Stop asking us to deliver the impossible, NHS trusts urge ministers

Ministers and NHS bosses are being urged to stop asking the health service to “deliver the impossible” of higher standards of care when it is being denied the money it needs to do its job properly.

The plea from the organisation that represents NHS trusts in England was accompanied by a blunt warning that care for patients is already deteriorating and that even a flu outbreak could “destabilise” some hospitals this winter.

NHS Providers, whose member trusts receive £65bn of the NHS’s £100bn annual budget, says the health secretary, Jeremy Hunt, and the NHS England chief executive, Simon Stevens, are making unrealistic demands of the service.

“The government has said there will be no more money. The government and our system leaders have said that the NHS still has to deliver everything that is currently being asked for,” Chris Hopson, the chief executive of NHS Providers, will say on Tuesday.

He will dismiss the idea that the NHS could hit its tough financial targets this year while also transforming how it delivers care, giving every patient high-quality care, meeting a host of waiting time targets, implementing the government’s “seven-day NHS” pledge and also improving patient safety.

Ministers and NHS bosses should scale back their expectations of what the NHS can do in all those areas given its parlous finances and the government’s refusal to boost its budget, Hopson argues.

Three-quarters (73%) of NHS trust bosses believe they do not have enough staff to function properly, according to a new NHS Providers report on the state of the NHS in England. More than half (55%) say they are worried or very worried by their organisation’s lack of staff. Many trust chairs and chief executives now say the difficulty in recruiting personnel is as onerous as balancing their books.

In a survey of 172 bosses from 136 of England’s 238 trusts, one said: “There are simply not enough high-quality clinical staff in the country to cover some specialities.” Another said: “Brexit has caused drying up of recruitment from the rest of Europe.” Widespread worry about the NHS’s workforce “concerns me more than the money”, said a third boss.

Just 10% are confident or very confident that they can maintain the level and quality of services they currently provide over the next six months because money is so tight. Nearly half (49%) expect their financial position to worsen over that time.

Hopson will tell his organisation’s annual conference that the government’s decision not to put more money into a cash-strapped NHS raises “four main risks. The first is that the service the NHS provides is now starting to deteriorate”, and that the deterioration will accelerate because of the “crisis” in social care services.

The NHS is also becoming less resilient, he will add. “When you run a system under as much pressure for as long as we have been running the NHS, it becomes much less able to absorb the shocks that any health system has to absorb – the winter flu outbreak [or] closure of a couple of care homes [or] a few experienced GPs retiring and being replaced by more risk-averse locums”.

In addition, Hopson will say, “pressure on staff and leaders becomes intolerable, which erodes morale”. Hopson is also worried that pressures are so great that “the invisible bond of mutual trust and faith between the government and NHS system leaders, on one hand, and frontline leaders, on the other, is starting to fray”.

NHS Providers’ warnings on staffing come as an audit of NHS stroke services in England, Wales and Northern Ireland found that patients who have suffered a stroke do not always receive optimum care because many units have too few nurses and doctors, especially at weekends.

Nearly half (49%) of stroke units do not have the recognised minimum number of nurses needed to ensure good care, according to the Sentinel Stroke National Audit Programme. At weekends as many as 80% of units do not have the three nurses per 10 beds that is recommended. In addition, 40% of units have at least one vacancy for a consultant and 28% do not provide consultant-led ward rounds every day of the week.

Staff shortages were a concern, the experts behind the audit said. A lack of nurses in stroke units has been shown to increase the risk of patients dying.

The Department of Health welcomed NHS Providers’ acknowledgement that trusts were treating record numbers of patients and also making good progress at reducing its collective deficit, which hit a record £2.45bn in 2015-16.

Stop asking us to deliver the impossible, NHS trusts urge ministers

More young girls asking GPs about genital cosmetic surgery, study finds

A world-first study has found that girls as young as 15 are asking their GPs about genital cosmetic surgery, and are increasingly concerned that their genitals don’t look “normal”.

Lead author of the study, Dr Magdalena Simonis from the University of Melbourne’s department of general practice, said she was compelled to conduct the survey after her own patients began asking about labiaplasty, a surgical procedure that removes tissue from the labia.

