Of all the startling findings from the inquiry into Gosport War Memorial Hospital, and the fact that workers raised concerns as early as 1991 but were disregarded will make for especially disturbing reading for the families affected.

Hospital administrators joined ranks and fired the nurses who made complaints as a small group of night staff making waves and it emphasizes the unfortunate reality that whistleblowers find themselves in a remote position.

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There have been some recent instances of how whistleblowers have been handled by their employers. Unfortunately, these incidents cast light on the way that whistleblowers continue to be subdued rather than supported, both in the NHS and the private sector.

And the use of gagging clauses when whistleblowing doctors get financial settlements on agreeing to leave their job is still endemic in the NHS. Even if confidentiality terms are expressed so as not to restrict a doctor making a protected confession under whistleblowing laws the perception must be that if paid to leave, the mouth should remain securely closed about whatever worries he or she had cultivated.

This is hardly consistent with the new spirit of openness and transparency in our health services.

 

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With the Care Quality Commission that said that two-thirds of NHS hospitals are giving unreliable care, and that budget constraint and cost-cutting will simply lead to more shortcomings, it is increasingly difficult to see why whistleblowers are not listened to and protected, supported, or even honoured as champions of the public interest.

Whistleblowing is not only about public disclosure of disrepute, early, internal admission of shortcomings and dangers gives administrators a chance to take early preventative measures, to learn from mistakes and possibly bypass the spiral of harm and risk that defines the embarrassments that continue to surface.

In severe situations, dangerous surgeons can be weeded out and their practices discussed.

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Concerns over Ian Paterson’s surgery had circulated since at least 2003 and his performance was examined in 2004, and in 2007 an in-house investigation ended in Solihull NHS hospital ordering him to stop performing his disreputable cleavage-sparing mastectomies.

But, he proceeded to carry out these and other dangerous and futile procedures until about 2010. The General Medical Council (GMC) forced restrictions on his practice in 2011 and a study of Paterson’s NHS practice was conducted by Professor Sir Ian Kennedy in 2013.

Ian Paterson served at two private hospitals run by Spire who ordered their own Verita independent review with results also published in 2013 but recent press news of his criminal case have not incorporated aspects of obvious whistleblowing activity but the Kennedy investigation into Paterson’s NHS ventures included references to the fact that whistleblowers were in fact repeatedly disregarded.

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Whistleblowers don’t fare well in the NHS. This is one of the main findings of management in the NHS that it is inwards-looking, over-defensive, and likely to destroy, by a diversity of means, those who suggest that the Emperor has no clothes.

This is not unprecedented to this Review. It is a scourge on the NHS and is one of the main areas where lessons must be learned and the Paterson situation confirmed a breakdown at all levels of oversight and rule in the NHS and the private sector.

Early exposure of his activities would have stopped injustice, injury and perhaps the mortality of the victims and evaded notable sums to meet several hundred compensation claims which are now practically incontestible.

It appears curious that nobody had felt able to speak out. Did doctors turn a blind eye and keep their heads down? Clearly, there must have been honest associates at Paterson’s NHS hospital and at the Spire hospitals who knew of the abuse he forced on subjects but may have been scared to raise concerns in the knowledge that they would be extinguished and victimised?

Were there doctors who attempted to take measures to protect patients from Paterson but were barred from doing so? Equally, were there doctors or administrators who for many reasons, none defensible, who did not want the truth to surface?

It has now been reported that up to ten doctors who served with Ian Paterson are under investigation by the GMC, probably for neglecting to act on concerns.

Trust managers risk punishment for neglecting to protect patients from harm, so neglecting to act on a whistleblower’s anxieties can be a dangerous approach and Bristol Medical Director Dr John Roylance was struck off for professional wrongdoing by the GMC in 1997 after he decided to ignore warnings from children’s heart surgery whistleblower Steve Bolsin.

