Tag Archives: doctors’

Overburdened NHS faces ‘winter of woe’, leading doctors warn

Full hospitals mean the NHS is facing “a winter of woe”, leading doctors have warned, after official figures released on Thursday again showed the service struggling to cope with the growing demand for care.

A total of 181,692 bed days were lost in hospitals in England in July to “delayed transfers of care”, when patients are fit to leave but cannot be safely discharged.

Prof Derek Alderson, the president of the Royal College of Surgeons, said hospitals’ ability to cope with the coming winter was at risk because so many beds were tied up with such patients.

“Hospitals and local authorities must look carefully at what they can do to speed up the transfer of patients between different types of care,” he said. “NHS leaders have already warned of a bad flu season this winter. Unless the backlog of delayed discharges begins to clear before then, it is hard to see how the NHS will cope with increased demand.

“NHS staff are doing the best they can with the resource they’ve been given and the unabating pressure they’ve tackled this year means morale remains low. Unless patients are moved more quickly to community care and planned bed capacity is better protected, the NHS will face a winter of woe, with patients feeling the brunt of this.”

Simon Stevens, the chief executive of NHS England, said earlier this week that hospitals and GP surgeries could struggle to cope if a major flu outbreak like that seen in recent weeks in Australia and New Zealand occurs in Britain this winter.

The 181,692 bed days lost to delayed transfers in July was worse than in June, though a slight improvement on the 184,578 seen in July 2016.

NHS Improvement (NHSI), the health service regulator, said more needed to be done to ensure hospitals were able to provide safe care this winter.

But an NHSI spokesperson admitted: “The operating environment is more challenging than last year, with an increase in admissions and delays to discharge. We are therefore working through a local process to ensure that there are enough beds in the system to cope with surges in demand, or an outbreak in flu.”

A war of words between local councils and the NHS broke out on Thursday over who was to blame for the high number of patients trapped in hospital.

NHS leaders frequently blame local authorities for the problem, which leads to what Alderson called “logjams” in hospitals, with patients facing delays in being admitted because of a beds shortage. Hospital bosses claim only one in three councils has been spending the extra £1bn provided by ministers to improve social care this year – and help patients get out of hospital quicker – for that purpose.

However, Izzi Seccombe, the chair of the Local Government Association’s community wellbeing board, said: “Across the country nearly six out of 10 people delayed in hospital are unable to leave because they require further NHS services, with just over a third awaiting support from council social care.

“Councils are doing all they can to get people out of hospital and back into the community quickly and safely,” she added, describing Whitehall targets for councils to reduce “bedblocking” in their area by set amounts as “unrealistic and unachievable”.

It also emerged on Thursday that the number of written complaints about NHS services in England rose by 5% last year – with GPs a particular target of patients’ frustration.

The latest annual figures for written complaints published by NHS Digital show patients made 208,400 of them in 2016-17 – an average of 571 a day and up 4.9% on the year before.

But complaints about the care and service received at GP surgeries and dental practices increased by 9.7% to 90,600, almost half the NHS-wide total, with the vast bulk (83%) related to GP premises. In comparison, complaints about hospitals only rose 1.4% year on year, despite the pressure hospitals are under.

Two in five (41%) complaints were about doctors – up 7.4% year on year. But complaints against nurses rose even more sharply, by 9.8%. Lack of time to give patients the amount of attention they want may be a factor behind the rises.

Overburdened NHS faces ‘winter of woe’, leading doctors warn

Full hospitals mean the NHS is facing “a winter of woe”, leading doctors have warned, after official figures released on Thursday again showed the service struggling to cope with the growing demand for care.

A total of 181,692 bed days were lost in hospitals in England in July to “delayed transfers of care”, when patients are fit to leave but cannot be safely discharged.

Prof Derek Alderson, the president of the Royal College of Surgeons, said hospitals’ ability to cope with the coming winter was at risk because so many beds were tied up with such patients.

“Hospitals and local authorities must look carefully at what they can do to speed up the transfer of patients between different types of care,” he said. “NHS leaders have already warned of a bad flu season this winter. Unless the backlog of delayed discharges begins to clear before then, it is hard to see how the NHS will cope with increased demand.

“NHS staff are doing the best they can with the resource they’ve been given and the unabating pressure they’ve tackled this year means morale remains low. Unless patients are moved more quickly to community care and planned bed capacity is better protected, the NHS will face a winter of woe, with patients feeling the brunt of this.”

Simon Stevens, the chief executive of NHS England, said earlier this week that hospitals and GP surgeries could struggle to cope if a major flu outbreak like that seen in recent weeks in Australia and New Zealand occurs in Britain this winter.

The 181,692 bed days lost to delayed transfers in July was worse than in June, though a slight improvement on the 184,578 seen in July 2016.

NHS Improvement (NHSI), the health service regulator, said more needed to be done to ensure hospitals were able to provide safe care this winter.

But an NHSI spokesperson admitted: “The operating environment is more challenging than last year, with an increase in admissions and delays to discharge. We are therefore working through a local process to ensure that there are enough beds in the system to cope with surges in demand, or an outbreak in flu.”

A war of words between local councils and the NHS broke out on Thursday over who was to blame for the high number of patients trapped in hospital.

NHS leaders frequently blame local authorities for the problem, which leads to what Alderson called “logjams” in hospitals, with patients facing delays in being admitted because of a beds shortage. Hospital bosses claim only one in three councils has been spending the extra £1bn provided by ministers to improve social care this year – and help patients get out of hospital quicker – for that purpose.

However, Izzi Seccombe, the chair of the Local Government Association’s community wellbeing board, said: “Across the country nearly six out of 10 people delayed in hospital are unable to leave because they require further NHS services, with just over a third awaiting support from council social care.

“Councils are doing all they can to get people out of hospital and back into the community quickly and safely,” she added, describing Whitehall targets for councils to reduce “bedblocking” in their area by set amounts as “unrealistic and unachievable”.

It also emerged on Thursday that the number of written complaints about NHS services in England rose by 5% last year – with GPs a particular target of patients’ frustration.

The latest annual figures for written complaints published by NHS Digital show patients made 208,400 of them in 2016-17 – an average of 571 a day and up 4.9% on the year before.

But complaints about the care and service received at GP surgeries and dental practices increased by 9.7% to 90,600, almost half the NHS-wide total, with the vast bulk (83%) related to GP premises. In comparison, complaints about hospitals only rose 1.4% year on year, despite the pressure hospitals are under.

Two in five (41%) complaints were about doctors – up 7.4% year on year. But complaints against nurses rose even more sharply, by 9.8%. Lack of time to give patients the amount of attention they want may be a factor behind the rises.

Doctors warn of online trolls targeting victims of terror attacks

Online trolls have aimed “vile and upsetting abuse” at victims of the London and Manchester terror attacks, NHS doctors have revealed.

Victims and family members have been targeted on social media, especially Twitter, by trolls who accused them of “cashing in” on the atrocities.

The vitriol received by people wounded in the bomb and vehicle attacks this year was so serious that NHS England has produced guidance warning anyone caught up in a terrorist incident to beware of “unpleasant and abusive” trolls.

