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Crisis, What Crisis?

Posted on January 18, 2017 at 11:40 PM Comments comments (0)

It’s a black alert, a humanitarian crisis, a major incident, exceptional measures are demanded. Where in the world could this be? Syria? Sudan? Or perhaps a terrorist attack in a major European city? No, it’s just a normal working day at your local hospital in January. No one, even those of us who have served the NHS for a long time (38 years for me) have witnessed anything quite like it. We are underfunded, understaffed and at the moment, desperately overstretched. In comparison with other European countries we have fewer beds, fewer doctors and nurses and fewer scanners. But when challenged the prime minister and the health secretary repeat the same mantra about the huge amounts of extra cash the NHS is receiving. You may feel that The Red Cross have overstated the problem by labelling this as a humanitarian crisis, but if you end up dying in A&E after waiting 36 hours on a trolley for a bed to become available, where is the humanity in that? If you wait months for an operation, only to have it cancelled at the last minute, or see your elderly relatives looked after on inappropriate wards by exhausted staff, you may well wonder whether this is a humane way to run a health service. None of this happens because of a lack of compassion amongst those in the hospital, it has been allowed to happen by depriving them of the resources they urgently need. As a member of the council of the Royal College of Physicians, representing Devon and Cornwall I am a co-signatory on an open letter to the prime minister laying out these facts.

Since the government says it is not their fault, who is to blame? Well, the boss of the NHS, Simon Stevens, has been sharply criticised for failing to make the necessary efficiencies and for pointing out the rather inconvenient truth that the government has got it’s sums wrong and there simply isn’t enough money to fund the NHS. The doctors are also to blame for striking last year and for failing to provide a full 7-day service, although the government has never been clear what it means by this. And of course, it’s your fault. Yes, you – for going to the Accident and Emergency department for problems that are neither accidents nor emergencies and wasting our precious resources. If, like me, you are a trifle sceptical about Jeremy Hunt’s handling of statistics, you would not be surprised to hear him claim that 30% of A&E attendances are unnecessary. But it is often difficult to say whether a hospital visit is needless until the patient has been fully assessed. Every day I see a number of patients with suspected heart attacks that turn out to be nothing more than indigestion. They are not at fault; they are not wasting our time or resources. It is far worse when people think they have indigestion and only come to hospital after munching handfuls of Rennies to no effect, by which time it is often too late to effectively treat their heart attack.

Over the last 14 years the number of beds in the NHS has fallen by over one third while the number of admissions has risen by over 50%. How have we coped? By reducing the length of stay in hospital. When I was in training 40 years ago a minor operation such as a hernia repair would require three to five days in hospital. Now the vast majority are day case procedures. But the intention is to cut the number of beds even further with the expectation that admissions will fall. The musical La La land may well have swept the board at the Golden Globes, but anyone who believes this plan will work should receive a special ‘cloud cuckoo land’ award. It is doomed to failure. Every attempt to reduce the number of emergency admissions has failed, the numbers rise relentlessly year on year.

I am sick to the teeth of hearing that the NHS is simply inefficient and would run like clockwork if it were reorganised. What, again? For pity’s sake, we are only just recovering from the fiasco created by Andrew Lansley’s reforms in 2010. The NHS is like a battered leather football, kicked around by each new government in turn. If anything what we need is to de-politicise the NHS and let the professionals run it.

The NHS deficit in Devon alone is expected to exceed £500 million by 2020, the highest in the country. But the financial crisis in the NHS is not bad news for everyone. Some believe that the underfunding is a deliberate ploy by the government to kill off the NHS by a death of a thousand cuts then sell it off to the private sector. Indeed, the chief executive of the private health company Spire said; “…as the gap between supply and demand grows, by nature people will turn to a private product.” So, if the NHS perishes, the vultures from the private sector, already circling overhead, are ready to pick off the juicy bits from the carcass.

Of course, the government denies this is their plan and reaffirms its commitment to a publicly funded, comprehensive national health service. They also claim that they have provided enough extra money to sort out these ‘winter pressures’. And at the time of writing this article, it is clear they do not intend to give any more. But the UK is the fifth largest economy in the world and spends less than almost all of its European neighbours on health. We would need to spend an extra £45 billion by 2020 to catch up with the average European Union health expenditure. I don’t want the NHS to fail, so I have written to ask for a meeting with my local MP (so far no reply), why don’t you do the same?

