‘care in the community plans’ we now see planned by these ‘GP leaders’ across the country. The plan put forward by Liverpool CCG is being <a href="https://opendemocracy.net/ournhs/jenny-shepherd/are-plans-to-move-nhs-into-community-wolf-in-sheeps-clothing" style="color: #0061bf; text-decoration: none;">replicated across every CCG in the country</a>. Some are already taking the rhetoric of 'self-care' to its extreme, attempting to <a href="https://opendemocracy.net/ournhs/caroline-molloy/devon-canary-in-nhs-coalmine" style="color: #0061bf; text-decoration: none;">deny all routine operations to patients who are overweight or smoke</a>, or <a href="https://opendemocracy.net/ournhs/shibley-rahman/treat-your-own-dementia-essex-patients-told" style="color: #0061bf; text-decoration: none;">telling dementia patients to 'treat themselves'</a>.</div>
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We know that doctors will get the blame when things go wrong – oh, and patients, of course.</div>
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But - though you wouldn't know it from last night's Panorama - it is the politicians, not the doctors and patients, who are culpable for the mess the NHS is in. It’s the politicians who have overseen <a href="http://www.telegraph.co.uk/news/politics/9722661/David-Cameron-ordered-to-stop-saying-NHS-spending-is-up.html" style="color: #0061bf; text-decoration: none;">falling NHS expenditure</a> – confirmed by the UK Statistics Authority – and across the board <a href="https://opendemocracy.net/ournhs/matt-dykes/death-by-thousand-tariff-cuts" style="color: #0061bf; text-decoration: none;">cuts of 10% to the money hospitals receive</a> for treating us.</div>
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It’s the politicians who have created an English NHS ‘market’ that <a href="https://opendemocracy.net/ournhs/caroline-molloy/billions-of-wasted-nhs-cash-noone-wants-to-mention" style="color: #0061bf; text-decoration: none;">wastes an estimated £10bn a year or more</a> on bureaucracy, just to enable their private health industry friends to ‘compete’ with our NHS hospitals (and rich pickings for the armies of lawyers, accountants, management consultants and bankers creaming off fees, too, of course). </div>
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It's the politicians who have also created the <a href="https://opendemocracy.net/ournhs/joel-benjamin/seven-things-everyone-should-know-about-private-finance-initiative" style="color: #0061bf; text-decoration: none;">Private Finance Initiative scandal</a> – also unmentioned last night, even though Liverpool is <a href="http://www.labournet.net/ukunion/1308/RoyalPFI.pdf" style="color: #0061bf; text-decoration: none;">still building hospitals</a>under this <a href="https://opendemocracy.net/ournhs/caroline-molloy/peterborough-hospital-nhs-and-britains-privatisation-racket" style="color: #0061bf; text-decoration: none;">expensively flawed</a>, wasteful model.</div>
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It’s the politicians who have <a href="https://opendemocracy.net/ournhs/benedict-cooper/nhs-agency-staff-market-reaps-as-hunt-sows" style="color: #0061bf; text-decoration: none;">wasted billions on agency workers</a>, as they treated the NHS workforce with contempt, <a href="http://www.bbc.co.uk/news/health-31048279" style="color: #0061bf; text-decoration: none;">slashing training</a>, <a href="https://opendemocracy.net/ournhs/jonathan-tomlinson/general-practice-after-general-election" style="color: #0061bf; text-decoration: none;">increasing workload</a>, <a href="https://opendemocracy.net/ournhs/rachael-maskell/scandal-of-low-pay-in-nhs" style="color: #0061bf; text-decoration: none;">reducing pay</a>, and accusing them of ‘<a href="https://opendemocracy.net/ournhs/james-lazou/what-lies-behind-hunts-message-of-bad-cruel-nhs" style="color: #0061bf; text-decoration: none;">normalising cruelty’</a>.</div>
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It's the politicians who have overseen a <a href="https://opendemocracy.net/ournhs/caroline-molloy/what's-really-causing-ae-crisis-and-how-can-we-fix-it" style="color: #0061bf; text-decoration: none;">halving in the number of hospital beds</a> in the last 30 years, and maintained a level of healthcare spend lower than just about anywhere in the developed world.</div>
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And who’ve nonetheless wasted a further fortune - <a href="http://www.theguardian.com/society/2014/dec/09/nhs-management-consultants-bill-doubles-640m" style="color: #0061bf; text-decoration: none;">£640million in 2014 alone</a> – on management ‘consultants’ to draw up further ‘care in the community’ plans which even Panorama admitted were ‘untested’ – and which <a href="http://www.yourlocalguardian.co.uk/news/12887872.Secret_plans_to_close_Epsom_and_St_Helier_and_build_new__super_hospital__overheard_on_train/?ref=mr" style="color: #0061bf; text-decoration: none;">often seem driven</a>more by a desire to <a href="https://opendemocracy.net/ournhs/deborah-harrington/going-going-gone-great-hospital-selloff" style="color: #0061bf; text-decoration: none;">free up hospital land for sell-offs</a>, than serious evidence about what is an cost-effective and efficient way to deliver healthcare.</div>
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It was a huge disappointment to see prime time TV on the BBC filled full of such tripe, blaming unwell patients for the failings of politicians, and perhaps softening us up for the misguided idea that we simply can't afford a comprehensive health service. But then again the BBC are under the cosh with their Charter Renewal coming up….</div>
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If only those of us who have spent years campaigning to save the NHS from the misdemeanors of politicians were given an hour of prime time TV to get our message across. Imagine what we could do with that!</div>