Prof Chris Moran, NHS Englnd’s lead for clinical trauma, said: “Social media can play a positive and negative role in the aftermath of a terrorist incident. At the most extreme end, we’ve seen from recent atrocities in Manchester and London that innocent people have unwittingly been the target of trolls who use social media to prey on victims, subjecting them to vile and upsetting abuse.

“These are individuals who are often in a deep state of shock.”

After the Manchester Arena bombing on 22 March, which killed 23 people and injured 250 others, four doctors working with casualties reported at debriefs that victims they had treated or their relatives had been trolled.


Social media can play a positive and negative role in the aftermath of a terrorist incident

NHS England has not released details of the abuse but it is understood that some trolls accused victims of “trying to cash in” on what had happened by talking to the media about their experience.

The perpetrators, who used Twitter, targeted people who had spoken out about the nail bomb attack by Salman Abedi at the Ariana Grande concert and directed messages at victims once their identities were known, NHS sources said.

The experiences in Manchester in particular have prompted NHS chiefs to warn victims of terror attacks, especially young people, to be careful what they say on social media after such an incident in case they unwittingly incite trolling.

Victims should also limit their use of social media and the information they share there in case it brings back painful memories, the NHS says.

The section of the guidance which advises young victims of a terror attack about social media states: “You can also attract trolls: people who draw the most negative conclusions they can, or question your motives that don’t exist or just be plainly unpleasant and abusive, often anonymously too; they can say things like ‘you’re only doing something for money’, or to abuse the system and so on.”

It adds: “This is incredibly hurtful – which is what the sender intends – and it will upset you, or make you angry, and that’s never the best time to think about what you tell [people publicly about their experience or views on something].”

Posting information about a terrorist attack on social media can also worsen the trauma of victims, according to the guidance, which also advises patients and NHS staff on how to deal with journalists after major incidents.

It says: “After an unsettling event try to stay off social media in case you say more than you intend because of what you experienced; messaging your story can keep you in the trauma; retelling your story can also bring back bad memories and can even relive the trauma.”

Those receiving abusive messages should not respond or reply but delete them and block the sender. “Consider reporting hateful and abusive messages to the police and service providers,” it says.

Moran will use a speech at the NHS Expo conference in Manchester next week to set out how social media platforms and conventional publishers can play a beneficial role after a major incident, as well as highlighting the potential downsides, such as trolling.

Prof Neil Greenberg, a spokesman for the Royal College of Psychiatrists, said online abuse could be very damaging to people who were struggling after being caught up in a terrorist attack.

“If someone is still suffering with, for example, PTSD after experiencing a traumatic event, and are trying to get on with their daily lives, then being trolled could lead to their condition deteriorating and them having a setback.

“That could increase their avoidance of social media and reminders of the traumatic event, or make them hyper-vigilant, worsen their concentration and bring up traumatic events in their minds.

“These trolling comments, which are intended to hurt, could stop people moving on from very traumatic events,” said Greenberg, an expert in psychological trauma at King’s College London.

The NHS’s initiative comes as Theresa May has stressed her support for a crackdown on internet bullying and harassment, which has been implicated in a number of cases in which young people have killed themselves.

“If it’s a crime offline, it’s a crime online. I think sometimes people think that online is a different sort of world and it doesn’t matter and you can do what you like. Actually, no, you can’t. You should behave online as you would offline,” the prime minister told the BBC.

Social media users should be educated to understand that their actions online can have consequences in the real world, especially for young people, May said.

Doctors warn of online trolls targeting victims of terror attacks

Online trolls have aimed “vile and upsetting abuse” at victims of the London and Manchester terror attacks, NHS doctors have revealed.

Victims and family members have been targeted on social media, especially Twitter, by trolls who accused them of “cashing in” on the atrocities.

The vitriol received by people wounded in the bomb and vehicle attacks this year was so serious that NHS England has produced guidance warning anyone caught up in a terrorist incident to beware of “unpleasant and abusive” trolls.

Prof Chris Moran, NHS Englnd’s lead for clinical trauma, said: “Social media can play a positive and negative role in the aftermath of a terrorist incident. At the most extreme end, we’ve seen from recent atrocities in Manchester and London that innocent people have unwittingly been the target of trolls who use social media to prey on victims, subjecting them to vile and upsetting abuse.

“These are individuals who are often in a deep state of shock.”

After the Manchester Arena bombing on 22 March, which killed 23 people and injured 250 others, four doctors working with casualties reported at debriefs that victims they had treated or their relatives had been trolled.


Social media can play a positive and negative role in the aftermath of a terrorist incident

NHS England has not released details of the abuse but it is understood that some trolls accused victims of “trying to cash in” on what had happened by talking to the media about their experience.

The perpetrators, who used Twitter, targeted people who had spoken out about the nail bomb attack by Salman Abedi at the Ariana Grande concert and directed messages at victims once their identities were known, NHS sources said.

The experiences in Manchester in particular have prompted NHS chiefs to warn victims of terror attacks, especially young people, to be careful what they say on social media after such an incident in case they unwittingly incite trolling.

Victims should also limit their use of social media and the information they share there in case it brings back painful memories, the NHS says.

The section of the guidance which advises young victims of a terror attack about social media states: “You can also attract trolls: people who draw the most negative conclusions they can, or question your motives that don’t exist or just be plainly unpleasant and abusive, often anonymously too; they can say things like ‘you’re only doing something for money’, or to abuse the system and so on.”

It adds: “This is incredibly hurtful – which is what the sender intends – and it will upset you, or make you angry, and that’s never the best time to think about what you tell [people publicly about their experience or views on something].”

Posting information about a terrorist attack on social media can also worsen the trauma of victims, according to the guidance, which also advises patients and NHS staff on how to deal with journalists after major incidents.

It says: “After an unsettling event try to stay off social media in case you say more than you intend because of what you experienced; messaging your story can keep you in the trauma; retelling your story can also bring back bad memories and can even relive the trauma.”

Those receiving abusive messages should not respond or reply but delete them and block the sender. “Consider reporting hateful and abusive messages to the police and service providers,” it says.

Moran will use a speech at the NHS Expo conference in Manchester next week to set out how social media platforms and conventional publishers can play a beneficial role after a major incident, as well as highlighting the potential downsides, such as trolling.

Prof Neil Greenberg, a spokesman for the Royal College of Psychiatrists, said online abuse could be very damaging to people who were struggling after being caught up in a terrorist attack.

“If someone is still suffering with, for example, PTSD after experiencing a traumatic event, and are trying to get on with their daily lives, then being trolled could lead to their condition deteriorating and them having a setback.

“That could increase their avoidance of social media and reminders of the traumatic event, or make them hyper-vigilant, worsen their concentration and bring up traumatic events in their minds.

“These trolling comments, which are intended to hurt, could stop people moving on from very traumatic events,” said Greenberg, an expert in psychological trauma at King’s College London.

The NHS’s initiative comes as Theresa May has stressed her support for a crackdown on internet bullying and harassment, which has been implicated in a number of cases in which young people have killed themselves.

“If it’s a crime offline, it’s a crime online. I think sometimes people think that online is a different sort of world and it doesn’t matter and you can do what you like. Actually, no, you can’t. You should behave online as you would offline,” the prime minister told the BBC.

Social media users should be educated to understand that their actions online can have consequences in the real world, especially for young people, May said.

