Tag Archives: CQC

Why is this Liverpool hospital being penalised for a political decision by NHS England?

Overwhelmed: across the northwest more than 2,660 patients are in hospital with Covid-19, including more than 200 patients on a ventilator.

You might think it is fair for the Care Quality Commission (CQC) to take possibly punitive action against the Liverpool University Hospitals Trust.

Trust medical director Tristan Cope had, in fairness, warned that the hospital had been overwhelmed by coronavirus and standards of care could no longer be maintained.

But would it be fair if, as he also claims, NHS England has been blocking the hospital from enacting plans that would redeem the situation – in the name of politics?

Here’s The Independent:

In the WhatsApp message to doctors, shared with The Independent by multiple sources, Dr Cope, a consultant in anaesthesia and critical care, said: “LUH is now essentially overwhelmed by the demand. We cannot maintain patient flow and usual standards of care. We have put forward a proposal to further reduce elective [planned] activity, but maintaining capacity for the most urgent cases that would suffer from a two-four week delay.

“It is a very sound plan that our divisional teams have worked up. However, NHS England are prevaricating and delaying with the usual request for more detail, more data, etc. It is clear to me that the politics is outweighing the patient safety issues of the acute crisis.

“There has been no meaningful support from the acute cell or NHS England. In fact, they are blocking us from acting in a rational way that would help us to manage the acute pressures.”

He added: “I am utterly demoralised by the catastrophic leadership failure at a national and regional level. I feel I have done everything I can in terms of escalation and lobbying for some courageous and meaningful action, but apparently to no avail, at least so far. Not sure what else I can do.”

Liverpool has been hit hard by the escalation of Covid-19 in recent weeks, as more and more people have succumbed to the virus as a result of Tory government policies that have allowed it to spread.

The Independent article’s comment from an NHS England spokesperson avoids the substantive issue already – merely commenting that the service is treating more people now than at the height of the first wave.

The statement also says more “clinical support” has been brought in from elsewhere in the region, but this must be balanced with the fact that it has demanded asymptomatic staff testing.

And who is going to be providing the facilities to test every single person in Liverpool, as often as necessary, as the government has claimed?

It seems clear that – yet again – the Tory “make do and mend” approach to medicine is heading for disaster. Perhaps Boris Johnson would treat the matter seriously – if only he were affected by it personally.

Source: NHS bosses accused of ‘putting politics before patient safety’ as leading hospital struggles to cope with second wave | The Independent

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Coronavirus: Medical groups unite to condemn bulk ‘Do Not Revive’ plan for sick and disabled people


This should be seen as absolute proof that it has been a policy to deny coronavirus care to people with long-term illnesses and disabilities.

This Writer has noted some scepticism in the responses to yesterday’s article about the GP practice in Wales that wrote to people with ongoing medical conditions, telling them that equipment used to treat coronavirus is being rationed and they were not likely to be treated if they contracted the disease. Instead, the letter asked them to sign a form directing medical staff not to attempt to resuscitate them if they succumbed to the virus.

My own attitude to this is clear: as we have all paid into the National Health Service, throughout our lives, we all deserve the best possible care available from it. I asked: do politicians and royalty get preferential treatment? If so, why?

Also, just because a person has an underlying condition, that doesn’t mean they won’t be able to shrug off the virus, given the same help that is provided to everybody else.

Now the British Medical Association, the Care Provider Alliance, the Care Quality Commission and the Royal College of General Practitioners have released a joint statement, saying more or less the same.

Here’s the statement:

It reads [boldings mine]:

The importance of having a personalised care plan in place, especially for older people, people who are frail or have other serious conditions has never been more important than it is now during the Covid-19 Pandemic.

Where a person has capacit, as defined by the Mental Capacity Act, this advance care plan should always be discussed with them directly. Where a person lacks the capacity to engage with this process then it is reasonable to produce such a plan following best interest guidelines with the involvement of family members or other appropriate individuals.

