07-May-2011 – good NOT TO HAVE THE FAILING NHS MANAGEMENT!

07-May-2011 – good NOT TO HAVE THE FAILING NHS

The logo of NHS Wales.Image via WikipediaMANAGEMENT!

Hi,

it is 08:30hrs. on Sunday morning and I’m showing signs of recovering from the damage that the utter incompetence of the management of the NHS in Wales was inflicting on me from Friday early evening until yesterday afternoon!

I was up on Friday morning after just on 4-4.1/2hrs. sleep and just as I was going to bed again tired I was called into the Royal Gwent just before 20:00hrs.

It took around 4 hours to ascertain I had a very low platelet count at 34 when petechiae was plain to see and recognise for anyone trained. It was also then apparent that anti biotics were required and the suggestion of a transfusion was made.

The decision was taken to watch and wait on the platelet count and decide based on a new set of bloods in the morning – they were taken and they showed a natural improvement in the platelet count to 39.

Still no anti biotics.

Due to crass and incompetent management no bed was found and I was forced to spend the night in a standard office chair in a side consulting office!

Not unsurprisingly I had no sleep whatsoever.


FINALLY more than 12 hours after I had come to The Gwent and the decision was made that I would have to stay a bed was found – that was 24 hours without sleep – not that it was due to unusual sleep times as I had got up at just after 09:00hrs.

The medical staff have been great up to Doctor level but then  above that in the food chain the system just collapses with more and more management and less and less results.

Read the YELLOW CARD and it is clear Velindre take the situation seriously yet clearly the Gwent’s management care little and do less. How can my treatment so far be seen as other than harming my survival chances which are pretty ropey anyway!

Eventually a porter is found and off we set on the great trek – what no ox waggon!

B6 is the Haematology Ward on the far side of the hospital off of the same staircase (same wing) as Maternity.

Here is the bed/room:

It looks very appealing after so long without sleep or food!

Unfortunately it is not a great deal of use as my petechiae is clearing and really all I want is to see the Consultant get my antibiotics and LEAVE.

There is absolutely no way this visit to hospital has been other than damaging to health and clearly as far as management is concerned the service is attrocious. They couldn’t run a bed and breakfast facility let alone a major hospital – it reflects the entire idiocy of the way Government is run with its massive over staffing, obscene feather bedding, Politically Correct crapology and over paying of top end staff – They are CLEARLY not fit for purpose and incapable of doing their job at any price!

Even were I staying the inconvenience of considering sleep starts with I have eaten nothing of any substance since Thursday as just as this started I was going for a shower before food and then to bed – That was yesterday afternoon!

Further since the room has no door (it is away being fixed!!) and is off of the main ward corridor – there would be little chance of sleep – particularly in view of the fact that the room is directly above the back road to service the hospital overlooking the dustbin / waste area, which is noisy.

You will note also that the sunlight is streaming in and consider how lightweight thin curtains would fail to help!

It is now 11:00hrs. and I’m waiting to see the Consultant in the knowledge that the pharmacy shuts at 12:00hrs. until Monday!

Do enlighten me in what way can my visit to The Gwent be seen as anything but seriously deleterious to my health!

It is no fault of the staff I have seen and it is entirely unfair of their employers to leave them to deal with my very rational and presented anger at such a level of utter incompetence on the part of the management of the NHS in Wales.

Is the aim to kill patients to make savings?

I still have not seen a specialist in this field – I have seen no Oncologist nor a qualified Haematologist – that the service is so far supplied by variously experienced nurses – whose only ranking is to all look like cleaners in their new and hugely costly uniforms all colour coded for insiders and the hell with the patients!

WHAT IS WRONG with a simple block of embroidered badge saying >STAFF NURSE< or >WARD SISTER< or >NURSE< or >HEALTH CARER< or even >CLEANER<
Too simple I guess when EVERY uniform has an embroidered badge showing they are NHS Wales in two languages – I just might have twigged that but what competence are the different colours?