Endometriosis left me in agony. Now doctors must take women seriously | Brydie Lee-Kennedy

I am writing this while lying in a semi-foetal position with a cold cloth on my forehead and a heat pack on my abdomen. This is not an ideal position from which to do any type of work, but for me and the other 176 million endometriosis sufferers worldwide, it’s often all we can manage. This is why the updated guidelines from the National Institute for Health and Care Excellence (Nice), released today, are to be commended.

These guidelines emphasise the importance of doctors believing their patients when they tell them about their menstrual pain and other attendant symptoms. This seems like obvious advice, but the average time it takes to diagnose endometriosis is seven to eight years. That’s seven to eight years of mind-numbing pain, clotting, diarrhoea, chronic bloating, self-medicating and, often, extremely low moods and anxiety. It’s seven to eight years of potential damage to your chances of conceiving.

It’s estimated that endometriosis affects one in 10 people with uteruses worldwide and yet when I was diagnosed a decade ago, I knew no one else with the disease. I was 20 and had been in chronic pain since the age of 13. While the pain would reach its peak during menstruation, leading to me vomiting and passing out, it affected me all the time. There was sharp, stabbing ovulation pain, dragging, relentless back pain, stinging rushes of pain through my legs and arms. I medicated, then medicated some more, then went to bed for days with nausea and misery, wondering why my body had betrayed me.

Despite all this, I was comparatively lucky because my parents and my GP took my pain seriously. By the age of 20, I had tried every non-surgical treatment available and all that was left was a laparoscopy, an invasive procedure that remains the only effective way of treating endometriosis. I went under for four hours and when I woke up I was shown pictures of my insides, which had been scraped and lasered and prodded about.

It was not a pretty sight. My endometrium – the stuff that’s supposed to stay in your uterus until it exits your body – had spent seven years attaching itself to my bladder, fallopian tubes and bowel. It had scarred my right ovary. If left unchecked, this could have rendered me infertile, not to mention further destroyed my quality of life. I spent a difficult month recovering, during which I suffered from a severe bout of depression (a common side-effect of the surgery) and needed help walking until I could rebuild my abdominal strength.


There are days when I am physically unable to get out of bed (or, even worse, off the bathroom floor)

I experienced around 18 months of reduced symptoms before they began to build up again. I have had surgery once since then and now have a piece of mesh behind my right ovary to prevent it from being trapped against my pelvic floor. When I decide to have a child, there is a strong possibility that I’ll need a third surgery if I hope to conceive naturally.

I have structured my life and my career around this disease. I’ve missed more social events than I can count and recently went to a wedding so medicated that I had to ask the friend next to me to keep me upright during the ceremony. I am the only person I know who doesn’t own a pair of jeans, but what seems like a kooky style choice is actually a result of my near-constant painful abdominal swelling, rendering anything with a tight waistband unwearable. I work as a freelance writer and editor partly because I need a job that I can do from home as there are days when I am physically unable to get out of bed (or, even worse, off the bathroom floor).

I spent my early 20s working minimum-wage jobs in bars, theatres and shops and the only way I got through shifts was by taking double the recommended painkiller dose and secretly throwing up in the staff toilets. Most sufferers are not as fortunate as me. They’re still doubling their doses and throwing up in your workplace because they don’t have any other options. They may not even know what’s causing their pain because the last doctor they saw recommended ibuprofen and sent them on their way.

This move from Nice is so welcome because endometriosis sufferers need to be believed. Treatment is a long road and it only gets harder the longer the disease is left unchecked. From my foetal position on the floor, I hope fervently that these guidelines make a difference.

Brydie Lee-Kennedy is an Australian-born, London-based columnist and writer for TV and theatre

Endometriosis left me in agony. Now doctors must take women seriously | Brydie Lee-Kennedy

I am writing this while lying in a semi-foetal position with a cold cloth on my forehead and a heat pack on my abdomen. This is not an ideal position from which to do any type of work, but for me and the other 176 million endometriosis sufferers worldwide, it’s often all we can manage. This is why the updated guidelines from the National Institute for Health and Care Excellence (Nice), released today, are to be commended.

These guidelines emphasise the importance of doctors believing their patients when they tell them about their menstrual pain and other attendant symptoms. This seems like obvious advice, but the average time it takes to diagnose endometriosis is seven to eight years. That’s seven to eight years of mind-numbing pain, clotting, diarrhoea, chronic bloating, self-medicating and, often, extremely low moods and anxiety. It’s seven to eight years of potential damage to your chances of conceiving.

It’s estimated that endometriosis affects one in 10 people with uteruses worldwide and yet when I was diagnosed a decade ago, I knew no one else with the disease. I was 20 and had been in chronic pain since the age of 13. While the pain would reach its peak during menstruation, leading to me vomiting and passing out, it affected me all the time. There was sharp, stabbing ovulation pain, dragging, relentless back pain, stinging rushes of pain through my legs and arms. I medicated, then medicated some more, then went to bed for days with nausea and misery, wondering why my body had betrayed me.

Despite all this, I was comparatively lucky because my parents and my GP took my pain seriously. By the age of 20, I had tried every non-surgical treatment available and all that was left was a laparoscopy, an invasive procedure that remains the only effective way of treating endometriosis. I went under for four hours and when I woke up I was shown pictures of my insides, which had been scraped and lasered and prodded about.

It was not a pretty sight. My endometrium – the stuff that’s supposed to stay in your uterus until it exits your body – had spent seven years attaching itself to my bladder, fallopian tubes and bowel. It had scarred my right ovary. If left unchecked, this could have rendered me infertile, not to mention further destroyed my quality of life. I spent a difficult month recovering, during which I suffered from a severe bout of depression (a common side-effect of the surgery) and needed help walking until I could rebuild my abdominal strength.


There are days when I am physically unable to get out of bed (or, even worse, off the bathroom floor)

I experienced around 18 months of reduced symptoms before they began to build up again. I have had surgery once since then and now have a piece of mesh behind my right ovary to prevent it from being trapped against my pelvic floor. When I decide to have a child, there is a strong possibility that I’ll need a third surgery if I hope to conceive naturally.

I have structured my life and my career around this disease. I’ve missed more social events than I can count and recently went to a wedding so medicated that I had to ask the friend next to me to keep me upright during the ceremony. I am the only person I know who doesn’t own a pair of jeans, but what seems like a kooky style choice is actually a result of my near-constant painful abdominal swelling, rendering anything with a tight waistband unwearable. I work as a freelance writer and editor partly because I need a job that I can do from home as there are days when I am physically unable to get out of bed (or, even worse, off the bathroom floor).

I spent my early 20s working minimum-wage jobs in bars, theatres and shops and the only way I got through shifts was by taking double the recommended painkiller dose and secretly throwing up in the staff toilets. Most sufferers are not as fortunate as me. They’re still doubling their doses and throwing up in your workplace because they don’t have any other options. They may not even know what’s causing their pain because the last doctor they saw recommended ibuprofen and sent them on their way.

This move from Nice is so welcome because endometriosis sufferers need to be believed. Treatment is a long road and it only gets harder the longer the disease is left unchecked. From my foetal position on the floor, I hope fervently that these guidelines make a difference.

