When is a strike not really a strike?

• When nurses and NHS managers aim to prevent harm to patients by negotiating which categories of patient can have necessary nursing care and which can do without (the derogation process). 

• When nursing members suggest to NfN that the staffing levels and quality of care might improve if derogation leads to drafting extra non-striking staff into services.

• When nursing staff in London Teaching Hospitals – arguably the best resourced hospitals in the country – vote for industrial action whilst nurses in London’s peripheral DGHs – with greater staff problems – do not.

A more appropriate description for the nurses’ responses might be ‘Days of Action’. But wait, we are talking about the NHS where hyperbole and drama are everything. ‘Strikes’ trump ‘Days of Action’, we suspect.

Days of Action!

Nurses will walk out for two consecutive days on Wednesday 18 and Thursday 19 January 2023, the Royal College of Nursing has announced. Unison announced that two full-day ambulance strikes would take place on 11 and 23 January. They will be joined by GMB members working at ambulance trusts, who have moved their planned industrial action from 28 December to 11 January. The nursing ‘strike’ will affect 55 trusts, none of which took part in the recent industrial action. The North West, South East and the South West are the most affected regions.

Source: New nursing strikes announced as Christmas ambulance walkout is called off

HSJ  Alastair McLellan  23 December 2022

Winter pressures, intensified?  

NHS managers feared that a combination of nursing ‘strikes’ and reduced ambulance services would drive people to use A&E departments, which would struggle to manage the pressure of demand. In reality the pressures were less than expected, and often lower than normal. Large numbers seem to have heard and understood the appeals to avoid using the NHS on dispute days. Ambulance services on strike seemed to have fewer calls, although 999 services may have crossed over to 111, which was busier than normal in some places. We will see if changed patterns of demand remain reduced, and for how long.

Source: HSJ  Strike blog: The real test is yet to come as ambulance strike causes little disruption 21 December 2022

Labour’s travails (part 3)

The Institute for Public Policy Research held its State of Health and Care Conference 2022 on December 8th in Westminster’s Central Hall. Support from Gilead, Sanofi, Bristol Myers Squibb, Siemens, Jansen, AstraZeneca and GlaxoSmithKlein, plus some voluntary sector bodies, showed the significance of the event. 

The gathering was designed to publicise and enrich the IPPR’s Commission on Health and Prosperity, and posed three questions to panels of experts: Is health good for business? Are flourishing NHS and social care services still possible? How are health inequalities related to the economy?  The answers were ‘yes’, ‘just about but needs lots more work’ and ‘reciprocally’. The discussions were rich and the audiences were diverse and knowledgeable.

So far, so sensible. Then came Shadow Secretary Wes Streeting who delivered a clear and confident speech about how Labour would put the NHS right. He used a bit too much catastrophism – nurses going to foodbanks, ambulances queuing up for days outside A&E departments, NHS on its knees etc. – for the liking of NfN moles, but it was forgivable. Then he firmly rejected the simplistic arguments of leftist critics of Labour (like those who had mistaken their successful NHS motion at Labour’s conference for policy - see News from Nowhere 114 and 115). Once NfN moles had regained their balance they began to enjoy themselves. Only one or two moles worried about giving the oxygen of publicity to cults. 

Labour’s travails (part 4)

Poor Wes Streeting. The diatribes aimed at him from the sectarian Left never end. The Lowdown took him to task for saying that private sector hospital capacity could and should be used for treatment of NHS patients when in-house resources were limited. What heresy! What Blairite treason! All NHS patients must be treated in NHS beds even if there are not enough (thanks to Tory austerity policies). Re-opening Nightingale hospitals would be ideologically acceptable, perhaps, but they would need to be staffed by NHS employees, which they cannot be at the moment, which is one reason why the nurses are staging walk-outs. Never mind, by waving a Leftist magic wand a new cohort of newly qualified home-grown NHS professionals will be conjured up….by about 2027. Tell that to the waiting list.

Source: https://lowdownnhs.info/private-providers/streeting-races-up-blind-alley/?

Twisting the figures.

The story that five million patients in England were denied a GP appointment when they tried to make one last October was reported by The Times, Mirror, Independent, Guardian, Press Association, Sun, Evening Standard, Labour List,  ITV and The Mail. These findings seemed popular within Labour, but the independent fact-checking group Full Fact described this figure as “an estimate which is not reliable. It’s based on survey data from earlier this year, includes some patients who were offered an appointment they did not take and assumes every appointment request came from a different patient. We’ve not seen a way to reliably estimate this figure with recent available data”. News from Nowhere ‘s moles point out that this is how the NHS catastrophe narrative is fed and sustained.

