Archive for the 'NHS' Category


Saving lives and protecting the NHS

Tuesday, May 12th, 2020

Buying Tramadol In Costa Rica In Lord Denning’s 1980 judgement preventing the Birmingham Six from suing the police for injuries while in custody, he stated: 

Buying Tramadol In Costa RicaJust consider………if their action were to proceed to trial………If they won, it would mean that the police were guilty of perjury; that they were guilty of violence and threats; that the confessions were involuntary and improperly admitted in evidence; and that the convictions were erroneous…….That was such an appalling vista that every sensible person would say, ‘It cannot be right that these actions should go any further’.”

go to link It is what happens when an institution is seen as more important than the purpose for which it was set up or the people it is intended to serve. Denning could not countenance his “appalling vista” so he turned away from the more important concept: “Let justice be done though the heavens fall.” If it was not quite Britain’s Dreyfus affair, it shared many of the same characteristics: honour and reputation were seen, especially by those most closely linked to the institution, as more important than its actual conduct; challenge was most unwelcome. It is a failing to which all institutions are vulnerable. So to the NHS. It is worth saying at the outset that the work, dedication and sacrifices of those working in it during this pandemic are worthy of praise and gratitude. It is possible to criticise an institution or the decisions taken at a policy level without demeaning its employees’ work and professionalism. Indeed, this is necessary if employees’ efforts are to be really worthwhile. Ultimately, any system is there for the benefit of its users, to serve the purposes for which it exists, not for those who work in it, however heroic they may be.

Tramadol Cheapest PriceProtect the NHS” has been a key message. Ahead of, curiously, “Save Lives”. The reason is that, were the NHS to become overwhelmed, lives (whether of patients or health workers) would not be saved. To that extent, this policy appears to have been a success. But it has come at a cost – a cost which may well mean that the lives saved have not been as numerous as they might have been. Was this cost unavoidable or was it, in part, the result of policy decisions taken? There are three (out of the many needing thorough examination in due course) worth looking at now.

Tramadol Visa A Too Successful Message? It’s not easy to calibrate people’s responses, even to the most carefully crafted message. People have stayed away from GP surgeries and hospitals. Out of fear or because their health issues were not that serious or health services were not available. Or because they took to heart the government’s message, because they thought they were helping. In some cases, this will not have mattered. But in others, the delay may well have meant people dying at home or not having symptoms treated and developing more serious conditions than otherwise or enduring pain or losing out on necessary treatment. In health, delay is not always a consequence-free option. This may have been inevitable and is now being remedied. But the consequences of delaying or removing treatment needs to be added into the balance at the the final reckoning.

Ordering Tramadol From 1800Petmeds Staying at home when ill The explicit advice from the 111 helpline anyone with Covid-19 symptoms was to stay at home. Only when a person’s condition became serious did hospital admission happen. Was this right? The risks of such a policy decision are that the more seriously ill a person is when they come hospital, the poorer their chances of survival or the greater the risks of surviving with long-term health damage. There is also a greater chance of them passing on the virus to others while at home. Delaying admission until absolutely essential was not Germany’s approach which was to intervene, not necessarily always via hospital admission, at an earlier stage, a practice enormously helped by its much more effective and wide-ranging testing regime. Both of these decisions by politicians and health officials were explicitly a rationing of health care because of a lack of capacity. Any state funded health system will, in some way or other, ration health care, a point often overlooked in discussions about structures, targets and monies spent. Covid-19 has made this explicit and in the most brutal way possible. When it arrived, the NHS did not have sufficient ICU capacity. There was also insufficient testing capacity – though this was only recently admitted. The decision was therefore taken to divert NHS resources to building up ICU capacity and limiting access to hospitals and GPs in the meantime. This certainly protected the NHS and patients from the distressing scenes seen in Italy but at the cost of hidden suffering and death elsewhere. Nowhere has this been more apparent than in care homes.

