The NHS is behaving like a spurned and angry lover. It tells a woman who is dying of cancer that if she has drugs that it refuses to pay for but which she herself will pay for, then she is unwelcome. She can no longer have free NHS care. Never mind that, like the rest of us, she has paid her taxes for a lifetime. It is as if she was unfaithful to the NHS and her lack of love and devotion should be punished by total rejection.

What a perversion this is of the welfare state. How horrified would be Attlee and Beveridge and others who had the dream of excellent healthcare provision for all.

The psychology of the NHS decision to abandon those who are so insulting as to pay for some better drugs is a fascinating subject. I guess the reason the NHS feels so bitter towards those who pay for better drugs is the implication that the drugs supplied by the NHS are not good enough. This, of course, is true. But the NHS cannot bear the truth to be pointed out or to accept it. So it wishes to punish those who assert it. This is the psychology, perhaps, not of the jealous lover but the spoilt, vain, self-centred child who cares nothing for the actual well-being of others.

The actions of the NHS are immoral and I hope they will prove to be illegal, too.

Here is the beginning of the story in today's Sunday Times:

A woman dying of cancer was denied free National Health Service treatment in her final months because she had paid privately for a drug to try to prolong her life.

Linda O’Boyle was told that as she had paid for private treatment she was banned from free NHS care.

She is believed to have been the first patient to die after fighting for the right to top up NHS treatment with a privately purchased cancer medicine that the health service refused to provide.

News of her death at the age of 64 has emerged as six other patients launch a legal action to trigger a test case that they hope would force the NHS to allow them to top up their care with private drugs.

The full story is here.

Posted by James Bartholomew • Indexed in NHS

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More than 8,400 beds were cut in the year ending March 2007, the largest fall in 14 years. One in six beds has been closed over the decade. There are now 167,019 beds in NHS wards, compared with 198,848 in 1997.

There is an argument for reducing the number of beds. Part of it is that doctors now believe that the long times in hospital that used to take place - after childbirth for example - were unnecessary and even undesirable for the patient. However it is hard to doubt that the massive drop in bed numbers that has taken place since the creation of the NHS goes beyond what would be suggested by improved medical treatment and revised theory on how long one should stay in bed.

Hospitals ought not to be working near to capacity. They ought to have spare capacity so that new arrivals can be admitted quickly and can be treated promptly. For many years, the NHS has been working too close to capacity. What is dismaying is that despite all the extra money spent by the Labour government since 1997 that this is still the case. The system is not working. The NHS does not just lack money. It is a bad system that causes suffering and unnecessary deaths despite the sometimes heroic devotion of those in the front line.

The full article on Labour's bed closures is here.

Posted by James Bartholomew • Indexed in NHS

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Further evidence comes that the NHS, despite the vast injection of funds, is failing to deliver medical care that is of the average standard in the rest of Europe.

Professor Mike Richards, the national cancer director, has said that in 2004, Britain spent £76 per head on cancer drugs compared with £143 in Germany and £121 in France. Even after adding in private spending on cancer drugs in Britain, our figure still fell well short of the others at £90 a head.

This spending on cancer drugs - particularly new and therefore expensive cancer drugs - is a forward indication of what the survival rates will be (so I am told by Professor Sikora, the leading cancer specialist). So we may be confident that when the figures finally emerge for cancer survival rates for the past few years, Britain will again be among the worst performers. Or, to put it quite clearly, thousands of people will continue to die of cancer in this country because we have the NHS instead of one of the other systems in the advanced world.

The story from the Daily Mail is here.

The situation with prostate cancer is more complex. But there is reason to suspect, at the very least, that the USA has dramatically lowered its deaths from prostate cancer because of active screening. A friend of mine in the USA is screened as a matter of routine for prostate cancer and colon cancer. Prostate cancer is apparently the second biggest killer of men in Britain. The screening test for it is far from ideal. The British medical profession tends to be sceptical of it to the point of hardly using it at all unless the patient pushes hard for it. I suspect that this is one of many instances where the medical opinion of the British has been influenced by the rationing mentality of the NHS. It is true that the American may over-test and over-prescribe but British medicine certainly has the opposite, more serious defect. In any case, in America, where they screen for prostate cancer, the death rates have come down more dramatically than in Britain. Or, to put it clearly again, many men die of prostate cancer each year in Britain because we have the NHS. The news story is here.

In a single week there was yet one more story about how the NHS has failed to perform as intended. Figures from the NHS Information Centre, apparently, show that nearly half the population has not seen an NHS dentist in the past two years. Story here.

It is possible that regular publicity about the bad record of Britain in treating cancer compared to other advanced countries will, eventually, prompt the government to spend more money on cancer drugs. That could be regarded as a 'good thing'. However, given the huge amount of money wasted in the NHS on excess back-up staff, poor use of staff and under-used equipment, it only means that money will be taken away from other service to patients that are less easily measured - care for the elderly for example. So even if the government moved to spend more on cancer drugs, it could well mean no net improvement in the amount of unnecessary suffering British people accept because we have the NHS rather than the medical care of other advanced countries.

Posted by James Bartholomew • Indexed in NHS

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Most of the media has cooperated with the idea that the enormous amount of extra money put into the NHS has made it good enough. This, of course, is not at all true. It is accepted by most people that at least the waiting lists and waiting times in emergency are now fine. Even these things are not true.

Here is a doctor who works in accident and emergency writing about the manipulation of waiting times:

But what about the 98 per cent success rate for meeting the four-hour target?

From the patient's point of view it sounds marvellous - it means you have a 98 per cent chance of being seen and sorted from arrival in A&E.

Right? Wrong. You haven't had a Department of Health maths lesson.

Say you come in to hospital complaining of abdominal pain. You wait three hours to see a doctor -they organise a scan and blood tests and transfer you to a ward next to A&E.