David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0tag:blogger.com,1999:blog-8316223883546171585.post-27836962693057977382015-05-22T07:25:00.000-07:002015-06-13T07:31:28.949-07:00A 7 point plan for Cameron's 7 day NHS<div style="line-height: 1.5em; margin-bottom: 15px; margin-top: 2px; word-wrap: break-word;">
<span style="font-family: Times, Times New Roman, serif;"><span style="color: #333333;">The media called this the “</span><a href="http://www.bbc.co.uk/news/uk-politics-32772548" style="outline: none; text-decoration: none;" target="_blank"><span style="color: blue;">first major speech</span></a><span style="color: #333333;">” in this brand new Conservative majority government. Prime Minister David Cameron, with five years of power ahead of him, decided to focus on the NHS, and, in particular, he focused on one particular aspect—seven day working. Trailed in the Tory manifesto and now offered to the nation it sounds appealing, but as is usually the case with many things Mr Cameron does, most of it doesn’t stand up to proper scrutiny.</span></span></div>
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<span style="font-family: Times, Times New Roman, serif;">Here is my seven point plan for Mr Cameron’s seven day NHS:<span id="more-34283"></span></span></div>
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<span style="font-family: Times, Times New Roman, serif;">1. Get the five days right first—If the government wants to make the NHS work safely and efficiently seven days a week, then it might be a good idea to get the five days of Monday to Friday working well beforehand. At the moment the NHS is in dire straits, struggling financially with medical, nursing, and allied staff leaving or retiring early in their droves. What was the adage Mr Cameron likes to use—fix the roof while the sun is shining? Well, the sun isn’t shining much in the NHS, but you certainly need to fix the roof Mr Cameron and pretty sharpish.</span></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="color: #333333;">2. Sort social care out—The huge top down austerity driven cuts to local authorities has led </span><a href="http://www.theguardian.com/society/2015/jan/28/social-care-funding-ridiculous-situation-local-government-association" style="outline: none; text-decoration: none;" target="_blank"><span style="color: blue;">to massive cuts to social care</span></a><span style="color: #333333;">. This has led to social care being cut to the bone, and many older and vulnerable patients left alone or with haphazard 10 minute visits from zero hour contract care workers who have to dash from client to client in order to make any sort of living. If you want a seven day NHS, Mr Cameron, then you need to properly fund social care as these patients are increasingly unwell and needing more NHS care. And with inadequate community services for them, they languish in hospital beds, unable to be discharged safely to the community</span></span></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="color: #333333;">3. Invest in your NHS staff—Many nurses, for example, have been </span><a href="http://www.theguardian.com/healthcare-network/2014/oct/08/everything-need-know-nhs-strike-pay" style="outline: none; text-decoration: none;" target="_blank"><span style="color: blue;">left with 0% pay increases repeatedly during the coalition years</span></a><span style="color: #333333;">. MPs, meanwhile, received </span><a href="http://www.telegraph.co.uk/news/newstopics/mps-expenses/11079707/MPs-will-get-10-per-cent-pay-rise-expenses-watchdog-says.html" style="outline: none; text-decoration: none;"><span style="color: blue;">a 10% pay rise</span></a><a href="http://www.telegraph.co.uk/news/newstopics/mps-expenses/11079707/MPs-will-get-10-per-cent-pay-rise-expenses-watchdog-says.html" style="color: #006990; outline: none; text-decoration: none;"> </a><span style="color: #333333;">during the coalition reign of power. Nurses’ pay has fallen back hugely, and they feel undervalued and demoralised. They were pilloried for failures that were not of their doing. Many scandals in the NHS in recent times have been owing to the fact that hospitals chased foundation trust status at all costs, forgot and disinvested in patient care, and forgot to support and care for the staff looking after those patients. Many health professionals are becoming unwell now because they cannot give any more to the job they love.</span></span></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="color: #333333;">4. Get your workforce planning sorted—Mr Cameron said at his press conference: “We are training and hiring many more GPs right now.” Errrr, no you are not, Mr Cameron—</span><a href="http://www.telegraph.co.uk/news/health/news/11517019/One-in-3-trainee-GP-posts-are-empty-amid-warnings-of-crisis-shortage.html" style="outline: none; text-decoration: none;" target="_blank"><span style="color: blue;">one third of GP training places are empty</span></a><span style="color: #333333;">. One in three GPs </span><a href="http://www.theguardian.com/society/2015/apr/15/nhs-stress-third-gps-plan-retire-five-years" style="outline: none; text-decoration: none;" target="_blank"><span style="color: blue;">plans to retire in the next five years</span></a><a href="http://www.theguardian.com/society/2015/apr/15/nhs-stress-third-gps-plan-retire-five-years" style="color: #006990; outline: none; text-decoration: none;" target="_blank">.</a><span style="color: #333333;"> This is all leading to a workforce time bomb and Mr Cameron has fuelled this with his past five years in charge of the NHS—with unpopular polices and cuts to frontline services, such as general practice.</span></span></div>
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<span style="font-family: Times, Times New Roman, serif;">5. End the dog eat dog competitive market in the NHS—Currently we see billions wasted on an unwanted healthcare market, where providers fight each other for contracts and NHS managers spend weeks on end refereeing and sorting this all out. No one has asked for this and the money saved could fund decent social care for all the older and vulnerable people in our society.</span></div>