Western Morning News 19th January 2017

The Era of Stupidity

Posted on November 25, 2016 at 10:05 AM Comments comments (0)

Debate should be based on facts, not hearsay or ideology

I am normally a good sleeper. But twice this year I have awoken from a peaceful slumber into a nightmare about clowns; it’s always clowns. In one of my nightmares I am a passenger on a plane where the pilot dies and a professional clown with a terrible comb-over and absolutely no experience with flying an aircraft takes the controls and prepares for a crash landing. Those of us in the back realise that there are quite a number of passengers on board who are fully qualified pilots, but the clown’s friends block the way to the cockpit and say he is undoubtedly the right man for the job; he told them so. Meanwhile we are in a rapid descent and the runway is fast approaching.

The second nightmare involves another clown, also with hair issues, who says he has a fortune to spend on our beleaguered health service as long as we join his campaign to cut ourselves adrift from continental Europe. It sounds like a great idea, so we do it. But when I wake up in a cold sweat I hear his fellow circus performers on the radio announcing deeper cuts in NHS spending. When the clowns wipe off their make up, it is clear both nightmares are reality. On both occasions the polls said I could sleep easily, on both occasions the polls were wrong. But what disturbs me the most about the outcome of the EU referendum and the election of Donald Trump is that we now appear to be entering an era of stupidity where mere facts can be swept aside by a fool’s opinion. And that, more than anything else, is likely to keep me awake at night.

The next US president will be a man supported by the Ku Klux Clan who has smeared his black predecessor in the harshest, indeed racist manner and who will now be in possession of the nuclear weapons codes. His narcissism, temper tantrums and manner of speech make him appear like a child trapped in a man’s body. But his rudimentary grasp on even the most basic facts of politics would make a ten-year-old of average intelligence blush with embarrassment. I suspect almost all politicians distort the truth to some degree, but this man’s habitual lies and disordered thinking is something that I have seldom witnessed outside a mental institution. His cabinet is a clown car packed with ideologues and religious fanatics. He has been a punch line in jokes for decades.

Donald trump is contemptuous of science and proudly announces that climate change is a hoax generated by the Chinese to undermine US trade. He has appointed Myron Ebell a leading climate change skeptic to lead the Environmental Protection Agency. He intends to repeal the Affordable Care Act (or ‘Obama care’) and replace it with…well, nothing. Effectively depriving up to 22 million Americans of access to health care insurance.

Back home, before the EU referendum Michael Gove said: ‘people in this country have had enough of experts’ and last month criticized ‘experts’ such as Mark Carney, the head of the Bank of England for ‘wreaking all kinds of economic disasters’. He is not alone in his distaste for expertise. The secretary of state for health, Jeremy Hunt who has been heavily criticised for using false statistics to impose a new junior doctor contract said at the Conservative Party conference: ‘let’s not argue about statistics’. But the correct application of statistics is fundamental to science and there is an intimate relationship between science and democracy, scientific thought flourishes in democratic countries and withers in autocracies where the tyrant replaces the expert. Like everyone else, I have my areas of ignorance. But when these are exposed I seek information from reliable sources, from people who have knowledge and experience to fill that gap. It is healthy to be skeptical about statements from experts until you can satisfy yourself that they are indeed experts and that the evidence base for their comments is sound. Debate should be based on facts, not hearsay or ideology.

Yet distrust of expert opinion is not uncommon, many people take so-called ‘complementary therapies’ even when there is not a shred of evidence that they have any medical value beyond the placebo effect. And many parents have put the future health of their children at risk by withholding vaccines based on discredited evidence that the MMR vaccine may lead to autism. The overwhelming majority of climate change scientists are of the view that the earth is warming up at an alarming rate and that this is related to greenhouse gases, but they are just the experts and surely anyone is entitled to their own opinion? Many people subscribe to the vast number of conspiracy theories they read about on the Internet and believe in the ‘fake news’ from websites that pay their writers by the click of a mouse rather than the integrity of their journalism.