Brydie Lee-Kennedy is an Australian-born, London-based columnist and writer for TV and theatre

Doctors back Stephen Hawking’s challenge to Jeremy Hunt | Letters

As NHS doctors we have been closely following the exchange between Stephen Hawking and the secretary of state for health over the past week (Why won’t Jeremy Hunt come clean?, 26 August). Since Professor Hawking delivered a momentous speech to the Royal Society of Medicine exposing the policy-driven reality of NHS underfunding and moves towards a US-style insurance system, tensions have mounted.

The profound irony of Jeremy Hunt claiming that a world-renowned professor, an academic pioneer who has dedicated his life to generating scientific evidence, is spreading “pernicious falsehoods”, or that his appraisals are “misguided”, when Jeremy Hunt himself has been unreservedly criticised for misuse of evidence for political expediency, is not lost on us. In fact, so audacious a claim is this that we have asked ourselves what could have prompted such a zealous response?

As the NHS crumbles around us, with scores of A&Es and maternity units being downgraded or closed via implementation of “STPs” (Sustainability and Transformation Plans), as patients wait months for outpatient clinics, operations and cancer treatments, with junior doctors leaving in droves and nurses desperately covering 40,000 unmanned posts, all the while the private sector flourishes and takes up swathes of once-NHS contracts, it is clear Hunt will do absolutely everything possible to distract the public from the politically motivated destabilisation of the NHS. His baseless promise of a “seven-day NHS” has masked underlying motivations behind contract and service changes now exposed to make NHS staff less valued, and allow routine profitable services to be increasingly outsourced.

Professor Stephen Hawking has spoken more truth in one week than has been said in five years of the secretary of state for health’s term.
Prof Allyson Pollock Director of Institute of Health and Society, Newcastle University
Dr Bob Gill GP, Producer, The Great NHS Heist documentary
Mr Chidi Ejimofo Consultant in emergency medicine
Dr Louise Irvine GP, Lewisham, Health Campaigns Together co-chair, London
Dr Tony O’Sullivan Retired paediatrician, Co-chair of Keep Our NHS Public
Dr Aislinn Macklin-Doherty Oncology trainee, Health Campaigns Together
Dr David Wrigley GP, chair of Doctors in Unite
Dr Rachel Clarke Palliative care doctor, Oxford
Dr Nadia Masood Anaesthetic registrar, London
Dr Jacky Davis BMA Council
Mr Chris Efthymiou Consultant cardiothoracic surgeon, Leicester
Dr Unmesh Bandyopadhyay CT2 Medicine, Kent, Surrey & Sussex
Dr James Haddock CT2 in anaesthesia, West Midlands
Dr Youssef El-Gingihy GP, London
Dr Amit Sud Clinical research fellow, London
Dr Lauren Gavaghan Consultant psychiatrist
Dr James Chan ST3 Doctor in emergency medicine, Leeds
Dr Taryn Youngstein Speciality registrar, rheumatology, London
Dr Robert Adams Urology CT2, Essex
Dr Coral Jones GP, Hackney
Dr Bernadette Borgstein Consultant paediatric audiovestibular physician
Dr Dominic Pimenta BSc (Hons) MBBS MRCP
Mr Rishi Dhir Orthopaedic surgical trainee, MRCS
Dr Ruth Wiggans ST5 in respiratory medicine
Dr Yannis Gourtsoyannis Infectious diseases trainee, London
Dr Ellen McCourt Anaesthetic trainee, north-west
Dr John Puntis Consultant paediatrician, Leeds
Dr Jackie Applebee East London GP
Dr Julia Paterson Psychiatry trainee, London
Dr Mona Ahmed Consultant psychiatrist, London
Dr Helen Groom GP Gateshead
Dr Pete Campbell Trainee doctor, north-west
Dr Lois Paton GP
Miss Stella Vig RCS Council, consultant surgeon
Dr Jon Dale Retired occupational physician
Dr Jan Macfarlane Retired GP
Dr Emily Whitehouse ST7 paediatric doctor
Dr David Church GP, mid-Wales
Dr Luke Foster CT2 anaesthetics
Dr Anna Livingstone GP, London
Dr Kambiz Boomla GP and lecturer, east London
Dr Ashling Liillis Paediatric trainee
Dr Hugo Farne Specialist registrar and clinical research fellow in respiratory medicine, London
Dr Ron Singer Retired GP and vice-president of Doctors in Unite
Dr Ellie Bard Obstetrics and gynaecology trainee, London
Dr Natasha Haringman ST1 obstetrics and gynaecology
Dr Amanda Owen Psychiatrist
Dr David Kynaston GP, Yorkshire
Dr Gary Marlowe Chair BMA London Regional Council
Dr Amy Squire Psychiatrist, MBChB MRCPsych
Dr Fionna Martin Medical registrar, London
Dr James Crane Medical registrar London
Dr Patrick French Consultant physician, London
Dr Pam Wortley Retired GP, Sunderland
Dr Paul Hobday GP, Sutton Valence, Kent
Dr Sarah Hallett Paediatric SHO, London
Dr Jonathan Fluxman GP, London
Dr Moosa Qureshi Haematology academic trainee, Cambridge
Mr Mark R Williams ENT ST5, north of England
Dr Edwina Lawson GP, London
Dr Piyush Pushkar Psychiatry CT3 doctor
Dr H Grant-Peterkin ST6 Adult/Older Adult Psychiatry
Dr Laura Davies MbChB MSc MRCS

NHS England’s Five Year Forward View and Sustainability & Transformation Plans (STPs) involve a massive restructuring of the NHS into a public/private enterprise. Much of this is drawn from the US private health insurance-based system. It includes new systems and structures to enable the dismantling of the NHS – the sell-off of NHS land/property (via NHS Property Services), the introduction of alternative funding sources (via Joint Ventures and Special Purpose Vehicles), and the creation of radically new healthcare overseers at the heart of the enterprise called Accountable Care Organisations (ACOs), Multispecialty Community Providers (MCPs) and Primary and Acute Care Services (PACs).

ACOs, MCPs and PACs will be awarded huge contracts to manage and provide whole packages of care. When almost inevitably faced by tax funding shortages, NHS England’s plans enable them to turn to private insurers for “help”. These new organisations are US concepts. The consultants involved in drawing up the plans include McKinsey and US giant United Health subsidiary Optum which have extensive US interests.

US insurance corporation Centene’s UK subsidiary has just been subcontracted to run Nottingham’s STP as it moves to the ACO system. Centene Corporation co-owns the management company of the ACO-like “Alzira model”. The Alzira and US healthcare insurance giant Kaiser Permanente, originators of the ACO concept, have been cited by Jeremy Hunt as the models for NHS England’s ACOs.

And Hunt suggests that Professor Hawking is being “pernicious” in his concerns that we are moving towards a US-style system!
John Furse
London

When one such as Stephen Hawking is so assertively outspoken on a political issue, any reasonable person is obligated to actively listen to what he says is happening to the NHS. What grieves me deeply is knowing that the government is hiding the fact that it is overseeing the shrinkage of the NHS – a safety-critical system – with cuts inevitably now leading to direct harm to patients.

