NHS accused of waving white flag as it axes 18-week operation target

Patients will face longer delays for operations after the NHS decided to shelve one of its most important waiting time targets as part of its ambitious survival plan, which will also result in hundreds of thousands of people being denied surgery.

Simon Stevens, NHS England’s chief executive, has announced that the NHS is significantly relaxing the requirement on hospitals to treat, within 18 weeks, 92% of all patients in England who are waiting for a hip or knee replacement, cataract removal, hernia repair or other non-urgent operation.

The Royal College of Surgeons of England (RCSE) immediately accused the NHS of “waving the white flag on the 18-week target”.

A clampdown on surgery deemed of “limited clinical value” will affect people with certain spinal conditions, for example. Overall, a greater number of people with back pain will be treated with physiotherapy rather than surgery.

Stevens said rolling back the 10-year-old 92% target was necessary so that hospitals could concentrate on more urgent priorities, particularly in terms of easing the strain on overloaded A&E departments, as well as enhancing access to GPs and improving the treatment of cancer – diagnosis will be speeded up to 28 days – and mental health care.

The RCSE said the move risked going back to the time when patients faced excessive delays for surgery, leaving them to suffer in pain for even longer before finally undergoing necessary procedures.

“We are concerned that the 18-week waiting times target for surgical treatment has now effectively been jettisoned in all but name, having been dropped from the list of priorities for the next 12 months,” it said.

Clare Marx, the RCSE president, said: “It will be difficult for the general public to understand how waving the white flag on this target is compatible with a vision of an improved health service. We risk returning to the days of unacceptably long waits for elective surgical treatment.”

The move could see the number of people waiting for surgery within 18 weeks under the referral to treatment system going above 4 million for the first time since September 2007. The political importance of the target is likely to prompt criticism of Jeremy Hunt, the health secretary.

Stevens said: “We are saying that we expect that the number of operations that the NHS pays for will continue to go up, but we recognise that [while] right now about nine out of 10 people get their operations in under 18 weeks, in some parts of the country that will be under pressure.

“There is a trade-off here. We expect there will be some marginal lengthening of waiting lists, but this will still represent a strong, quick waiting times experience compared to 10 years ago, let alone 20.”

Simon Stevens, chief executive of NHS England. Photograph: Jonathan Brady/PA

The British Medical Association claimed the NHS’s inability to meet all its waiting time targets showed that it was “at breaking point”. Its leader, Dr Mark Porter, said: “Achieving one delivery promise only by missing another is a textbook example of rationing access to care. It should not be happening in today’s NHS.”

Hunt insisted that the fact that hospitals were still giving around nine out of 10 patients elective care within 18 weeks, despite the huge demands being placed on them, was a sign of success, not failure. The NHS met the 92% target every month since its inception in April 2007 until December 2015, when performance was 91.8%.

However, medical bodies fear that watering down the 92% target will lead to a significant further jump in the number of patients forced to wait beyond the maximum 18 weeks guaranteed under the NHS constitution. Although the target is not being formally scrapped, in future NHS trusts will face no sanctions for failing to deliver on it.

Hospitals have already breached the target for the past 11 months and, in January, hospitals only achieved a 89.9% rate: 3.255 million people were treated on time but 364,218 were left waiting. Scores of hospitals across England had to declare large-scale alerts and convert gyms and other non-clinical areas into makeshift wards.

Chris Hopson, the chief executive of NHS providers, which represents most hospital trusts in England, welcomed Stevens’s move as proof of “greater realism” among NHS bosses. “But we do need to remember the impact on patients. The [NHS] plan reinforces a simple, stark truth: that you get what you pay for,” said Hopson.

NHS England’s 75-page delivery plan outlines how it intends to transform healthcare by 2020. The document makes repeated reference to how “modest” budget increases mean that it is unable to provide as much care or care within existing waiting times.

The plan makes clear that what critics call greater rationing of some types of care was imminent. GPs will be expected to refer fewer people to hospital and instead arrange treatment in the community. NHS England will expand the use of “referral management processes”, under which doctors assess whether patients need to go to hospital at all. More patients will be offered online advice.