If you disagree with me and share Michael Gove’s contempt for experts: good luck when you allow the clown to take control of the cockpit.

Western Morning News 25th Nov 2016

Western Morning News 6th September 2016

Posted on September 6, 2016 at 5:25 AM Comments comments (0)

Brexit and The NHS

Posted on August 23, 2016 at 11:15 AM Comments comments (0)

Today I was introduced to someone extraordinary: a newly recruited nurse who is not from continental Europe, but from the UK - Taunton to be more precise. In the hospital where I work 20% of the registered nurses are from overseas, the majority from the European Union (EU). Chatter in the common room is a mongrel mix of Spanish, Italian, Greek and even Catalonian. To help them communicate with our local population I have encouraged them to use some West Country expressions. Hearing a nurse from Barcelona tell the patient that we have done a ‘proper job’ always makes us giggle.

In his commencement address at Yale University in 1962 John F Kennedy said: “The great enemy of truth is very often not the lie; deliberate, contrived and dishonest, but the myth; persistent, persuasive and unrealistic…”

I doubt that many voted to leave the EU because they really believed that this would result in a massive cash boost for the NHS, but this is precisely what was promised. Up to £350 million per week extra was promised at one stage of the campaign. This was downgraded to £100 million per week later on when the leave campaigners realised the sums did not add up. And as the referendum day drew near this amount was reduced even further or not discussed at all. Now that the vote to leave has been won and our new Prime Minister clearly intends to follow Brexit through, no one in power is talking about extra investment in the NHS.

According to an analysis by the independent think tank, The Health Foundation, any potential savings the UK might make in payments to the EU “would be more than cancelled out” by the economic consequences of leaving. It said that even if the UK remained in the European Economic Area (EEA) after leaving the EU, the NHS could have a funding shortfall of at least £365m a week. But if the UK does not remain part of the EEA, the report said that this could be as high as £540m a week. Anita Charlesworth, director of research at the Health Foundation, said: “The recent decision for the UK to leave the EU will create additional challenges both in terms of finances and the ability to attract and retain valuable European staff. It is widely anticipated that leaving the EU will lead to lower economic growth, and when the economy sneezes, the NHS catches a cold. The NHS is already half way through its most austere decade ever, with finances in a truly dire state—it cannot afford to face another hit.”

Despite these dire warnings, the government has consistently reassured us that the NHS is adequately funded (it isn’t), adequately staffed (it isn’t) and the cause of the huge deficit is lack of ‘financial discipline’ (it isn’t). Patients are given high expectations (such as seven day access to a GP) and then encouraged to complain when they fail to materialise.

The Health Foundation report highlights that the NHS is short of 28,000 nurses, 2,300 consultants and 2,500 junior doctors. The EU has provided rich pickings for employers looking to fill vacant nursing and medical posts. So can we expect our new Prime Minister to encourage overseas recruitment? It seems unlikely. The Daily Telegraph described her speech at last October’s Conservative Party Conference as a cynical bid to scapegoat immigrants, whip up anger at foreigners in order to win support as a leadership candidate.

If you voted to leave the EU to reduce immigration, how did you think gaps in hospital staff would be filled? We certainly cannot do it from our local population. Even if we massively expanded medical school places in the UK today, we would not see any expansion in home grown hospital consultants or General Practitioners until 2033 at the earliest. There is understandable concern amongst the EU workforce already working for the NHS as to what will happen after Article 50 is triggered. People are planning their futures and thinking about where they want to be in two to three years' time and I doubt they will wait to find out. We need to move on from simply reassuring our EU workforce that they are valued to giving them some security and certainty should they choose to remain in this country. If we don’t we could see a lot of people who are already here leaving. And it seems certain that many EU nationals who were considering a future working in the NHS will think again. And if you voted Brexit for a much-needed massive cash injection for the NHS you may well see exactly the opposite. All the talk now is of further cuts in public spending.

JFK concluded his address: “…too often we hold fast to the clichés of our forebears. We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of thought”. If you had the chance to vote again, would you still vote leave?