click click Why are social care and NHS not integrated? 

here You may well ask. Decisions by successive governments to do nothing effective about social care, other than bunging a bit more money at councils from time to time, commissioning reports from the eminent then ignoring them were made long before this virus was a twinkle in its bat mother’s eye. But the virus has cruelly exposed these failings. Policies – lockdown, shielding vulnerable groups, staying away from Granny so as not to infect her – designed to protect those most at risk have been undermined by a policy which has treated care for the elderly and sick at the end of their lives as somehow distinct from and less important than health, an unfortunate after-thought. It’s as if we labelled pregnancy, birth and a child’s early years nursery care and left it largely to parents to sort out. If babies die, too bad: easy enough to make another. As easy as dismissing the elderly “bed blockers”.

Tramadol Order Overnight Shipping Care for the elderly is not an optional extra when a virus dangerous for them comes. Why did NHS England give specific guidance on March 7 to “urgently make available 15,000 hospital beds nationally by discharging anyone who was medically fit to leave without thinking of the consequences for care homes? Were patients sent there without testing for the virus even if they had symptoms? Or even if they had them or were known to be infected? And what did the Department of Health think would happen when it said on April 2nd that negative virus tests were “not required” before discharging people into a care home? What did they think would be the consequences of not making provision for PPE for care home workers? Or of having no policy for managing the movement into and out of care homes of care workers? Or of reduced access to GPs? Or of not having family members able to visit and speak up for their relatives? 

Tramadol Online Pay With Mastercard However laudable the desire to protect the NHS is, its failure is that the NHS’s patients are too often defined – unthinkingly perhaps – as excluding some of the most vulnerable, especially in a pandemic. It’s not as if the government was not warned, as the report into Exercise Cygnus in 2017 stated. Care homes, their need for staff, for a plan, the dangers of discharging patients to them were all expressly raised as serious risks – but little was done. So when a crisis came and health care had to be rationed, hospitals were given priority. Patients in hospitals over those in care homes. Hospital workers over care home workers. Social care took its accustomed second place in our priorities. And that is, in part, why there has been an epidemic of the virus among the most vulnerable group, the group which government policies were ostensibly designed to protect. Rather than cocoon the most vulnerable, they were left horribly exposed.

Tramadol Order Online Mexico Perhaps in reality this is no different from what has always the case. This time we have noticed. This time, as Boris has said, we “bitterly regret” what is happening. Perhaps it could not have been otherwise. Other countries have suffered similarly high rates of care home deaths. There is little good likely to come from this virus. Maybe one thing which might is that we – finally – do something serious about how we care for the old, the disabled, the vulnerable rather than simply talk about it.


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Northern Italy is getting a bit too close for comfort

Monday, March 9th, 2020

A sign of things to come in the UK? Although we now have had three confirmed deaths in the UK the overall scale here is much less than in several other countries that are almost on our doorsteps which is why most of the papers are leading on what’s going on in Northern Italy. Could this be an indication of what things will be like here just a few months on? Northern Italy, after all, is a part of the world which many Brits are familiar with which is why it hits home harder. Only the Mail is leading on the third UK death which is a sign of things to come. More people older people with pre-existing conditions losing their lives is going to struggle to make the headlines. But the Italian experience is a good indicator of how the UK should prepare. This is from today’s Times:

follow link Critical care experts in Italy have warned hospitals in Britain and across Europe to prepare for a surge in admissions of people with severe lung failure caused by the virus who need ventilators in intensive care units (ICUs). In a letter to the European Society of Intensive Care Medicine, they reveal that up to 10 per cent of all those infected with coronavirus need intensive care, with hospitals becoming overwhelmed.

Tramadol Sales Online Will this advice be taken? This could get very political.