NHS rationing and under-resourcing operate concurrently to increase demand for self-pay or insurance. Elective surgery spend on outsourcing to private sector increased 60% in the last two years. Privatisation of the NHS also comprises forms other than outsourcing, and the players and apparatus to speed this direction of travel indeed incline towards a US-style ACO system.

The government doesn’t actively have to do any more. It can now just let it happen. I’ve no doubt that the government is holding back its rescue fund for the NHS until some of the multibillion STP contracts have been tendered into private hands. Hence the urgency to develop STPs so hastily.

Hawking’s cogent warning is clear and real, beseeching public and media action to be heard and acted upon. This is not a conspiracy theory; it’s a government-facilitated downgrading and corporate takeover of your health service.
Dr Nick Mann
London

A key question about accountable care organisations (Stephen Hawking is wrong about our NHS plans, 28 August) is whether there will be a direct relationship between publicly provided ACOs and NHS England, or whether the ACOs will be put out to tender to the likes of Virgin Care and United Healthcare. If the latter, it will bring about the complete privatisation of the NHS.
Morris Bernadt
London

About 30 years ago Mrs Thatcher declared that the NHS was “safe in our hands” and that expression became something of a Tory mantra. However, it has not been heard for quite a while. We are now told that under the Tory party the NHS will remain “free at the point of use”. This formula is reiterated by Jeremy Hunt. In theory healthcare could be free at the point of use and provided entirely by the private sector, eg US-style Health Maintenance Organisations, or indeed Virgin Healthcare. In that scenario, control would have passed out of government hands and the NHS as most people understand it would have ceased to exist. If a private company providing a vital service said it would collapse without a substantial infusion of money it would have the government over a barrel. Private provision has now reached about 7% in the NHS, and the trend to private provision was bolstered by the Health and Social Care Act of 2012, which made it mandatory to allow “any qualified provider” to bid for NHS contracts. This specific point of increasing private provision in the NHS was raised by Stephen Hawking in his criticism of government policy and ignored by Jeremy Hunt in his responses. It is high time he addressed the issue.
Brendan O’Brien (retired GP)
London

Has Jeremy Hunt had a Damascene conversion about the NHS? In 2005 he co-authored a pamphlet that called for the NHS to be replaced by an insurance-based system and for denationalising the provision of healthcare in Britain. So is he being honest when he says that he wants the NHS to remain a taxpayer-funded system for ever? He challenged the suggestion by Professor Hawking that the adoption by the NHS of Accountable Care Organisations (ACOs) is a step towards an insurance-based system. Such a step might not yet be clear, but the steps towards denationalising the NHS are clear. ACOs will be responsible for the great majority of health and care services within their areas under contracts let by STP commissioning groups. In time, these contracts will be open to competition by private providers. If we do not want companies like Virgin Care to be running the majority of our health services then I would hope that people like Professor Hawking will keep speaking out.
Jim Pragnell
Otford, Kent

Jeremy Hunt uses an old politician’s bluff in saying “the health service has record funding”. Costs continually rise, so this quote is a meaningless boast. Funding increases have to be measured against both inflation and need. Perhaps the argument boils down to, who would you trust: Stephen Hawking or Jeremy Hunt?
Ian Close
Paisley, Renfrewshire

Read more letters on the NHS

Doctors back Stephen Hawking’s challenge to Jeremy Hunt

NHS staff feeling drained by endless reorganisation

Labour ought to speak out about the NHS as strongly as Stephen Hawking

When waiting for health services can have fatal consequences

Bloody NHS didn’t even allow me time to read my mag

Join the debate – email guardian.letters@theguardian.com

Doctors back Stephen Hawking’s challenge to Jeremy Hunt | Letters

As NHS doctors we have been closely following the exchange between Stephen Hawking and the secretary of state for health over the past week (Why won’t Jeremy Hunt come clean?, 26 August). Since Professor Hawking delivered a momentous speech to the Royal Society of Medicine exposing the policy-driven reality of NHS underfunding and moves towards a US-style insurance system, tensions have mounted.

The profound irony of Jeremy Hunt claiming that a world-renowned professor, an academic pioneer who has dedicated his life to generating scientific evidence, is spreading “pernicious falsehoods”, or that his appraisals are “misguided”, when Jeremy Hunt himself has been unreservedly criticised for misuse of evidence for political expediency, is not lost on us. In fact, so audacious a claim is this that we have asked ourselves what could have prompted such a zealous response?

As the NHS crumbles around us, with scores of A&Es and maternity units being downgraded or closed via implementation of “STPs” (Sustainability and Transformation Plans), as patients wait months for outpatient clinics, operations and cancer treatments, with junior doctors leaving in droves and nurses desperately covering 40,000 unmanned posts, all the while the private sector flourishes and takes up swathes of once-NHS contracts, it is clear Hunt will do absolutely everything possible to distract the public from the politically motivated destabilisation of the NHS. His baseless promise of a “seven-day NHS” has masked underlying motivations behind contract and service changes now exposed to make NHS staff less valued, and allow routine profitable services to be increasingly outsourced.

Professor Stephen Hawking has spoken more truth in one week than has been said in five years of the secretary of state for health’s term.
Prof Allyson Pollock Director of Institute of Health and Society, Newcastle University
Dr Bob Gill GP, Producer, The Great NHS Heist documentary
Mr Chidi Ejimofo Consultant in emergency medicine
Dr Louise Irvine GP, Lewisham, Health Campaigns Together co-chair, London
Dr Tony O’Sullivan Retired paediatrician, Co-chair of Keep Our NHS Public
Dr Aislinn Macklin-Doherty Oncology trainee, Health Campaigns Together
Dr David Wrigley GP, chair of Doctors in Unite
Dr Rachel Clarke Palliative care doctor, Oxford
Dr Nadia Masood Anaesthetic registrar, London
Dr Jacky Davis BMA Council
Mr Chris Efthymiou Consultant cardiothoracic surgeon, Leicester
Dr Unmesh Bandyopadhyay CT2 Medicine, Kent, Surrey & Sussex
Dr James Haddock CT2 in anaesthesia, West Midlands
Dr Youssef El-Gingihy GP, London
Dr Amit Sud Clinical research fellow, London
Dr Lauren Gavaghan Consultant psychiatrist
Dr James Chan ST3 Doctor in emergency medicine, Leeds
Dr Taryn Youngstein Speciality registrar, rheumatology, London
Dr Robert Adams Urology CT2, Essex
Dr Coral Jones GP, Hackney
Dr Bernadette Borgstein Consultant paediatric audiovestibular physician
Dr Dominic Pimenta BSc (Hons) MBBS MRCP
Mr Rishi Dhir Orthopaedic surgical trainee, MRCS
Dr Ruth Wiggans ST5 in respiratory medicine
Dr Yannis Gourtsoyannis Infectious diseases trainee, London
Dr Ellen McCourt Anaesthetic trainee, north-west
Dr John Puntis Consultant paediatrician, Leeds
Dr Jackie Applebee East London GP
Dr Julia Paterson Psychiatry trainee, London
Dr Mona Ahmed Consultant psychiatrist, London
Dr Helen Groom GP Gateshead
Dr Pete Campbell Trainee doctor, north-west
Dr Lois Paton GP
Miss Stella Vig RCS Council, consultant surgeon
Dr Jon Dale Retired occupational physician
Dr Jan Macfarlane Retired GP
Dr Emily Whitehouse ST7 paediatric doctor
Dr David Church GP, mid-Wales
Dr Luke Foster CT2 anaesthetics
Dr Anna Livingstone GP, London
Dr Kambiz Boomla GP and lecturer, east London
Dr Ashling Liillis Paediatric trainee
Dr Hugo Farne Specialist registrar and clinical research fellow in respiratory medicine, London
Dr Ron Singer Retired GP and vice-president of Doctors in Unite
Dr Ellie Bard Obstetrics and gynaecology trainee, London
Dr Natasha Haringman ST1 obstetrics and gynaecology
Dr Amanda Owen Psychiatrist
Dr David Kynaston GP, Yorkshire
Dr Gary Marlowe Chair BMA London Regional Council
Dr Amy Squire Psychiatrist, MBChB MRCPsych
Dr Fionna Martin Medical registrar, London
Dr James Crane Medical registrar London
Dr Patrick French Consultant physician, London
Dr Pam Wortley Retired GP, Sunderland
Dr Paul Hobday GP, Sutton Valence, Kent
Dr Sarah Hallett Paediatric SHO, London
Dr Jonathan Fluxman GP, London
Dr Moosa Qureshi Haematology academic trainee, Cambridge
Mr Mark R Williams ENT ST5, north of England
Dr Edwina Lawson GP, London
Dr Piyush Pushkar Psychiatry CT3 doctor
Dr H Grant-Peterkin ST6 Adult/Older Adult Psychiatry
Dr Laura Davies MbChB MSc MRCS

