Tag Archives: Sarah Wollaston

Thomas the Tank wreck

Parents will have seen a program if they have kids, they all love to see that cheeky tank engine. The simple life in the town of Knapfort, or is that Nap Forth? The complication of not getting uncoupled, and even as it was merely an episode one, the not so young population might remember the rap edition of this Thomas (at https://www.youtube.com/watch?v=ETfiUYij5UE), so in all this. Is it about the music or the story? Consider that, when we see the Guardian claim ‘Revealed: NHS cuts could target heart attack patients in Surrey and Sussex‘ (at https://www.theguardian.com/politics/2017/jul/14/revealed-nhs-cuts-could-target-heart-attack-patients-in-surrey-and-sussex). So when we see “Organisations in the area are considering limiting angiogram and angioplasty despite positive evidence for procedures” should we be surprised? You see, I have had one, I understand that it is at times essential and that it is needed to assess the situation. We might see: “Hospitals routinely use an angiogram to assess the health of a patient’s heart“, so there is not surprise here. Yet when we see “Patients at risk of a heart attack could be denied vital tests and potentially life-saving operations under NHS plans to make £55m of budget cuts in Surrey and Sussex, the Guardian can reveal“. Why is anyone surprised? You remember that vague promise from some politician named, I think it was Jeremy Carbonite? Labour was going to hire a thousand nurses. So with what money were they going to do that? The NHS is out of cash and out of options. Whilst we see the NHS being politicised, everyone forgot that whilst those optional solution bringers remain talking, not much gets done whilst they talk and whilst they contemplate the decisions that need to be made; no resolutions and the money kept on draining for another 5 months. So we might feel sorry to the smallest degree for Tory MP Sarah Wollaston, with the mention of “the secretive cost-cutting regime which the NHS is imposing on 14 areas of England in an attempt to save £500m – because it involves “draconian” cuts to services that will hit patient care“, which is fair, it is Draconian and nobody wants it, but as the politicians were shouting at each other time went on and nothing was done, the changes for long term gain were all not done, pretty much none of them. Perhaps Labour can help? Do they not have a leader named Jeremy Carbonite? Is Carbonite not a backup program? Perhaps he has a backup option? He was so ‘speechy’, so clear on what needed to be done. So, Jeremy, what would you do next? Spend more money? It’s gone, your Labour predecessors took care of that, to have an NHS, you need an actual economy, if your side had not wasted the massive chunk of a £trillion in total, there would be options to move the track. Did you think of that as you paraded your addition of 4 figure amounts of nurses, police officers and others?

Did you think that the governing party was not aware of the issues? Did you think that those who are governing are not aware of the fact that the NHS is ending far below the line of zero before the end of quarter three? When we see the quote “Hospitals routinely use an angiogram to assess the health of a patient’s heart. The number of people in the UK undergoing angioplasty has risen eightfold since the early 1990s to almost 100,000 a year, reflecting its growing popularity as a non-invasive alternative to a heart bypass“, we understand that it is routinely done (I had one), oh wait! I never had an angioplasty, I had an angiogram. So why is the Guardian just shovelling two issues together on a pile making it seem as one? Perhaps it is done to make it all a little more trivial? When we consider that an angioplasty is set at roughly £17,500, we see that this procedure alone would cost £1,750,000,000 annually, that is a lot of fish and chips repair, or am I trivialising here? So how much are the costs of an angiogram? One source gave me £5,529, so how many a year operations are needed of those and why was there one number, but not the other? It should be a larger number of ‘operations’ needed, but with the cost being merely a third, the impact is less severe. None of that part matters when it is needed, yet what does matter was given to us in 2010 by USA today. Here (at http://usatoday30.usatoday.com/news/health/2010-03-10-heart-angiograms_N.htm) we see a point that matters. With “A troublingly high number of U.S. patients who are given angiograms to check for heart disease turn out not to have a significant problem, according to the latest study to suggest Americans get an excess of medical tests. The researchers said the findings suggest doctors must do better in determining which patients should be subjected to the cost and risks of an angiogram. The test carries a small but real risk — less than 1% — of causing a stroke or heart attack, and also entails radiation exposure“. Now, we get that it is an American source on US patients, and not on UK patients, yet there have been correlations in health care in many nations, so it is not without merit to state that there is the chance that the same issue to some extent in the UK is taking place. Now, in the NHS age where £500 million in cost cutting, is it such a stretch to cut the one procedure that is seemingly only actually required in 1% of the cases? I am not stating that it is a great idea, yet if we accept that we need to get £500 million down, going after the 1% group might be one of the better ideas. In all this Labour should not object, a truckload of their politicians have made a career out of going after the 1% group their entire life, so there should be a consensus on both sides on the isle on this subject! The quote that is hugely helpful is ““We have to rationalise cardiac investigations and treatments. There’s variation of 60% to 70% between hospitals. We’re looking into why that is. Who in future won’t get an angiogram? That’ll be up to cardiologists,” said one senior doctor“, which makes perfect sense and as we accept that there will be a group of people that goes through one way of treatment, some of this will be done because a doctor had a certain education from a certain medical school, another takes route 2. I am largely convinced that both paths have merit and are in the best interest of the patient. In addition, when we see the 60%-70% variation, what happens when we drill down deeper and set it against the years of practice of the cardiologist. Will there be clustering? I am not stating that any of them are wrong. Yet, is there a chance that a junior cardiologist would see a few more (perfectly valid) reasons to do the cardiogram? I am not stating, not judging, I am merely asking. You see, as stated by: ‘the Guardian can reveal‘, yet that part they did not reveal. Why not? Perhaps the data was missing, yet the article on how “NHS organisations in Surrey and Sussex are considering restricting the number of patients who have an angiogram or an angioplasty” it would have been nice to see more than merely quoting “I don’t think that these extra cuts are reasonable. You can’t justify £500m to the DUP while taking another £500m out of the English NHS“. When we see the numbers I see that £500 million can be cut from one side where the costs are implied to be £1.75 BILLION, meaning that here we see that cost cutting is met whilst that budget remains to get 72% and none of the other parts are affected.