Mike Smithson

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A Journal Of The Plague Year. The politics of Covid-19

Wednesday, February 19th, 2020

If you aren’t worried, you haven’t been paying attention.  Recent outbreaks of contagious illnesses – SARS, Ebola, bird flu – have been contained fairly efficiently.  So, many have assumed that the same will apply to the coronavirus Covid-19. That’s not inevitable.  

On such occasions, everyone becomes an instant expert in epidemiology.  Let’s try to avoid that and concentrate on what we do, and more importantly, don’t know.  We don’t know with any reliability how many cases there are now (China seems overwhelmed by the epidemic), we don’t know with any reliability how the numbers of cases grew over time, so we don’t know how infectious the disease is, nor how lethal it is.  We do know that it has now repeatedly spilled over the Chinese borders and we do have anecdotal evidence that it can be easily transmitted. Both Japan and Singapore are currently struggling to stop Covid-19 going wild. On a cruise ship, 454 out of 3,700 passengers have been infected so far.  That does not augur well for the hopes of wrapping this up quickly.

So we should prepare ourselves for the likelihood that this epidemic will become a pandemic.  Others will look at the public health implications. There are political implications too.

follow Best case

Covid-19 is brought under early control as before without spreading much further.  Even in this best case, China’s economy is going to have been seriously disrupted for a period of months and a series of other countries are going to have taken stringent precautions that will have had a substantial impact on them culturally and economically.  

On this outcome, Britain gets off quite lightly, though it may suffer a bit of collateral economic damage.  China seems to have taken extreme measures to control the spread of the virus and this is likely to have had major social and economic effects.  Those are likely to ripple out to Britain at some point. 

The disruption may lead to less enthusiasm for “just in time” models of commerce, as the risks of it not being alright on the night become more obvious.  This might lead to a repatriation of some business activities over time. As a whole, however, the impact on this scenario is essentially temporary or second order for Britain.

From a non-expert viewpoint, this looks possible, but it is far from a done deal.

see url Medium case

If Covid-19 has reached escape velocity internationally, as seems very possible, things get a lot hairier.  Even if it proves to be capable of being contained and at the milder end of current expectations, health services are going to be put under strain across the world and social orders are going to change, at least temporarily.

The economic disruption is likely to be substantial if this happens.  Supply lines would be seriously disrupted. Goods would become unpredictably unavailable.  Globalisation would, at least temporarily, be thrown into reverse.

The public is already – rightly – concerned.  It may start to panic. The effects of any panic are hard to predict.  

The trend to remote working and travelling less would be given a powerful push.  That in turn might make big transport infrastructure projects look like extravagant luxuries.

Culture will be seriously affected even if Covid-19 is at the mild end of expectations, if it spreads widely.  One Grand Prix has already been postponed and a second looks at risk. Right now, even the Olympics look in serious jeopardy.  They were last cancelled in 1944, at the height of the Second World War. Concerts, festivals and theatres look very vulnerable to a concerted outbreak – even if they still take place, who is going to want to go out to catch an unpleasant and perhaps lethal disease?

Covid-19 may well be temporary but its impact may be permanent.  Many cultural organisations are run on a hand-to-mouth basis already.  A sudden shock to cashflows may be terminal.

Politically, it would be difficult for the government.  The NHS has been creaking for years and the government has put protecting it at the heart of its policy.  This kind of strain would be likely to lead to serious disruption of it. In the short term at least, the public would probably be unforgiving of major lapses.

Set against that, it would be a first post-Brexit event that would allow the country to move on.  How it would move on, however, would remain to be seen.

Cheap Tramadol Mastercard Worst case

It’s not yet at all clear that Covid-19 is going to be particularly mild.  We have yet to establish reliably how dangerous it is. If it started to kill people in the millions, and that remains possible, it would become one of those cultural discontinuities like the fall of the Berlin Wall or 9/11, a before-and-after event.  Even those who had not been infected would be mentally scarred.