Stevens announced that hospitals would be financially penalised if they did not screen patients who smoked or drank too much and refer them to tobacco or alcohol services, and said he was determined to reduce the wide variation in patients’ chances of being referred for certain surgery depending on where they lived in England.

Radical modernisation of how the NHS works is needed to ensure it survives as a service funded by general taxation that is free at the point of use, the document adds.

But Niall Dickson, the chief executive of the NHS Confederation, called the plan “a leap in the dark”, adding: “We have no alternative but to embark upon such fundamental change, but to do so when services are under enormous pressure and money is so tight is without precedent.”

NHS accused of waving white flag as it axes 18-week operation target

My dad"s heart operation taught me a few things about being a doctor

“Look at this.”

My dad handed me an information leaflet open on a page titled Sex after major heart surgery.

“It says I can’t put weight on my arms!”

“Right.” I said, not even sure what the joke was, and refusing to engage in any discussion.

Dad was due for major heart surgery. He’d recently been rushed to hospital with breathlessness, and a couple of hours later I was at his bedside adjusting to the new perspective of family member. His heart was struggling and it was serious; he needed a complicated, life-threatening operation. The operation was just before Christmas; I would be in hospital every day over the festive period, alternating between working as a junior doctor and visiting my father. As a comedian, I also had a few gigs in London lined up one evening.

Beforehand, humour kept things light. He joshed avidly with my brother that he wouldn’t be “following the light”. But below the surface we were suffering. Christmas was cancelled, no big celebration, retail and decorations stripped down to minimum. As the date grew closer we all noticed subtle changes; every hug goodbye a bit tighter, every moment as a family more appreciated.

On the morning of the operation I drove in at 6am and sat with dad until he was called to theatre. I’d never been to the hospital he was in, and although as a doctor I knew what the signs meant and where things were, I felt a stranger in the place. I walked down the corridors and passed the discharge lounge and superstitiously thought that might be a good sign. I then turned a corner and passed the bereavement lounge and, amazed at how close they were, decided not to be superstitious. I sat and chatted until he was called to theatre, then we hugged goodbye and I walked down the corridor.

I left. I got into my car and cried. I was so tired, and the weeks of holding it together had built up. As I sat with his phone and glasses in my hands, my feet crunching against empty sandwich packets from last-minute meals before hospital shifts and comedy gigs, I saw all the unread well-wishing messages flash up, including mine.

When you work in a hospital you are so consumed by the job, so busy working out what the patient needs, that it’s almost impossible to take time to consider what the family has already been through. For families it all starts much earlier: the initial concern, the anxiety, the waiting, the unknown outcome.

In the days that followed, while working I was acutely aware of this when seeing families of patients. As family, you are a team for that one patient, every waking moment is about them, everything is time critical. When working as a doctor you have to care for many people, so you do the best you can for every patient you see and prioritise. Communication is paramount. I suddenly saw myself in the families’ shoes and empathised more than I’d been able to previously.

After dad’s operation, the surgeon and nurses were cautious – there were complications, but it had gone as well as expected and he wouldn’t be waking up today. My brother and I went to see dad in intensive care, we were asked to come back in 30 minutes. We returned and were told the same, returned a third time and told again at which point we panicked and asked what was happening. Was he in trouble? It turned out they meant “at least” 30 minutes and they were just getting routine things ready. A stark reminder of how communication is so important, how timely and accurate information is essential.

Working in hospital was a strange relief; a juxtaposition of doing a job but being constantly reminded of what was happening by familiar tests, results, and medications. I was reassured by all the brilliant staff I work with – doctors, nurses, healthcare assistants and more – all of them professional and caring, consoling me that dad was surrounded by similar people.

The evening after the operation complications arose that the intensive care team were struggling to sort out. I discussed with them some of the tests and instantly realised how serious the situation was; they didn’t know how it would go. We called almost every hour for updates – no change. The only reassurance was in talking to nurses and doctors who were calm and in control. They’d contact us if he deteriorated further – so we barely slept. By morning everything had changed and dramatically improved, with the previous 12 hours seeming like a nightmare.

