Whistleblowers still hit by closed culture 5 October 2018 As whistleblower Dr Chris Day finally gets his case fully heard, it is clear the health service and the rest of the public sector is still far from establishing the open culture that has repeatedly been promised. Day is the latest in a long line of NHS staff forced to fight in an employment tribunal after making what he asserts was a “protected disclosure”. It is true there has been progress. Following the 2015 review of health service whistleblowing by Robert Francis QC, there is now a network of “freedom to speak up guardians” across NHS trusts, supported by a national guardian for the health service, a post energetically filled by Dr Henrietta Hughes. Her first report, published in September, reveals that more than 7,000 cases were raised with freedom to speak up guardians over the previous year. A third involved patient safety and service quality, and 361 people alleged they had suffered at the hands of their employer as a result of raising concerns. That thousands of people feel able to approach the guardians – albeit a fifth of them anonymously – is promising, and Hughes pushing for action at the trusts that failed to record any cases is a good sign. Read the full article at Guardian Society __________________________________________________________________ Public sector staff are being pummelled 1 October 2018 Despite some cautious indications that the worst of the public sector job cuts may be over, local government is still being hammered, pay is still being suppressed and the future for many workers is still precarious. After eight years of being beaten down by austerity, the once- unacceptable has now been normalised. The relentless attrition upon adults’ and children’s services, including the loss of 70,000 local authority adult care jobs since 2009, has become framed as merely the annual round of difficult decisions, rather than the withdrawal of essential services for the most vulnerable. Even the shocking realisation that austerity is shortening lives has caused barely a ripple. Sharp rises in gun and knife crime have accompanied a huge decline in police numbers. Having bottomed out in December 2016, police staffing staged a brief recovery before slipping back. While the NHS has certainly avoided the worst of austerity, a failure over many years to plan for its workforce requirements has left roughly one in 10 medical and nursing posts unfilled. These vacancies mean that patient safety is being compromised every day in virtually every hospital. Operations are being cancelled. Read the full article at Guardian Society __________________________________________________________________ NHS urgently needs a workforce plan 21 September 2018 As the NHS leadership develops its 10-year plan, the service is trapped in a vice of eroding performance and rising vacancies. The latest quarterly performance statistics from NHS Improvement revealed that, up to the end of June, delivery in five key maximum waiting time targets – four hours in A&E; an 18-week referral-to-treatment time; six weeks for diagnostic tests; 62-day urgent GP referral to treatment for cancer; 52 weeks for treatment – were all worse than the same period last year. The deficit also worsened by £78m, to £814m. A reduction in delayed discharges from acute beds was one of the few pieces of good news, but there were still almost 275,000 bed days. Meanwhile nursing vacancies were close to 42,000 – an increase of more than 3,000 since last year. We are short of more than 11,500 doctors, which is also worse than a year ago. Alongside the 10-year plan, Health Education England is finalising the workforce strategy following the launch of its consultation document last December. It includes one killer fact: if no action is taken to reduce demand, the NHS will need an additional 190,000 clinicians by 2027. Read the full article at Guardian Society __________________________________________________________________ Hancock makes big healthtech promises 7 September 2018 Passing chatbots for dementia patients and tools for manipulating big data as he entered the annual NHS Health and Care Innovation Expo in Manchester on Thursday, the health secretary, Matt Hancock, could have been forgiven for thinking the health service is well on the way to exploiting the potential of digital technology. But visits to see hospital and ambulance services in action as he gets to grips with his new post have left him horrified at the pervasive and lethal weaknesses in NHS technology, and he has wasted no time in giving vent to his feelings. Hancock loves tech. He used to work for his family’s software business, was the first MP to launch his own app and was responsible for digital policy as a minister for two years in the Department for Digital, Culture, Media and Sport. Since being appointed health secretary two months ago, he has made three big calls. He has scrapped the famous Monday morning meetings in which his predecessor Jeremy Hunt brought together system leaders and delved deep into operational detail. He has used his first appearance in front of the health and social care select committee to attack the “very, very old school” NHS management culture, and he has declared that his mission is to sort out NHS technology. Read the full article at Guardian Society __________________________________________________________________ Sexual health services need an overhaul 24 August 2018 The health and social care select committee has launched an inquiry into sexual health. The move comes as serious infections are rising and funding is falling, hitting services of vital importance to young people and many others. Demand for services has been rising relentlessly. Between 2013 and 2017, total attendances at sexual health services in England rose 13% to more than 3.3 million. New diagnoses for gonorrhoea increased 66% between 2012 and 2017, while syphilis jumped 136%. Chlamydia infections fell by 3.5%, but infections are still diagnosed in more than 200,000 people each year. Chlamydia testing has been falling, while drug resistant strains of gonorrhoea have emerged. The news on HIV is more encouraging, with Public Health England reporting a UK-wide 18% decline in diagnoses  between 2015 and 2016. The power of good sexual health services was underlined by a 29% decrease in London, with the largest declines seen in boroughs with the highest testing rates and prompt access to treatment. According to the select committee, the impact of sexually transmitted infections remains greatest in heterosexuals aged 15 to 24 years, black ethnic minorities and gay, bisexual and other men who have sex with men. Read the full article at Guardian Society __________________________________________________________________ Healing the scars of the Bosnian War 10 July 2018 More than two decades after the Bosnian war, memories of the conflict and caring for the living—and the dead—still define many lives in the Balkan state. Ilijaz Pilav was a doctor in the mining town of Srebrenica, close to the Serbian border, when Serb forces encircled the largely Muslim population in 1992. Like many Bosnian towns it is surrounded by hills, an easy target for artillery and mortars. The 1992-95 war followed the breakup of the former Yugoslavia. After the republic of Bosnia and Herzegovina voted for independence Serb forces mobilised to secure continuous territory across a swathe of the country, forcing out inhabitants through its policy of ethnic cleansing. Most doctors in Srebrenica fled. That left five—including Pilav and one trapped there while visiting after graduating medical school—for a population swelled to 40 000 by refugees. “The city was under siege from the beginning—no electricity, no medicines, no sanitation materials, and for a couple of months no food. We five doctors with humble experience of medicine had to solve every problem,” Pilav says. Until the Serbs advanced on Srebrenica three years later and massacred Muslim men and boys, in what the International Criminal Tribunal in The Hague described as genocide, “there were bombardments every night,” says Pilav, who as a Muslim was at risk himself. “From the beginning the number wounded was huge.” Read the full article at the BMJ __________________________________________________________________ NHS won’t be saved by reorganisation 5 July 2018 The seven-decade history of the National Health Service is littered with organisations which have come and gone. Regional health authorities, primary care trusts, strategic health authorities, the NHS University, the Health Education Authority, the Health Development Agency, the NHS Modernisation Agency, the Commission for Healthcare Improvement, the Trust Development Authority – all bodies scrapped in what Nuffield Trust chief executive Nigel Edwards has described as “major extinction events”.  Politically driven re-engineering has tended to focus on intermediate management structures such as regional layers, commissioning and regulatory bodies, and agencies designed to drive system changes such as clinical improvement. The UK’s predilection for reorganising its health system is unusual by international standards, according to Mark Britnell, former director general for NHS commissioning and now global chair of healthcare, government and infrastructure for KPMG. “That doesn’t mean to say that systems don’t change. For example, in the Nordics there has been a greater push towards regionalisation while Australia and Canada have pushed for larger hospital and health board areas to facilitate integration, but my impression is that the NHS goes through reorganisation convulsions whereas other systems try to manage change more organically.” Read the full article at Civil Service World __________________________________________________________________