The GMC ruled that Dr Roylance had failed in his duty to intervene to ensure the protection of patients, and the GMC had control because he was a registered medical practitioner (a radiologist).

More recently former Royal Cornwall Hospital, Truro Medical Director Dr Robert Pitcher was struck off by the Medical Practitioners Tribunal Service at a misconduct hearing in October 2016 for neglecting to protect patients from the risk of harm at the hands of disgraced gynaecologist Rob Jones.

Robert Pitcher had declined to act between 2007 and 2008 on shortcomings reported by Jones’ associates and confirmed by four investigators, three of whom were independent consultants, who had identified significant concerns that require resolution.

One of the reports had identified 46 dangerous failings in Jones’ practice but Pitcher chose to disregard its findings and some of Jones’ co-workers especially junior consultants and senior trainees who gave testimony at the Medical Practitioners Tribunal Service (MPTS) hearing stated they believed it had been hugely hard to raise concerns about a senior co-worker, they were afraid of the consequences on their own careers, being perceived as agitators.

They also expressed their disappointment that nothing productive was done in response. It was not until concerns were heightened directly by the Trust’s Chief Executive in 2012, skirting the clinical and medical administrators, that sufficient response was finally taken.

rcog-logo.jpgThe Royal College of Obstetricians and Gynaecologists (RCOG) investigators then described the team as divided and dysfunctional and that social and personal concerns had led to bungled opportunities to investigate impartially.

Robert Pitcher was punished for putting the interests of his associates above patient safety and an entirety of 204 compensation claims in the interest of Jones’ victims for their avoidable injuries was managed by associates at Enable Law (Foot Anstey).

Nearly half of those claims related to injuries sustained following treatment by Jones following 2008, so may have been circumvented altogether if Pitcher had taken suitable action.

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Cardiologist Kevin Beatt’s situation has further been in the headlines. Dr Beatt had voiced concerns for 3 years over staffing and supplies deficits and workplace oppression and intimidation of junior workers at Croydon’s Mayday hospital and this came to a climax following the death of a cardiac patient during a routine angioplasty procedure in 2011.

Kevin Beatt was fired in September 2012. The Trust said he had made vexatious unsubstantiated and unproven allegations of an unsafe service but a tribunal ruled two years later that he had been unjustly fired in a calculated attempt to damage his reputation and subjected to the unlawful detriment for making protected disclosures.

Dr Beatt has now subsequently been victorious in the Court of Appeal following a 5-year battle and the Court of Appeal accepted the initial 2014 employment tribunal ruling.

The Trust viewed Dr Beatt as a rabble-rouser and it’s too easy for an employer to endorse its view of a whistleblower as being a challenging co-worker or an awkward person, as whistleblowers usually are and it blankets reason.

Parliament had quite deliberately, and for understandable policy reasons, conferred a high level of protection on whistleblowers and if there’s a moral from this rather disturbing story, which has turned out so terribly for the Trust as well as for Dr Beatt, it is that employers should proceed to the removal of whistleblowers only where they are as positive as they honestly can be that the admissions in question are not protected.

In Whistleblowing cases, the three relevant questions for an employment tribunal are whether the worker has made a protected disclosure, whether he or she has been handled detrimentally and whether the reason why the worker has been handled detrimentally was that he or she had made the protected disclosure.

The third point is relevant. Why has the worker been treated detrimentally as he or she maintains?

Whistleblowing is expected to have implications for a patient’s consent before he or she undergoes treatment and the hospital’s duty of candour following the procedure has taken place that is expected to become apparent as more evidence comes before the courts.

We are now in an era of self-determination and the well-informed victim. The Supreme Court ruling in Montgomery in 2015 announced that it’s a doctor’s duty to take just consideration to guarantee that a patient is conscious of physical dangers implicit in treatment, and of logical choices.