That morning I walked in and saw him awake, I felt an overwhelming sense of relief. “Bloody hell dad, you scared the crap out of us.”

“But I told you I wouldn’t go towards the light,” he said wearily.

By Christmas day he had been moved to a ward, almost out of the woods. Yesterday he was discharged into my mum’s exhausted but delighted arms.

After dad heard how serious the situation was, he called and told me he’d asked a nurse overnight: “Did you know how serious it was for me?” The nurse smiled, put her arm round him and said: “Yes we all did. You, sir, were our Christmas miracle”.

Comedian and doctor Ed Patrick is performing his debut show Junior Optimist across the UK. For tickets and locations visit www.edpatrickcomedy.com

If you would like to contribute to our Blood, sweat and tears series which is about memorable moments in a healthcare career, please read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more about issues like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

My dad"s heart operation taught me a few things about being a doctor

NHS patients told to lose weight and quit smoking or face operation delays

Obese people and smokers will be asked to lose weight and give up cigarettes or face delays to routine operations after a health authority’s proposals were approved by NHS England.

Patients with a body mass index (BMI) of at least 30 will be asked to lose weight or face a 12-month delay for elective surgery while smokers will be asked to quit for two months or face a six-month postponement, the Vale of York Clinical Commissioning Group (CCG) announced.

The North Yorkshire CCG ruled out a “blanket” ban and said each patient would be dealt with on a “case-by-case basis” when the plan comes into force in January.

The CCG said: “Smokers and obese patients that need routine surgery, but do not wish to access the support services or fail to meet the criteria will not be denied their operation, but it could mean they have to wait longer than they otherwise would have done.”

Dr Shaun O’Connell, the CCG clinical lead who is also a local GP, said the plans would give patients the “best possible health outcomes in the long term” while helping to protect finances.

O’Connell said: “There is no ban and no blanket policy … decisions about what is in the best interests of their health, will be made on a case-by-case basis.”

The CCG, which serves a population of more than 351,000 in areas including York, Selby and Tadcaster, said there would be exclusions from the plan, which will probably include emergency and bariatric surgery and operations on patients under 18.

This year, NHS England intervened in the policy after the Royal College of Surgeons raised concerns that the proposals went against clinical guidance and made smokers and overweight patients soft targets for financial savings.

But the public body has now approved the plan.

An NHS England spokeswoman said: “Vale of York CCG has made clear its commitment to supporting patients to achieve better health and clinical outcomes by referring them to an established weight loss or stopping smoking programme, where appropriate.

“However, every patient’s case will be considered in the light of their own particular circumstances and on the basis of clinical need.”

NHS patients told to lose weight and quit smoking or face operation delays

Coroner criticises care of woman who died after kidney stone operation

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Third inquest into death of Carmel Bloom 14 years ago rules that ‘absences’ in routine aftercare contributed to cardiac arrest

A series of medical “absences” played a part in the death of a woman 14 years ago after a routine kidney stone operation, the third inquest into her death has ruled.

Carmel Bloom, 54, from Ilford, Essex, died on 8 September 2002, after surgery at the private Roding hospital in Ilford, where she worked as a health controller. She was taken to Whipps Cross intensive therapy unit (ITU) but died after her blood pressure fell and she suffered cardiac arrest.

Continue reading…

Coroner criticises care of woman who died after kidney stone operation

Surgeon utilizes Google Glass throughout cancer operation

Mr Shafi Ahmed, Colorectal Cancer Lead at Barts Health NHS Trust, wore the glasses which allowed his view to be broadcast live to 13,000 surgical students around the globe who were able can interact and put their questions directly to him as he performed the operation.

The students typed their questions online as they watched, and their queries appeared on the bottom left-hand side of Mr Ahmed’s Google Glasses who answered them verbally, transmitted via the online feed.

The questions appear to the side of the Google Glass so it does not restrict the surgeon’s view.

In an online questionnaire, 90 per cent of students who watched the live broadcast said that they wanted this type of learning to be part of the curriculum.

