Health tourism claims are a distraction from NHS’s real problems | Letters

We know of no good evidence that “health tourism” – individuals travelling to England solely to access NHS services – is a significant burden on the NHS (Hospitals to check patients’ right to care, 6 February). Such patients are seen very rarely, if at all, in clinical practice.

Assurances that individuals with infectious diseases and those requiring “emergency treatment” will not be turned away fundamentally misunderstand how healthcare is delivered. People present with symptoms, not diagnoses. Unless people can access routine investigations, communicable diseases and life-threatening conditions will go undiagnosed. Case studies show that, even under the existing charging regulations, individuals are coming to harm.

The NHS in England sees around a 650,000 patients every 24 hours. The administrative costs involved in accurately assessing whether each patient is “lawfully resident” would be substantial. Everyone would be inconvenienced by the requirement to carry means of identification. As Nye Bevan wrote, “if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody.”

It is not naive to suggest that the NHS should offer treatment to everyone regardless of immigration status and that the task of policing our borders be left to the immigration authorities. This is the approach taken in Scotland, in Wales, and in a number of other European countries. The media noise about health tourism is a distraction. The primary reason the NHS is struggling is that we choose to spend a much lower proportion of gross domestic product on healthcare than other high-income countries.
Dr Tom Yates CT1 doctor in acute medicine, London, Ibrahim Abubakar Professor of infectious disease epidemiology, University College London, Dr Rob Aldridge ST5 doctor in public health, University College London, Dr Alex Armitage Paediatric registrar, Lewisham Hospital, London, Dr Peter Baker Public health speciality registrar (ST4), Imperial College London, Dr David Barr Specialist registrar in infectious diseases, Glasgow, Dr Sunil Bhopal Wellcome Trust research training fellow, London School of Hygiene & Tropical Medicine, Dr David Biles GP Trainee, London, Dr David Blane Academic GP, Maryhill Health Centre, Glasgow, Dr Mike Brown Consultant, Hospital for Tropical Diseases, University College Hospital, London, Dr James Chan ST2 doctor in emergency medicine, West Yorkshire, Dr Jim Cole General practitioner, Tower Hamlets, London, Dr Rosie Crane Paediatric registrar, Oxford, Dr Jonny Currie GP and public health specialty registrar, Liverpool, Dr Angharad Davis Neurology registrar, National Hospital for Neurology and Neurosurgery, London, Dr Delan Devakumar ST5 doctor in public health, University College London, Dr Chris Dugan Specialist registrar in infectious diseases, London, Dr Chi Eziefula Consultant in Infection, Brighton and Sussex University Hospitals, Dr Catherine Isitt CT1 Doctor in Haematology, London, Dr Søren Kudsk-Iversen LAS senior house officer in anaesthetics, Reading, Dr Michael Marks Infectious diseases registrar, Guy’s Hospital and St Thomas’ Hospital, London, Dr Lizzie Moore ST2 doctor in public health, Oxford, Dr Miriam Orcutt Research associate, Institute for Global Health, University College London, Dr Tom Parks ST3 registrar in general medicine and infectious diseases, University College Hospital, London, Dr Erica Pool Academic clinical fellow (CT3) in HIV/genitourinary medicine, Brighton, Dr Helen Preston ST4 doctor in obstetrics and gynaecology, North West Deanery, Dr Carl Reynolds Specialist registrar in respiratory medicine, Imperial College Healthcare NHS Trust, London, Dr Jenny Riches ST2 doctor in obstetrics and gynaecology, North West Deanery, Dr Rafi Rogans-Watson Specialist registrar in geriatrics, London, Dr Partho Roy ST3 doctor in public health, Croydon, Dr Adam Sandell General practitioner, Cumbria, Dr Deepa Shah General Practitioner, London, Dr Catherine Sikorski ST3 doctor in paediatrics, London, Dr Vasundhara Verma GP trainee (ST2), Brighton, Dr Stephanie Wilmore Specialist registrar in microbiology, London, Dr Christopher Wood Consultant HIV physician, North Middlesex University hospital, London, John S Yudkin Emeritus professor of medicine, University College London