Such advance care plans may result in the consideration and completion of a Do Not Attempt Resuscitation (DNAR) or ReSPECT form. It remains essential that these decisions are made on an individual basis. The General Practitioner continues to have a central role in the consideration, completion and signing of DNAR forms for people in community settings.

It is unacceptable for advance care plans, with or without DNAR form completion to be applied to groups of people of any description. These decisions must continue to be made on an individual basis according to need.

It’s saying that any policy requiring medical staff to write off any individual – of any age and condition – as untreatable without discussing their situation with them is wrong.

If the government has handed that down to healthcare providers as a requirement, then it is wrong.

If anybody has already died as a result of such a policy, then those responsible must be identified and must pay the appropriate penalty.

This is real. It is important. It could be deadly. Don’t let the Tories get away with it.

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Discredited Maximus adds care inspections to DWP portfolio


This may be a longshot, but can anybody else detect a stitch-up for care services on the horizon?

Maximus runs assessments for sickness benefit claimants – people who need care. Now it will oversee the management of advice on care in homes and hospitals.

Is it paranoid to see a conflict of interest here?

The source article quotes the chair of one service-user network who said his organisation had not been contacted to work in the new system. That may not be enough to condemn Maximus/Remploy – but who will be carrying out the work.

People with a vested interest in saying what Maximus/Remploy wants to hear?

The care watchdog has been criticised for awarding a discredited outsourcing giant new contracts to manage the use of service-users as expert advisers in care homes and hospitals.

Two-thirds of the new contracts to run Experts by Experience – which pays people with experience of using care services to take part in Care Quality Commission (CQC) inspections – have been awarded to Remploy.

Remploy, which will start delivering the Experts by Experience programme on 1 February 2016, was formerly controlled by the UK government but is now mostly owned by the US outsourcing company Maximus, which already has a huge chunk of Department for Work and Pensions (DWP) contracts to provide employment support and assessment services for disabled people.

Since Maximus was awarded the DWP contract to take over provision of its controversial “fitness for work” tests from Atos, activists have repeatedly drawn attention to its troubling history in other countries.

The company has a lengthy record of discrimination, incompetence and alleged fraud in the US and has also been linked with allegations of exploitation and manipulation of government contracts within the Australian welfare-to-work industry.

Source: Discredited Maximus adds care inspections to DWP portfolio

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Greatest Coalition Failures: National Health Service

zcoalitionfailNHS

National Health Service staff went on a four-hour strike today (Monday) against a pay freeze which has meant one in five of them have had to take other jobs in order to make ends meet.

Health Secretary Jeremy Misprint Hunt, whose 10 per cent pay rise on his ministerial salary of around £140,000 is safe, said the health service could not possibly afford to add one per cent to workers’ pay. The minimum starting salary for a registered nurse is £21,478; Hunt’s pay rise alone could cover a one-per-cent increase for no less than 65 such nurses, and they are by no means the lowest-paid NHS workers.

The strike has come as The Times newspaper claimed that “senior Tories have admitted that reorganising the NHS is the biggest mistake they have made in government,” with at least £5 billion a year wasted on inefficiencies.

The paper’s online version is hidden behind a paywall, but its front page states: “David Cameron did not understand the controversial reforms and George Osborne regrets not preventing what Downing Street officials call a ‘huge strategic error’, it can be revealed.

“The prime minister and the chancellor both failed to realise the explosive extent of plans drawn up by Andrew Lansley, when he was the health secretary, which one insider described as ‘unintelligible gobbledegook’.

“An ally of Mr Osborne said ‘George kicks himself for not having spotted it and stopped it. He had the opportunity then and he didn’t take it.’

“The admission came during an investigation by The Times that has found at least £5 billion is wasted every year on inefficiences, such as overpaying for supplies, out of date drugs, agency workers and empty buildings, a study carried out for ministers said.”

