Jeremy Hunt to replace GPs with far less qualified, cheaper alternative, ‘Physician Associates’ | Evolve Politics

The Tory manufactured NHS crisis continued this week with the Health Secretary, Jeremy Hunt, slapping hard-working, stressed-out, NHS medical professionals in the face (yet again). The widely-despised Tory Health Secretary revealed his latest ingenious ‘money-saving’ (definitely not privatisation-related) scheme – this time the plan was to replace your local GP with a cheaper, much less […]

Source: Jeremy Hunt to replace GPs with far less qualified, cheaper alternative, ‘Physician Associates’ | Evolve Politics

Eight specialist stroke units at risk of downgrade, sending patients further afield : i NEWS.

This all down to finance and not for the benefit of the patients, have impact assessments been done, for will the impact mean the risk is increased that people will not survive, meaning that eventually there will be less people to look after.

So a cost saving at the expense of the quality of life, exactly the opposite of what the NHS should stand for.

We should all be against STP.

More than 10 avoidable deaths a day linked to A&E overcrowding : Express.

Problems can occur in any organisations and situations and if they are not attended to outcomes will be affected. In some instances the problems will create blockages in processes thereby, more than likely, the outcomes will related to shortages. In others the problems could produce outcomes relating to over supply.

In manufacturing and industry these outcomes could be dealt with by changing production systems, reallocating employees, increasing or decreasing production and even stop production over a period. All these can be considered as the products being produced are inanimate objects. But when the outcomes, as in health and social care are relative to human life other methods need to be considered and implemented.

More money being available is one such consideration and for a time this may solve the problem, but if the root cause or causes are not being identified, then the problems will continue to reappear and more often with a greater intensity.

The problems could be not having the right staff in the right place at the right time, system deficiencies, lack of effective management or supervision or the wrong type. In time all of the these problems can be overcome, but the biggest problem is identifying the problem or problems in the first place. In this does the system even allow for this identification to take place and if it does do those in power or control of the system consider the findings and or act accordingly.

For in health and social care much of what is brought to bear on both health and social care is governed by political motives.

Funding for both is mainly in the hands of who is in power at any particular time and what is their own political outcomes, which may or may not be beneficial to health, social care and those in receipt of the services.

All that being said there are some savings or changes which could be found, however, these will most likely not be sufficient to solve the problems.

What should solve the problems is that all persons, organisations and political masters to work together to formulate a common aim that everyone could take ownership of, in other words ‘co-production’.

Unfortunately, those in power do not care for co-production as the resultant aim is owned by the co-production team and not those with the purse strings.

Frontline teams are the key to delivering better value care for patients

Original post from The King’s Fund

‘…………..By Ruth Robertson  Fellow, Health Policy

We need to talk about patients not pounds if we are to engage clinicians in meeting the NHS productivity challenge. That means focusing on providing the best possible health outcomes at the lowest possible cost, rather than a single-minded push to save money.

This is one of the main messages from our new report, Better value in the NHS: the role of changes in clinical practice, and was the main topic of discussion at The King’s Fund conference on better value health care. At that event, Sir Muir Grey put the issue more succinctly by asking the audience to join him in instigating a ban on the word ‘savings’.

Past performance shows we need a new approach. Since the 1980s, NHS productivity – that is outputs (activity) divided by inputs (physical inputs, mainly staff) – has increased by around 1 per cent a year on average. That figure has been higher over the past five years but this has been mainly due to the freeze of NHS wages and real-terms reductions in the tariff price paid for services. These centrally driven measures cannot slice much more from NHS budgets, as demonstrated at the end of last year bythe first pay-related strike action in the NHS for 30 years (we await the NHS reaction to the latest pay deal announced in the budget) and re-emphasised this year, when the majority of NHS providers rejected proposals for the reduced 2015/16 tariff for hospital services. To get anywhere near the 2–3 per cent annual productivity growth required to meet the £22 billion productivity challenge set out in the NHS five year forward view will require clinical teams to find ways to improve the quality of their services and get more value from every pound spent on health.

The link between quality and cost is complex. A large review of the evidence on whether quality-improvement interventions saved money for health care providers found mixed results; some interventions (often those on a small scale) resulted in quality improvements and reduced costs but others (particularly those on a large scale) failed to do so. While this paints a fairly pessimistic picture for those seeking to deliver better value care, looking at what NHS clinical teams are doing on the ground to redesign their services tells a very different story.