The results come back two hours later and you can be discharged. In the real world, three plus two is five - that's five hours you've been waiting.

But in fact, because you were transferred to the A&E ward before four hours, officially you weren't actually in A&E all that time.

Confused? Me too - and I spend my working life in A&E!

It is even worse if you are a patient referred by your GP for emergency treatment. You bypass A&E and go straight to a ward.

As there are no targets for patients who bypass A&E, you may wait four hours before even being seen by a doctor, but this is not even recorded in the official figures as you went to an emergency ward and not the accident and emergency department.

If you are starting to understand the logic, a job in NHS management awaits you.

As well as the rules being "bent", the fact is the figures are often "fiddled".

This is done in numerous ways, from simply changing the discharge time - it is amazing how many patients are discharged at three hours 59 minutes - to delaying when ambulances are allowed to hand over patients to the hospital.

The most cynical way the figures are massaged is when patients are "moved" on the computer when in reality they are not physically moved at all, but perhaps go from a trolley to a bed, have a curtain drawn round them and the light turned off.

You don't have to be a brain surgeon to know this shouldn't happen, but it does, because A&E staff are concerned that if they have too many breaches, then they will face the Spanish Inquisition from management the next day.

But the saddest thing for me as a doctor, and you as a patient, is that I often have to see people not according to the urgency of their need but simply to satisfy a government target.

I remember having to treat a bloke who had called an ambulance for an ingrowing toenail and wanted to sort it out there and then as he was "off to Ibiza that evening".

Because his four-hour target was nearly up, he was seen before a patient in severe pain with a dislocated shoulder.

So Government claims that everything is lovely-jubbly are inaccurate.

In my experience, the real picture is that between 5 and 10 per cent of patients end up waiting longer than the four-hour target.

At peak times that can rise to 15 per cent - that's a million patients nationwide. And it will probably only get worse.

There has been a year-on-year rise in A&E attendances; many factors have contributed to this - an expanding population (in number and waist size), more alcohol and drug-related attendance, lower-quality GP out-of-hours services, and an increasingly elderly and frail population.

However, there has not been a corresponding increase in resources.

In A&E there are not enough nurses treating patients and there is a lack of senior A&E doctors to make treatment decisions.

When we do decide to admit a patient, there are not enough beds on acute wards, so patients have to wait unnecessarily in A&E.

Why is it that France and Germany have double the number of acute hospital beds that we do in the UK?

The doctor is Dr Nick Edwards. The full article in the Daily Mail is here. He has also written a book, IN STITCHES: The Highs And Lows Of Life As An A&E doctor.

Posted by James Bartholomew • Indexed in NHS

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Gordon Brown announced yesterday that the National Health Service would become preventative as well as curative. Actually, this is precisely what Labour promised in 1943 in its pamphlet which originally proposed "A National Service for Health".

Item 2 of the section describing the "The Medical Service that we need" (and which the National Service for Health would provide) began:

(2) Preventive as well as curative. It must be equipped for preventing avoidable damage to the intricate working of body and mind, and for promoting the full flowering of every man's and woman's physical and mental strength; it must be positive as well as negative, helping those who are fit to keep fit, and those who nearly fit to become fully fit.

I expect that some extra testing will indeed take place as a result of Mr Brown's initiative. But this is spinning while Rome burns. The NHS is providing an inadequate curative service, as previous postings in the NHS category have described. There is something grotesque, in the circumstances, about creating new services which will, inevitably, take money away from other areas of the NHS which might have a more important role in the health and well-being of people. Physiotherapy will be even more stringently rationed. Cancer drugs will be more rationed. Care for the elderly will be even worse and so on and on.

Posted by James Bartholomew • Indexed in NHS

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A few days ago, I met a consultant who told me patient care has become worse in the past five years. She mentioned a number of things that were worrying and/or were making the business of treating patients more difficult.

1. The NHS management has imposed an expectation that, in her speciality, there should be two follow-up meetings with patients for every one meeting with a new patient. This target varies from one speciality to another. Her target is, as far as she is concerned, wholly arbitrary and damaging to good patient care. She believes that good care requires, on average, a higher proportion of follow-ups. But if the hospital fails to keep to the proportion prescribed, then it will lose some funding. So an attempt must be made to keep to it or to fake it.
If they were to keep to it, then patients who needed to be seen more than twice after the initial visit would suffer. She suggested that therefore, in order to maintain good patient care despite the target, they fake it - at least some of the time. They call an old patient a new patient. Presumably they pretend that the patient has a new ailment whereas, in fact, it is the continuation of the old one.
How depressing it is that senior doctors have to spend their time getting around silly rules rather than devoting themselves to their job of looking after patients.

2. She told me that doctors gain the status of consultants far more quickly than before. Previously they spent four years training generally and then another seven years in their speciality. They also worked all hours, thereby seeing a great deal of illnesses and their treatment. Now, however, they can be called 'consultants' after only five or six years and they have had significantly less experience in those years than they would have done previously because of the new rules limiting their working hours. A consultant today is often not the highly experienced top doctor that he or she would have necessarily been in the past.

3. Another effect of the new working hours is that the new consultants more frequently than before have a shift mentality. When their time is up, they go home regardless of the state of their patients. This is a change from the time when a consultant very frequently felt his or her prime responsibility was to the patient and that this would quite often mean he or she would stay around until a procedure involving the patient was complete.

4. She told me that there is a drive for doctors to account for everything thing they do. She said that in one hospital, I think it might have been Great Ormonde's in London, they were trying out a system whereby doctors would account for each thing they did for patients on a personal digital assistant (PDA. I remarked that I had recently seen another consultant in a different hospital swiftly moving from task to task - ordering an X-ray for one patient, asking for another patient to go to his office, consulting with another doctor about a third patient, examining the second patient, looking at X-rays for a fourth patient, having a word with the relatives of that patient all in quick succession. If he had had to itemise such things, he would not have had time to do them. She heartily agreed. In trying to monitor such things, the administrators were going to damage the productivity of doctors and thus damage patient care.