• The proposal detailed in your report adds “action to recoup treatment costs from overseas visitors” to an already expanding list of government “responses” to the current healthcare crisis. This now includes: sundry restructurings; experiments with private/public partnerships; periodic “efficiency” drives; reallocating existing limited funds between cash-strapped services; increasing calls upon the voluntary sector; and blaming health workers and managers for their ineffectiveness, patients for their lifestyles and obesity, and relatives for failing to observe their in-family care responsibilities. Indeed, it includes anything but the establishment of a properly weighted, fully progressive system of taxation that can alone provide the fundamental human and material resources needed to solve the problem, and expand much-needed services, jobs, incomes and purchasing power among the poor and needy in deprived areas.

As the vast majority of us have made clear our willingness to contribute appropriately to this, it is difficult to see how the government can avoid the obvious conclusion; except for the fact that it would (at last) involve people like themselves and their wealthy friends making a full and proper contribution to society’s needs. As things get increasingly desperate, either we increase public pressure to an extent necessary to force them to take effective action and give a true moral lead, or we replace them with people more morally and humanly inclined.
Bernard Cummings
London

• We can all see that the government’s proposal to make foreign nationals show proof of ability to pay before receiving NHS treatment is monstrous; but have they realised it is also misplaced? If the problem is that too many travellers to Britain fail to acquire adequate health insurance before departing, surely the fault is not with our hospitals but the airlines? If the carriers were to be made liable for the NHS costs for any uninsured passenger that boarded one of their planes, they would take steps to ensure no one flew to Britain without insurance; which would mean no proof of payment at the hospital entrance would be necessary and also that the problem would be addressed before rather than after the passenger fell ill. Problem solved.
Ian Mackillop
Ilminster, Somerset

• The harrowing case of Iris Sibley and her family, reported on your front page (Six-month hospital ordeal exposes crisis in social care, 6 February), highlights the complexities and confusion that exist in relation to the long-term care of vulnerable elderly people, which no doubt adds to any stress and strain experienced by those caught up in the system.

In this case it was the lack of appropriate healthcare sector resources, not of those in social care, that created the so-called bed-blocking scenario, given that Mrs Sibley was assessed initially as needing continuous professional healthcare in a nursing home rather than in a residential care home. Most nursing home care of this type, ie continous healthcare provision, is not subject to financial assessment, while residential – ie social – care is subject to means testing and financial contributions from residents. There are also a variety of in-between “hybrid” options, as reported in your story, that can create further uncertainty and distress at very difficult times in people’s lives.

The mantra from ministers for greater integration of health and social care continues to ring hollow when, in addition to the problem of massive under-funding, the two systems are funded and resourced, commissioned, provided and managed so differently. Until these issues are addressed in their totality, the cracks in the creaking systems will just get bigger, adding to the current lamentable situation. I see no evidence of any coherent strategy, let alone the political will from this government to tackle these fundamental structural problems – time now for a royal commission, maybe?
Colin Biggins
Dedham, Essex

• Few people deny that the NHS and social care are underfunded. As a Conservative MP has pointed out, recent increases in funding have been less generous than ministers claimed. In the recent autumn statement, the chancellor declined to allocate more money for the adequate provision of social care for frail or lonely people leaving hospital.

It is not well enough realised that a major loss of funds from the health service arose in 1991 when the then government resolved to manage it as though it were a market, with “providers”, eg hospitals, “selling” their services to “purchasers”, eg health authorities.

For the market to work, tenders, contracts, invoices and payments from one part of the service to another were necessary, causing huge increases in administrative costs. Before the market, these costs were about 5% of the NHS budget. By 1997 they had risen to 12% of the budget, and by 2010 to 14%.

With the market comes competition, which many politicians thought would improve performance. Complex medical care needs cooperation, not competition. With a commercialised market hospital, managers have to consider the hospital’s income from a treatment, as well as what treatment the patient needs.