In order sufficiently advise, the doctor must engage in a discussion with the patient and must disclose the possibility of intermediary circumstances and complexities that might happen. Placing the responsibility on a patient to ask questions when the patient may not know what questions he should be asking is no longer enough.

The test of materiality is whether, in the circumstances of the particular situation, a rational person in the patient’s condition would be expected to append importance to the risk, or if the doctor is or should really be conscious that the particular case would be required to attach importance to it.

The relevant circumstances involve the amount of responsibility owed by the doctor and the information of the risks and benefits of each decision before the patient undergoes treatment and for the patient to make a very informed choice, shouldn’t he be informed of the associated benefits of undergoing surgery at a separate hospital unit with excellent experience and knowledge, better equipment or whose surgical and medical workers have a more solid safety record in that procedure?

If a surgeon lacks skill in the particular procedure to be achieved, patients should be informed of this.

The whistleblowers whose cases have been recorded have intensified concerns over shortcomings at their own hospitals. The difficulty for the hospital is that if patients are informed that a senior doctor in that unit has mounted concerns over inadequate resourcing, lack of adequate staff, or extraordinary death rates or maybe an unfortunate happening in a particular procedure those patients will definitely choose surgery at another centre.

If parents had been informed of the true position at the Bristol children’s heart unit in the 90s they would have chosen other hospitals which may eventually have ended in the loss of supra-regional status and associated supplementary NHS funding.

The availability of readily accessible, comprehensible, up-to-date, risk-adjusted facts allowing patients and families to examine units and realise the hazards they and their children risk undergoing surgery at a particular hospital is clearly a fundamental element of consent yet it seems to be a long way off in spite of this being a primary recommendation of the 2001 Kennedy Report.

Infinite patients may not want to probe into the cosmos of facts but some will want to examine the circumstances and will want to be able to match the record of other units in that particular procedure.

What is the Trust’s obligation to inform a patient if their treatment has gone wrong? The duty of candour begun in 2014 for the NHS and in 2015 for all healthcare providers forced a duty to give notification of a patient safety incident, a notifiable event which has or which could in the future give rise to particular, defined kinds of harm.

This burden befalls the NHS or private sector provider rather than the specific doctor. Failure to abide by this is a crime punishable by a penalty of up to £2500 and may result in the Care Quality Commission (CQC) excluding the provider’s certification.

The duty of candour has not caught up with the law on consent and the impression from the guidance that has been issued inside the NHS and private sector is that this is a box-ticking process, with the use of template letters giving usually formulaic solutions.

They apologise but don’t admit liability or acknowledge fault, a mantra on which much of the guidance appears to be founded may comply with the wording but only shows the essence of the responsibility.

There appears to be a moral nonconcurrence between honesty before treatment and reticence following that treatment and there are implications of the relationship between a doctor and his management and his contradictory commitments to both patient and employer, normally an NHS Trust in this context, which represents additional possible impediments to the execution of the duty of candour.

This proposes a difficult moral problem for doctors involved in a patient’s treatment, their commitment to do no harm and has a doctor fulfilled his obligation to the patient if he neglects to inform him before proceeding or to tell him after treatment has taken place that matters have been expressed by senior co-workers?

There are many perplexities and struggles that can arise for doctors serving in the NHS when it comes to complying with the duty of candour. These can be difficult problems for NHS workers which were not completely thought through when the duty of candour bill was introduced.

Violations of the duty of candour may be viewed by management as obvious wrongdoing on the role of the employee even if the underlying treatment failure if ascribed to the doctor’s own shortcomings, would not have led to his removal.

In addition, the worker could be opened to the risk of fitness to practice proceedings by the GMC both for the latent failure and the failure to comply with the duty of candour. Even though doctors may wish to comply with their moral responsibility to the patient, given how whistleblowers have been handled by administrators in the NHS in a long list of notorious cases.

Would you be happy with your employment status as a doctor if you were to give a full explanation to a patient who had experienced an unfavourable outcome?