The report raises several questions. Firstly, if Lansley’s reforms were a mistake, that doesn’t mean Cameron and Osborne would have proposed anything better. Tories are almost universally dedicated to the end of the National Health Service and the worsening of working-class health.

Secondly, if David Cameron did not understand Lansley’s plans, why did he allow them to go through? As Prime Minister, he is responsible for the activities of his government and a lack of comprehension indicates that he is not fit for the role – and never was. Is it possible that Cameron was swayed by the fact that Lansley was his mentor at the Conservative Research Department and he thought he owed a favour?

Thirdly, if Gideon didn’t spot it, what does that say about his abilities as Guardian of the Public Purse? (Actually, here’s a link to an article about his abilities in this regard. Read it and weep, George!)

Finally, and perhaps most importantly: How did the government let the NHS fall into this terrible condition? For the answer, we have to go back, again, to the Coalition Agreement.

22. NHS

The Government believes that the NHS is an important expression of our national values [From this we may conclude that the Tories (and their little LD friends) decided to change the NHS and make it reflect their values]. We are committed to an NHS that is free at the point of use and available to everyone based on need, not the ability to pay [Fail]. We want to free NHS staff from political micromanagement [Fail], increase democratic participation in the NHS [Fail] and make the NHS more accountable to the patients that it serves [Fail]. That way we will drive up standards, support professional responsibility, deliver better value for money and create a healthier nation [Fail].