Parliament is soon to debate the NHS reinstatement bill, one of whose aims is to get rid of the expensive competitive market. All voters should write to their MP urging support for this bill. This is not a political matter because all political parties in government have supported this market, though individual MPs have not. MPs may change their minds, and their votes, when they consider the evidence and the views of their constituents.
Dr Richard Gunstone
Rugby, Warwickshire

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Health tourism claims are a distraction from NHS’s real problems | Letters

Private providers are part of the NHS’s problem, not the solution | Letters

I’m afraid Stephen Dalton is wrong about pretty much everything (Private money is the NHS’s saviour, not its bogeyman, 22 November). Where sustainability and transformation plans have been published (most have been shrouded in secrecy, and for good reason) it is clear that cuts and closures are on the way. For instance, 600 GPs are to be reduced to 400 in one part of London alone, and maternity units and A&E departments face the axe. We have the second lowest number of hospital beds per capita in the EU, and that is set to fall further. Dalton says we must move care away from hospitals, but that means investing in primary and community care, both of which have been undermined and cut.

Dalton says that the private sector can help the NHS. Well, up to a point, Lord Copper. The private sector has always been there, but as a peripheral presence and not competing with the NHS. The compulsory competition introduced by Andrew Lansley has been a very costly failure. The private sector is expensive, unaccountable, and will walk away when it can’t make a profit. By cherrypicking profitable services it destabilises the local NHS, which can’t drop the expensive work or turn away patients with complex problems. And its ethos is questionable, leading, for example, to profits being sent offshore with no tax paid.

The answer for the current NHS crisis is to fund the NHS to the EU average (it is currently heading down to less than 7% GDP), to deal with the costly market and PFI schemes which are wasting money hand over fist, to value and support the staff, and to stop re-disorganising it every two years in a futile effort to sort out the last political mess inflicted on it.
Dr Jacky Davis
Founder member, Keep Our NHS Public

• The article by Stephen Dalton is simplistic in the extreme. Here in Cornwall we have examples of two of the privatisations he extols. Both failures.

Twelve years ago a panel I was a member of voted to give Serco the out-of-hours service for Cornwall. It was a mistake. They were condemned by a parliamentary committee for cooking the books and they have since abandoned the contract. I voted against them.

In 2014 the Royal Cornwall hospitals trust board of which I was vice-chairman voted to allow Mitie to run their hotel services, catering, cleaning etc. I voted against. They have proved to be a disaster. If Stephen Dalton wishes to write these misleading articles he should at least give examples of the successes of privatisation. Does Hinchingbrooke ring a bell with him?
Rik Evans
Truro, Cornwall

• Stephen Dalton argues that “examples of beneficial of private sector involvement include … more rapid discharge from hospital through well-established ‘recovery at home’ services and access to private sector community diagnostic facilities”. Meanwhile you report that the private company Mitie has said it would withdraw from its healthcare business, which provides home care for the elderly (Mitie profit warning as it bales out of elderly care, 22 November); your article quotes the chief executive as saying that government spending cuts had made the healthcare business unviable: “If we are serious about social care in the UK it needs significantly more than the funding that has been suggested.” Quite.

More generally it is worrying that Dalton, as chief executive of the NHS Confederation, still does not understand that for private companies profits come before patients, and that any system that has to fork out to shareholders has less to spend on care. Supposed benefits from “greater efficiency” usually means cutting corners and paying workers less.
Dr David Griffith
London

• Despite Stephen Dalton’s assertion of an apparent “political negativity” towards privatisation of the NHS, the non-public-sector involvement within our healthcare system actually continues unabated: the Department of Health’s funding of “independent sector providers” rose from £4.1bn in 2009-10 to £8.7bn in 2015-16. And a study published in the Journal of Public Health in July this year found that: “An increased use of private sector provision by NHS boards was associated with a significant decrease in direct NHS provision and with widening inequalities by age and socio-economic deprivation.”
Steven Jouanny
Sheffield

• We completely agree with Stephen Dalton’s assertion that we need to shift the focus away from hospitals in order to help create a more sustainable NHS. However, being more open to private providers is not the only answer.