I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
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Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar. You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
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YOU are welcome to call me if you believe I can help in ANY way.
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Posted by: Greg Lance-Watkins
tel: 01291 – 62 65 62

06-May-2011 – I’ve Sprung A Leak & Gone Dotty! (PETECHIAE)

06-May-2011 – I’ve Sprung A Leak & Gone Dotty! (PETECHIAE)

Hi,
with the election on and waiting to see if by some outright fluke UKIP might get a seat in The National Ass for Wales I eventually trundled off to bed (not remotely tired!) at about 04:30hrs.
I was awake at 09:30hrs. Woken by my mouth now just as the Ulcers are clearing a bit the molars on the left seem to consider a bit of infection top and bottom might be fun!
I gave up on the idea of sleep and went back to the computer!
Lee surfaced sometime later and did her normal dash around – new ink for the laser printer to pick up from Maxine’s – delivery there is always easier!
Then she had to go to the Post Office and pick up some forms – then to see James to sort some gas.
Then a quick panic to catch Boots for the prescription only to find the the pharmacist in a grump and no sign of the prescription I arranged for last night!!
I just managed to catch the surgery and they were very helpful as they had not put it theough in time for the Boots collection!
Eventually the Scrip was phoned through paperwork to follow and when Lee went up to collect the Pharmasist had had a personality change and was chatty and helpful – Strange.
Whist she was dashing about I raided the fridge and subsequent events make that a happy accident!
Having eaten and now with an ample supply of mouth wash and deadener I thought I was OK for the weekend and with Clinic on monday all was well until I looked at my legs! Fortunately I was still wearing a dressing gown!
I was just off for a shower and looked at my legs!!!!!!!!!!!!
I have large areas of pin prick rash under the skin – looks to me as if my platelettes have dropped further and I’m getting some kind of leakage from the capillaries – what know I, but since I was told to ring the help line if in doubt – this registers as doubt.
Icalled Velindre duty pager chemo. She was not prepared to reach a decision without checking with the duty Doctor as the symptoms do indicate a possible fall in platelettes.
Dr. called back and wants my bloods checked! I was on 45 for plateletts, Wednesday week ago, when I last had chemo. 
On Monday when my temperature was high I had been down to 43(000) although these readings are very low considering normal range starts at 150 to 300! Actually I gather one has 150,000 to 300,000 platlets per ?
My low levels are within the peramaters expected, I understand – much lower would start to concern!
I gather the condition (symptom) is known as PETECHIAE
I just want to be certain they are OK and all my counts etc. are OK to pump more of the loverly Carboplatin & Gemcitabine that is due next Wednesday!
When you have cancer you make chemo. Your friend as it is only trying to help – even if it does tend to beat you around a bit – the enemy is the cancer not the chemo!
Hard at times to be convinced the drugs that make you feel rotten are the only deterrent to the cancer and without the drugs AND the side effects the outcome becomes inevitable!

I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
 Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar.

You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help. . YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins
tel: 01291 – 62 65 62
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NHS Wales BUDGET 22-Oct-2009

NHS Wales BUDGET 22-Oct-2009

The logo of NHS Wales.A SIGN of TANGLED THINKING INSIDE THE BOX
Logo: The NHS Wales has Gone To A GIG to hear Cymru Band

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Finance Committee

FIN(3)-18-09 paper 2

Welsh Assembly Government Draft Budget 2010-11 – Evidence from Welsh NHS Finance Directors

1. Introduction

The draft budget laid before the National Assembly for Wales proposes a revenue Health and Social Services budget of £5.8bn for 2010-11. This is some £41m less than that set out in the indicative budget and represents an increase of 2.6% above the 2009-10 budget compared with the indicative budget increase of 3.3%.
Whilst it is acknowledged that this reduced uplift reflects the Welsh Assembly Government’s overall budget reduction from decisions at UK-level, it is by far the lowest increase received for many years against a backdrop of increasing non-avoidable financial pressures.
The main priority for the NHS is to maintain and improve safe, high quality citizen-focused services but this becomes increasingly challenging in the context of constrained budgets. The nationally negotiated pay settlement, increases in demand, particularly in relation to continuing NHS healthcare, costs of new drugs and technologies as well as the requirement to deliver Ministerial priorities will place enormous financial pressure on the Health Service in Wales in 2010-11.
In order to meet these challenges, it is recognised that there needs to be transformational change in the way that we deliver services. Such wholesale changes will take some time to deliver but it is important that this journey is started immediately. The opportunity to secure monies from the Invest to Save Fund is welcomed to support initiatives to deliver both increases to productivity and cash releasing savings.
The scale of the challenge, however, cannot be underestimated as savings requirements are estimated to be 5 – 6% for 2010-11. There is a concern about the pace by which the required transformational changes can be implemented and so shorter-term savings plans will also be fundamental to ensuring financial balance. This creates a dichotomy as such short-term savings may well require reductions in support staffing, infrastructure and training which makes the job of transformation in future years more difficult to achieve.