Surgeon utilizes Google Glass throughout cancer operation

First operation streamed dwell with surgeon sporting Google glass

As the concerns seem to the side of the Google Glass there is no risk to the patient as it isn’t going to restrict the surgeon’s view.

Mr Shafi Ahmed, Colorectal Cancer Lead at Barts Wellness NHS Believe in and Associate Dean at Queen Mary University of London, Barts and The London College of Medication and Dentistry performed the operation.

He said: “I am delighted that by making use of Google Glass technologies we are transporting our future surgeons directly into the working theatre. Making use of this technologies will assistance us to supply high-top quality and protected care now and in to the future.”

Professor Richard Trembath, Vice-Principal for Overall health at Queen Mary University of London, said: “We are thrilled to be involved in the initial live-streamed surgical process taking spot in the Uk.

“This is a pioneering piece of function, enabling us to broaden our reach around the globe. We feel harnessing technologies in this way will eventually turn out to be a core component to the cutting-edge undergraduate and postgraduate teaching we supply our students and trainees.”

The Google Glass provides viewers a surgeon’s-eye see of the process from starting to end, as effectively as providing insight into how an operating theatre operates. People viewing had been also capable to observe medical college students from Queen Mary University of London as they assisted in the procedure.

In an on the internet questionnaire, 90 per cent of students who watched the live broadcast mentioned that they desired this variety of finding out to be portion of the curriculum.

Hemant Kocher, Advisor Liver Surgeon at Barts Wellness NHS Believe in and Reader in Liver and Pancreas Surgery at Queen Mary University of London, eliminated the cancerous tissue in the patient’s liver which had spread from the bowel.

Hemant added: “I am very enthusiastic about this new way of teaching. We are now capable to demonstrate this expert mixed operation of liver and bowel which is only achievable in a specialist hospital this kind of as The Royal London due to our professional crew operating with each other.”

Roy Pulfer, 78, from Chadwell St Mary, near Tilbury, agreed to have his operation broadcast around the globe.

He mentioned: I’m content that it will support educate youthful men and women. They like employing engineering so it’s excellent for them. The employees have been wonderful to me all the way and explained each and every step of the operation so plainly.”

Professor Norman Williams, President of the Royal School of Surgeons mentioned: “Today we received a glimpse of what technologies can do for the future of surgical training.

“The unique and unparalleled view of an operation means trainee surgeons know much better what to assume when they go in to the working theatre. There is prospective for trainee surgeons from close to the planet to watch and learn from leading surgeons in their fields of skills.”

First operation streamed dwell with surgeon sporting Google glass

Traumatised patient relives hospital nightmare soon after she woke up throughout operation

Alexandra Bythell, 36, came round minutes ahead of surgery to remove her appendix at the Royal Blackburn Hospital in Lancashire.

“I woke up, considered I was in recovery. Almost everything was black. I started attempting to breathe and that was when I knew some thing was wrong, simply because I could not get any air into my chest,” she advised ITV’s Daybreak.

She described how she felt a person poking and prodding at her abdomen just before there was a shout for a lot more morphine and she fell back asleep.

Source: ITN / Cascade News

Traumatised patient relives hospital nightmare soon after she woke up throughout operation

Plastic surgeon"s profession in tatters following transsexual patient falsely claims he botched ear operation

“I’m going to see you dog, f****** c***. You’ve deformed me for lifestyle.”

^{Dr. Brian Mayou founded the Cadogan Clinic in Belgravia}

Charles also talked about Dr Mayou’s wife and daughters, calling 1 of his ladies a “pig” and a “slut” and branding the surgeon a “kiddie fiddler.”

The medical doctor was also forced to apply for fifty on the web posts to be eliminated from three different sites, which contained material this kind of as: “He is a paedophile and demands to be locked up.”

The former advisor and honorary lecturer at Guys and St. Thomas’ Hospital, who was the plastic surgeon who initial launched liposuction to the United kingdom, now has the complaint completely on his Common Health-related Council record.

“There have been a number of forms of threats over a long period of time,” magistrate Mrs Nicola Leach advised Charles. “The threats have impacted Dr Mayou’s family, occupation, track record and earnings. The impact is unimaginable.”