In Walsall, commissioners, pharmacists and GPs have improved patient care and saved money by introducing a pharmacist-led repeat-prescription service. The 200+ prescriptions that GPs had to authorise each week are now managed by pharmacists, who – among other things – eliminate duplicate medications, switch patients from branded to chemically identical generic drugs, and address any issues patients have taking their medicines. By reducing over-ordering and wastage this service generated more than £800,000 of savings in 2014/15, a return of £3.54 for every £1 invested. Additionally, medications are better managed, there are fewer prescribing errors and GPs have more time to focus on patient care. Read more about this case study in the full report

At Plymouth Hospitals NHS Trust frontline staff have also managed to improve quality and cut costs. They analysed patterns of activity in their acute stroke unit and identified a group of frail older patients who had had severe strokes who consumed the highest proportion of their resources and were having a particularly poor patient experience. They redesigned the care pathway for these patients by adding daily reviews of their care and a range of different treatment options. Within a year, transfers to the stroke unit were happening 12 per cent faster and the average length of stay had fallen by 6 per cent. This allowed 13 acute and 4 rehabilitation beds to be permanently closed and saved an estimated £1,000 per patient. Read more about this case study in the full report

The NICE local practice collection has many more examples like these from different parts of the country and of the health system. Despite their diversity these innovations have a number of things in common:

  • they were driven by frontline teams who know best how to improve their services
  • they managed to improve the care that patients receive and save money
  • they showed results relatively quickly – often within a year.

This leaves us with one obvious question: how can the creativity and success shown in these examples be spread across the country?

There’s no simple answer to that question, but in our report we make a start by outlining an agenda for action. We put clinicians at the top of the pyramid as they must be the powerhouse behind improvement in the NHS. However, action will be needed across the health service to create an environment that gives clinical teams the time and space to transform services. And patients must be involved at every level too, from decisions about their own care to the design of a national quality strategy.

An agenda for action

Better value 13

We need to shift the debate on productivity to focus on delivering better value care for patients. Unless we do, the value-driven clinical community will not engage with the challenge of transforming services in a time of tight budgets – and the NHS cannot meet its current and future challenges without them.

More on this topic

Kindness and compassion – why they matter.

Original post from Loving Baby



One dictionary defines Kindness as going out of your way to be nice to someone or to show a person you care. Other definitions say kindness embodies generosity, selflessness and love. Compassion one dictionary states is, caring more about the thoughts and feelings of others than your own,  another definition says compassion is, a feeling of deep sympathy and sorrow for another who is stricken by misfortune. The question is for those of us that work in healthcare are kindness and compassion just words banded about at the many conferences and meetings we attend, or do they reflect the care we give and the services we provide? The truth is kindness and compassion are just as important as the medical care we provide, the equipment we use, the policies we are guided by and the safety of our patients.

When I gave birth to my first daughter medically the care we received was life saving for us both. However the poor aftercare, devoid of kindness and compassion, confounded my traumatic birth and left me coping with PTSD. The effects for me and my family have been long lasting and life changing.

While of course it matters the medical care we give, without it being enveloped with kindness and compassion we can unknowingly cause harm and heartache to those we are seeking to care for. Simple acts of kindness and showing compassion in our dealing with patients and as staff, each other, can go along way in making very difficult and sometimes traumatic situations such as the death of a loved one, the diagnosis of a terminal illness or caring for a desperately ill child just that little bit easier to bear.

So as people who work in a healthcare setting how can we keep kindness and compassion at the centre of care? What can we do as individuals and teams to keep kindness and compassion firmly in focus?

Patients put their trust in us to help them when they are at their most vulnerable, sometimes even placing their very lives in our hands. They rely on us to not only to give good accurate evidence based information, medical care that will help them enjoy a better, healthier, life, but also that we protect them from harm not only physically, but emotionally. But with the pressures of the modern healthcare system we can lose sight of the simple things, the language we use and the things that make a hospital visit or stay easier. We forget sometimes the kind words and the ‘feeling of deep sympathy and sorrow for someone who is stricken by misfortune’. Hospital in particular can be a scary place. Away from home, without loved ones around, often in pain or worried about what will happen all patients can do is look to those there to care for them for reassurance and comfort.

Do patients come first?

Two things are important to help us keep kindness and compassion in all we do. These are, the culture of our workplace and also our own personal, inner, values. Both culture and inner values are linked, they feed each other. How?

Does the culture we work in allow for kindness and compassion, does it help them nurture and grow? Are we working as a team, supporting each other, trusting each other?  Are individual talents and gifts allowed to flourish? Does our culture show that patients come first, that patients are viewed not as a label or a diagnosis but a mother, a father, a daughter or a son. Do we reflect in our language that we care, that we have time for, but also want to listen to patients and that their thoughts, needs and opinions matter?

What about patient needs? Does the culture allow for patients to feedback their needs and thoughts, are these valued and appreciated or just token listened to? Is the culture flexible to meet the needs of more complex needs, if the patient is blind or disabled, does the patient need family to communicate due to language needs or maybe learning difficulties. Or maybe mental health issues mean a patient needs extra support and understanding.