NHS England’s Five Year Forward View and Sustainability & Transformation Plans (STPs) involve a massive restructuring of the NHS into a public/private enterprise. Much of this is drawn from the US private health insurance-based system. It includes new systems and structures to enable the dismantling of the NHS – the sell-off of NHS land/property (via NHS Property Services), the introduction of alternative funding sources (via Joint Ventures and Special Purpose Vehicles), and the creation of radically new healthcare overseers at the heart of the enterprise called Accountable Care Organisations (ACOs), Multispecialty Community Providers (MCPs) and Primary and Acute Care Services (PACs).

ACOs, MCPs and PACs will be awarded huge contracts to manage and provide whole packages of care. When almost inevitably faced by tax funding shortages, NHS England’s plans enable them to turn to private insurers for “help”. These new organisations are US concepts. The consultants involved in drawing up the plans include McKinsey and US giant United Health subsidiary Optum which have extensive US interests.

US insurance corporation Centene’s UK subsidiary has just been subcontracted to run Nottingham’s STP as it moves to the ACO system. Centene Corporation co-owns the management company of the ACO-like “Alzira model”. The Alzira and US healthcare insurance giant Kaiser Permanente, originators of the ACO concept, have been cited by Jeremy Hunt as the models for NHS England’s ACOs.

And Hunt suggests that Professor Hawking is being “pernicious” in his concerns that we are moving towards a US-style system!
John Furse
London

When one such as Stephen Hawking is so assertively outspoken on a political issue, any reasonable person is obligated to actively listen to what he says is happening to the NHS. What grieves me deeply is knowing that the government is hiding the fact that it is overseeing the shrinkage of the NHS – a safety-critical system – with cuts inevitably now leading to direct harm to patients.

NHS rationing and under-resourcing operate concurrently to increase demand for self-pay or insurance. Elective surgery spend on outsourcing to private sector increased 60% in the last two years. Privatisation of the NHS also comprises forms other than outsourcing, and the players and apparatus to speed this direction of travel indeed incline towards a US-style ACO system.

The government doesn’t actively have to do any more. It can now just let it happen. I’ve no doubt that the government is holding back its rescue fund for the NHS until some of the multibillion STP contracts have been tendered into private hands. Hence the urgency to develop STPs so hastily.

Hawking’s cogent warning is clear and real, beseeching public and media action to be heard and acted upon. This is not a conspiracy theory; it’s a government-facilitated downgrading and corporate takeover of your health service.
Dr Nick Mann
London

A key question about accountable care organisations (Stephen Hawking is wrong about our NHS plans, 28 August) is whether there will be a direct relationship between publicly provided ACOs and NHS England, or whether the ACOs will be put out to tender to the likes of Virgin Care and United Healthcare. If the latter, it will bring about the complete privatisation of the NHS.
Morris Bernadt
London

About 30 years ago Mrs Thatcher declared that the NHS was “safe in our hands” and that expression became something of a Tory mantra. However, it has not been heard for quite a while. We are now told that under the Tory party the NHS will remain “free at the point of use”. This formula is reiterated by Jeremy Hunt. In theory healthcare could be free at the point of use and provided entirely by the private sector, eg US-style Health Maintenance Organisations, or indeed Virgin Healthcare. In that scenario, control would have passed out of government hands and the NHS as most people understand it would have ceased to exist. If a private company providing a vital service said it would collapse without a substantial infusion of money it would have the government over a barrel. Private provision has now reached about 7% in the NHS, and the trend to private provision was bolstered by the Health and Social Care Act of 2012, which made it mandatory to allow “any qualified provider” to bid for NHS contracts. This specific point of increasing private provision in the NHS was raised by Stephen Hawking in his criticism of government policy and ignored by Jeremy Hunt in his responses. It is high time he addressed the issue.
Brendan O’Brien (retired GP)
London

Has Jeremy Hunt had a Damascene conversion about the NHS? In 2005 he co-authored a pamphlet that called for the NHS to be replaced by an insurance-based system and for denationalising the provision of healthcare in Britain. So is he being honest when he says that he wants the NHS to remain a taxpayer-funded system for ever? He challenged the suggestion by Professor Hawking that the adoption by the NHS of Accountable Care Organisations (ACOs) is a step towards an insurance-based system. Such a step might not yet be clear, but the steps towards denationalising the NHS are clear. ACOs will be responsible for the great majority of health and care services within their areas under contracts let by STP commissioning groups. In time, these contracts will be open to competition by private providers. If we do not want companies like Virgin Care to be running the majority of our health services then I would hope that people like Professor Hawking will keep speaking out.
Jim Pragnell
Otford, Kent

Jeremy Hunt uses an old politician’s bluff in saying “the health service has record funding”. Costs continually rise, so this quote is a meaningless boast. Funding increases have to be measured against both inflation and need. Perhaps the argument boils down to, who would you trust: Stephen Hawking or Jeremy Hunt?
Ian Close
Paisley, Renfrewshire

Read more letters on the NHS

Doctors back Stephen Hawking’s challenge to Jeremy Hunt

NHS staff feeling drained by endless reorganisation

Labour ought to speak out about the NHS as strongly as Stephen Hawking

When waiting for health services can have fatal consequences

Bloody NHS didn’t even allow me time to read my mag

Join the debate – email guardian.letters@theguardian.com

Doctors back Stephen Hawking’s challenge to Jeremy Hunt | Letters

As NHS doctors we have been closely following the exchange between Stephen Hawking and the secretary of state for health over the past week (Why won’t Jeremy Hunt come clean?, 26 August). Since Professor Hawking delivered a momentous speech to the Royal Society of Medicine exposing the policy-driven reality of NHS underfunding and moves towards a US-style insurance system, tensions have mounted.