The mixed economy for end-of-life care in the UK is a case in point, and the role of charitable hospices in this should not be overlooked. Last year hospices in the UK spent more than £868m on care and supported 200,000 people with life-limiting conditions – a significant contribution to the UK’s health economy.

Hospice care is provided free and yet hospices receive only a third of their funding from the NHS, having to raise the rest themselves through community fundraising. Hospices have a strong ethos of compassionate care, coupled with a vibrant culture of innovation and enterprise reflected in the new and different ways they raise income and successful partnerships developed with other providers.

In these hugely challenging times for the NHS, improving end-of-life care by working more closely with hospices could help deliver the sustainability that is so desperately needed.
Tracey Bleakley
CEO, Hospice UK 

• On the occasion of American Thanksgiving, as a British citizen who lives in the US but finds myself in the UK with an ailing father, I feel compelled to express my gratitude for one of the things that makes the UK exceptional: the NHS and associated strongly held value that good healthcare for all is a right not a privilege. I am a management consultant and have spent a large chunk of my career working within the American healthcare system. The recent US election troubles me greatly as the incoming administration seems to offer little vision for healthcare other than the aspiration to unwind the recent gains of improved access to all. In recent weeks I have sat holding my sleeping father’s hand as he moves beyond a stroke. As I’ve watched the wonderful staff on the Dunkery stroke unit at Musgrove Park hospital in Taunton, which, somewhat ironically, started as an American army hospital during the second world war, I have felt incredibly grateful for the compassionate care he – and my family – are receiving. Absent is the additional stress of wondering how we as a family will be able to pay for his care, which would already be well into the hundreds of thousands of dollars had he been born on the other side of the pond.
Celia Kirwan
Boston, Massachusetts

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Private providers are part of the NHS’s problem, not the solution | Letters

Private money is the NHS’s saviour, not its bogeyman | Stephen Dalton

Recent headlines about the NHS drawing up secret “sustainability and transformation plans” have led to speculation about widespread cuts to local services and allegations of an orchestrated attempt by the NHS to keep the public in the dark. For the record, indiscriminate closures are neither planned nor legal. But the need for a rational, national debate about how we secure a viable health and care system is urgent, and made more difficult by partisan and party-political arguments.

What’s more, and with this week’s autumn statement highly unlikely to offer anything other than jam tomorrow, we must shift the focus away from hospitals. I don’t know any NHS leaders who believe that more hospitals are the answer. Quite a few hospitals and services could do with shifting to where they’re most needed, but the NHS has no appetite for solutions reliant on more institutional settings.

Right now NHS leaders are calling for the priority to be social care. But with the country’s most publicly treasured institution facing unprecedented demand, exponential growth in high-cost complex care and a post-Brexit economic landscape that leaves little room for optimism, what are our political leaders talking about? The threat posed to the service by the private sector.

What was seen a decade or so ago as a sensible way of attracting investment, and what helped get average waiting times down from 18 months to 18 weeks, is now seen as a political no-go area, with the Tories and Labour locked in an arms race over who has used the private sector least while in office. This is a con trick, as in reality the private sector has been used for decades to help sustain a health service that is free at the point of use and available to all based on need and not ability to pay.

Currently, NHS leaders are working through how to bridge the quality, access and finance gaps in their areas, and it’s not unusual for these plans to be predicated on the need for multimillion-pound injections of capital. Across the country, funding requirements run into billions, and there will need to be significant private investment if plans for transforming the NHS care landscape are to be realised. This raises the spectre of the rightly discredited PFI schemes. Acknowledging and learning from their failure, rather than being paralysed by past events, is the way forward.

Independent-sector healthcare providers, which increase the system’s capacity to respond to demand, help meet waiting-time targets and enable investment to bring important benefits for patients – most of whom are relaxed about who provides their care, so long as it’s high-quality and free at the point of use. This is particularly important at a time of lengthening waiting times and unprecedented demand, and in advance of winter, which always adds to existing pressures.Examples of beneficial private sector involvement include quicker access to treatment through the use of private hospitals paid at NHS prices, more rapid discharge from hospital through well-established “recovery at home” services, and access to private sector community diagnostic facilities for scans, tests and examinations, again at NHS prices.