Western Morning News 20th August 2016

Safe Cycling

Posted on March 18, 2016 at 11:10 AM Comments comments (0)

According to a recent European study, I am one of the 4%; I do it every day (well, almost every day). If you never do it, you are amongst the majority of UK residents (69%). In Holland the picture is strikingly different, 27% do it every day and only 13% never do it. I am referring to cycling, of course. But why on earth would anyone want to cycle on West Country roads? Well, I’ll tell you why I do it.

Firstly, I enjoy it; even though England seems to have replaced winter with a monsoon season and there are times when it feels like I am cycling in a war zone. The rhetoric of road war is fuelled by the likes of Jeremy Clarkson, labeling cyclists as “lycra Nazis” and “pushbike Bolsheviks”. And asking the question…"When will people understand that roads are for cars and that there is no danger at all from speeding motorists if walkers and cyclists steer clear?" I can also put up with the abuse I get, indeed the often-heard taunt: “you don’t pay any road tax” is false: I do, and when I’m on my bike and my car is in the garage I’m doing much less damage to the roads and the environment.

Secondly, it is the fastest way to travel in cities, especially during peak hours. There used to be an annual ‘commuter challenge’ from the outskirts of London to the city centre. An average cyclist was pitted against a taxi, or public transport. Every year the bike won easily – even after a helicopter was introduced into the competition.

Thirdly, cycling is the healthy way to travel. When I bump into colleagues in the corridor at work wearing my cycling gear, many feel the need to justify why they do not cycle to work. Safety usually appears high on their list of reasons. But the risks of cycling are overestimated. A cyclist would need to commute every day for 8,000 years before they would be killed on the roads. The extra years of life gained by the regular exercise of cycling far outweighs the risks of death. I appreciate that cycling in the UK can feel dangerous, but it needn’t be like that. Hop across the Channel and you will find cities full of people on bikes wearing everyday clothes and almost none wearing helmets. Space for pedestrians and cyclists is frequently shared and no one seems to get het up about it. So why is cycling such a popular means of travel on the continent, but not in the UK? Of course, some countries have the advantage of being as flat as a pancake whereas it is almost impossible to travel any distance in Devon and Cornwall before being confronted with a hill to climb. More importantly, these countries have invested heavily in separating bikes from cars (and more crucially lorries) making it feel a lot safer.

Finally, it is clearly the right thing to do from an environmental perspective. If you are physically capable, you should walk or cycle short trips (40% of all journeys in the UK of less than two miles are made by car). We read about the harm caused by rising levels of CO2 and exhaust pollutants almost every day, but this discourages few from motoring. I suspect this is because they are not directly affected by global warming. If the water level in your house rose an inch every time you turned the ignition key in their car, I bet you would take climate change more seriously.

What is needed is a change in mindset and this requires a change in legislation. For starters we need laws that protect cyclists. In Holland if there is a collision between a car and a bike, the motorist is held responsible unless he can prove he is innocent. Penalties for injuring cyclists are severe. Open a car door in Amsterdam in the path of a passing cyclist and you may well end up in jail. In the UK, the law favours the motorist, the onus for safety is put squarely on the shoulders of those who choose to cycle.


Cyclists should be allowed to pass through red traffic lights if the road is clear. This is widely considered to be dangerous, but the greatest risk to cyclists comes from lorries turning left at junctions, so allowing the bike to go ahead would improve road safety. This fact has been grasped by many European cities, including Paris, and even some in the USA, the spiritual home of the motorcar. Also, employers should have schemes that encourage their staff to cycle to work, providing secure cycle storage and facilities for workers to shower and change clothes.

You might feel that such changes are unconscionable, but just reflect on what has happened to smoking. There was a time when it was deemed perfectly OK to smoke almost anywhere you liked; including pubs, cinemas, restaurants and even on airplanes. But all that has changed and the same could happen for cycling. Am I dreaming? Well, maybe not. The day after the BBC sacked Clarkson (no, that’s not in my dream); journalists mobbed him leaving his home … riding a bike. Surely if he can do it, so can you.