The profound irony of Jeremy Hunt claiming that a world-renowned professor, an academic pioneer who has dedicated his life to generating scientific evidence, is spreading “pernicious falsehoods”, or that his appraisals are “misguided”, when Jeremy Hunt himself has been unreservedly criticised for misuse of evidence for political expediency, is not lost on us. In fact, so audacious a claim is this that we have asked ourselves what could have prompted such a zealous response?

As the NHS crumbles around us, with scores of A&Es and maternity units being downgraded or closed via implementation of “STPs” (Sustainability and Transformation Plans), as patients wait months for outpatient clinics, operations and cancer treatments, with junior doctors leaving in droves and nurses desperately covering 40,000 unmanned posts, all the while the private sector flourishes and takes up swathes of once-NHS contracts, it is clear Hunt will do absolutely everything possible to distract the public from the politically motivated destabilisation of the NHS. His baseless promise of a “seven-day NHS” has masked underlying motivations behind contract and service changes now exposed to make NHS staff less valued, and allow routine profitable services to be increasingly outsourced.

Professor Stephen Hawking has spoken more truth in one week than has been said in five years of the secretary of state for health’s term.
Prof Allyson Pollock Director of Institute of Health and Society, Newcastle University
Dr Bob Gill GP, Producer, The Great NHS Heist documentary
Mr Chidi Ejimofo Consultant in emergency medicine
Dr Louise Irvine GP, Lewisham, Health Campaigns Together co-chair, London
Dr Tony O’Sullivan Retired paediatrician, Co-chair of Keep Our NHS Public
Dr Aislinn Macklin-Doherty Oncology trainee, Health Campaigns Together
Dr David Wrigley GP, chair of Doctors in Unite
Dr Rachel Clarke Palliative care doctor, Oxford
Dr Nadia Masood Anaesthetic registrar, London
Dr Jacky Davis BMA Council
Mr Chris Efthymiou Consultant cardiothoracic surgeon, Leicester
Dr Unmesh Bandyopadhyay CT2 Medicine, Kent, Surrey & Sussex
Dr James Haddock CT2 in anaesthesia, West Midlands
Dr Youssef El-Gingihy GP, London
Dr Amit Sud Clinical research fellow, London
Dr Lauren Gavaghan Consultant psychiatrist
Dr James Chan ST3 Doctor in emergency medicine, Leeds
Dr Taryn Youngstein Speciality registrar, rheumatology, London
Dr Robert Adams Urology CT2, Essex
Dr Coral Jones GP, Hackney
Dr Bernadette Borgstein Consultant paediatric audiovestibular physician
Dr Dominic Pimenta BSc (Hons) MBBS MRCP
Mr Rishi Dhir Orthopaedic surgical trainee, MRCS
Dr Ruth Wiggans ST5 in respiratory medicine
Dr Yannis Gourtsoyannis Infectious diseases trainee, London
Dr Ellen McCourt Anaesthetic trainee, north-west
Dr John Puntis Consultant paediatrician, Leeds
Dr Jackie Applebee East London GP
Dr Julia Paterson Psychiatry trainee, London
Dr Mona Ahmed Consultant psychiatrist, London
Dr Helen Groom GP Gateshead
Dr Pete Campbell Trainee doctor, north-west
Dr Lois Paton GP
Miss Stella Vig RCS Council, consultant surgeon
Dr Jon Dale Retired occupational physician
Dr Jan Macfarlane Retired GP
Dr Emily Whitehouse ST7 paediatric doctor
Dr David Church GP, mid-Wales
Dr Luke Foster CT2 anaesthetics
Dr Anna Livingstone GP, London
Dr Kambiz Boomla GP and lecturer, east London
Dr Ashling Liillis Paediatric trainee
Dr Hugo Farne Specialist registrar and clinical research fellow in respiratory medicine, London
Dr Ron Singer Retired GP and vice-president of Doctors in Unite
Dr Ellie Bard Obstetrics and gynaecology trainee, London
Dr Natasha Haringman ST1 obstetrics and gynaecology
Dr Amanda Owen Psychiatrist
Dr David Kynaston GP, Yorkshire
Dr Gary Marlowe Chair BMA London Regional Council
Dr Amy Squire Psychiatrist, MBChB MRCPsych
Dr Fionna Martin Medical registrar, London
Dr James Crane Medical registrar London
Dr Patrick French Consultant physician, London
Dr Pam Wortley Retired GP, Sunderland
Dr Paul Hobday GP, Sutton Valence, Kent
Dr Sarah Hallett Paediatric SHO, London
Dr Jonathan Fluxman GP, London
Dr Moosa Qureshi Haematology academic trainee, Cambridge
Mr Mark R Williams ENT ST5, north of England
Dr Edwina Lawson GP, London
Dr Piyush Pushkar Psychiatry CT3 doctor
Dr H Grant-Peterkin ST6 Adult/Older Adult Psychiatry
Dr Laura Davies MbChB MSc MRCS

NHS England’s Five Year Forward View and Sustainability & Transformation Plans (STPs) involve a massive restructuring of the NHS into a public/private enterprise. Much of this is drawn from the US private health insurance-based system. It includes new systems and structures to enable the dismantling of the NHS – the sell-off of NHS land/property (via NHS Property Services), the introduction of alternative funding sources (via Joint Ventures and Special Purpose Vehicles), and the creation of radically new healthcare overseers at the heart of the enterprise called Accountable Care Organisations (ACOs), Multispecialty Community Providers (MCPs) and Primary and Acute Care Services (PACs).

ACOs, MCPs and PACs will be awarded huge contracts to manage and provide whole packages of care. When almost inevitably faced by tax funding shortages, NHS England’s plans enable them to turn to private insurers for “help”. These new organisations are US concepts. The consultants involved in drawing up the plans include McKinsey and US giant United Health subsidiary Optum which have extensive US interests.

US insurance corporation Centene’s UK subsidiary has just been subcontracted to run Nottingham’s STP as it moves to the ACO system. Centene Corporation co-owns the management company of the ACO-like “Alzira model”. The Alzira and US healthcare insurance giant Kaiser Permanente, originators of the ACO concept, have been cited by Jeremy Hunt as the models for NHS England’s ACOs.

And Hunt suggests that Professor Hawking is being “pernicious’ in his concerns that we are moving towards a US-style system!
John Furse
London

When one such as Stephen Hawking is so assertively outspoken on a political issue, any reasonable person is obligated to actively listen to what he says is happening to the NHS. What grieves me deeply is knowing that the government is hiding the fact that it is overseeing the shrinkage of the NHS – a safety-critical system – with cuts inevitably now leading to direct harm to patients.

NHS rationing and under-resourcing operate concurrently to increase demand for self-pay or insurance. Elective surgery spend on outsourcing to private sector increased 60% in the last two years. Privatisation of the NHS also comprises forms other than outsourcing, and the players and apparatus to speed this direction of travel indeed incline towards a US-style ACO system.

The government doesn’t actively have to do any more. It can now just let it happen. I’ve no doubt that the government is holding back its rescue fund for the NHS until some of the multibillion STP contracts have been tendered into private hands. Hence the urgency to develop STPs so hastily.