Or, is the culture based on policy, data, paperwork and procedures. Is the culture target driven and what’s best for staff not patients? Does the culture dictate the care given, unyielding to the needs of those it serves? Are patients made to feel like they are a burden, bothering staff or too afraid to ask for help?  This can be hard with so many demands and lack of resources, it can feel overwhelming maybe impossible to give care that is not only medically good but shows genuine kindness and compassion too. So what can help?

Firstly staff need support. Good communication, praise and kindness to each other are vital. Good management is also important. Allowing staff to grow, treating them with respect and making them feel appreciated will help keep a culture healthy. Its important too that staff are listened to. Winning minds and hearts of staff starts with an approachable management. Feeling that issues can be raised, ideas can be shared and they have an active role to play in improving services builds up staff and makes hearts swell with pride. Often if managers listen to their staff they will know what the service needs, what patients need and how care can be given in a productive but kind and compassionate way.

The second important link for showing kindness and compassion is our own inner values. We can ask ourselves?

  • Do we see labels or people?
  • Do we take responsibility for our own actions or do we blame the culture?
  • Are we showing kindness with each other and patients?
  • Do our actions show that compassion is our focus?
  • How do we view patients, are they a privilege or a burden?
  • Does the way we manage or treat work colleagues set an example in kindness.
  • Are we critical and indifferent to the needs of others?

These can be hard questions to face. But why must we look at our inner self and values? Because if all of us maintain our inner values, if we remember we are accountable for our actions, if we stay true to ourself and not let others dull our shine. If we keep patients as our focus and do everything to make care given right, if we speak up when we see something is wrong and do all we can to be an example of kindness and compassion then we affect the culture. Often thinking about how we would feel in that persons shoes, or thinking about what we would want for our family member needing care can help us keep our inner values on track. Our inner values and a healthy culture go together, with everyone displaying values that are patient focused there is no poor culture.

If we are struggling with our inner values then reflect on our motivation. Why we are in our job, how did we feel when we first started. No doubt we were full of enthusiasm and excitement. Maybe we wanted to help people, relieve suffering, make a difference or find our inner joy and happiness. Whatever it was that drove us on, that ignited our passion, make sure it is still burning strong. If the flames have some what died, then find ways to rekindle the embers till the passion for caring for others once again burns bright.

Inner values and a healthy culture so together.

Why does it matter? Because what we do and the way we do it can profoundly affect someones life.  We may not be able to bring back someones loved one that has died, or prevent someones child being sick or cure someone of an incurable disease, but we can make sure we give them kindness and compassion. It may only be small things, the way we say “Hello” on a reception desk, holding an older persons hand while they under go a test, sitting talking about the weather with a mother sat by her babies incubator, fetching a cup of tea for a son waiting for his father to come out or surgery or sometimes just saying ‘sorry’ that your appointment is late. But these small acts can mean so much to a person, to a family that is suffering, that are worried, that are looking to us to help. We may never know the effect of out kindness and how we have helped others but we will in our hearts know that we are doing our best.

Thankfully there are many working hard to show real kindness and compassion everyday, both in small ways and in making large scale changes. By working closely with patients and listening and sharing ideas they are improving services to reflect not only good evidence based care, but kindness to others and compassion especially to those in society that are most vulnerable. Medically we give our best, some saving lives everyday, however we cannot forget to show kindness and compassion. When we do it improves the culture, improves care, it helps staff feel appreciated and valued and patients feel cared for and safe. It means feedback for our services that builds a good reputation and gives staff praise for all their hard work but more than that it will bring us inner joy and happiness knowing we made a difference and we helped those who depended on us in times of distress to have a journey a little more bearable. Yes, kindness and compassion matters to us all.




Let’s start promoting wellbeing, not just treating illness

Original post from The Health Foundation

An extract

‘………The NHS Five Year Forward View promises unprecedented opportunities for the ways in which people with long-term health needs are enabled to live well, in the ways which matter to them. It calls for a ‘more engaged relationship with patients, carers and citizens so that we can promote wellbeing and prevent ill-health’.

This is a fundamental shift from treating illness to promoting wellbeing. To be successful, we must make use of collaborative approaches.

For most of us, contact with formal health services is only a tiny fraction of our lives. Indeed, the bulk of our care comes from informal sources such as our spouses, children and other unpaid carers.

But wellbeing is so much more than health. Wellbeing starts with us, our communities and the daily opportunities, challenges and habits which shape the bigger picture of our lives.

How then can the Forward View’s dual ambitions of more engaged relationships and promoting wellbeing be achieved? Three broad approaches may offer a good start…  …………’