So cutting 28% from a program, whilst one of the other considerations is ‘Shut beds or even whole wards in community hospitals‘. It is merely a good idea to contemplate what could be cancelled, postponed of even considered in other ways. Another part that is true, yet limited to merely a small paragraph is “Saving the £55m this year will prove to be a false economy that costs the NHS more money in the long term, warned Nigel Edwards, chief executive of the Nuffield Trust health think-tank” Now, we might think that Nigel Edward is talking politics to the people that hire his consultancy (which is fair enough), yet he has a point and the point he is trying to make has been proven again and again. Yet, the NHS needs a massive overhaul and for the longest of times, people seemed to have been merely talking about it. Is it mere complacency or is there more? Consider the American source 17 years old gave us a 99% not needed rate. There is no evidence (at present) that this is as high in the UK, yet when we see “rationalise cardiac investigations and treatments. There’s variation of 60% to 70% between hospitals“. In an age of cost cutting that 60-70% is an enormous amount of variation and until properly looked at that data there is no way to tell how valid it is in the end.

The article merely gives us a lot more questions than they answer. That is gotten from the final part with “A Department of Health spokesperson said only that “Given the NHS budget has gone up by £6 billion in the last two years in real terms NHS England and NHS Improvement are ensuring that local areas spend their increasing share equally based on best clinical practice.”“, and in addition we see the mention of Tory MP Sarah Wollaston and “while taking another £500m out of the English NHS“, whilst at the end we see “Jeremy Hunt, the health secretary, declined to comment on the £55m cuts“. In addition there is “under NHS plans to make £55m of budget cuts in Surrey and Sussex“, so the article does not give us many things. Like why these two counties have to cut a little over 10%, the final part is given in the weirdest of ways. Now, it could be merely the reporter having a creative thought. If that is not the case, the entire issue in the NHS is a lot weirder and even more problematic than the Guardian could have revealed. The issue “The bodies made clear that they have to contemplate such controversial measures because NHSE and NHSI have told them to save the £55m. Despite already having “ambitious financial plans for 2017-18”“, so here we see part of a larger problem. We have seen for the longest time that the NHS over overspending, that the cash is gone and that cuts were needed, we have all seen that news for about 2-3 years and here we see “ambitious financial plans for 2017-18“. So based on what budget were those ambitious plans conceived, perhaps on a gurney with a few nurses (a somewhat speculative imaginative thought)?

The clarity of the problem has been there for the longest of times, the governing bodies need to take several matters a lot more serious, and in all this the shifting numbers, the mentioning of the blended events and numbers give rise to several other questions too. All this because certain numbers were thrown at the readers, yet the overall numbers called in questions from the very first moment and as such the article (in my humble opinion) merely stats that there is a lot more wrong at the NHS than most people realise, with all that, caught in the middle are the doctors and nurses. None are getting hired in addition and there are issues for the doctors two, so when they rightfully demand that these ‘ambitious financial plans for 2017-18‘ are being made public, what kind of a story will they receive? The tension should be an interesting one as the pay rise for health care workers was capped at 1%.

So as we conclude today’s event, we all need to take a long hard look at the decision makers in the UK NHS, they are seemingly wasting too much time of the preferential prospect of presentation, whilst the reality was never a given element of that presentation at all. The fact that there are actual issues rising to the surface of the NHS, whether already looked at or not, when we see the amount of issues linked to high variations, in an age where costs are cut to the extent they need to be, is it not weird that those numbers had not be properly looked at and reported on at least 2 years ago? The 2010 article is indicative of that to at least some degree. You see, if it had been, that that would have been evidence that could have been added to this article. The fact that it was not gives rise to the questions I added and in all this it took not that much time. Now in all fairness, to add 30% on a £105M cut. Yet in all this, there is still the issue with the £1.75 billion of angioplasty in the UK.

In addition, to add the amounts that are added, how was it decided where they would fall?

Now we get that there are issues in several places and some would state ‘It will be alright‘, and ‘things will get fixed‘. Yet from my point of view and from the issues presented there are merely more and more questions coming up and it seems to me that the growing issues with the NHS is due to inaction, not merely through cut backs. That is one actual clear given, the issue at that point is not how we can solve the NHS issues, it becomes how can we temper towards zero the amount of idle time and inaction, not in the staff, but in the governing and infrastructural sides.

The additional part that was not seen at present is the realisation that the NHS issue will tighten, and get worse for the next foreseeable future (up to 5 years), you see, the turnaround will take longer with every delay and the recovery from any delay will take longer with every delay we see. The second part that we will be shown with the time to come is that there is a growing concern that the UK aging part has been shelved with the NHS for too long, so in about three years we will see that the NHS geriatric division is not up to scrap and there will be additional increasing pressures on the NHS soon thereafter.

 

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