What if you knew of broader systematic failings, lack of resources, bad habits, or the ineptitude of associates which may have acted as a part in the outcome?

The insurance factor may also be a hindrance to an effective and genuine duty of candour and a concern is whether private insurers, or in the case of the NHS their indemnifiers, the NHS Litigation Authority (NHSLA)/Clinical Negligence Scheme for Trusts (CNST) scheme, will really allow their insured or their workers to satisfy the obligations of the statutory duty of candour in agreement with what is the intended spirit of the legislation.

Whilst being open and impartial will be second nature to the large preponderance of doctors, there are pressures which may have the unintended consequence of making doctors unwilling to acknowledge that transgressions have taken place.

Taking the Bristol children’s heart surgery embarrassment of the 90s as an illustration, families were not given detailed explanations after their children died or sustained brain damage and other notable harm. In this position, if a duty of candour is to have any significance clearly a patient must be notified of the part the known ineptitude of a surgeon or lack of necessary resources or inept amounts of suitably qualified personnel has or may have participated in the disadvantageous outcome?

On the other hand, there may be a danger that the Trust loses its indemnity if it is determined that there has been a failure to comply with the duty of candour.

Children’s heart surgery, in many ways little has improved since the 1990s when concerns were heightened by whistleblower Steve Bolsin and parents of a child with an extremely complicated congenital cardiac defect such as Hypoplastic Left Heart Syndrome may be unaware but should be told that Birmingham is currently the best national centre for corrective surgery on this lesion.

Inevitably units with a higher level of skill in hugely complex procedures such as surgery to correct HLHS or the Fontan are going to deliver better results in terms of lower fatality rates and a lower percentage of and capacity to deal with surgical complexities.

So what can a parent anticipate from the duty of candour if their child has undergone surgery at a unit that lacked expertise in this procedure? They may be given a frank account of why their child died or suffered complications but in the same way that they should have been notified of the broader facts before surgery, and they should have been notified that there may have been a very different outcome if their child had been operated on at one of the leading centres.

These are questions of life or death and the failure to disclose this sort of information after a child has died or survived with brain damage is unlikely to satisfy a family’s understanding of the level of candour they can expect.

What if Steve Bolsin and Raj Mattu had raised their concerns today?

This story of an individual suffocated by an NHS trust reluctant to accept its shortcomings has been replicated at many other hospitals since Bristol. Some of the systemic, cultural failures at Bristol in the 90s are being repeated now, a generation later, failures that the law protecting whistleblowers or duty of candour as currently framed are able to address. News reports of scandals in the NHS raise the inevitable question ‘Have the lessons of Bristol been learned?’

Missed chances to act on internal matters have been a recurring topic of the large-scale inquiries into NHS shortcomings of the last 20 years. In 2001, the Kennedy Inquiry into children’s heart surgery at Bristol discovered severe, structural failures at a unit that had shrouded itself in a club culture of deliberate blindness to safety concerns.

As early as the late 1980s, the recently-arrived consultant anaesthetist Stephen Bolsin had made his concerns over disturbing surgical death rates explicit to his superiors at the Trust, fellow clinicians and administrators, occupying all levels of authority right up to the summit of the NHS and the Royal Colleges, declined to heed his warnings.

Operations at Bristol continued, in the hands of surgeons whose shortcomings were later laid exposed in the GMC disciplinary inquiry. By this time, scores of children had died or sustained harsh injuries. The information was sketchy but it was determined by extrapolation from the insufficient data available that 171 children who could have survived if they had been operated on in other hospitals had died at Bristol over the period 1982–1994 reported by the Public Inquiry.

There was no data for the incidence of non-fatal unfavourable outcomes so no ghoulish examples could be made.

Even though cardiac surgery has led the area in the publication of outcomes data, to this day the only data accessible to evaluate the performance of a surgeon or unit is a 30-day mortality. This absence of data and the poor quality of the data that is accessible can make it hard for a doctor to confirm his anxieties over the performance of his or her colleagues are justified.