Charles made the unfounded allegations during a two-and-a-half 12 months campaign, resulting in the surgeon’s appropriate to perform at South Kensington’s private Cromwell Hospital currently being withdrawn.

Charles, Cowbridge Road East, Cardiff, of pleaded guilty to harassing Dr Mayou between December sixteen, 2010 and May possibly 16, last 12 months by sending many unwanted insulting messages and was sentenced to 6 months imprisonment, suspended for two many years.

“This surgeon, who has pressed these charges, has induced me so a lot pain and distress,” Charles informed the court. “If you knew the full story and what this man has completed to me you would be shocked.”

Charles was also ordered to pay out £2,500 compensation to the surgeon, £150 fees an £80 victim surcharge and was made topic to a 9-month drug rehabilitation necessity.

Charles was arrested when arriving in the Uk at Bristol Airport on July 22, final 12 months, after a journey to the continent.

In his victim impact statement Dr Mayou explained the abuse gave him sleepless nights and patients had cancelled surgical procedure as a end result of Charles’ on the internet rants.

“He has carried out a social media campaign towards me and the clinic,” stated the surgeon. “Sufferers have cancelled as a direct outcome of the posts.”

Charles’ lawyer Miss Julie Stanhope advised the court: “My client suffers a large-degree of self-hatred and in his early thirties decided to handle his gender issues.

“The very first stage was surgery on his ears by Dr Mayou and he accepts the behaviour the physician endured was extreme and unacceptable.”

Charles has because had facial reconstruction surgical treatment and breast augmentation.

He previously jumped bail right after telling the court: “I am halfway through a intercourse-change and sending me to a male penitentiary would be sexual abuse.”

Plastic surgeon"s profession in tatters following transsexual patient falsely claims he botched ear operation

Surgeons attach leg to arm in cancer operation

The large tumour which was removed in the procedure had spread from Mr McGregor’s pelvis into his thigh, and attempts to treat it over the last decade had failed.

Surgeons at Newcastle’s Freeman Hospital designed a procedure to remove the tumour and use his calf to repair the hole that it left.

They detached part of his leg, except for the bones, and attached it to one of his forearms, allowing blood to continue flowing through it. Following the removal of the tumour, the calf was disconnected from his arm and attached to the site.

The operation, which took place last August, lasted from around 9am one day until after 3am the following day.

It was carried out by three consultants, whose work Mr McGregor described as “amazing”.

“You can’t describe the feeling, you think you’re at death’s door and then you wake up and think wow, I’m here. It’s a wonderful feeling,” he said.

The team of consultants believe this was the first procedure of its kind, although it is thought that it may have been attempted before over the course of two operations.

One of the consultants, Mani Ragbir, a plastic and reconstructive surgeon, said: “It’s not easy for a surgeon to tell a patient that they haven’t done this particular procedure before.”

Surgeons attach leg to arm in cancer operation

Surgeons attach leg to arm in cancer operation

The large tumour which was removed in the procedure had spread from Mr McGregor’s pelvis into his thigh, and attempts to treat it over the last decade had failed.

Surgeons at Newcastle’s Freeman Hospital designed a procedure to remove the tumour and use his calf to repair the hole that it left.

They detached part of his leg, except for the bones, and attached it to one of his forearms, allowing blood to continue flowing through it. Following the removal of the tumour, the calf was disconnected from his arm and attached to the site.

The operation, which took place last August, lasted from around 9am one day until after 3am the following day.

It was carried out by three consultants, whose work Mr McGregor described as “amazing”.

“You can’t describe the feeling, you think you’re at death’s door and then you wake up and think wow, I’m here. It’s a wonderful feeling,” he said.

The team of consultants believe this was the first procedure of its kind, although it is thought that it may have been attempted before over the course of two operations.

One of the consultants, Mani Ragbir, a plastic and reconstructive surgeon, said: “It’s not easy for a surgeon to tell a patient that they haven’t done this particular procedure before.”

Surgeons attach leg to arm in cancer operation