Dying Matters

Whatever the result of the election, and whatever promises were made, we are all still going to die. Three million UK citizens die during a five year Parliament, and millions more are bereaved. Better palliative care is one area where the NHS and social care system could make huge improvements in compassionate care and make considerable financial savings. 50 per cent of deaths are in hospital, yet fewer than 5 per cent of people say they want to die in hospital. Hospital costs at the end of life can be more than five times the cost of social care in the community, yet fewer than one in ten Clinical Commissioning Groups commission dedicated nurse-staffed palliative support, advice and co-ordination for dying people, their families and carers around the clock.

Unsurprisingly, there are significant variations in the quality of care that people experience depending on where they are, what services are available and what conversations they’ve had about dying. Kate Granger is an inspirational doctor with terminal cancer. She works with elderly patients and has this advice on death planning. ‘The most important first decision is “‘where?”’ Preferred place of death is rarely achieved in the UK and

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Funding the NHS fantasy promise auction – whose policies add up?

The pre-election NHS rhetoric has descended into a predictable fantasy promise auction. Politicians know they don’t have a hope in hell of providing a 7 day NHS (Tory), a same day GP appointment for anyone over 75 (Tory), or a midwife by your side every minute of labour (Labour). Even if the money was available, where would we suddenly grow 8,000 more GPs, 20,000 more nurses and 3,000 more midwives (Labour and UKIP)? And is being able to see a GP on a Sunday afternoon really the best use of the NHS’s precious resources? (Tory).

If the NHS is to improve, it needs to be funded at the level of other G7 countries (it’s currently bottom of the league) and it must stop wasting money on policies and treatments that are substandard or don’t have a good evidence-base. According to the best guess of NHS England, the NHS needs a funding increase of £30 billion over and above inflation by 2020-21, to cope with an ageing, frailer population. CEO Simon Stevens hopes that increased productivity and the efficiencies of ‘new care models’ will generate an extra £22 billion,

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Damage limitation

Which party would do least damage to the NHS? The Coalition has increased NHS funding by 0.9% a year in the last five years, when the previous average increase has been 4% a year. Unsurprisingly, given the cuts in social care, many services are now hideously overstretched. In England 3 million people are now waiting to see a specialist with 250,000 more patients needing treatment who are not on the official waiting list. But had Labour won in 2011, it seems unlikely they would have been able to fund the NHS any more generously given the economic circumstances.

The Coalition’s biggest error has been the Health and Social Care Act, not just because it destroyed trust in breaking a key pledge not to have a massive structural reorganisation of the NHS, but because it has lead to a rapid expansion of the role of commercial companies in the NHS. Outsourcing is rarely the answer to anything, and the record in the NHS thus far is woeful. Many of Labour’s early PFI schemes for hospital development have been eye-wateringly expensive, with some trusts lumbered with payback fees more than ten times the original build cost. The withdrawal of

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Dementia Time Bomb

David Cameron’s reluctance to contest a third term or talk about the NHS is entirely understandable given the state it’s likely to be in whenever he leaves office. Last week, the Kings Fund reported that performance has regressed to 1990’s levels. NHS funding needs to increase year on year not just because people are living longer, but because they are living longer with multiple diseases, and particularly dementia. When the NHS was founded in 1948, half the population didn’t make it to 65. Now one in three people in the UK are likely to live to a hundred, and the person who lives to 150 may already have been born.

Between 1948 and 2011, NHS annual funding growth averaged 4%. From 2011-2015 it was 0.9%, and the target growth 2015-2020 is 1.5%. If Cameron wins the election, and even if he loses, the NHS is likely to be stretched beyond repair in five years. NHS England gets very excited about the efficiency savings from new models of working (Vanguard locality commissioning has now replaced GP Pathfinder commissioning on the bullshit bingo cards), but the biggest challenges to the NHS remain inequality, poor self-care and frailty. The

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The GMC wrote to me and others on 1 April 2015 stating it will be undertaking a review of the ‘patient safety’ aspects of the complaint against Dr Barbara Hakin in her role as chief executive of the former East Midlands Strategic Health Authority because the original review “may have been materially flawed” and that a “review is necessary for the protection of the public or otherwise necessary in the public interest.”

The complaint was made by Andrew Bousfield and myself on 19/7/2012. Here is the letter of response to the GMC from Gary Walker, the former NHS trust chief executive and NHS whistle-blower, whose career was destroyed in the process of raising legitimate patient safety concerns. He has not been able to secure another NHS post since. His letter outlines serious failings in the GMC investigation.

Letter to the GMC re Dr Hakin case