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<span style="font-family: Times, Times New Roman, serif;">6. Make all NHS services available seven days a week—This will, however, cost billions. As a GP if I see a patient on a Saturday or a Sunday, I need the full range of services available to me in order to treat my patients effectively. I need a fully functioning hospital laboratory with blood collection services twice a day over the weekend. I need access to NHS physiotherapy for my patients with urgent musculoskeletal problems. I need access to health visitors to refer children needing their input. I need access to a fully functioning radiology department offering x-rays, CT scans, MRI scans, ultrasound, and other investigations. For those who say the patients can be seen Monday to Friday, I am afraid that won’t work because more patients will be seen at weekends so capacity needs to increase to cater for them.</span></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="color: #333333;">7. Beware of the unintended consequences—Increasing the NHS to a full seven day service will increase demand and this will increase cost. The NHS is already struggling financially, and Mr Cameron’s extra </span><span style="color: blue; outline: none; text-decoration: none;"><a href="http://www.bbc.co.uk/news/election-2015-32260220" style="outline: none; text-decoration: none;" target="_blank">£8bn was only plugging one small gap in the £30bn</a> </span><span style="color: #333333;">black hole opening up in the centre of the Department of Health. To stretch services further will lead to a poorer service in the coming years, and would lead the electorate to blame the government for a failing NHS—not something Mr Cameron will want running up to 2020. Mind you, </span><a href="http://www.independent.co.uk/news/uk/politics/david-cameron-admits-he-wont-serve-beyond-2020-10128858.html" style="outline: none; text-decoration: none;" target="_blank"><span style="color: blue;">he has already said</span></a><span style="color: #333333;"> he will be leaving Downing Street by then anyway.</span></span></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="color: #333333;">A seven day NHS service is attractive to patients and attractive to politicians seeking votes. No other western health economy has </span><a href="https://www.gov.uk/government/speeches/pm-on-plans-for-a-seven-day-nhs" style="outline: none; text-decoration: none;" target="_blank"><span style="color: blue;">managed to provide it</span></a><span style="color: #333333;">, and with the NHS already struggling, many really doubt this government can do it properly. I hope it won’t be imposed on an already beleaguered NHS staff, who are forced to provide the seven day service against their professional advice. Doctors are here for our patients—politicians are there for the votes.</span></span></div>
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<span style="font-family: Times, Times New Roman, serif;">Be careful of what you wish for, Mr Cameron and Mr Hunt. This one could come back and bite you very hard indeed.</span></div>
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David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com2tag:blogger.com,1999:blog-8316223883546171585.post-57630135082120210762015-03-01T10:21:00.000-08:002015-03-11T05:09:22.059-07:00Manchester - the birth and death of the NHSOn July 5th 1948 in Manchester Labour Secretary of State for Health Aneurin Bevan announced the <a href="http://www.bbc.co.uk/manchester/content/articles/2008/07/03/nhs60_trafford_general_hospital_feature.shtml" target="_blank"><span style="color: blue;">birth of the NHS</span></a> .<br />
On March 27th 2015 in Manchester Conservative Chancellor of the Exchequer George Osborne signed a <a href="http://m.bbc.co.uk/news/uk-england-manchester-31656313" target="_blank"><span style="color: blue;">piece of paper</span></a> that would bring about the end of a <i>National</i> Health Service.<br />
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These two events are 67 years apart but signal huge differences in how health care would be provided to the population.<br />
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In a surprise announcement just weeks before a General Election the Tories signed a deal with the <a href="http://www.agma.gov.uk/agma/authorities/index.html" target="_blank"><span style="color: blue;">Greater Manchester Authorities</span></a> - which includes Manchester, Bolton, Salford, Oldham, Stockport, Wigan, Tameside, Trafford, Rochdale and Bury Council - a huge area. The actual deal can be <a href="http://www.agma.gov.uk/cms_media/files/mou.pdf" target="_blank"><span style="color: blue;">read here</span></a>. It hands over £6bn from central government to a new organisation to run health and social care services for 2.7 million residents in the Greater Manchester area. On the face of it this may sound attractive - no longer having Whitehall poking its nose into local health issues, but there is much to be concerned about.<br />
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The very fact this deal was hurriedly signed off just before a General Election should ring alarm bells. Many <a href="http://www.newstatesman.com/politics/2015/02/real-devolution-has-come-public-consent-not-whitehall-diktat" target="_blank"><span style="color: blue;">local MPs</span></a> had not been aware of how advanced the negotiations were and more shockingly the public had not been consulted or asked to make a decision on this huge change to their local NHS. To the horror of many, Councillor Jim McMahon, Labour leader of Oldham Council, told the BBC Sunday Politics programme on 1st March 2015 that 'the changes happened too quickly to ask the public what they thought'...<br />