  • We will guarantee that health spending increases in real terms in each year of the Parliament, while recognising the impact this decision will have on other departments  [Vox Political has just spent several weeks demonstrating to the BBC that this has not happened].
  • We will stop the top-down reorganisations of the NHS that have got in the way of patient care. We are committed to reducing duplication and the resources spent on administration, and diverting these resources back to front-line care [Andrew Lansley’s Health and Social Care Act 2012 was the largest top-down reorganisation ever imposed on the National Health Service. It was also gibberish (as top Tories now concede) and has cost the service more money than it could ever hope to save].
  • We will significantly cut the number of health quangos [Clinical Commissioning Groups are quangos – so in fact it seems likely the number has increased].
  • We will cut the cost of NHS administration by a third and transfer resources to support doctors and nurses on the front line.
  • We will stop the centrally dictated closure of A&E and maternity wards, so that people have better access to local services [The Coalition government has never – let’s have that again: NEVER – refused permission for a plan to close A&E wards].
  • We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf [This refers, again, to CCGs. In fact, overworked GPs do not have time to plan and commission services, and have handed responsibility over, in most cases, to private health companies. This has opened the way for a huge amount of corruption, as these companies may commission services from themselves. More than one-third of doctors who are board members of CCGs have financial interests in private healthcare (NHS SOS, p 5].
  • We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT). The remainder of the PCT’s board will be appointed by the relevant local authority or authorities, and the Chief Executive and principal officers will be appointed by the Secretary of State on the advice of the new independent NHS board. This will ensure the right balance between locally accountable individuals and technical expertise.
  • The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs [Fail. This hasn’t happened]. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations [Fail].
  • If a local authority has concerns about a significant proposed closure of local services, for example an A&E department, it will have the right to challenge health organisations, and refer the case to the Independent Reconfiguration Panel. The Panel would then provide advice to the Secretary of State for Health [Fail. The right to challenge seems to have been introduced but has been ineffective].
  • We will give every patient the right to choose to register with the GP they want, without being restricted by where they live [Fail. In fact, the Coalition has given GPs – or rather, CCGs – the right to choose the patients they want, meaning they can exclude patients with expensive, long-term conditions. This has an effect on the promise to provide care to everyone that is free at the point of use, of course].
  • We will develop a 24/7 urgent care service in every area of England, including GP out-of-hours services, and ensure every patient can access a local GP [Fail, for reasons indicated above]. We will make care more accessible by introducing a single number for every kind of urgent care and by using technology to help people communicate with their doctors [The service was launched in 2013 and was a complete and utter failure – it could not cope with demand on any level].
  • We will renegotiate the GP contract and incentivise ways of improving access to primary care in disadvantaged areas.
  • We will make the NHS work better by extending best practice on improving discharge from hospital, maximising the number of day care operations, reducing delays prior to operations, and where possible enabling community access to care and treatments.
  • We will help elderly people live at home for longer through solutions such as home adaptations and community support programmes.
  • We will prioritise dementia research within the health research and development budget.
  • We will seek to stop foreign healthcare professionals working in the NHS unless they have passed robust language and competence tests.
  • Doctors and nurses need to be able to use their professional judgement about what is right for patients and we will support this by giving front-line staff more control of their working environment.
  • We will strengthen the role of the Care Quality Commission so it becomes an effective quality inspectorate [The CQC has been rocked by the revelations of one cover-up after another, involving physical and psychological abuse of clients]. We will develop Monitor into an economic regulator that will oversee aspects of access, competition and price-setting in the NHS [Monitor has been turned into the enforcer of the government’s privatisation initiative].
  • We will establish an independent NHS board to allocate resources and provide commissioning guidelines [This is NHS England, which now takes decisions that would once have been in the hands of doctors. It can intervene in the running of any CCG, forcing changes where they don’t fall into line. It rigidly enforces spending limits].
  • We will enable patients to rate hospitals and doctors according to the quality of care they received, and we will require hospitals to be open about mistakes and always tell patients if something has gone wrong.
  • We will measure our success on the health results that really matter – such as improving cancer and stroke survival rates or reducing hospital infections.
  • We will publish detailed data about the performance of healthcare providers online, so everyone will know who is providing a good service and who is falling behind.
  • We will put patients in charge of making decisions about their care, including control of their health records [Jeremy Hunt wanted to sell your health records to private companies. Although the scheme was put on hold in February 2014, it seems to be running now. Your health records may already be in the hands of private companies].
  • We will create a Cancer Drugs Fund to enable patients to access the cancer drugs their doctors think will help them, paid for using money saved by the NHS through our pledge to stop the rise in Employer National Insurance contributions from April 2011.
  • We will reform NICE and move to a system of value-based pricing, so that all patients can access the drugs and treatments their doctors think they need.
  • We will introduce a new dentistry contract that will focus on achieving good dental health and increasing access to NHS dentistry, with an additional focus on the oral health of schoolchildren.
  • We will provide £10 million a year beyond 2011 from within the budget of the Department of Health to support children’s hospices in their vital work. And so that proper support for the most sick children and adults can continue in the setting of their choice, we will introduce a new per-patient funding system for all hospices and providers of palliative care.
  • We will encourage NHS organisations to work better with their local police forces to clamp down on anyone who is aggressive and abusive to staff.
  • We are committed to the continuous improvement of the quality of services to patients, and to achieving this through much greater involvement of independent and voluntary providers [Fail. The introduction of independent (read: private companies) and voluntary providers has been a costly disaster].
  • We will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers [Not true. The patient never has a choice].

The comments (in bold, above) relate only to a few of the calamities that have been forced on the NHS by the Coalition government (you may be aware of others) – and it is important to add that these took place only in England, where the Coalition has control. Health in Scotland, Wales and Northern Ireland is a devolved responsibility but the Tories and Liberal Democrats have tried to influence the provision of services by restricting the amount of money available to the other countries of the UK.

In addition, fears are high that the proposed Transatlantic Trade and Investment Partnership between the European Union and the United States of America will “lock in” the privatisation of health services, as corporations will be allowed to sue national governments if they impose changes that would affect a company’s profits. These claims have been rubbished by the European Commission and Tory ministers – but they would, wouldn’t they?

In summary: The last four and a half years have witnessed a sustained attack on the National Health Service in the United Kingdom, by a government that won most of its votes on a claim that it would protect and strengthen that organisation. It was a lie that has caused misery for millions – and is likely to have cost many, many lives.