Professor Bolsin, as he became after leaving Bristol, earned the most fame as a whistleblower, and paid the ultimate price, emigrating with his family to Australia in the light of extensive bias in the medical field. Bolsin became in his own words the most hated anaesthetist in Europe.

Fortuitously, he’s since received a number of prestigious awards and accolades in honour of his actions. The idea of a clinical rule that took root in the United Kingdom and internationally rose straight out of Bolsin’s efforts.

As with all other whistleblowers whose stories are now commonplace to us, all he had done was to attempt and heighten concerns over the safety of his unit. He had served in accordance with his morals and took a course of action that he knew to be honest and morally right.

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In his address to the latest Turn Up the Volume conference, he warned us of the single fact that we must never lose sight of the patient.

Hiding data about risky practices leaves hospitals exposed to negligence allegations relating to failures of consent. It is self-evident that, in medical procedures, a patient or his family, must give properly informed permission to treatment, recognising the dangers and ramifications of what they’re about to encounter.

At Bristol, parents were given surgical outcome predictions, figures for survival rates and surgical danger, which may have reflected national standards but which the Trust apparently knew to be incorrect for their own unit at Bristol.

Where patients or families consent to surgery at a unit or hospital that is known to have a poor record or unsatisfactory safety record, maybe even dangerous staffing levels, their consent could be tainted. The NHS may well face allegations affirming a failure to warn, that it will find hard to defend.

Raj Mattu, the former cardiologist at Walsgrave Hospital in Coventry, revealed a crisis of overcrowding and patient safety at his unit in 2001. The Trust had imposed a 5 in 4 policy of squeezing an additional bed into cardiac wards meant for four patients, a policy that left essential services such as oxygen, mains electricity and suction less available to some patients.

Raj Mattu and his co-workers believed this presented a risk to patients and would take lives, they begged for the practice to end but the administration refused to listen.

Raj Mattu witnessed the death of a 35-year-old patient who had suffered a cardiac arrest. He and his co-workers had been unable to provide the patient with the expected standard of cardiopulmonary resuscitation because they could not reach the patient or deploy the equipment due to his position as a fifth patient in a four bedded bay.

Raj Mattu and two senior nurses recorded a serious clinical incident report and recorded aspects of these obstacles in the patient’s case notes. His co-workers nominated him to put forward their concerns and in a letter to the Trust’s Chief Executive David Loughton, Mattu complained that the concerns he had expressed had not been acknowledged or replied to by the Trust management.

Raj Mattu’s reward was a suspension and a decade-long fight before he was finally exonerated. This was despite the CQC issuing a report following 2001 reporting it as the worst ever patient safety report they had produced for any Trust, verifying an excess death rate of 60 per cent compared with the following excess death rate of 29 per cent at what became the notorious Mid Staffs.

The excitement over Raj Mattu’s treatment by his management is one of several case studies in the opprobrium suffered by those who break ranks and voice concerns and whose careers are ruined.

Some 200 grievances about Raj Mattu were made by the Trust to the GMC, health regulators, the former Strategic Health Authority and even the police, every single one of which was found to be without justification. In the meantime, the NHS, and the public lost the services of an experienced and honest doctor.

The question of how much it takes to dispense with the fallout of a fumbled whistleblowing process, let alone the human deaths of patients who have experienced avoidable harm, is becoming glaringly obvious. This, astonishingly, is a factor that appears to have eluded the notice of Jeremy Hunt in his drive to decrease NHS expenditure.

The failure to foster a culture in which hospital staff are urged to come forward with their patient safety concerns is a missed chance to save public funds.

Significant legal costs are incurred by the NHS challenging allegations made by whistleblowers and challenging them through continuous disciplinary procedures, tribunals and the courts. The economic expense of snubbing whistleblowers’ warnings can be enormously costly for the NHS.