For a full analysis of the relevant data go to: https://fullfact.org/health/labour-gp-appointments-denied/ 

It does what it says on the bottle (2)

One NfN mole reminded us about the opioid veterinary product Immobilon and it’s antagonist Revivon!  Another cheekily ignored editorial advice to relate a story published decades ago in the magazine ‘World Medicine’ about a beta Blocker named Olololol. Allegedly it was a derivative of 2strokepetrolololol, and had no therapeutic benefits at all, only adverse effects. Neither Olololol nor World Medicine have survived, but if you have either in the back of a cupboard NfN moles would welcome a brief look because we believe the story is absurd but need to check the facts.

Trouble in the Marketplace

Analysis of data on private medical treatments from independent consultancy Broadstone reveals a narrowing “insurance gap” as both self-pay and insured admissions fell despite growth in NHS waiting lists.

 Self-pay admissions in Quarter 2 2022 stood at 134% of their 2019 level, down from 136% in the prior quarter. Meanwhile, insured admissions are 88% of the 2019 level, down from 89% previously.

In real terms, self-pay admissions dropped slightly to 67,000 in Q2 2022 (from 68,000 in Q1) in the first sign that the cost-of-living crisis is starting to impact on the ability of people to fund their own private medical treatment -  albeit levels are still significantly higher than in 2019 (50,000 admissions per quarter).

A Broadstone commentator said: “We are now starting to see self-pay treatments drop off as household savings accumulated during the pandemic are eroded by the rising cost of living, including higher mortgage rates. The self-pay demographic tends to be wealthier so we might expect sustained demand for self-pay given the inexorable rise in NHS waiting lists”, but this is not happening. Fears of a two-tier Health Service may be exaggerated, at least for the moment.  

Source: Sam Livingstone 

Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/

Sir David Haslam talks to Health Matters about his book ‘Side Effects’ published in August 2022

A few years back, I read a biography of Sir James Mackenzie – an eminent GP, researcher, and cardiologist who practised well over a century ago. It struck me that almost all the conditions he dealt with as a GP have now disappeared, and yet today’s GPs are busier than ever. If we extrapolate forwards another hundred years, would the same situation apply?

The boundaries and aspirations of health care seem to constantly shift. Many aspects of life have become increasingly medicalised. Troubled people consult doctors about problems that in the past might have been taken to religious leaders or others in the community, and – as the old saying goes – to a man with a hammer, everything looks like a nail. Problems may be treated medically because that is what doctors do. Current behaviours and expectations – both public and professional – tend to drive high tech medical interventions, and costs are constantly escalating. 

Is the solution to the many long-term problems facing healthcare always and only a question of needing more money? (Though I am clear that in the short-term significant investment in the NHS and particularly in workforce is critical)

The fact that we are living longer is a great success, but it gives us more time to accumulate multiple morbidities. Despite the critical need for generalists, investment and support always tends towards ever-increasing specialisation. Money is poured into acute services, often to the detriment of primary care, public health, community services, and mental health?  Is this what the public want? How would we know? 

I have long found it fascinating that the narrower your clinical focus the more prestige is attached to your job. The more one thinks about this, the more bizarre it is. We often talk about patient centredness, but all too often It is doctors who define the boundaries of their specialty - what is in, what is out, where research should focus, what is interesting. As a simple example , it turns out that only 11% of PROMs (Patient Reported Outcome Measures are actually designed by patients. The rest are designed by clinicians.

 There are many unintended consequences (or side effects) of this overspecialisation and over medicalisation which is often driven by the medical profession and the pharmaceutical industry.  

For all manner of reasons, the expectation of a pill for every ill has worsened the situation. 

In contrast, I am fascinated by doctors and teams who have chosen a different approach – examples being the Frome Medical Practice and Bromley-by-Bow - which promote social intervention and achieve improved outcomes, fewer hospital admissions, and lower cost. Nevertheless, it is clear that we do need more spare capacity in the health care system – as Covid made all to evident.  

We suffer from the “tyranny of the urgent, dramatic, and new”, whilst ignoring other less dramatic and news worthy conditions. We choose to fund new drugs that offer relatively minor benefits in health at huge cost, whilst there are whole tribes of people who seem to be forgotten – such as frail older people at home who are not living their life to the full, whose final years are lived in misery and distress. Did anyone positively decide that was what society wanted? Or is this just a side effect of well-intentioned policy decisions?  

In the UK NICE deals with some of these questions, but often with a narrow focus on effectiveness and costs.  Could citizen juries help with a wider debate about priorities, and take the discussion to the point where we accept that “It’s not just the money”? 

Finally, I make it clear in the book that this is not just a question of reforming the NHS, a constant mantra of too many politicians and commentators. Similar challenges face all health care systems, whether single payer, social insurance or private. The problems are much more generic. What we do have in common with other countries is professional training that inevitably replicates the system. 

As we well know, every system is perfectly designed to get the results it gets. Does current medical education, and medical student recruitment, perpetuate over-specialisation and the inappropriate application of the medical model? What are we really trying to achieve? It’s a question well worth asking.

Side Effects: How Our Healthcare Lost Its Way – And How We Fix It   Atlantic Books 

ISBN 9781786495365