Right now we are at a crisis in the true sense of the word, a moment when we do not know which course a disease is going to take.  The stakes are very high indeed. Those of us who are not experts must hope that those who are find a way to keep Covid-19 tamed. The alternatives are just awful. Alastair Meeks


On healthcare Farage, Trump’s biggest British cheerleader, is vulnerable

Monday, April 22nd, 2019

Those opposed the Brexit party should change the subject to the NHS

Last November Donald Trump took a beating in the midterm elections when his opponents, the Democrats, were able to make his threats to undermine what public health system there is in the United States into an issue. This is an approach that will be used at WH2020 for once something has become an an entitlement then it is exceedingly difficult and politically dangerous to take it away.

In the UK, of course, the NHS has become something of a religion and none of the mainstream parties dare to do anything but support it. Is it any wonder that successive CON Health Secretaries have made sure that wear an NHS button badge. In the referendum campaign the official Leave organisation made extra funding for the NHS their pivotal selling point.

In the past Farage has talked of the NHS being replaced  by private health insurance a move that was not supported when he was in UKIP.  A few years ago he told UKIP supporters:

“I think we are going to have to move to an insurance-based system of healthcare. Frankly, I would feel more comfortable that my money would return value if I was able to do that through the marketplace of an insurance company, than just us trustingly giving £100bn a year to central government and expecting them to organise the healthcare service from cradle to grave for us.”

If I was advising Mrs May at this difficult time I would say launch a speech defending the NHS against the Farage  threat. This would get big headlines and take the subject away from brexit.

Farage has never made any secret of his views on the NHS and in this he is treading along very tricky ground in the UK because of the very strong public support that there is there and this covers backers of all parties.

Mike Smithson


The main loser from the MidTerms looks set to be “Big Pharma”

Thursday, November 8th, 2018

One of the things we take for granted in the UK is the cost of our prescription medications. This is all part of the NHS and the majority of patients are too young/old or have chronic conditions which mean that they don’t pay.

Even those who don’t benefit from free prescriptions are not asked to pay the cost price of their medication but a fixed fee.

This means the NHS as almost a monopoly buyer is able to secure even the latest and most expensive medications at a pretty good prices.

How very different from the the US where public health programmes are barred by law from using their buying strength to negotiate big discounts for pharmaceuticals. This in one of the reasons why US health is so expensive.

To take an example. I an on a newish medication called Rivaroxaban which controls a genetic condition that causes me to have blood clots. The NHS pays about $2 per day for my pill which keeps me alive. The US price for exactly the same medication is just under $16 which many patients have to pay themselves.

Is it any wonder that the cost of pharmaceuticals is the biggest healthcare issue in US politics. The Democrats have promised to take action and Mr.Trump is also saying the same.

After Tuesday’s elections it clear that something will happen and big pharma is likely to be squeezed.

Mike Smithson


Three Score and Ten? Has the NHS reached the end of its natural life?

Sunday, July 1st, 2018

On July 5th the NHS marks its 70th birthday, and the occasion will be marked by a significant financial injection as a means of life support by the Conservative government. This should keep it breathing for a while yet, but like any ageing process we should consider whether the condition is terminal, and what the objective of continued treatment is. Is the NHS a model of health care fit for the 2020’s or are there better ways of organising it in the modern world?

Why then was 1948 the moment of the birth of the NHS? And why has it taken up such a central place in Britain’s self-image? Other nations do not seem to fetishise their health care system to the same degree, or make it such a sacred cow. British politicians find this both a benefit and a curse, but as we saw with the £350 million per week Brexit Bus pledge, it is one that moves votes. The NHS was a central part of the first truly secure Socialist majority government in the UK, but also a product of its times.

In 1948 there had been substantial governmental involvement with management of hospitals for a decade, beginning in 1938 with planning for anticipated mass bombing casualties, health care staff had also spent a decade either in uniform, or in civilian government control. It was a unique moment in British history, when Attlee’s genteel Socialism and Blitz spirit of national unity came together as parents of the NHS. It was also the year of peak post war austerity.