There will need to be significant private investment if plans for transforming the NHS care landscape are to be realised

We need to remember too that the public sector does not have a monopoly on caring. I have more than 40 years of public sector clinical and leadership experience, and in that time we have seen high-profile failures in the private, public and voluntary sectors. I don’t seek to deny the incidence of failure, but providing choice beyond a single, public option, introducing personal budgets and enabling different forms of independent sector provision has more often been a force for good, and improved people’s lives.

And this is still the NHS – free at the point of use, with strong safeguards over quality and safety.

So let’s stop pretending that private sector involvement in the NHS is a uniformly bad thing: it isn’t. Around 10 million NHS patients per year are treated by private sector organisations operating across nearly 2,000 sites. Patient feedback and Care Quality Commission inspection reports demonstrate that these services are generally safe, responsive and high-quality.

The political debate over the future of the NHS urgently needs refreshing, and portraying private sector healthcare organisations as bogeymen that should either be pushed out of the NHS or never spoken about simply serves to bind the hands of NHS leaders who want to bring about change in partnership with others.

As long as this political negativity exists, it will be patients who feel the consequences.

Private money is the NHS’s saviour, not its bogeyman | Stephen Dalton

NHS"s psychiatric stresses | @guardianletters

‘Richard Thompson’s description of overworked clinicians running close to like scalded cats sums up the pressure for doctors in the NHS.’ Photograph: Getty Photographs

Congratulations to Sir Richard Thompson, President of the Royal College of Physicians, on his frank diagnosis of the NHS and for telling it as it is (Report, 5 April). His description of overworked clinicians “operating close to like scalded cats” vividly sums up the sense of stress medical doctors are dealing with in the NHS. And he rightly highlights the reality that the NHS is underneath-doctored, below-nursed, underneath-bedded and beneath-funded.

Like physicians, psychiatrists are under pressure to provide top quality care with a minimum of sources. They witness the distress of sufferers and carers who are sent long distances to receive care because they are unable to accessibility local solutions. Youngsters as youthful as twelve are getting left on adult psychiatric wards – which is completely unacceptable. And the decline in previous age psychiatry as a consequence of “ageless providers” signifies older folks with mental health concerns are not obtaining the specialist care they need.

The actual threat in all this is finance getting to be a larger driver than care and compassion, which brings us back to what none of us want – a recurrence of what occurred at Mid Staffordshire.
Professor Sue Bailey
President, Royal College of Psychiatrists

NHS"s psychiatric stresses | @guardianletters

Target on wellbeing an different cure for the NHS"s ills

Younger youngsters function out at a children’s gymnasium session. Prevention is better than remedy when it comes to obesity, which leads to many illnesses later in life. Photograph: Murdo Macleod

The Division of Well being (DH) faces an enormous challenge: how to meet ever-rising demand from an ageing society whilst public spending increases no more rapidly than inflation. And perhaps significantly less quick: last month’s price range implies more public expenditure cuts, to meet the government’s deficit targets.

The “solution” most frequently proposed is more beneath-inflation spend rises for NHS workers, a lot more reconfiguration of hospitals and new methods of improving productivity. There is no option? Well, really this time there is: but it entails a radical alter of concentrate, a Whitehall shakeup, and some challenging spending alternatives.

The drive to increase productivity has led to ever-more emphasis on “output” measures for the NHS: numbers of operations carried out, or sufferers examined. But the inadequacies of this approach have heightened curiosity in a wider concept: existence satisfaction, or “wellbeing”. In a current report “Wellbeing and Policy”, commissioned by the Legatum Institute, my fellow economists and I advocate producing wellbeing the government’s overriding aim when designing policy.

This would call for a enormous modify of priorities for the DH: 1st, shifting interest from physical to mental wellness, generating a reality of the department’s theoretical commitment to equal standing for both.