John Dean March Western Morning News March 2016

Pacemaker battery scandal BMJ 4th Feb 2016

Posted on February 3, 2016 at 11:55 PM Comments comments (0)

Western Morning News 17th December 2015

Posted on December 17, 2015 at 10:50 AM Comments comments (0)

Perfect storm brewing as NHS struggles against £22bn 'cut'

Posted on October 14, 2015 at 11:25 AM Comments comments (0)

The government seems to be dismantling our treasured health service

There is never a good time to be sick, but if that is your destiny, I suggest you do it sooner rather than later. Why? Because there is a perfect storm brewing and if your illness is bad enough to need admission to hospital, there is every chance you will get caught up in it. Firstly, so-called ‘winter pressures’: the inevitable influx of emergency admissions that swells our hospitals is about to start. Despite attempts to stem the tide, the number of admissions increases year on year. So much so that hospital managers have been forced to invent a state of readiness beyond ‘red alert’: they call it ‘black alert’. What lies beyond black is anyone’s guess, but when your hospital is already bursting at the seams it is hard to imagine things getting any worse, but they can. During black alert, all non-urgent admissions are cancelled to make room for the emergencies. If you are unfortunate enough to be admitted to hospital during a black alert, you may find yourself on a ward staffed by a highly skilled team of nurses, doctors and therapists, it’s just that they are not necessarily skilled in looking after your ailment. It’s rather like a football manager asking his top striker to act as goalkeeper for a while. He might be OK, but he is not really playing in his best position.

Secondly, cuts in funding to the NHS (The government calls this £22bn of ‘efficiency savings’ have left the regions hospitals massively overspent. This is a situation hospital trusts clearly want to avoid (the penalties can be severe) but when you have already trimmed off off all the visible fat, what is there left to cut? If you reduce the number of frontline staff, you pose a risk to patient safety and if you fail to satisfy a Care Quality Commission inspection you may find your hospital subjected to ‘special measures’, something to be avoided at all costs. To compound the situation, cuts in social care funding are having a significant negative impact on the health service. About one quarter of all patients who are admitted as an emergency are detained in hospital despite being medically fit to be discharged, there is simply nowhere safe for them to go.

And finally, the junior doctors who will attend you if you are admitted to hospital may be about to go on strike. And I wouldn’t blame them if they did. From August next year the government intends to impose a new employment contract upon them that will extend their standard working hours and reduce their pay by up to 15%. Those who work unsocial hours providing emergency services will be hit the hardest. Even if they decide not to strike, do you really want to be seen in your hour of need by doctors who feel exhausted, undervalued and demoralized? If we continue to treat our doctors in this shabby fashion, the exodus from this country will accelerate. There are already about 500 trainee emergency doctors who qualified from UK medical schools working abroad (mostly in Australia and New Zealand). More than 90% of these have no intention of returning home. A quick glance at their working conditions, their prospects for training and their quality of life will make you understand why.

Those who choose to stay in this country have already seen an attack on their pensions such that junior doctors face the prospect of having to work well beyond the age of 65 and pay higher contributions. Also a heavy-handed approach to the introduction of seven-day working for hospital consultants (as if most of us are not doing this already) has made them feel enough is enough.

Although this government repeatedly states its commitment to the NHS, it appears to be systematically dismantling it. Behind a smokescreen of good fiscal governance, it is starving hospitals of essential funding, claiming that more efficiency measures are all that are needed to maintain (indeed improve) standards of care while selling off the profitable bits to the private sector. Yet the UK spends just over half as much on health as in the privately funded system of the USA and still (despite ‘Obama care’ a significant proportion of their population have no access to the sort of healthcare that we take for granted in this country.

So is there anything you can do? Well, bear in mind that this government has a slender majority of 12 seats. It would only require a minor backbench rebellion to make them think again. So why not write to your MP today? Unless you live in Exeter, he or she will be a member of the ruling party. Let them know how you feel about the disintegration of our public health service. The NHS is a national treasure to be cherished. Over the last few years this gem has become rather tarnished, but rather than buff it up it looks as if this government is determined to prise it out and send it to the pawnbrokers. So stay healthy this winter, if you can.

Western Morning News October 14th 2015