5. She also remarked what a vast army of people there must be doing all the monitoring of targets. Somebody from her hospital would have to collate all the figures showing whether or not she was meeting the unnecessary and damaging target of two follow-up consultations for every one initial consultation. Then the information would have to be sent to the central administrators who would have to check and analyse the figures. I presume someone would have to decide if the funding should be cut. Letters and warnings would be issued and replied to. Someone must also have been paid who thought up the idea. Someone must have thought up how it should be implemented. Stationery would have been designed, printed and distributed to hospitals. And so on and on. One bad 'bright' idea. Hundreds more people employed by the NHS to produce no improvement in treatment. In fact their employment damages patient treatment since their wages and costs such as office space, heating, lighting, pension rights and so on have to be taken out of the NHS budget and taken away from patient care.

I had spoken to this consultant when researching The Welfare State We're In. She told me that she thought things in the NHS were bad then but they are worse now. She also remarked that having damaged the NHS, the regulators and administrators have also moved in on the private sector, requiring more and causing more damage even to the private sector.

6. There is a requirement now that hospital consultants can only do certain treatments if the hospital concerned has beds that are suitable for that particular speciality. Presumably this is in case there is a mishap and the patient needs a hospital bed. But the result is that hospitals where a consultant used to do minor treatments immediately and on the spot are not allowed to do this any more. In the past, the consultant could decide whether or not it was wise to do such treatments. Now he or she is not allowed to decide. The patient has to make a new appointment at a different hospital, quite possibly seeing a different consultant who has to learn about the case afresh. Patient time and care is damaged. More consultant time is wasted.

She painted a very depressing picture of how the NHS is being administered and how even the private sector is being interfered with and damaged by government.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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When I calculated, for The Welfare State We're In, how many people a year die prematurely because Britain has the National Health Service rather than an averagely good system for an advanced country, I did not include deaths from Deep Vein Thrombosis (DVT). There is now plenty of reason to think that if these deaths were added, the toll of unnecessary deaths Britain endures would be even higher.

Today most papers have a report of the high death rate from DVT. However what is lacking, as far as I know, is any comparison with how other countries perform. If anyone knows of an international comparison, I would be grateful to hear of it. It is hard to believe they do worse.

I have personal experience of how much of the British medical establishment has got into the habit of not giving the risk of DVT proper attention (as with hospital acquired infections). A close relative broke her hip and afterwards, I came to learn, being elderly and not very mobile, she was at considerable risk of developing DVT. But she was not monitored. I, as the main person responsible for her, was not told of the risk. And although she was visited by a district nurse and developed symptoms, no effort was made to check whether she had the problem. It was only when I rang the consultant who did the operation to ask about her inflated leg that a check was ordered. She did indeed have DVT and might well have died as a result if I - not the district nurse - had not seen that there was a problem that should be checked out.

I suspect it is true that the failure of the National Health Service in general and, in truth, large parts of the private medical service in Britain, too, to take DVT seriously has caused tens of thousands of unnecessary deaths.

Here is some of the coverage of the story in the Daily Mail:

Nearly 11,000 patients have died during the past seven months because of a failure by NHS hospitals to prevent them developing blood clots, a report claims.

Guidelines introduced in April mean every patient at risk should be assessed for treatment to cut the toll of deep vein thrombosis, or DVT.

But only one in three trusts is taking action, according to the damning report from the All Party Parliamentary Thrombosis Group.

It estimates that the failure to implement the guidance has cost 10,700 lives from DVT in the past seven months - nearly three times the number of deaths from the MRSA superbug and C Difficile infections.

The death toll in a year is greater than that from breast cancer, Aids and traffic accidents combined.

DVT is caused by blood clots forming in the deep veins of the legs. If they travel to the lungs it may trigger a pulmonary embolism that can cause them to collapse, and heart failure.

The blood clots often form as a result of immobility during and after surgery. If part or all of the clot breaks off and lodges in the lung, 30 per cent of those affected will die without treatment.

A substantial number of patients are struck by a surgical DVT - whose medical name is Venous Thromboembolism, or VTE - after they have been discharged from hospital.

The report says it is a "public health emergency" yet preventive drugs given at the time of surgery cost just £1 a day, while compression stockings can help others.

Altogether, 99 per cent of 140 NHS Trusts surveyed in the report are fully aware of the guidelines, but only 32 per cent are taking steps to assess patients at risk.

These include patients in hospital for longer than four days with reduced mobility, severe heart failure, respiratory failure, acute infection, inflammatory illness or cancer.

John Smith, chairman of the parliamentary thrombosis group, said: "The stark realisation is that while nearly all hospitals are now aware of what best practice looks like, and the steps they should be taking on a daily basis to protect their patients, over two-thirds of NHS Trusts admit to not having in place a mandatory risk assessment for every hospital patient on admission.

"DVT causes more than 25,000 deaths each year. It is worrying

that some NHS Trusts are still failing to adhere to these guidelines, which could reduce deaths by over 40 per cent."

Campaigners say DVT causes 10 per cent of all hospital deaths.

Dr Beverley Hunt, medical director of Lifeblood: The Thrombosis Charity, said: "The total costs of managing DVT within the NHS are estimated to be £640million and it's deeply concerning that the simple step of risk-assessing patients is not being taken.

"Any unwell adult entering a hospital bed has a 17 per cent risk of DVT but this risk rises considerably if they are over 40, are having surgery or have a predisposing condition such as cancer."

In March 2005, a report from the Health Select Committee warned the NHS was systematically and dangerously underestimating the threat from bloodclotting.

It found preventive drugs were cheaply and easily available but not widely administered.