Where a Trust knows of a serious problem but declines to act or takes measures to cover it up, negligence cases grow and heeding Steve Bolsin’s anxieties and grasping the problem may have saved the NHS in excess of £100 million when one factor in the costs of the GMC Inquiry, Public Inquiry and the cost to the NHS fighting some 200 cases for mortal injuries and 50 claims for significant damages where children survived but sustained severe injury.

This calculation does not include the immense suffering and harm done to lives, which makes for even more unpleasant calculation.

Raj Mattu’s incident is also an object lesson in the cost to the NHS of pursuing whistleblowers. Incorporating the price of all the disciplinary processes and legal proceedings, his Trust built up a detailed bill of up to £10 million.

Figures of a comparable amount have been insinuated in the media representing the compensation given to Raj Mattu for his broken career, out of which he has had to pay his own large legal expenses to accomplish that outcome.

Press releases imply that the Trust’s legal expenses for their failed five-year fight upon the now fully vindicated Kevin Beatt now stands at £440,000.

Compensation claims on the NHS for Ian Paterson’s NHS operations are reported to have cost the taxpayer upwards at least £10 million. Many of these claims could have been bypassed if his Trust had put into practice methods to help, receive and act on the concerns of whistleblowers.

The legal expenses incurred by the NHS in fighting the Ian Paterson cases are not yet known. Spire and their insurers are fighting allegations brought by Paterson’s private patients, a stance that may well harm the reputation of private health providers and potentially reduce their chances of securing sourced out NHS contracts.

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Junior doctor Chris Day was victorious in the Court of Appeal in May 2017. Dr Day had raised concerns over staff deficits and informed administrators at London’s Queen Elizabeth Hospital that he was the only doctor covering an 18-bed intensive care unit.

He maintains that his career has been slaughtered after malicious accusations were then made against him, making it difficult for him to proceed with his training. Chris Day was prevented from pursuing an employment claim because Health Education England maintained that junior doctors were excluded from the protection of whistleblower laws.

Following a 2-year appeal process, the Court of Appeal decreed that the case must be sent back to the employment tribunal for them to determine whether the Health Education England (HEE) had broken Day’s terms of employment.

Support for Day has been so great that he was able to raise £140,000 for his legal expenses through crowdfunding. In the meantime, the costs to the taxpayer will surely be in six if not seven figures by the time the case has reached a conclusion.

This does raise a question mark over the seemingly narrow view of whistleblower cases taken by the NHS and perhaps their lawyers. And seemingly, so far there hasn’t been a case where there has been a successful challenge, invariably whistleblowers have been vindicated but at a great personal cost to the whistleblower and the taxpayer. In the meantime, patient safety has been endangered.

A great deal has changed for whistleblowers, a fear of whistleblowing still penetrates the NHS and a number of whistleblowers reported their stories at the recent Turn Up the Volume conference. Sadly the warning to would-be whistleblowers was simple and severe, only do what is right if you are very strong.

Be prepared to be beaten, individually, professionally and legislatively. Only proceed if you have insurance to meet the legal costs and the time to spend with your lawyer going through the facts in great detail.

Expect little or no assistance from the regulators, your MP or anyone else. Be aware that your career may be permanently damaged; former colleagues will shun you and you will lose friends.

So how would a Steve Bolsin or a Raj Mattu be dealt with today? Sadly I can’t help thinking the answer would be little different and they would find many obstacles placed in their way.

Giving enhanced rights to pursue a claim in an employment tribunal after alleged discrimination has taken place is only a partial solution. Suspending whistleblowers and treating them as potential litigants rather than fellow medical professionals working towards a common goal cannot be the answer.

If managers continue to take steps to crush whistleblowers such as Kevin Beatt when they raise concerns over dangerous practices or conditions presenting a possible safety risk, are they really going to allow a doctor to be candid when explaining an adverse outcome to a patient? If hospitals conceal wider problems and systemic failures from patients this would suggest we haven’t come far.