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Local GPs, who were promised by the Tories to be more involved in local healthcare with the Health and Social Care Act, were kept in the dark and not given any say in the matter.<br />
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This all leads to the conclusion that it has been a done deal behind closed doors and rushed through prior to an election.<br />
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Local Authorities often outsource services as they cannot provide them from their own resources - this was one reason why Aneurin Bevan didn't offer healthcare provision to Local Authorities in 1948. Bevan ensured a nation service was offered to all across the UK with no regional discrepancies and not at the whim of councillors. This deal also significantly advances the risk of charging for services when social care is added into the mix of health care provision. Already in parts of Manchester cuts to services are occurring - as we have seen in <a href="http://www.manchestereveningnews.co.uk/news/greater-manchester-news/salford-cuts-council-approves-spending-8721581" target="_blank"><span style="color: blue;">Salford this week</span></a>. With further severe cuts to Local Authorities in the coming years (promised by Tories and Labour) where does this leave health services under this devolved deal?<br />
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There are a number of reasons this deal has been done and many of them help the Tories<br />
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<li>Andy Burnham is put on the spot by Osborne, trying to wrong foot him in the election period. The local Labour leadership have not done Andy Burnham any favours!</li>
<li>Osborne is seen as the hero of the day - riding to the rescue of Manchester - this will help his aspirations to be Tory leader if Cameron fails to win a majority in May 2015</li>
<li>The push for devolution in Manchester helps the 'English votes for English MPs' cause that the Tories are desperate to see come about. Why do they want this - because it will lead to a Tory Government in England for ever - Labour relies on MPs from Scotland and Wales to win majorities in Westminster. The Tories want to stop this. </li>
<li>Osborne puts his mark on health policy to try and eradicate the disastrous health policies of Andrew Lansley - in one flick of wrist by signing this deal he has swept away many of Lansley's 'reforms'. Lansley's Health Act didn't last a Parliament!</li>
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Local patient groups, local GPs, local NHS staff, local MPs, national medical organisations and patient groups need to be all over this deal like a rash. They need to ask where the consultation was and why democracy has been sidelined. They need to ask what the implications are for their care and what happens when Local Authority budgets are cut further in coming years. </div>
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The Manchester Devolution deal is hugely worrying and has many risks attached to it. There is likely to be much debate on the deal in the coming months but one thing is for sure - the deal is signed, sealed and delivered without so much of a debate or consultation with those it will most likely effect - patients and local NHS staff.</div>
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<br />David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0tag:blogger.com,1999:blog-8316223883546171585.post-31837042938982042332014-12-21T16:08:00.001-08:002014-12-31T03:25:49.563-08:00NHS for Sale - Myths, Lies & DeceptionIn early 2015 a new book written by Dr Jacky Davis, John Lister and myself will be published.<br />
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It will be an expose of the ongoing sale of our English NHS and the privatisation of many contract and services. It will tell the truth about what has happened to our NHS since the coalition came to power - how they have acted in their own interests and been economical with the truth. You will not read this information in any political manifesto or think tank pamphlet. No politician will ever utter what is in the book and will use weasel words to deny it all. We have researched the evidence and presented it all together.<br />
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<a href="http://www.merlinpress.co.uk/acatalog/NHS-FOR-SALE.html" target="_blank"><span style="color: blue;">Here is a link to the publishers website</span></a> - pre-orders can be made there with free P&P and a reduced cover price.<br />
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All profits will go to the campaigning group <span style="color: blue;"><a href="http://www.keepournhspublic.com/index.php" target="_blank"><span style="color: blue;">Keep Our NHS Public</span></a> - </span>the authors will take no income at all from the book.<br />
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We hope you will find it an interesting read - though it may raise your blood pressure!<br />
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<br />David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com2tag:blogger.com,1999:blog-8316223883546171585.post-11978988492899318862014-11-08T02:52:00.001-08:002014-11-08T02:52:43.751-08:00Robbing Peter to Pay Paul<div>
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In April 2014 this press release was sent out</div>
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<a href="https://www.bedfordshireccg.nhs.uk/news/index.php?story_id=364&id=&area_id=" target="_blank"><span style="color: blue;">https://www.bedfordshireccg.nhs.uk/news/index.php?story_id=364&id=&area_id=</span></a></div>
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Full of the usual fluff about ‘integrated, seamless services’ making ‘a huge difference to patients' . the contract winners Circle made out this was the best thing since sliced bread. </div>