The full article is here.http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=495064&in_page_id=1770

Posted by James Bartholomew • Indexed in NHS

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I have been unable to upload any entries for a number of weeks and the site has been down for a few days, so I want to catch up on a few items that I have not been able to write about in the past month or more.

The Sunday Telegraph had an article on October 21st about people going abroad for dentistry. I myself have been one of these people, getting dental work done in Malta by British-trained dentists at a fraction of the price in London. But this is still a small business and we should not lose sight of the bigger issue: the decline and fall of NHS dentistry. It is one of the services of the NHS that is simply falling off the back of the lorry, as this passage in the article makes clear:

In April 2006, when new NHS dental contracts were drawn up, they severely limited the number of treatments dentists could claim from the NHS. The supposed aim was to make the service less complicated. Instead, the result was that dentists flocked into the private sector.

While it is true that the number of dentists has increased from 15,000 in 1999 to more than 24,000 now, almost none works exclusively for the state.

Thus, in the past year, 1.4 million people have been left without access to a NHS dentist and, according to a survey by HSA, the medical payment plan provider, about 40 per cent of those questioned believed it was ''only a matter of time" before NHS dentistry disappeared altogether.

Needless to say, the private sector is booming. Virtually non-existent 20 years ago, it is now worth £2.4 billion. In 1990, for example, only five per cent of a dentist's income came from private patients. Today it is nearer 60 per cent.

Posted by James Bartholomew • Indexed in NHS

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It is said by some in Britain that although the NHS has its failings, it is still great when it comes to emergencies. I am sceptical about this claim. For one thing, if a hospital lacks up-to-date scanners (as many hospitals in the NHS do)then it may not be able to do the best possible scan for the particular emergency concerned.

I believe, as I have written before, that the only reason that private medicine in Britain includes very little in the way of emergency care is that the scale of private care is not yet big enough in the UK to make the big investment worthwhile for a private company. Companies might also fear political opposition.

There is, incidentally, one emergency care private clinic in London for relatively minor conditions. It is, understandably, in London near the road which leads to Heathrow airport and the West.

Meanwhile, I am interested to get this from a correspondent in Australia,

Hello James, Thought you might be interested in the huge increase in the use of private emergency rooms here in Australia:

"Record numbers of patients are paying up to $300 to beat public
hospital emergency queues by seeking treatment at Perth's only private
emergency department, which charges them according to how sick they
are."

"In the past year, 25,000 people have attended its 24-hour emergency
department, about half the number of patients seen by each of the
emergency departments at (the Public) Royal Perth and Sir Charles
Gairdner hospitals."

http://www.thewest.com.au/default.aspx?MenuID=158&ContentID=35113

Posted by James Bartholomew • Indexed in NHS

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The UK National Screening Committee, which advises ministers, recommended screening for aortic aneurysms in January 2006. In May this year, it agreed detailed plans on how it would work. But the government still has not made a decision.

The Vascular Society of Great Britain and Ireland, which represents surgeons who work in the specialism, said the delays had already cost thousands of lives.

Jonothan Earnshaw, the society's honorary secretary and a leading surgeon, said: "The Government needs to get on with this. There are at least 3,000 men dying an early death every year who could be saved if screening was introduced."

The full article is here.

In the book, I calculated how many people die each year because Britain has the NHS instead of an average system of European healthcare. Perhaps another 3,000 deaths a year should be added to the calculation. But I am not sure because I have not had the opportunity to discover to what extent other countries - and not just European ones - screen for aortic aneurysms. Any comments with information on this would be most welcome.

Posted by James Bartholomew • Indexed in NHS

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This is a grim account of one way in which treatment in the NHS is, effectively, being delayed. None of this, I assume, will appear in the calculation of 'waiting lists'. So this is also another way in which the waiting list calculation is being manipulated. To put it more bluntly, it is anothe way in which the waiting list figures are lies.

Family doctors say that new "referral management" systems, set up to allow primary care trusts (PCTs) to overrule decisions taken in the surgery, are being used to delay and cancel hospital care, and to divert patients referred to a hospital consultant to cheaper clinics in the community.

Other schemes run by PCTs have offered GPs payments if they reduce the number of patients sent to hospital.

Of 750 doctors polled across Britain, 75 per cent said they had referred patients to hospital only to have their decision overruled, with 40 per cent saying that it happened regularly. Dr Laurence Buckman, the chairman of the British Medical Association's GP committee, himself a London family doctor, said such schemes were a short-sighted attempt to save money by delaying hospital care.

"If I think my patient needs to see an orthopaedic surgeon, the chances are they do," he said. "These kinds of schemes just set up an extra layer, which delays the patient getting to see the right person."

Dr Buckman said he believed the schemes were "simply about saving money" by delaying hospital bills. "Most PCTs are on the verge of bankruptcy and if they can find a way to defer payment until the next quarter, or next financial year, they will," he added.

Norman Lamb, the Liberal Democrat health spokesman, said that GPs in his North Norfolk constituency had complained to him after referrals for teenagers requiring psychiatric help were delayed, while local PCTs had introduced "minimum waits" for surgery in order to push hospital bills into the next financial year.

He warned: "Patients will be confused. They will trust their GP to make the right judgment and when their referral comes back, they can only assume it was for financial reasons."

Katherine Murphy, from the Patients' Association, said her group was hearing a growing number of complaints from orthopaedic patients who believed their health had worsened after they were diverted for treatment by a physiotherapist when their GP had intended them to see a surgeon. She described the policy as "a prime example of deficits putting lives at risk".

Paul Rybinski, a GP in Croydon, Surrey, said doctors were under increasing pressure to reduce hospital referrals to save NHS funds. His own practice has a referral cuts target of 5 per cent.

Dr Rybinksi said he feared "referral centres" would make decisions based on very partial knowledge of the patient. "When I make a referral it is based on a complex decision relating to the individual in front of me. It is very difficult for a panel at a PCT to second-guess what I was thinking, and the factors I was taking into account, based on a reading of a basic referral letter."