2. Service Pressures and Risks

2.1 Inflation Costs

Whilst the costs of inflation in the NHS for 2010-11 have yet to be fully assessed, a significant element is in relation to previously negotiated pay increases as part of the 3-year pay deal. This is estimated to result in an overall inflationary increase of 2.7% above current baselines.

2.2 Access 2009

The Assembly’s maximum waiting time target from referral to treatment of 26 weeks is set for delivery by December 2009.  The service has made extremely good progress towards this target but the costs of ensuring ongoing sustainability remain a risk. This is due to continuing increases in demand for services as the waiting times for treatment falls. Whilst these costs can partially be met by increased productivity, services such as orthopaedics will result in additional costs as a significant proportion of the treatment cost of hip and knee replacements is the cost of the implant itself.

2.3 Growing Elderly Population

The NHS continues to experience increased pressure and demand upon its services due to an ageing population with more elderly patients whose needs are often more complex with other co-morbidities and chronic conditions. The provision of appropriate services to meet care needs at all levels including acute, rehabilitative and community settings is a major priority for health and social services.  

2.4 Continuing NHS HealthCare

The impact of the growing number of elderly patients has led to the increased numbers of patients eligible for continuing NHS health care.  It is important that these patients receive the appropriate care in the right clinical setting.  However, as a result of the Grogan legal judgement, the impact on the Health budget is substantial. In terms of expenditure, there have been significant increases in Mental Health and Learning Disability costs where there has also been marked shifts of costs previously funded by Local Government to Health.  Whilst it is extremely difficult to forecast with absolute certainty, based on the current growth in demand and costs this will place a 2 – 3% financial pressure to Health Boards hospital and community budgets.

2.5 NICE/High Cost Drugs

Based on the published work programme of NICE and the All-Wales Medicines Strategy group, Public Health Wales have undertaken an exercise to estimate the likely impact for 2010-11. This is extremely difficult to estimate with certainty as some of the drugs to be reviewed have yet to be licensed and the likely decision by these bodies is also unknown. Nevertheless, based on best professional knowledge, the costs of new drugs in 2010-11 is estimated as a 1% cost pressure.

2.6 Policy and statutory compliance implementation

There are numerous examples of Welsh policy initiatives within the Health and Social Services Department that if unfunded will place significant additional pressures on Hospital and Community Health budgets. The most significant issues facing the NHS for 2010-11 are the costs of the standardisation of nurse uniforms and ward housekeepers. With additional legislative requirements, these could amount to an additional 0.7% pressure if unfunded from central budgets.

2.7 Other Cost Pressures

In addition to the pressures set out above, there are numerous other cost pressures that inevitably arise for which there is no additional funding source.  These have historically tended to be in the order of 1% and Health Boards and Trusts will need to make an equivalent amount of general efficiency savings in order to meet these additional costs.

2.8 Summary

As highlighted, there are numerous service and financial pressures that will impact upon the NHS Wales in 2010-11 and beyond. The scale of these is such, that they are likely to exceed the proposed growth monies available on Hospital and Community Services allocations by 5 – 6%. Whilst it is clear that there is always scope for further efficiencies and improvements, it is doubtful if the service has the ability to manage such a shortfall without serious repercussions for service delivery and the affordability of the current workforce.