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Roll forward a few months and the article below was in the Health Services Journal (paywalled so copy and pasted). </div>
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It transpires Circle have tried to subcontract the service back to the local hospital (grab the money and let someone else do the work) and the hospital now has serious concerns over the viability of A&E and orthopaedic services due to patients being seen by Circle and removing vital income from the hospital. Often hospitals rely on such income to keep it financially viable and support very costly departments like intensive care units. </div>
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This is reprehensible behaviour by the private sector. Another blow to the NHS at the hands of the City - <span style="color: blue;"><a href="http://en.wikipedia.org/wiki/Circle_(healthcare_partnership)" target="_blank"><span style="color: blue;">Circle is owned by hedge fund managers</span></a>.</span></div>
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This situation has come about due to the decision of a CCG which (much to the delight of politicians) is ‘GP led’. The GPs on the CCG are having to abide by the rigid legislation as laid down by the coalition. They have to put services out to tender and private companies have a huge advantage in the tendering process due to their deep pockets. It is yet more evidence that privatisation of NHS services is bad news for local services. </div>
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This is happening all over England now under the privatising coalition Health and Social Care Act. </div>
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We must all speak out and tell our politicians we do NOT want our NHS services run by private companies. You can this by easily emailing your MP <a href="https://www.writetothem.com/" target="_blank"><span style="color: blue;">using this great website</span></a>. It takes a few minutes and is time very well spent. Feel free to use my text above in your letter or from previous blogs on here. </div>
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From HSJ 7th Nov 2014 </div>
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Bedford refuses to sign Circle MSK contract</h1>
<strong>Health Services Journal 7 </strong>November, 2014 | By <a href="http://www.hsj.co.uk/judith-welikala/1203533.bio" rel="author" target="_blank"><span style="color: #0066cc;">Judith Welikala</span></a><br />
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<strong>An NHS hospital has pledged to compete with Circle Partnership, the private provider appointed to run Bedfordshire’s £120m integrated musculoskeletal service, after refusing to become its subcontractor, <em>HSJ</em> can reveal</strong>.</div>
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<strong>Bedford Hospital Trust has refused to sign the contract after seeing the number of MSK referrals plunge 30 per cent after Circle took over the service in April.</strong></div>
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The trust chief executive said there was now a risk its income from MSK would no longer support its consultant surgeons</div>
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<strong>The trust claims the service’s arrangement “endangers the viability” of its trauma and accident and emergency services and could undermine its capacity to retain the seven trauma surgeons it employs.</strong></div>
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<strong>Circle was awarded the five year “prime provider” contract by Bedfordshire Clinical Commissioning Group in April. </strong><a href="http://www.hsj.co.uk/hsj-local/ccgs/nhs-bedfordshire-ccg/circle-named-preferred-bidder-for-musculoskeletal-120m-contract/5062227.article#.U01JjVeo2Dc" target="_blank"><span style="color: #0066cc;"><strong>The deal consolidates 20 separate contracts into a single service and gave Circle the role of running it.</strong></span></a></div>
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Bedford Hospital’s board papers say it “would not be in the trust’s best interests to sign a contract without any mitigation to the consequent impact on trauma and linked services”.</div>
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“<strong>The significant reduction in referrals since April, and associated potential loss of income (assuming these convert to elective work) mean a direct impact on the viability of the trauma service which in turn will undermine the ability of A&E to see and admit trauma patients,” they say.</strong></div>
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<li><a href="http://www.hsj.co.uk/hsj-local/ccgs/nhs-bedfordshire-ccg/circle-awarded-120m-msk-contract/5070034.article" target="_blank"><span style="color: #0066cc;">Circle awarded £120m MSK contract</span></a></li>
<li><a href="http://www.hsj.co.uk/hsj-local/ccgs/nhs-coastal-west-sussex-ccg/controversial-msk-contract-award-to-be-checked/5076428.article" target="_blank"><span style="color: #0066cc;">Controversial MSK contract award to be checked</span></a></li>
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<strong>Trust chief executive Stephen Conroy told <em>HSJ</em> there was now a risk its income from MSK would no longer support its contingent of consultant surgeons</strong>.</div>
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“At some point at the future that would mean the service would either lose a lot of money or become non-viable,” he said. “We’ve got enough need to keep us going until the end of next financial year [but] it remains an open risk for next year.”</div>
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Bedford has requested a minimum income guarantee for 2014-15 to cross subsidise the trauma service. This was declined by the CCG and Circle on the grounds it would limit patient choice.</div>