The poll, by Pearl Medical, which provides mobile communications to GPs, also found that doctors strongly opposed Government plans to create networks of "polyclinics", replacing individual GP surgeries with huge group practices, serving populations of 50,000.

The full article in The Sunday Telegraph is here.

Posted by James Bartholomew • Indexed in NHS

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After writing The Welfare State We're In, I now notice instances of welfare provision as they appear in novels which previously I would have missed. Recently I listened again to an audio-book of Mapp and Lucia, the comic novel by E.F.Benson. For the first time, I noticed that the focus of the early rivalry between the two women was the competition between their two charitable events for the benefit of the local hospital.

Lucia won this battle hands-down. Everyone went to her fete. No one went to Mapp's event. But underneath the comedy lies the way in which it was simply normal for people of their class to put on events to raise money for local hospitals.

These hospitals might be charitable or run by the local authority. In either case, the people of the town or locality felt that they were connected to it. They, personally, might need it one day. They had a stake. They could also gain status by helping it financially and probably in other ways, too.

The town in which Mapp and Lucia is set is called Tilling. But I think I am right in saying it is based on the very pretty Sussex coastal town of Rye.

I wonder how hospital provision in Rye has changed since Mapp and Lucia was written (circa 1930?)? Did it have a hospital then? Does it have a hospital now?

Whatever may be the case, it is certainly true that hundreds of local hospitals have been closed down since the NHS was created. There are some good reasons for this and some bad. It is noticeable that the Labour Party, when it promoted the idea of the NHS in 1942 argued that local provision of hospitals was important. After the NHS was created, both parties were persuaded that big hospitals offered economies of scale and could develop the capacity to deal with all eventualities. They could also develop particular strengths. But since then, the political parties have re-discovered the idea that local healthcare has it merits in maxi-GP practices or mini-hospitals.

Of course local hospitals have their merits. That is why pre-NHS healthcare created them. In some ways the value of them has actually increased. If there is an emergency in one part of London and a patient needs to be rushed to hospital, it now takes longer to get there because of the density of traffic. The same applies all around the country. I presume that, in some cases, patients lives can be at risk because of the distance between an emergency patient and a hospital.

A local hospital can promote loyalty and commitment on the part of both staff and patients. Patients in hospital are also easier to visit if they are local and this, in turn, means they are more likely to be visited and, I believe, those who are visited are more likely to get well soon.

The closure of quite so many local hospitals has surely been one of the range of bad effects of the creation of the NHS.

Posted by James Bartholomew • Indexed in Charity • NHS

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A commenter on the posting below has argued that American healthcare is inferior to British healthcare. Here is a link to an article I wrote on this subject a few years ago:

http://www.thewelfarestatewerein.com/archives/2005/02/which_is_better.php

which I followed up with this posting a little later

http://www.thewelfarestatewerein.com/archives/2005/02/perhaps_i_was_t.php

Posted by James Bartholomew • Indexed in NHS

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Here is a new and important report providing evidence that despite the increased spending on the National Health Service, it still provides substandard care.

A report by the spending watchdog concluded that Britain has one of the worst records in Europe for ensuring dementia sufferers receive the best drugs available.

It likened the situation to 1950s cancer care when GPs did not tell patients of their diagnosis because they did not want to distress them and because they believed nothing could be done to help them.

In 2004, the UK was in the bottom third of European countries in terms of the proportion of patients receiving antidementia drugs.

Only 18 per cent of British dementia patients received drugs to alleviate their condition - compared with 50 per cent in France and 46 per cent in Ireland. Only Poland, Bulgaria, the Netherlands, the Czech Republic and Slovakia fared worse.

Care for the elderly has been one of the services that has been allowed to fall behind international standards while the NHS has concentrated its attention on the more politically sensitive issue of waiting lists. There is not enough money for everything in the NHS because the huge amount of waste and inefficiency (please see the book for more on this) uses up a large part of the budget.

The story is from the Daily Mail, citing a report from the National Audit Office. It has a league table which is particularly telling. I assume it comes from the National Audit Office report.

Posted by James Bartholomew • Indexed in NHS

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From the Guardian:

One in eight NHS hospital patients still has to wait more than a year for treatment, the government acknowledged yesterday in its first attempt to tell the full truth about health service queues in England.

A Department of Health analysis of 208,000 people admitted to hospital in March showed 48% were wheeled into the operating theatre within 18 weeks of a GP sending them for hospital diagnosis. But 30% waited more than 30 weeks and 12.4% more than a year.

In a key manifesto pledge at the 2005 general election, the government promised that by December next year all patients would be treated within 18 weeks.

Posted by James Bartholomew • Indexed in NHS

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One of the ways in which the government has sought to hide the dreadully low effectiveness of the extra money it has put into the NHS has been by cutting back on services which are not in the public eye.

Great effort has been put into cutting waiting lists. Plenty of money has been put into hiring staff, especially managers but also doctors and nurses. But the money has not reached many other service which are less in the public eye but extremely important. One of the major ones is care for the elderly.

This is from yesterday's Sunday Telegraph:

Hundreds of thousands of elderly people have had their "social care" cut in the past decade.

Seven in 10 councils in England have been forced to "ration" services since Labour came to power, according to the Local Government -Association.

Most town halls now provide services - including meals-on-wheels, trips to day centres and home visits from social workers - only to pensioners with "substantial" or "critical" needs.

and later,

Although council spending on care for the aged has risen 65 per cent since 1997, central government grants have increased only 14 per cent. In a foreword to the document, Lord Bruce-Lockhart, chairman of the LGA, says: "[To receive care] people have to wait until their life is threatened, they have serious physical or mental illness, or they are unable to carry out the majority of domestic routines."

Full article here.