The NHS was a sickly child from birth, with a vast legacy of untreated conditions, inadequate finance and staffing, and unsuitable legacy estate. Waiting lists were immediate, and the first co-payment charges shortly followed, precipitating Cabinet splits and resignations.

While waiting lists, central planning, and grey bureaucracy were acceptable, even state of the art, in 1948 they became increasingly grating to a population that had become more sophisticated and consumerist. Since then there has been a political desire to satisfy consumerist demands by both Conservative and New Labour governments, and also to introduce elements of competition. Largely this has been via the mechanism of internal market and contracting out of services to private providers, and one that continues today.

This element of privatisation has rarely met the desire for consumer choice, as the competition has been for contracts from the government. Operations and services are put up for bidding like cattle at auction, with the winner rarely being awarded the contract on the basis of clinical outcomes, but rather on the basis of price. This demonstrates that the customer is the government rather than the patient. We have arrived at a solution that meets some of the government’s aims, but at the expense of combining the worst of central planning, corporate profiteering, and lack of consumer responsiveness.

The  challenges to the future include medical inflation exceeding consumer inflation, rising expectations, failure to recruit and retain staff, the obesity crisis, and each of these deserve analysis. The biggest challenge is the demographic one, as summarised in this tweet:

Just as the solution to the pensions issue will be a combination of working longer, paying in more and getting less, the answer in health will be much the same. We will need to stay healthy longer, pay more (either in tax or privately) and get less, or a combination of the above. Staying healthy longer requires a public health approach such as that in the Marmot Report, and it seems increased rationing is on the way. The latter is likely to increase consumer dissatisfaction.

Funding remains the political football. Whether funded by a single government payer, or via compulsory insurance, universal healthcare is essentially redistributive. Those that gain are the elderly, the poor, the mentally infirm and the chronically sick, while the system is paid for by light users, who by and large are young healthy and relatively affluent. There will therefore always be tension between payers and recipient.

Any universal system has to be based on the greatest good for the greatest number, but should this be on the basis of need or of economic benefit? Should the system favour the working plumber over the retired one? The stockbroker with a breast cancer over the dinner lady with the same? I would argue that to do so would be politically suicide, and strike at the founding principle of the NHS. One parent of the NHS was that feeling of wartime national unity that defines postwar Britain, and is central in British psyche and in particular of social conservative voters.

As such, benefits have to be independent of economic utility, and defined on cost effectiveness for the whole nation. How then should we address the increasing restiveness and consumer demand for 24 hour access and rationed treatments? Well, the safety valve for this has historically been the private sector, but this is much smaller in the UK than in comparable OECD countries with universal access. To meet the demand, the UK private sector needs to grow, reform, to become more affordable, more transparent on price and outcomes, and to have robust clinical governance over rogue clinicians. If these were to happen then the consumer would find it more palatable to fund out of discretionary income.

This could be done via a combination of tax relief for private health insurance, vouchers for co-payment by the NHS to pay for an element of the private cost, and a Speedy Boarding co-payment for private wings at NHS hospitals. Private insurance has its merits, but insurance companies are rather prone to sell umbrellas on sunny days and take them back on rainy days, with nearly all policies excluding chronic conditions, mental illness, and pre-existing conditions.

Perhaps the answer for this is for individuals to be permitted to save for their own families health care in tax-deductible accounts analogous to private pensions, with the funds restricted to self funded health care. These could be preserved post retirement and include funding for approved social care. In many ways, such a system would be a return to the pre-NHS mix of workhouse hospitals, friendly societies and private provision, but better adapted to modern Britain.

Are there betting implications? Not really, other than that the NHS will become increasingly frail as it moves into its dottage, and post Brexit will return as a touchstone issue in British politics. It is also likely to remain fatal to political careers, whether in government or opposition. Health Ministers rarely get the top job. In the immortal words of John Reid, on being reshuffled into the job “Oh F***, not Health!”