Mental illness accounts for an massive amount of struggling, or reduction of wellbeing. And it is estimated that 3-quarters of it goes untreated. To tackle this needs not just income, but also a joined-up method with the Department for Schooling. There need to be a minister for psychological overall health with a seat in the two departments, complementing much better treatment method with greater prevention, by way of programmes to advertise emotional and social development in schools. In reality, there would require to be a basic emphasis on prevention of sickness. As a lot of as 4-fifths of deaths from significant diseases are primarily the consequence of life-style elements, such as smoking, drinking and obesity. Far much more of the price range demands to be directed at reducing individuals hazards, and not just through elevated fiscal investment: this is an region desperately in need of a combination of private-sector innovation and sensible regulation.

Take street safety. Considering that the 1930s, the quantity of vehicles on our roads – and the amount of miles we drive – has risen enormously. But far fewer men and women are killed on the roads. Innovations in car style, road style and driving regulations, backed up by social pressures, have aided to transform road safety. Today, 3 occasions as several individuals die from suicide as in motor car accidents. Now we require to emphasis on avoiding these tragedies with the identical blend of skills.

This kind of modifications won’t be simple, simply because even if they yield cost savings in the extended term, they will need income to be reduce from other elements of the wellness price range in the short phrase. But the third vital alter will be, institutionally, even more difficult.

Well being services and social care need to have to be brought a lot closer together. That is much more or less accepted. A lot more controversially, the DH need to be offered portion of the spending budget for disability benefits, so it focuses on getting folks back to perform. This would aid the reallocation of assets to the two physical and psychological therapies. Increased employment costs among disabled individuals may possibly look like an previous-design, output-driven measure of good results. It is not. For not only would their perform contribute to greater GDP, it would have a strong result on their wellbeing. One of the clearest insights from wellbeing investigation is that unemployment has a huge psychological expense. (In truth, making adjustments for a variety of disabilities is a whole lot less expensive than most employers realise and such workers have a tendency to be extremely loyal.)

Other Whitehall departments need to also review their priorities. But health demonstrates the possibilities, and the problems, of defining, measuring and pursuing the wellbeing of the nation as a total. It is a fantastic location to begin on this vital journey of policy reform.

Target on wellbeing an different cure for the NHS"s ills

What frightens me about the long term? The NHS"s lack of comprehending | Barbara Frith

‘Don’t allow the nurses or medical professionals say they have given you all the pain medication you can have right now.’ Photograph: Voisin/Phanie/Rex Attributes

I have continual pain. It really is not typically acute but it does restrict my life. I have purchased a higher chair so I can get up a lot more easily, but there is a snag. I use my arms to push myself up, because my leg muscle tissues are now too weak to operate the way they did when I was younger and match and took my wellness for granted. The a lot more I use my arms, the significantly less I’m capable to use my legs. It really is a vicious circle. My new chair is fantastic, but when I need to get up I am faced with the unnatural phenomenon of deliberately inflicting discomfort on myself. You spend your daily life staying away from pain. However now I do it to myself on a everyday and nightly basis.

When I lie down at night, the bed feels great, but inside of seconds I am shifting about to get relaxed, since, as I unwind, the muscles holding my knees in a excellent place loosen up and then they start off to harm. I have tried to persuade myself that it will go away if I wait a second. How silly – of course it will not. At last I am cozy, and then I get an itch or an ache someplace. Thankfully, I can move, even even though that implies going via the entire procedure once again. But – and here’s the scary bit – what if I could not move and necessary an individual to move me? What if that individual had left the room? I would have to wait with the itch or the soreness until they came back. Can you imagine that? It’s tough to. I would be concerned how long they would be, regardless of whether they would make it better, or if moving me would make it worse.

I feel discomfort is the worst factor. No matter whether it is a burning gut, consistent headache or aching limbs, what ever else occurs to me, I consider it is the most critical thing that I will need care with. But what if there is some thing worse waiting for me that I never know about, and what if my carers will not know both, and I do not have the capability or opportunity to inform them? It’s all really scary.