Posted by James Bartholomew • Indexed in NHS

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One of the allegations in The Welfare State We're In is that the published figures for deaths resulting from MRSA in Britain are seriously understated.

This suggestion was supported this weekend by Dr Mark Enright, a microbiologist at Imperial College, London. He was quoted in the Sunday Telegraph saying,

"I would expect that the death figures substantially under-report the true situation. In a lot of cases, MRSA doesn't make it on to the death certificate when it should. Instead you see organ failure, pneumonia, or sepsis.

"Often it is hard to say exactly how much of a contribution MRSA caused to the death, but there is a tendency not to include it."

And further on,

He said that neither the number of deaths officially linked to MRSA nor the rate of bloodstream infections provided a full picture.

"I would say bloodstream infections account for 10 per cent of the infections in total," he said. "If people tested every infection, the rate would be far, far higher."

The Sunday Telegraph also offered a particular example of someone who was not classified as dying from MRSA yet who was evidently suffering from it very seriously:

John Howard Crews, 50, died in hospital in December 2003, three months after suffering a heart attack. His death certificate recorded the cause of death as pneumonia and cardiac failure. However, his stepson Derek Butler, who witnessed the last six hours of his stepfather's life in which he was "coiled up in a foetal position with his legs turned blue", was convinced an infection was to blame. When he and his mother asked questions of Blackpool Victoria Hospital, it emerged that Mr Howard Crews's lungs were "profusely infected with MRSA" and that the infection had been identified a week before his death.

Katherine Murphy, of the Patients Association, was also quoted as saying,

"We hear time and time again of cases where there is MRSA but the death certificate says pneumonia, or a chest infection, and it is only when relatives start asking questions that they find out that MRSA was present."

The full article is here.

Posted by James Bartholomew • Indexed in NHS

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After all the extra money that has been pumped into the NHS, we still underprescribe the latest drugs. People have died as a result and will continue to die. It is shocking and dismaying.

The report - in lots of newspapers this morning - is very important. It is based on an updated version of the report I cited in the revised and updated paperback edition of The Welfare State We're In. It is the clearest evidence that the extra money put into the NHS has not and will not result in an improvement in Britain's inferior treatment of those with cancer. It is simply the case that if a person gets cancer in Britain, he or she is more likely to die than would be the case in France, America or other advanced countries. Since the NHS is continuing to underprescribe the latest drugs, this will continue to be the case.

Here is the story as it appears in the Independent:

British patients are being denied access to life-saving cancer drugs that are widely available in the rest of Europe and the developed world, according to a report.

The NHS's "penny-pinching" attitude to new treatments and "excessive bureaucracy" surrounding their assessment is condemning cancer sufferers in Britain to an early death, it says.

A review of the availability of 67 new cancer drugs in 25 countries has found that Britain languishes close to the bottom of the league. along with Poland, the Czech Republic, South Africa and New Zealand.

The authors, from the Karolinska Institute in Sweden, say research in the US, which has the highest use of new cancer drugs, has shown that new treatments have significantly increased the chances of surviving cancer.

A separate study of 20 countries showed that nearly a third of the improvement in cancer survival between 1995 and 2003 could be attributed to new drugs.

In Europe, the UK has the lowest survival rates and the lowest use of new drugs compared with the major Western countries of France, Spain, Germany and Italy. In all four countries, more than half of cancer patients were being treated with drugs launched since 1985, but in the UK only 40 per cent were.

The full story is here.

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The simple point about the NHS computer fiasco is this: that governments repeatedly botch up major projects. The result is that huge amounts of money that could have been spent on patient care has been wasted.

Why do governments keep on wasting money on this spectacular scale? Because no one is truly both a) in charge and b) accountable. When Marks and Spencer was adrift and losing market share, the chief executive and many others got the sack and their reputations were damaged. No one has publicly got the sack for this vast waste of public money.

Here are some of the details as described by Richard Bacon M.P. in the Daily Telegraph today:

By now, almost every hospital in England is supposed to have key administrative software deployed as the essential first step in introducing the shiny new electronic patient record. They are miles behind schedule, yet the limited deployment has already caused havoc, with significant delays in providing inoculations to children, waiting list breaches, missing patient records and the inability to report activity statistics. Not to mention the trifling matter of the largest computer crash in NHS history, when 80 hospitals had no access to patient administration systems for four days.

This is a truly grim tale. More than £2 billion has been spent, and although there is no detailed record of overall expenditure on the programme, estimates of its total cost have ranged from £6.2 billion up to £20 billion. There have been six bosses in five years. Timetables are fictitious and the programme is now years behind.

Doctors, nurses and hospital managers have been left spitting with rage. Most GPs think the appointment booking system is a joke. And three fifths of the programme is dependent on a software supplier called iSoft, which is currently under investigation by the Financial Services Authority and whose flagship software product, "Lorenzo", does not exist yet (even though the company said it was available three years ago). In the meantime, iSoft has been merrily selling old software that pre-dates the national programme.

Today, Parliament's spending watchdog publishes a report on this multi-billion-pound fiasco, which concludes: "At the present rate of progress, it is unlikely that significant clinical benefits will be delivered by the end of the contract period." The whole project has been an object lesson in how not do it.

The full article is here.

The news story is here.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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The poor treatment of cancer sufferers in Britain is reflected in this article in The Sunday Times (March 25, 2007:

Delays give patients new cancers

Sarah-Kate Templeton, Health Correspondent

CANCER patients who have had tumours removed are dying because they are waiting so long for for follow-up radiotherapy that their tumours return, a government report has found.

After surgery, patients should receive radiotherapy within 28 days, according to the Royal College of Radiologists. However, in some areas, patients are waiting three times as long. In Kent, for example, the waiting time for breast cancer patients who have had tumours removed by surgery is three months.

Dr Michael Williams, vice-president of the Royal College of Radiologists and co-author of the report, said that, in addition, some patients were not receiving enough radiotherapy.