Dr Foxy

Dr Foxy is a Hospital Specialist in NHS and Private Practice in Leicester. He also has worked and studied in the USA, Australia and New Zealand. He has an interest in statistics and public health planning, is an occasional political punter and longstanding contributor to PB.


LAB continues to have double digit lead on the NHS but the gap is narrowing

Sunday, June 17th, 2018

Will TMay’s latest move make it even better for her?

A few weeks ago at PMQs Jeremy Corbyn reminded the PM that in the 1947/48 period when the NHS legislation was going through parliament it had been opposed by the Tories. That such a line can still resonate 70 years on is really quite remarkable and highlights the ongoing vulnerability that the Conservatives have on the National Health Service.

The National Health Service has always been a LAB issue and will always be raised whenever the pressure is placed upon them. In the recent Lewisham East by-election the main message from the successful Labour candidate was that they were the party of the NHS and that they would protect services better.

Quite what the Tories can do about this is hard to say. My general view in the past is that the best thing for the blue team is that they all is keep off the subject because it’s one on which they can never win.

The above polling table from YouGov shows how the firm’s best party on the NHS tracker has moved since the general election. The positive news for the Health Secretary, Jeremy Hunt, is that the gap is closing which is good for him and his party. In fact he is now the longest serving Health Secretary ever and I think that his manner has played a part in the Conservatives recovery on the matter. I like the fact that he does a simple things like always wears an NHS badge in his buttonhole whenever he appears in public.

Now we have got this morning’s announcement from Mrs May fleshing out the promise to put more money into the service and that might reinforce the trend the fact that it is going to be paid for buy resume, presumably, higher taxes is irrelevant period there seems to be a public attitude appetite4 more going out for better services.

The real problem, of course, is that the pressure gets so much greater as each year goes by because of the proportion of elderly in the population. So the 3.4% that Mrs May is now talking about will really only enable the NHS to stand still.

The most that the Tories can ever really hope for on the NHS is that it is not a big and negative for the party and political liability as it could be.

Mike Smithson


New ComRes poll for the Daily Mirror shows 82% of voters, across all the main parties, would support a 1p rise in National Insurance contributions to fund NHS

Tuesday, June 5th, 2018

There’s a new ComRes poll out for The Daily Mirror on the NHS which shows really strong support for a 1p increase in National Insurance contributions to fund the NHS. The findings seems to reaffirm Lord Lawson’s view that “the NHS is the closest thing the English people have to a religion.”

ComRes say

The findings are revealed in the wake of yesterday’s dramatic intervention by Gordon Brown who warned that with mounting financial pressures and an ageing population, the NHS is in dire need of help and called for a repeat of his 1p rise in National Insurance to rescue it.

Tonight’s poll also shows the underlying political importance of the issue, with almost one in five people (18%) who say they would definitely be willing to change their vote at the next election in favour of a party which pledged additional NHS funding, and a further one in three (33%) who would probably be prepared to do so.  In a warning to the Government and Theresa May, more than four in ten Conservative voters (41%) say they would definitely or probably be prepared to switch vote as a result of the issue.

Importantly, the poll reveals the source of such strength of voter opinion.  When asked if the quality of service in the NHS has improved, stayed the same or declined since 2010, the year when the Conservative-led Coalition took power, 55% of voters answered negatively while just 9% said the quality of service in the NHS had improved.  There is significant variation in perceptions across the country, with fully three quarters of people living in the North East of England who say the quality has declined (75%), compared to 48% in Scotland and 45% in Wales.

You can see why Vote Leave made the NHS such an important part of the referendum just like NO2AV did in the AV referendum.

The question is if a party does propose this will there be a backlash like there was with the dementia tax?


Fieldwork note:  Order Tramadol Paypal ComRes interviewed 1,073 GB adults online on 5th June 2018. Data were weighted to be representative of all adults by region, gender and age.