Here’s the latest survey from the British HIV Association. Further evidence that Local Authority commissioning changes were poorly thought through and executed.  <5% of services have improved since April 2013, over a third have deteriorated, some markedly.

From: “O’Mahony Colm (COUNTESS OF CHESTER HOSPITAL NHS FOUNDATION TRUST)

Subject: Chester situation email sent to local GP’s and CE of Chester Council by Dr O’Mahony

Date: 10 November 2014 12:54:15 GMT

Dear General Practice Colleagues

I have just seen this latest Public Health Update which has been issued to all practitioners and partners and feel I need to make some comment.

All of us in Sexual Health and HIV, running integrated services in the city of Chester and my colleagues in Leighton Hospital, Crewe, were totally shocked when the council initially awarded the contract to East Cheshire Trust in July 2014.

The joint bid between The Countess of Chester, Mid-Cheshire Trust (Leighton Hospital) and Body Positive had been put together by a very experienced team of 5 consultants in Sexual Health and HIV, along with procurement teams from both Trusts. This extensive clinical experience on the ground in Cheshire was used to create a comprehensive bid which would have given equity across Cheshire and improved the services in Mid-Cheshire to the current high standards of both Chester and Leighton.

In Chester, extensive consultation with local GPs had established that it would be best to

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Simon Says Sort Yourself Out

The five year plan for the NHS, as seen by NHS England CEO Simon Stevens, is mercifully free from the government’s five minute gimmicks (£55 and a pat on the back for GPs who diagnose dementia, a red flag and public humiliation for those who fail to diagnose cancer). But his big idea to reward workers for losing weight – an incentive that helped Stevens shed 3 stone in America – may not ‘gain traction’ over here. Steven’s predecessor David Nicholson became obese and developed type II diabetes whilst in the job, which he managed to disguise with Marks and Spencer elasticated waist trousers. Poor physical health usually starts with poor mental health, and the most urgent health need facing the NHS staff is to reduce the stress, overwork, bullying and fear.

Steven’s inherited chaotic structural reforms that unnamed senior Tories apparently told the Times are the government’s ‘worst mistake’. The idea of making clinical staff as responsible for spending taxpayers’ money wisely as they are for getting the diagnosis and treatment right has merit, but it could simply and cheaply have been done by putting clinical staff in control of the old PCTs. The

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A Solution to the Alder Hey Problem?

MD was recently invited to a high-level meeting at the Department of Health to discuss, amongst other things, what to do about the Alder Hey problem. The charge sheet against Alder Hey is long and complicated (Eyes passim ad nauseam). While no hospital is able to provide the highest standards of care for all its patients at all times, the main concern is that the culture of secrecy, bullying and poor practice that allowed the organ retention scandal (1988-1995), persists today.

The culture of fear, secrecy and the silencing of whistleblowers is not unique to Alder Hey, but as the Bristol whistleblower Prof Stephen Bolsin commented, the best way to resolve bitter NHS disputes is simply to focus on patients. The key questions for anyone charged with investigating Alder Hey is whether children have been harmed by poor care, or whether proper informed consent has been denied for acid reflux operations that are not approved by NICE.

Holding surgeons to account has never been easy. When MD trained, a surgeon could invent an operation of dubious rationale and no evidence base, and carry on for years unchallenged. Another might do an established operation

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The Black Hole

The NHS in England alone is facing a £30 billion deficit over the next five years, as demand in just about every area outstrips both the supply of services and the funding for them. Ed Miliband’s extra £2.5 billion a year would plug the debt for 2015-2016 but not cover it subsequently, leaving nothing to pay for 36,000 more staff he has also promised. He is right that the NHS is hitting the wall now, with over two-thirds of acute hospitals in England failing to balance their books this summer and five of the key waiting times standards missed, including the maximum of two-month waits of urgent GP referrals for treatments. David Cameron’s promise of a marginal year on year increase does nothing to address this. The bottom line is that if no party is prepared to fund care for a population living longer, patients will have to wait longer for care, accept brief, poor quality care or not get it at all.

NHS England has allowed the £400m normally used for ‘winter’ planning to deal with this backlog, and is doubtless praying for a warm January. But NHS England has very little control over what devolved Foundation Trust

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