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Mr Conroy said the trust was still negotiating with the CCG about the possibility of a risk share arrangement in 2015-16. </div>
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Bedford’s contract with the CCG to provide MSK services came to an end in September.</div>
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A spokesman for Circle said: “Most providers recognise our job is to integrate MSK services, so they are more joined up for patients and more efficient for the local NHS.”</div>
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“We’ve had constructive discussions with Bedford and expect to sign a contract in the coming months.”</div>
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“The new system is led by informed patient choice. The best way for any provider to increase referrals is to give patients what they want.”</div>
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Bedfordshire CCG declined to comment</div>
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David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0tag:blogger.com,1999:blog-8316223883546171585.post-64073410761454532642014-09-21T08:43:00.000-07:002014-12-31T03:20:16.636-08:00GPs are NOT private companies - and this is why...<div class="MsoNormal" style="font-family: Helvetica, Arial, 'Liberation Sans', FreeSans, sans-serif; font-size: 13px; line-height: 19px; margin-bottom: 20px;">
‘All you GPs are private providers anyway’</div>
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I often have this charge thrown at me when I speak at NHS campaign meetings. Those who level this charge at me are often those arguing in favour of a privatised NHS.</div>
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They will say that ever since 1948 GPs have been private companies, so not much is changing.</div>
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Nothing could be further from the truth.</div>
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It is true that GPs are self employed and have been since 1948. They often own the GP surgery that they work from and the NHS pays the GPs to allow them to employ the staff, pay for the electricity and lighting in the surgery and take home their own income too. GPs do earn a good income.</div>
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But the vast majority earn nowhere near the telephone number salaries the Daily Mail talk about. But GPs cannot sell or advertise our surgeries or set up a practice wherever we like. </div>
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And GPs stay at their surgery through thick and thin. They invest in a community. Even during the bad times they stay with their patients and ensure their surgery is the best it can be. We are not answerable to shareholders wishing to maximise return on their investment by increasing profit margins.</div>
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The private sector will <a href="http://www.chroniclelive.co.uk/news/north-east-news/private-company-exiting-newcastle-gp-7067521" style="text-decoration: none;"><span style="color: blue;">hand the keys back and move on</span></a> when the profits begin to fall – they don’t want to hang around if their profit margin suffers or the shareholders start to complain at their AGMs.</div>
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These points are glossed over by those misleadingly claiming GPs are an example of how NHS privatisation is nothing new.</div>
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But the false claim that ‘GP practices are just businesses’ has just been given a massive push towards reality. </div>
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Last month, it emerged that NHS England has said that, because of competition law, <a href="http://www.pulsetoday.co.uk/home/stop-practice-closures/revealed-all-new-gp-contracts-will-be-thrown-open-to-private-providers/20007596.article#.VBA0nfldUdR" style="text-decoration: none;"><span style="color: blue;"><em>all</em> new GP contracts will have to be opened up to bids from the profit-making</span></a>, private corporate sector. And - whilst struggling under funding cuts - they will have to fight off the private sector to keep their practice every 5 years. They will all be forced into contracts as ‘Alternative Providers of Medical Services’. This was a new concept introduced by New Labour in 2004. It allowed contracts to be held by the private sector, including by non-GPs. It gave companies like <a href="http://www.gponline.com/virgin-care-beats-17-bids-dorset-apms-practice/article/1169555" style="text-decoration: none;"><span style="color: blue;">Virgin</span></a> and Care UK a foothold in general practice, though hiding behind the NHS logo. It was a defining moment for general practice and many feel the BMA GP Committee should have resisted it harder. </div>
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But last month’s announcement is a step change towards the rapid corporatisation of General Practice. </div>
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The Chair of the British Medical Association GP Committee has said this would “spell the death knell of the whole ethos of long-term, continuity of care in the way general practice operates”.</div>
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The BMA have taken legal advice and believe NHS England’s policy is flawed because it focuses only on competition but ignores the need to consider “securing the needs of patients” that is supposedly written into the law and guidance. They have <a href="http://www.pulsetoday.co.uk/home/stop-practice-closures/gpc-challenges-decision-to-open-all-new-gp-contracts-to-competition-after-legal-advice/20007693.article#.VBA1TvldUdQ" style="text-decoration: none;"><span style="color: blue;">written to NHS England</span></a> calling on it to reverse this policy.</div>