How can you explain pain to an individual, or get them to believe you? By the time several older folks get to this stage of illness they are unable to articulate sufficiently to clarify what is occurring to them and what they need. Just simply because they can not communicate isn’t going to indicate they can’t hurt. Imagine that. But carers are as well thin on the ground, as we all know, and also rushed to do the listening and knowing. Hospitals require much more permanent nurses, who see you by way of, rather than agency nurses, who come and go and have no background knowledge of you.

I’m 70 now and my buddies are catching up in the pain and incapacity departments. So what is there to recognize, and what frightens me about the potential? The lack of comprehending. The NHS demands to recognise the value of the patient’s top quality of daily life – and to pay attention, think and realize.

So don’t allow the nurses or medical doctors say they have offered you all the ache medication you can have right now – if you are in ache, you need to have a lot more. Don’t let your young children say: “They are doping my mom so that all she does is lie there in a daze.” It is most likely all I will want to do by then.

My kids won’t say that, due to the fact I have manufactured a residing will, and they know what I want. This is my plan, anyway, for when I have to hand my life more than to other individuals. Will they recognize and apply my wishes? I do be concerned. It is all quite frightening.

• Barbara Frith is a pseudonym

What frightens me about the long term? The NHS"s lack of comprehending | Barbara Frith

NHS"s bureaucratic failures put lives at threat

The NHS is a massive organisation that employs well in excess of a million people. Inevitably, items will often go wrong: the management and employees are only human. Most people would sympathise with staff who find themselves below huge stress, which may properly influence the good quality of their determination producing. Nonetheless, when it comes to dealing with the overall health of the nation, errors must be recognized swiftly and resolved.

These days, The Sunday Telegraph discloses a serious issue with the management of sources. It is astonishing to uncover that some locum medical professionals are getting paid up to £3,000 per shift by hospitals desperately short of staff in in excess of-stretched Accident and Emergency units. In 2013, the bill for hiring locum medical doctors (which involves fees to agencies) reached virtually £250 million, new figures suggest.

Having to pay this kind of huge amounts to plug gaps was only supposed to happen in moments of crisis, but our investigation confirms that it has become a matter of program in some NHS trusts. The dilemma is a mix of poor management and a national shortage of consultants, some thing that the Government clearly demands to tackle because failure to invest in recruitment is forcing trusts to commit exorbitantly on locums alternatively – a decidedly false economic system. Of program, the need for a lot more physicians is itself a solution of the increasing burden on A&ampE, which several individuals use merely simply because they cannot get an appointment with a GP. And the ring-fencing of the wellness budget, a Coalition promise, has led to a squeeze on social care. For want of a handrail, for instance, accidents will come about and end result in a journey to A&ampE.

Meanwhile, one more horrific story displays how undesirable choice-creating could be costing lives. A complete of twelve households are now taking legal action towards Bristol Royal Hospital, in which as numerous as 20 children died or suffered extreme right after-effects following cardiac treatment. On Friday, Sir Bruce Keogh, the country’s most senior medical doctor, met parents who told him that sometimes there have been so number of nurses offered to care for their children that they were forced to clean up vomit, monitor oxygen amounts and administer medicine by themselves. In one specifically distressing case, a child boy’s operation was delayed 5 occasions in one week. Only when he was deemed an “emergency” was he operated on. He died a few hours later on, following issues.

Sir Bruce thanked this newspaper for assisting to expose the scandal, for getting “identified and brought to light the failings at Bristol”. He also explained that the NHS often fails to support men and women when items go wrong all also usually, individuals with grievances are treated in a bureaucratic, cold method. Sir Bruce mentioned, rightly, “We can’t just say ‘sorry, we’ve accomplished our best’ and move on.”

The great information is that there is a expanding push for transparency in the NHS. For instance, the Government is operating to release league tables of overall performance that need to not only highlight failures, but also encourage review of greatest practice. The well being service needs to seem at itself honestly and rigorously. It can’t proceed to fall back on comforting myths about it getting “the envy of the world”. Failure to get things proper – to preserve adequate amounts of staffing and to control that personnel nicely – can be a matter of existence and death.