If a breach of the duty of candour carries criminal sanctions it is difficult to see why suppressing a whistleblower, and ignoring safety concerns, is not handled with equal seriousness. It should be a mandatory requirement for hospital management to listen to what a whistleblower has to say, investigate and act on those concerns and only dismiss them after a full investigation has found them to be groundless.

More than 450 patients died after being given strong painkillers inappropriately at Gosport War Memorial Hospital and taking into account the missing records, an additional 200 patients may have experienced a similar outcome.

Clearly, there has been a disregard for human life of a huge amount of patients from 1989 to 2000 and there was an institutionalised regime of prescribing and giving dangerous amounts of a medication not clinically supported at the Hampshire hospital.

And a hospital opiate scandal that killed up to 650 patients could happen again because the NHS is still ignoring whistleblowers.

Nurses raised the alarm about the use of the powerful painkillers at Gosport War Memorial Hospital, Hampshire, in 1991, but administrators rejected their concerns but then an independent panel determined that 456 patients died at the hospital between 1989 and 2000 because of an institutionalised practice of the shortening of lives through administering opioids without medical justification.

One of the main lessons from the inquiry is the need for a constant practice of openness and honesty in the NHS. The health and care system needs to move away from past closed and defensive responses to mistakes. It must understand the importance of being open about blunders so that mistakes can be discussed and lessons learnt.

All organisations have fields of excellence as well as weakness. It’s important, to be impartial, and open to those flaws, inside organisations and with the people and all healthcare professionals must be open and impartial with patients when something that goes wrong with their treatment or care causes or has the potential to create, harm or distress.

Communications between patients and medical practitioners can sometimes be testing. We have all had consultations where the communication was not the best, both as medical practitioners or as a patient ourselves.

Neither usually wants to create a complicated situation but general mistakes, by both groups, frequently occur in such an event and communication and paying attention are necessary for each consultation but in particular, for situations where communication may become difficult.

However, two-thirds of hospitals are offering poor care and further warns that pressure to decrease costs could lead to a further substandard health service in future years.

The NHS is failing on safety due to lack of finance and bad administration. The finger of blame points at you, David Cameron and the NHS get billions and the CQC are accountable for the levels of care and safety so they are sinking hugely.

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Everyone knows the traditional perception of Florence Nightingale. This worthy, self-sacrificing woman would be rolling in her grave now if she could see what was going on with our health service.

This gentle maiden of high degree cast aside the pleasures of life to relieve the pain of the afflicted as the Lady with the Lamp floated through the aversions of the hospital at Scutari and anointed with radiance her morality to dying soldiers.

The National Health Service today, staff spirit is at its deepest decline. Staff shortages appear to be endemic at nearly every level. The Health Service is practically extinct, destroyed by the government.

All the evidence points to the reality that there’s a grave deficiency of doctors everywhere in the Health Service, in the hospital setting and in general practice, and this deficit is increasing, and it’s become perilous.

It is not a shortage, like the others, due to pay. It’s a deficit which arises essentially out of a failure of planning not perhaps so much by the Minister of Health as by his forerunners, but a failure of planning which began out of statistical misinformation.

The best estimation is that we need at this time, no less than 250 more doctors a year coming into the Service that we’re now getting and it’s pretty obvious that an increase like this can’t be compressed into the current medical schools.

One necessary action that the Government needs to take and take now is to ensure the immediate establishment of two, probably three, new medical schools and even if they take that decision now, it will be eight or ten years before those new schools can make any real enrichment to the medical staffing of the Health Service.

If there seems to be any problem in getting enough medical students, the medical students might in future be induced from a slightly broader social status that has been used in the past and much publicity has been made in recent months about the migration of doctors, and suggestions have been made that this has been the principal reason for the lack of medical staff in our Health Service.