3. Planned Improvements In The Use Of Resources

3.1 Continuing Cash Releasing Efficiency

During 2009-10, NHS bodies have needed to significantly increase levels of cash releasing efficiency savings to meet shortfalls from the financial settlement with most bodies needing to make savings of circa 5% if they are to deliver financial balance.  The service in response to the significant savings requirement has undertaken a full range of efficiency measures which includes improvements in procurement, utilisation of staff, reductions in the cost of temporary staff, service modernisation and the ongoing elimination of waste and duplication. Despite these efforts, due to the scale of the challenge, sizeable deficits are currently being experienced in a number NHS bodies and are largely as predicted in the response to the 2009-10 draft budget settlement. Given the numerous emerging service pressures and the proposed level of growth, the ability to achieve further annual savings of this scale will present a challenge of an unprecedented scale within NHS Wales unless there is major strategic and transformational change to the way that services are currently provided. This will undoubtedly require a considerable change for the workforce and workforce costs if a sustainable financial position is to be achieved given that 78% of NHS expenditure is on staffing.

3.2 Improvements in Productivity

Considerable attention has been given to increasing the utilisation of facilities and services to improve the speed of access for patients as well as delivering high quality care.  The delivery of the Access 2009 targets has especially led to reduced lengths of stay, increased use of day case procedures and the reduction in DNA rates at outpatient clinics.  It is recognised, however, that whilst this has created an environment to deliver increasing throughput, this additional work has also generated substantial additional costs. In order to ensure that all services benchmark with the very best performance, there now needs to be a more vigorous and fundamental change programme to make the stepped changes required.

3.3 Shared Services

The NHS has led the development of shared services in the delivery of high quality and efficient corporate services, including payroll, procurement and finance.  The establishment of the Shared Services Board to oversee the future policy direction is seen as a significant step forward in driving this agenda. The Directors of Finance wholly support the direction of travel.

3.4 Reconfiguration of Services

Health communities throughout Wales are engaged in developing and implementing plans to provide more suitable services to reflect the changing health needs of their populations and to ensure that they meet modern clinical standards. These plans will often require capital investment to facilitate the change, but more often it is redesigning clinical models which ensure that patients have the right care at the right time and place. Such an example is the model that are proposed to shift care out of hospital into community and primary care settings. Fundamentally, this also reviews the manner by which emergency care is provided within hospitals. Such changes are often not popular with the populous as there is a perceived loss of services when beds are reduced or access to hospital services reduced. There will be a challenge to balance the views of the citizen and health professionals as well as the need for bridging finance. It will therefore, take some time to implement such changes and to realise the significant benefits that should occur. These strategic changes will be reflected in the new 5 year planning requirements which will ensure a sharper focus on year on year delivery milestones to ensure the dovetailing of strategic and operational plans.  

3.5 NHS Reorganisation

The reorganisation presents significant opportunities to improve efficiencies across the whole patient pathway. It is important that key posts are now quickly filled, including the local Directors of Public Health, to ensure that appropriate skills and knowledge are in place to support robust citizen-focused decisions about the level and manner by which services should be provided in the future.

3.6 Quality focused patient care

The quality and finance agenda are closely linked as improved quality often leads to lower costs. This has been visibly demonstrated in the 1000 lives campaign. The intention is to ensure that Wales delivers world-class integrated care over the next 5 years and finance professionals welcome the opportunity to be part of this agenda.

4. Summary

The budget proposals for next financial year, pose a considerable challenge to the Health Service.  The increase in resources will not be sufficient to meet the significant challenges without further substantial transformational change and improvements in efficiency.
There is concern about whether the pace of such changes will fully meet the financial challenge in the short-term so it is likely there will be a need to make difficult choices impacting on services and workforce if the NHS is to deliver financial balance in 2010-11.
Paul Davies
Chairman, All Wales Directors of Finance
To view the original of this document CLICK HERE
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I Have Been Fighting Cancer since 1997 & I’M STILL HERE!
I Have Cancer, Cancer Does NOT Have Me
I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

.

If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar.

You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help. . YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins
tel: 01291 – 62 65 62
on: http://GregLanceWatkins.Blogspot.com  
TWITTER: Greg_LW  
Health/Cancer Blog: http://GregLW.blogspot.com