NHS"s bureaucratic failures put lives at threat

A excellent death with the NHS"s assist | @guardianletters

‘It felt like an extraordinary privilege to see someone slip from lifestyle to death.’ Photograph: Michaela Rehle/Reuters

Thanks to Julie Myerson for her report (Death in hospital need not be a medicalised trauma, 13 January). Although one cause I purchase the Guardian is for its coverage of the NHS, I have for a long time had a sense of disquiet that the stories are so biased in the direction of the poor news (great news is no news?). While we require to shout loud about the problems of the NHS, we also need to continually celebrate its successes. Not undertaking so would seem to me to be, ironically, getting ready the nation for letting the NHS, depicted as ineffective and malfunctioning, slip away to open private hands. As someone who operates for the NHS, I would also stage out that we need to see a reflection of the services we give as worthwhile, even outstanding at occasions, to aid us carry on to strive to be the very best that we can be, specifically considering that our managers seem to be hellbent on completely demoralising us at times. The NHS will survive only if the public can worth what it does well alongside campaigning for far better when it does not provide.
Suzanne McCall
Luton, Bedfordshire

• I was moved by Julie Myerson’s stylish report about her mother-in-law’s death. I know specifically what she signifies. In 2007, my mother suffered a cerebral haemorrhage which left her in a coma. The consultant at St Richard’s hospital, Chichester, recommended that we “let nature consider its program”, to which we agreed. Unlike Julie’s mother-in-law, my mom was capable to die at residence, with the hospital arranging almost everything. She lasted two a lot more weeks, with a group of nurses coming in three times a day and a man or woman sitting with her by way of the evening, allowing members of the family to pay a visit to her each time they wished. My brother and I had been with our mom at the second of death. It was profoundly moving. Sad although it was, it felt like an extraordinary privilege to see a person slip from existence to death. Seeing our mother die peacefully in her personal residence produced her dying seem to be like the all-natural event it was. I thank the NHS for making that possible.
Emma Dally
London

• Julie Myerson writes movingly of the organic death of her mother-in-law. The workers communication and selection-producing sounded delicate and knowledgeable. Even so, non-medical intervention can be an umbrella to hide bad practice underneath, and that is the danger. My 94-yr-old mom was in her neighborhood hospital in Scotland, soon after a fall. They discovered tumours in her chest and even though she expected to get property after soreness manage, a person somewhere decided she wasn’t well worth the bother when she acquired a bladder infection right after three days. No therapy meant that we located her in agony, alone, with no nursing care. The doctor refused to attend as it was a bank holiday and when we begged for aid he prescribed morphine by phone until, right after hours of pain, the last dose killed her speedily. Apparently this is all acceptable for an outdated man or woman since someone had made a decision it was time she was dispatched and she was denied the natural death that Julie’s mother-in-law had.

Allowing nature to consider its program in which enlightenment and information prevail is the excellent. But where ignorance and callousness prevail it turns into a quite distorted and harrowing encounter that haunts loved ones evermore.
Andrene Messersmith
Innellan, Argyll

• It was the image utilized by Julie Myerson that drew my interest. Death is “oddly akin to a birth”. My father John Hughes (Obituary, two January) died on 1 November. Previously a principal at Ruskin University, he sadly produced dementia and invested years in an increasingly locked-in state. I had taken a break from his bedside when my sister called. He was on no medicines and the nurses at the nursing house were fine about leaving us alone. We the two strangely – or perhaps not – seemed to know exactly what to do. We talked gently, stroked his head and hands, told him we loved him but we were prepared for him to go. We reminded him of his superb contribution to people’s lives and said he deserved a rest now. It came into my thoughts that I felt like some type of midwife assisting him on. He died so peacefully. It was amazing to be at a “normal” death. I have been at two deathbeds in which medicines had been very rightly involved so this was quite unique. We ought to speak about death more and allow men and women to feel they can support folks they adore die so peacefully.
Katherine Hughes
Oxford

A excellent death with the NHS"s assist | @guardianletters