It has been implied that about one-third of the doctors who qualify in each year discover themselves, inside a really short time, migrating either to Commonwealth nations or to the United States of America.

Put to one side for a moment the most consistent river of negative NHS stories, of cuts and shortages and waiting lists, and examine how victorious the NHS has been and still can be, supplied the proper funding.

The NHS is one of the few entirely publicly-funded healthcare services in the world and since 1948 has treated and saved the lives of millions of people. Each one of those patients was treated on a basis of their need rather than their capacity to pay.

Each one of those patients was able to obtain advanced medical technologies and up-to-date medicines as a consequence of the NHS.

The world has evolved a lot in the sixty or so years since the start of the NHS and the NHS is facing multiple difficulties as society ages and the expense of innovative medicine and medical technologies progresses but, these difficulties are not uncommon to the NHS, all developing countries are facing significant constraints on healthcare due to an ageing society and the growing expense of innovative medicine and medical technologies.

Despite the unprecedented pressure in funding, the NHS has survived one of the best and most effective healthcare systems in the world. The reason the NHS has this position is rooted in the reality that it’s an entirely publicly-funded system that is countrywide in England.

Through a broad chain of organisations, the NHS gives value for money, provides adequate and fair access to care, and is flexible to a developing world. The NHS has precisely what is required to afford world-class healthcare for the future, if only it were financed well enough.

There are always critics that maintain that a social insurance based-system is more effective but these results from the Commonwealth Fund report confirm that this is not the case and in the United Kingdom is not unparalleled in facing rapidly increasing healthcare expenses.

Yet, in developed countries where healthcare is financed by a method of mandatory social insurance, then insurance contributions have to increase to support healthcare standards. These contributions are by people and employers and in many respects, social insurance works as another kind of tax on the person and employers. Transferring to a social insurance paradigm would be substituting one kind of tax with another kind of tax.

At the core of the NHS is the belief that access to healthcare should be equal for all and not dependent on anyone’s economic standing. In the Commonwealth Fund report, the United Kingdom was the leader in access to care, which included measures of patients going without health care due to payment problems or problems obtaining the right kind of medical care.

Without a doubt, the NHS is one of the best healthcare systems in the world as by sharing the costs through taxation, high-quality healthcare can be applied to everyone according to their requirement and since 1948 the NHS has proved that it can adjust to variations in the medical profession.

New medicines and medical technologies are extremely costly. In other healthcare systems access to these would be subject on your insurance protection, which would, in turn, be subject on how much you and your employer are prepared to pay, or conditional on how much you can afford to give in medical expenses.

In contrast, under the NHS it’s possible for everyone to have access to the latest technologies despite financial status and because everything has evolved over the years people are prepared to give a little more in tax to embrace that.

The NHS has always succeeded to include new technologies into its service, making them accessible to the entire population. Organ transplants started in 1960, computed tomography in 1972, and keyhole surgery and magnetic resonance imaging in 1980 and since 1948 the NHS has prescribed innovative medicines shortly following their launch for hundreds of medical conditions, including heart disease, cancer and diabetes.

But Care patients are being punished with huge bills because of a postcode lottery for NHS funding and people can be 25 times more likely to get their costs covered depending on where they live.

South Reading Clinical Commissioning Group (CCG) funded social care costs for 8.78 patients per 50,000 people while Salford financed 220.38.

Reading has a really low ageing community, 12 per cent against the national average of 17.7 per cent and the NHS funding data for October to December 2017 found vulnerable people in England with the most costly medical needs were not handled in the same way despite where they live.

The model doesn’t work because it is not financed correctly. Here’s some data the United Kingdom uses, approximately 9.5 per cent of GDP on healthcare. Most other developed countries spend more than us by 1-2 per cent.

That’s a lot of extra cash we could use, other countries do, why are UK taxpayers not worthy of that investment in their well-being?

Because Nurse Nightingales lamp is too dim. Blame the government.

 

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