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The Health and Social Care Act opened up the English NHS to many more private providers. Tory and Lib Dem ministers repeatedly promised us that the NHS would not be forced to tender services to the private sector. Yet this is what is happening now, to the cornerstone of the NHS, your local GP.</div>
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Lord Howe should be made to answer the question ‘Can the NHS offer a contract to a non commercial provider (such as a family GP) without going out to tender, without fear of legal challenge from the private sector?’</div>
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It is a very dangerous time for the English NHS. Competition is the name of the game now and billions of our taxpayers pounds will be wasted on legal fees, accountancy fees, management consultancy fees and complex tendering exercises – all in order to satisfy the demands of the Tory led coalition.</div>
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No wonder only 1 in 5 GP practices think their partnership will survive in 10 years time, and 85% think it will be fully privatised by then - and what a worrying state of affairs for the cornerstone of the English NHS.</div>
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This article first appeared on Open Democracy website and can be <a href="https://www.opendemocracy.net/ournhs/david-wrigley/gps-aren%27t-private-companies-but-private-takeover-is-nearing" target="_blank"><span style="color: blue;">found here</span></a></div>
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David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0tag:blogger.com,1999:blog-8316223883546171585.post-59303112353085610062014-06-12T02:30:00.002-07:002014-06-15T15:46:22.969-07:00Privatisation behind an Invisibility CloakI was a guest speaker last night at a packed meeting in central Newcastle where we discussed and debated the changes to the NHS. Everyone in the room was very concerned and indeed very angry at what they heard. A lot were unaware of the scale of the issue over privatisation in the English NHS (Scotland has committed to having no private companies running NHS services).<br />
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Time and again I hear 'we didn't vote for this at the last election - it wasn't in any manifesto' or 'the coalition have no mandate to make such huge changes to our NHS - no single party won the election'. And I agree with them. The coalition have been very clever in making out GPs were on board with the NHS changes (they weren't) and that it was what the NHS needed (it wasn't) and that the NHS is in a massive hole (it isn't) and their coup de grace is that they are selling off many services to the private sector hidden behind the well trusted and well respected NHS logo. It is privatisation behind an invisibility cloak.<br />
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One story last night hit home to me though and explains perfectly why the coalition privatisation of the NHS is disastrous for patients and the taxpayer and also explains the huge difference between NHS GPs and the private sector. Time and again when I debate NHS changes I get the allegation 'you GPs are just like the private sector' - well this story explains exactly why we are poles apart from the corporate sector.....<br />
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A few years ago the local NHS managers in Newcastle decided to 'put out to tender' a large GP practice in Newcastle. The bidding process (as I have written on this before) is hugely in favour of large corporate companies who have the back office staff available to fill out the masses of forms and paperwork. They also have the ability to put in a 'low bid' as a loss leader in order to get a foot in the door. Local GPs bidded for the contract but the upshot was that <a href="http://www.careuk.com/" target="_blank"><span style="color: blue;">Care UK</span></a> won the contract much to the anger, and opposition of local patients. <a href="http://www.thejournal.co.uk/news/north-east-news/private-firm-takes-over-newcastle-4404983" target="_blank"><span style="color: blue;">Here is the news report</span></a> in 2012 of the outcome of the bidding process. Please take special note of the reassurances by Care UK that they would 'meet the high standards that the NHS expects of us and which the patients deserve'.<br />
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Move the clocks forward two years and last month a <a href="http://www.chroniclelive.co.uk/news/north-east-news/private-company-exiting-newcastle-gp-7067521" target="_blank"><span style="color: blue;">shock announcement was made by Care UK</span></a> that they would be handing the keys back to the surgery they took over in 2012. They gave very little notice and 7,000 patients were very frightened as to whether they would continue to receive care from a GP. Refusing to give reasons why they were walking away from the patients it is quite clear there wasn't adequate profit in the venture for Care UK.<br />
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This short story explains clearly why we should not be selling off our English NHS and why the private sector cannot be trusted with NHS contracts. It also explains the huge difference between the private sector and GPs. GPs stay with a practice for their whole career and stay the course when times are bad. The private sector do not do this. They just walk away and move on to the next contract they can make some money on. They have no affinity to the patients or desire to maintain that longitudinal and ever so important doctor/patient relationship.<br />