Follow me on Twitter: @MidWalesMike

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A&E fears fall on deaf ears

Andy Burnham, Shadow Health Secretary: He'd rather listen to real doctors than spin doctors.

Andy Burnham, Shadow Health Secretary: He’d rather listen to real doctors than spin doctors.

The title of this article should seem brutally ironic, considering that the Coalition government famously ‘paused’ the passage of the hugely controversial Health and Social Care Act through Parliament in order to perform a ‘listening exercise’ and get the views of the public.

… Then again, maybe not – as the Tories (with the Liberal Democrats trailing behind like puppies) went on to do exactly what they originally wanted, anyway.

Have a look at the motion that went before the House of Commons today:

“That this House is concerned about recent pressure in Accident and Emergency departments and the increase in the number of people attending hospital A&Es since 2009-10; notes a recent report by the Care Quality Commission which found that more than half a million people aged 65 and over were admitted as an emergency to hospital with potentially avoidable conditions in the last year; believes that better integration to improve care in the home or community can relieve pressure on A&E; notes comments made by the Chief Executive of NHS England in oral evidence to the Health Select Committee on 5 November 2013, that the NHS is getting bogged down in a morass of competition law, that this is causing significant cost and that to make integration happen there may need to be legislative change; is further concerned that the competition aspects of the Health and Social Care Act 2012 are causing increased costs in the NHS at a time when there is a shortage of A&E doctors; and calls on the Government to reverse its changes to NHS competition policy that are holding back the integration needed to help solve the A&E crisis and diverting resources which should be better spent on improving patient care.”

Now have a look at the amendment that was passed:

“That this House notes the strong performance of NHS accident and emergency departments this winter; further notes that the average waiting time to be seen in A&E has more than halved since 2010; commends the hard work of NHS staff who are seeing more people and carrying out more operations every year since May 2010; notes that this has been supported by the Government’s decision to protect the NHS budget and to shift resources to frontline patient care, delivering 12,000 more clinical staff and 23,000 fewer administrators; welcomes changes to the GP contract which restore the personal link between doctors and their most vulnerable patients; welcomes the announcement of the Better Care Fund which designates £3.8 billion to join up health and care provision and the Integration Pioneers to provide better care closer to home; believes that clinicians are in the best position to make judgements about the most appropriate care for their patients; notes that rules on tendering are no different to the rules that applied to primary care trusts; and, a year on from the publication of the Francis Report, notes that the NHS is placing an increased emphasis on compassionate care, integration, transparency, safe staffing and patient safety.”

Big difference, isn’t it?

From the wording that won the vote, you would think there was nothing wrong with the health service at all – and you would be totally mistaken.

But this indicates the sort of cuckooland where the Coalition government wants you to live; Jeremy Hunt knows what the problems are – he just won’t acknowledge them. And he doesn’t have to – the media are run by right-wing Tory adherents.

So here, for the benefit of those of you who had work to do and missed the debate, are a few of the salient points.

Principal among them is the fact that ward beds are being ‘blocked’ – in other words, their current occupants are unable to move out, so new patients cannot move in. This is because the current occupants are frail elderly people with no support in place for them to live outside hospital. With no space on wards, accident and emergency departments have nowhere to put their new admissions, meaning they cannot free up their own beds.

Health Secretary Jeremy Hunt had nothing to say about this.

Andy Burnham, who opened proceedings, pointed out the huge increase in admissions to hospital accident and emergency departments – from a rise of 16,000 between 2007 and 2010 to “a staggering” 633,000 in the first three years of the Conservative-Liberal Democrat Coalition government.

Why the rapid rise? “There has been a rise in people arriving at A and E who have a range of problems linked to their living circumstances, from people who have severe dental pain because they cannot afford to see the dentist, to people who are suffering a breakdown or who are in crisis, to people who cannot afford to keep warm and are suffering a range of cold-related conditions.”