Hawking’s cogent warning is clear and real, beseeching public and media action to be heard and acted upon. This is not a conspiracy theory; it’s a government-facilitated downgrading and corporate takeover of your health service.
Dr Nick Mann
London

A key question about accountable care organisations (Stephen Hawking is wrong about our NHS plans, 28 August) is whether there will be a direct relationship between publicly provided ACOs and NHS England, or whether the ACOs will be put out to tender to the likes of Virgin Care and United Healthcare. If the latter, it will bring about the complete privatisation of the NHS.
Morris Bernadt
London

About 30 years ago Mrs Thatcher declared that the NHS was “safe in our hands” and that expression became something of a Tory mantra. However, it has not been heard for quite a while. We are now told that under the Tory party the NHS will remain “free at the point of use”. This formula is reiterated by Jeremy Hunt. In theory healthcare could be free at the point of use and provided entirely by the private sector, eg US-style Health Maintenance Organisations, or indeed Virgin Healthcare. In that scenario, control would have passed out of government hands and the NHS as most people understand it would have ceased to exist. If a private company providing a vital service said it would collapse without a substantial infusion of money it would have the government over a barrel. Private provision has now reached about 7% in the NHS, and the trend to private provision was bolstered by the Health and Social Care Act of 2012, which made it mandatory to allow “any qualified provider” to bid for NHS contracts. This specific point of increasing private provision in the NHS was raised by Stephen Hawking in his criticism of government policy and ignored by Jeremy Hunt in his responses. It is high time he addressed the issue.
Brendan O’Brien (retired GP)
London

Has Jeremy Hunt had a Damascene conversion about the NHS? In 2005 he co-authored a pamphlet that called for the NHS to be replaced by an insurance-based system and for denationalising the provision of healthcare in Britain. So is he being honest when he says that he wants the NHS to remain a taxpayer-funded system for ever? He challenged the suggestion by Professor Hawking that the adoption by the NHS of Accountable Care Organisations (ACOs) is a step towards an insurance-based system. Such a step might not yet be clear, but the steps towards denationalising the NHS are clear. ACOs will be responsible for the great majority of health and care services within their areas under contracts let by STP commissioning groups. In time, these contracts will be open to competition by private providers. If we do not want companies like Virgin Care to be running the majority of our health services then I would hope that people like Professor Hawking will keep speaking out.
Jim Pragnell
Otford, Kent

Jeremy Hunt uses an old politician’s bluff in saying “the health service has record funding”. Costs continually rise, so this quote is a meaningless boast. Funding increases have to be measured against both inflation and need. Perhaps the argument boils down to, who would you trust: Stephen Hawking or Jeremy Hunt?
Ian Close
Paisley, Renfrewshire

Read more letters on the NHS

Doctors back Stephen Hawking’s challenge to Jeremy Hunt

NHS staff feeling drained by endless reorganisation

Labour ought to speak out about the NHS as strongly as Stephen Hawking

When waiting for health services can have fatal consequences

Bloody NHS didn’t even allow me time to read my mag

Join the debate – email guardian.letters@theguardian.com

Rogue doctors ‘use superhero status to abuse patients’

The health service must do more to spot warning signs that staff are using their position in order to abuse patients, a new report into sexual and physical assaults committed by rogue medical personnel has found. The problem is particularly acute for doctors who achieve “superhero” status, it warns.

The analysis of how healthcare professionals were able to get away with their misbehaviour for years has concluded the NHS needs to overhaul its procedures to prevent a repeat of such scandals. Examples included breast surgeon Ian Paterson, who was jailed in May for 15 years for carrying out unnecessary cancer operations, and specialist Myles Bradbury, who was jailed for 22 years (reduced to 16 on appeal) in 2014 for abusing young cancer patients.

The probe, by experienced NHS investigators Verita, has been shared with the Observer. It has identified three key types of devious and deceitful tactics used by NHS personnel to create opportunities to exploit vulnerable patients.

The firm has previously examined the NHS’s handling of scandals including Jimmy Savile’s abuse and rape of patients. This time it has identified patterns of behaviour that bosses, management teams and its 1.4 million staff need to be warned about and told to report if they become suspicious.

Its findings are based on an in-depth inquiry into the misdemeanours of Paterson and Bradbury as well as George Rowland, a consultant urogynaecologist who performed unnecessary or botched operations on hundreds of women with incontinence, and David Britten, a senior nurse who groomed and had sexual relationships with young women undergoing treatment for eating disorders.

“The NHS ought to have been on to these cases faster than they were,” said Ed Marsden, the firm’s managing director. “Our analysis showed there were common traits which, if identified and challenged earlier, could help stop or prevent safeguarding issues. NHS organisations must be much more alert to these patterns of behaviour to identify and stop abuse by staff. The NHS must learn lessons from these cases.”

Verita says that NHS bosses should be wary of health professionals who acquire what it calls the “superhero status” of the three doctors and one nurse studied in the review. Their seniority and expertise in their field meant that their unusual behaviour was not challenged by colleagues or patients.

“Myles Bradbury cultivated unusually close relationships with patients and families for a doctor. He made them feel special and dependent on him. For example, he gave them his mobile phone number and he ran clinics out of hours. That’s unusual behaviour. They thought he was going above and beyond to help them. But those kinds of oddities should give long pause for thought,” said Marsden. Bradbury was jailed for abusing 18 children with cancer at Addenbrooke’s hospital in Cambridge between 2009 and 2013.

“This ‘superhero status’ also allowed Ian Paterson to make false diagnoses and carry out unnecessary or dangerous breast surgery while receiving plaudits from many unsuspecting patients,” added Marsden. “It took nine years before concerns raised about him finally led to his suspension by the General Medical Council. Britten convinced his victims they were receiving special treatment to resolve their eating disorders and then betrayed their trust. He, Paterson and Rowland were all treating vulnerable people who were very seriously unwell. ‘I can bring about a cure, I can fix it’ – that’s what they cultivated and got patients to think. Patients want to trust that they’re getting the very best care and a health professional with bad intent can exploit that.”

Alarm bells should also ring when any member of staff starts acting like a “lone wolf” – creating space and opportunities within the working environment to carry out abuse. “For example, Rowland practised in a separate location where he was subject to less stringent assessment and away from the eyes of colleagues who may have challenged his approach, while Britten relocated to a specialist eating disorders unit physically separate from the main hospital,” said Marsden.

NHS bosses also needed to be much quicker at picking up signals that someone who was not abiding by the usual rules might have a sinister agenda, he added. Bradbury and Paterson both resisted being monitored, while Bradbury was reluctant to be shadowed by students and trainee doctors, which is a long-established way of consultants helping young recruits learn medicine.

Verita has also found that hospitals need to be clearer and more consistent with both staff and the public about what will happen in an appointment, especially if it involves an intimate physical examination, and offer a chaperone if requested to help patients know what to expect and make them less deferential.

“We must do all we can to prevent these crimes. This work by Verita offers useful insights and information on particular behaviours that, combined with other concerns, may well indicate that abuse is taking place,” said Saffron Cordery, the director of policy and strategy at NHS Providers, which represents NHS trusts in England. “Ultimately, every member of staff and every patient must feel safe to raise the alarm.”