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I hope this explains why many of us campaign to stop the privatisation of the NHS under the disastrous Health and Social Care Act and why we oppose the private sector moving in and winning NHS contracts. The Health Act needs repealing. We need a complete halt to the market in the NHS and for the NHS to be a 'preferred provider' of services to stop the scenario that was explained so clearly last night in Newcastle.<br />
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PS One interesting point to note is that Care UK is backed by the huge global private equity firm Bridgepoint Capital. <span style="color: blue;"><a href="http://www.bridgepoint.eu/en/our-team/alan-milburn/" target="_blank"><span style="color: blue;">One of Bridgepoint's advisers is no other than Alan Milburn</span></a>,</span> Labour MP for Darlington from 1992-2010. He was the architect of New Labours opening up of the NHS to the private sector and <span style="font-family: inherit;">much has been written elsewhere about this. He is now making a handsome income from advising those who seek to profit from the NHS - those whom he made it possible for them to bid for such contracts. Also of note is that a paid adviser to Bridgepoint Capital is no other than the former Director General of the BBC Lord Patten (former Tory MP for Bath and then Governor of Hong Kong). The BBC have been notorious in failing to highlight the privatisation of the English NHS. The name mentioned to take over from Lord Patten at the BBC (who has stood down due to ill health) is Lord Coe - former Tory MP for Falmouth. </span><br />
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<span lang="EN-US"><span style="font-family: inherit;">I will leave those sobering thoughts with you.</span></span><br />
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<br />David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com5tag:blogger.com,1999:blog-8316223883546171585.post-20831693409005279262014-05-18T15:18:00.004-07:002014-05-18T15:18:44.758-07:00Standing up Against NHS PrivatisationThe BMJ have published an article I have written about the ongoing privatisation in the English NHS. The onslaught is relentless and appears to be speeding up - perhaps to get as many contracts sold off prior to the General Election in 2015.<br />
Every campaigner and patient I speak to about this privatisation are opposed to it. No one has been asked whether they want their NHS to be sold - remember it wasn't in any election manifesto for the 2010 General Election and no party won a majority. The Health and Social Care Act was sprung upon a surprised medical profession and electorate.<br />
We must continue to fight for our NHS - it is too precious to lose.<br />
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You can read my article in the BMJ <a href="http://blogs.bmj.com/bmj/2014/03/28/david-wrigley-standing-up-against-the-fragmentation-of-the-english-nhs/" target="_blank"><span style="color: blue;">here</span></a>.David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0tag:blogger.com,1999:blog-8316223883546171585.post-39201481742177806612014-03-15T09:43:00.002-07:002014-03-20T02:34:36.940-07:00The Complicity of Cameron and Clegg<span style="font-family: Calibri;">They've done it again.</span><br />
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<span lang="EN-US" style="font-family: Calibri;">The Tories and LibDems
have once more voted together to push through a law that dramatically affects our
English NHS. The 'hospital closure clause' - Clause 119 of the Care Bill - <a href="http://www.bbc.co.uk/news/health-26531807"><span style="color: blue; text-decoration: none; text-underline: none;">has been voted through Parliament</span></a>. The law was only passed because of the Parliamentary arithmetic of the LibDems<span style="color: #fb0007;"> </span>voting<span style="color: #fb0007;"> </span>with the Tories to
bring about a majority against the opposition. Clause 119 allows any hospital
that is near a struggling one to be closed with just 40 days consultation
period - yes that's right just 40 days!<span style="color: #fb0007;"> </span>Any
talk by the LibDems of extricating important amendments from the Tories can be
dismissed as hubris. They only say this to justify their voting habits.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Calibri;">It beggars belief that Liberals can vote for something that diminishes the power of a citizen to have
their say. The same goes for the Gagging Bill the Liberals voted for recently which removes the right to free speech for many citizens who feel passionately about a subject. The dictionary definition of a Liberal is 'someone willing to accept opinions different from one's own'. Perhaps a name change is due soon for the Liberal Democrats...</span></div>
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<span lang="EN-US" style="font-family: Calibri;">There is also no electoral mandate
for any of these laws being passed now. No party won the General Election in 2010 and the <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/78977/coalition_programme_for_government.pdf"><span style="color: blue; text-decoration: none; text-underline: none;">coalition agreement</span></a>
did not mention any of these changes to the English NHS. This means the
government of the day are undemocratically changing the society we live in.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Calibri;">The NHS is much worse off again because of this coalition. The damage done to it since 2010 is immense
and there is real concern much of it may not be reversible. We will have to
hope it is. We must keep campaigning and keep highlighting all that is bad about current political ideology.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: Calibri;">As Tony Benn said 'If we
have enough money to kill people, then we have enough money to help people'.
This coalition should take heed of these wise words.<span style="font-size: medium;"><o:p></o:p></span></span></div>
David Wrigleyhttp://www.blogger.com/profile/07690130241937764911noreply@blogger.com0