He said almost a million people have waited more than four hours for treatment in the last year, compared with 350,000 in his year as Health Secretary; the statement in the government amendment that waiting times have halved only relates to the time until an initial assessment – not total waiting time. Hospital A and Es have missed the government’s targets in 44 of the last 52 weeks.

Illnesses including hypothermia are on the rise, and the old Victorian ailments of rickets and scurvy are back, due to increased malnutrition.

Hospitals are filling up with the frail elderly, who should never have ended up there or who cannot get the support needed to go home because of a £1.8 billion cut in adult social services and support. This, Mr Burnham said, was “the single most important underlying cause of the A and E crisis”; ward admissions cannot be made because the beds are full. The number of emergency admissions of pensioners has topped 500,000 for the first time.

Ambulances have been held in queues outside A and E, unable to hand over patients to staff because it is full. That has left large swathes of the country — particularly in rural areas — without adequate ambulance cover.

The government is downgrading A and E units across the country into GP-run clinics, while pretending that they are still to be used for accidents and emergencies – in the middle of the A and E crisis.

People in England are reducing the number of drugs they are taking because they cannot afford to buy them. Families are choosing between eating, heating or other essentials, like prescriptions.

Competition rules have been stifling care, Mr Burnham said: “The chief executive of a large NHS trust near here says that he tried to create a partnership with GP practices and social care, but was told by his lawyers that he could not because it was anti-competitive.”

He added: “Two CCGs in Blackpool have been referred to Monitor for failing to send enough patients to a private hospital. The CCG says that there is a good reason for that: patients can be treated better in the community, avoiding costly unnecessary hospital visits. That is not good enough for the new NHS, however, so the CCG has had to hire an administrator to collect thousands of documents, tracking every referral from GPs and spending valuable resources that could have been spent on the front line.”

And the health trust in Bournemouth wanted to merge with neighbouring Poole trust, but competition rules stopped the merger taking place.

Mr Burnham demanded to know: “Since when have we allowed competition lawyers to call the shots instead of clinicians? The Government said that they were going to put GPs in charge. Instead, they have put the market in charge of these decisions and that is completely unjustifiable. The chief executive of Poole hospital said that it cost it more than £6 million in lawyers and paperwork and that without the merger the trust will now have an £8 million deficit.

“The chief executive of NHS England told the Health Committee about the market madness that we now have in the NHS: ‘I think we’ve got a problem, we may need legislative change… What is happening at the moment… we are getting bogged down in a morass of competition law… causing significant cost and frustration for people in the service in making change happen. If that is the case, to make integration happen we will need to change it’ – that is, the law. That is from the chief executive of NHS England.”

The response from current Health Secretary Jeremy Hunt needs to be examined carefully.

He said more than 96 per cent of patients were seen within four hours – but this conforms with Mr Burnham’s remark; they were seen, but not treated.

He tried to rubbish Mr Burnham’s remarks about scurvy by saying there had been only 26 admissions relating to scurvy since 2011 – but this misses the point. How many were there before 2011? This was an illness that had been eradicated in the UK – but is now returning due to Coalition policies that have forced people into malnutrition.

He dodged the issue of competition rules strangling the NHS, by saying that these rules were in place before the Health and Social Care Act was passed. In that case, asked Mr Burnham, “Why did the government legislate?” No answer.

As stated at the top of this article. he did not answer the question of the frail elderly blocking hospital beds at all.

The vote was won by the government because it has the majority of MPs and can therefore have its own way in any division, unless the vote is free (unwhipped) or a major rebellion takes place among its own members.

But anyone considering the difference between the Labour Party’s motion and the government’s amendment can see that there is a serious problem of perception going on here.

Or, as Andy Burnham put it: “This Secretary of State … seems to spend more time paying attention to spin doctors than he does to real doctors.”

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