Williams said: “One problem is delays in some areas of the country and the other is that, when patients are treated, they receive fewer fractions [doses] of radiation than they would receive elsewhere in Europe and America.”

It is understood that the report, co-authored by Mike Richards, the government’s “cancer czar”, also says that the NHS is administering only about half the amount of radiotherapy needed to treat British patients properly.

Williams has research showing that, in Britain, only 28,000 doses of radiation are given per million people compared with the recommended 54,000.

Williams accepts that the government has invested heavily in radiotherapy since 2000, but he says: “Restricted access to radiotherapy services means that some British cancer patients are dying.”

The full article is here.

Posted by James Bartholomew • Indexed in NHS

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The debate which I took part in today went pretty well. My argument was helped by those who spoke from the floor. While many present, no doubt, had been brought up to believe that the welfare state was a good thing, they were old enough to have had experience of how the dream has gone badly wrong.

The speaker on the other side of the debate naturally argued the case that public spending was a jolly good thing and improved people's lives. But the first person speaking from the floor told how she had had a terrible time looking after her mother. The hospital had refused to give her mother a drug which the GP had been giving her. Why? It wasn't in the hospital budget, she said she had been told.

She said that she had had to fight to get her mother looked after. She had no doubt that if she had not been around, that her mother would now be dead - due to the poor care of the NHS.

Other speakers spoke of immense waste in government departments that they had known.

I find increasingly that people relate to the criticisms I make of the welfare state. They can see how my analysis fits in with their own experiences.

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Here is an email I have just received. I copy it here because sometimes I sense that people think that mine are 'ivory-tower' views. I have left off the name of the sender in case he/she wishes to remain anonymous.

Dear Sir,

I commute 3 hours a day to my job in London, as a NHS dentist in a
deprived area. In this most boring time I usually crave a good reading. Your book "The Welfare State We're In" accompanied me on my daily commute for the past week.

I am extremely disappointed with it because I paid £12.99 for it and I believed that it would keep me company for 2-3 weeks. However, its
content was so rich and irresistible that sadly it only lasted me for a week! I practically devoured it.

Your book was not exactly an eye-opener for me, as I had reached pretty much the same conclusions through the almost daily contact I have with the welfare state. I was amazed however by the strength and clarity of your argument and by all the evidence you've mustered to support it.

It saddens me to think that I considered myself a socialist before I
started working and it only took 3 years working in the coalface with
the welfare zombies to bring about a complete reversal of my beliefs. I have spoken with colleagues that shared the same beliefs and everyone has undergone a similar transition. You are very right to say that most middle- and upper-class people do not understand the real extent of the problem because they don't come in close contact with the welfare state.

Keep up the excellent work.

--
Regards,

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Belatedly, I want to mention the extraordinary mess the government has made of the hiring of junior doctors. It has been well covered in the Telegraph.

It should not come as a surprise that the NHS has completely mucked up this business. The government is a bad administrator. It is also in a monopoly position. This kind of disaster is the sort of thing that governments operating monopolies go in for - although this does rank among the most cack-handed foul-ups that even a government monopoly has managed.

The dislocation the NHS has brought upon itself and the misery endured by doctors are appalling. The only possible silver lining is that perhaps more in the medical profession will come to view the NHS as a failed idea. Already there are far more who take that view than there were a decade ago.

Here is part of a letter printed there which was written by a doctor:

These last few weeks have been the final straw for many of us. We have been subjected to the most unfair and least meritocratic selection process ever seen, MTAS [medical training application service] via MMC [modernising medical careers].

Here is a link to several letters.

We have had to sum up our years of work and experience in several politically correct short answer questions, on which we are then judged. Examinations, experience and references are all but ignored in the pursuit of vague waffle. Shame on those who are behind this scheme. Many a tear will be shed this week by many brilliant young doctors who have had their hopes and dreams crushed in a quite barbaric fashion. Many of us will emigrate and many of us will leave the profession; I hope those behind the scheme are proud of these achievements.

Here is the beginning of an excellent article on it by Dr Max Pemberton:

Posted by James Bartholomew • Indexed in NHS

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The interesting thing about the call for charges to made for certain treatments is where it comes from.

The argument has not been put by some right-wing think tank. It has come from the Association of Directors of Public Health. So it has come from within the NHS. This represents another milestone in the change of attitude to the NHS. It seems like a long, gradual shift both of attitude and actuality.

Dentisty on the NHS has gone to a large degree. It is difficult for most people to get sustained physiotherapy. I suspect that the same goes for osteopathy. Care for the elderly has been cut back. Now part of the NHS itself suggests dropping various treatments.

The background is quite simple. The NHS is incompetent as an organisation. Its costs are high, its bureaucratic overhead is enormous, it fails to make full use of its assets and it has powerful unions which contribute to the above. Meanwhile the politicians know there is a limit to have much people are prepared to pay in tax. So as the costs grow, the only way to keep the taxpayer half-way happy is gradually to lop off some of the branches of what the NHS does. This process has been going on for a long time. It has continued through the big increase in NHS spending and it will go on into the future.

Here is the the recent news about cutting back treatments:

The NHS should consider billing patients for ineffective treatments and drop all prescription charges, senior public health doctors said yesterday.

Spiralling health costs had to be controlled, said Dr Tim Crayford, the president of the Association of Directors of Public Health, and one way would be to charge patients for treatments for which there was not good evidence that they worked or when cheaper options were available.

Their list includes insertion of grommets, surgery for benign moles, varicose veins procedures, hysterectomy for heavy bleeding, carpel tunnel surgery for sore wrists, tonsils removal and homeopathy.

Dr Crayford also said not offering cataract or hip replacement surgery too early in the progression of the disease, could be added to the list.

He called for national standards to be set as to when NHS surgery should be offered for these complaints.

Posted by James Bartholomew • Indexed in NHS

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There is a danger that, as time passes, people will begin to think that the communist states were not so bad after all.

Gradually the generation that lived through the last few decades of European communism will become a minority. New generations will grow up who never heard the many anecdotes of deprivation, misery and political oppression that were widespread in those years. I have already heard one BBC radio programme in which Russian communists lamented the passing the 'good old days'.

It is, of course, a reflection of the political bias at the BBC that this programme idea was selected from the thousands that which are constantly being submitted. The way in which the programme was done - giving credence to the idea of 'good old days' - also reflected this bias. But this kind of thing is likely to become more common, not less.

Last night I heard another story of just how bad things were in the Soviet Union. Professor Christopher Andrew, the historian of secret services, gave a talk in which he mentioned in passing that mothers to be 'fled' from hospitals in Moscow and Leningrad. They went to the country to have their babies because they were terrified of having them in City state hospitals where the cross-infection rates were so dreadful.

Later, Mary Kenny, who was in the audience, told me that when she stayed with the Irish ambassador in Moscow in the 1980s, she learned that an American anti-abortion film sent to the Soviet Union had not had the effect intended. An American lobby group had wanted to shock Soviet women with pictures of how dreadful is the reality of abortion. Instead, Soviet women seeing the film were ecstatic by how wonderful - particularly how clean - were American hospitals.

I asked Professor Andrew if he knew of any book which documented the terrible state of the Soviet Union prior to its collapse. He did not. Surely someone has written about this. If not, someone should gather together and verify the stories and the data. The disaster that was communism should not be forgotten. Otherwise it could well be repeated.

Posted by James Bartholomew • Indexed in General • Media, including BBC bias • NHS

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It is good to hear of someone suing an NHS hospital over MRSA. One of the great scandals of the NHS, as detailed in The Welfare State We're In, has been it dreadful record in combating infection and MRSA in particular. The NHS's record is very dramatically worse than that of the private sector - a fact which I have never seen anyone else report.

The story reported below is reminiscent of the famous case in medical history in which women giving birth were mysteriously dying in alarming numbers at a particular hospital (in Vienna, perhaps?). No one could work out why the women were dying. Some women no longer wanted to have their babies in this hospital but preferred to take their chances at home. Going to the hospital came to be seen as dangerous. Finally a doctor worked out that the mothers were being examined by medical students who had previously been working in the hospital's mortuary. The students were infecting the mothers and, effectively, killing them. So washbowls were installed outside the ward and all the students were required to wash before entering. The death rate fell. That was a very long time ago. Yet we now have a woman who goes into hospital perfectly healthy. She, too, comes out dead because she became infected in the place that was meant to help her. I wish Mr Espaba well in his suit. The hospital might claim that it followed procedures. That is not good enough. The NHS has 'form' when it comes to MRSA.

The husband of a nurse who died from a virulent strain of MRSA six days after giving birth said yesterday he was suing the hospital at the centre of the outbreak.

Maribel Espaba, 33, died at the University Hospital of North Staffordshire after contracting Panton-Valentine Leukocidin-producing MRSA after an emergency caesarean in September.

Mrs Espaba is one of 11 people connected to the UHNS who have caught the infection, which destroys white blood cells and can kill within 24 hours.

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Nine members of the medical staff and two patients, one of whom died in March, have also been infected.

Yesterday Mrs Espaba's husband, Wen 30, said: "I am absolutely heartbroken. It was the worst and best time of my life. My wife had just given birth to our beautiful baby boy and then just days later she had died.

"It was all very sudden. We had just moved into our new house and were looking forward to our new life with our son. Only a couple of days after she came out of hospital she suddenly fell very ill.

"She was rushed into the hospital but her condition just kept deteriorating. I was helpless and I could see she was dying.

"When the doctors told me she had died I was numb. I had no idea why she had died. They never mentioned MRSA and they had not mentioned to my wife that there had been an outbreak of MRSA even though she worked at the hospital."

He added: "Maribel was a strong and happy person who was dedicated to her work and was always helpful. I was very dependent upon her support and have found it extremely difficult to cope. "This was our first child and the only comfort I have is that Maribel got to see him and spent six days with him before her death."

Posted by James Bartholomew • Indexed in NHS

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Visiting Siena I came to learn that opposite the wonderful cathedral is a charitable hospital called Santa Maria della Scala that was founded, if I remember rightly, some 800 years ago. It was a charitable venture like St Bart's in London. And like St Bart's, it has some wonderful art in it. It was, also like the British charitable hospitals, taken over by the government. The last ward was apparently only closed quite recently. The ill found themselves surrounded with early renaissance frescoes.

Wherever one goes, if one's eyes are open, one comes across welfare provision before welfare states took over.

This does not prove this kind of provision (alongside the family, mutual organisations, friendly societies and self-support) was better. But many people are not aware at all that, prior to government welfare, that there was any welfare provision at all.

Below is a little more about it:

Posted by James Bartholomew • Indexed in General • NHS

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Below is a disturbing article from yesterday's Sunday Telegraph. Can it really be true? It seems like a grotesque parody of how the NHS is now working. I would like to see more sources identified to be fully confident that the situation is as described. But if the story is, indeed, true, then the Government has set up - or has allowed the creation of - a new layer of bureaucracy which in theory exists to speed up access to consultants but, in fact, delays access to them. In short, it is a new way of hiding the waiting list and a new way of denying access to patients whose doctors think they would benefit from such access. It puts together a waste of resources (the new offices and personnel) and a denial of healthcare to those who need it. It appears to add to the evidence that the reduction in the waiting lists - which is assumed by most observers to be an uncontested fact - is, in reality, exaggerated or a lie in which this dishonest government and frightened officials in the NHS collude.

The paperback edition of The Welfare State We're In has a extra small chapter called The NHS: so did