“I felt underprepared to respond to those requests,” she said.

“When I spoke to colleagues who were also working in areas of women’s health, they also expressed the same sort of experiences with women questioning whether their genitals looked normal. Many of them volunteered that that 20 or 25 years ago, this was never an issue.”

Simonis said she believes fashion, online pornography, perceptions of beauty, as well as Brazilian waxes were playing a major role in women’s dissatisfaction with and concern about their genitals.

While some women experience medical issues related to their labia and require a labiaplasty, more than 1,500 labiaplasties were performed in Australia in 2013, representing a threefold increase in the procedure over the previous decade despite there being no increase in genital abnormalities.

Over a 10-week period last year, Simonis and her research team conducted interviews with 443 Australian GPs and asked them 31 questions about their patients and requests for female genital cosmetic surgery. Most were GPs who specialised in women’s health.

Of the respondents, 54% had seen female patients requesting genital cosmetic surgery. Overall, 75% of GPs rated their knowledge of the surgery as inadequate and 97% said they had been asked by women of all ages about genital normality.

More than half the GPs suspected psychological disturbances in their patients requesting the surgery such as depression, anxiety, relationship difficulties and body dysmorphic disorder.

Surgery could sometimes lead to complications such as ongoing pain and could also affect sexual response, “because the clitoris is not just a ‘pea’ as described in textbooks, but is a larger organ, most of it not visible to the eye”, Simonis said.

“When we talk about adult women into their 20s of course they are entitled to make their own decisions about their body and surgery, provided they are well informed and have good information and don’t have any mental health disorders that might be affecting their decision,” Simonis said.

“But the really vulnerable here are young women and teens impressed by what they see online and what a lot of the portrayals are like in pornography. I think we need to be carefully looking at those women and ensuring they are supported and better informed.”

Simonis was an author of the Royal Australian College of General Practitioners clinicians’ guide on female genital cosmetic surgery, the first guide for Australian GPs and other health professionals, published last year. She said while this was helping GPs to navigate questions and concerns about female genitals, cosmetic surgeons also had a role to play.

Surgery for mental health issues is not a appropriate therapy

Dr Magdalena Simonis

“They are simply building a business around demand,” she said.

“The question is, why is there demand? It behoves them to look more closely at the psychological background of women and girls and make sure they are well screened for mental health issues, because surgery for mental health issues is not a appropriate therapy.”

The study was published in the British Medical Journal and was the first large survey to explore GP experience of female genital cosmetic surgery.

More young girls asking GPs about genital cosmetic surgery, study finds

If you want to know how to help an alcoholic, you are asking the wrong question | Patrick Strudwick

‘How do you reply to hearing a thud, and it is them on the stairs? Or when they burst into our bedroom raging?’ Photograph: Stephen Barnes/Urban Exploration/Alamy

Making an attempt to assist an alcoholic is, at greatest, like making an attempt to water a dead plant. It is not a situation of diminishing returns – there are none. Only two solutions surface, as a result, to the question of how any of us with loved ones who descend into dipsomania can assist. Very first, you cannot. Pleading, screaming, reasoning, removing their stash, calling their GP, frantically Googling AA meetings, phoning the police, the ambulance, their mothers and fathers, or young children, or anyone – no, it is all useless.

2nd, it is the incorrect question, and 1 that cloaks the query we can not attain (since a carer’s perform is in no way accomplished): how do we support ourselves? And then, exactly where is the aid for us?

I ask simply because these concerns by no means occurred to me for the duration of the two intervals I lived with alcoholics, nevertheless have been triggered by studying of another’s predicament. Nobel prize-winning biologist Sir John Gurdon, 80, and his wife Jean, 77, were, a court heard this week, attacked by their alcoholic son. John confronted William, forty, in their kitchen over his drinking – he had attempted the Priory. William lashed out.

“You got drunk and pushed your mom above so she hit her head on the floor leading to injury,” said Ken Sheraton, the judge who gave William Gurdon a suspended prison sentence. “You then pushed your father on to the floor and grabbed him by the throat and attempted to strangle him.”

It was not this that winded me it was one more crushing detail. When his mom smelled booze on his breath at 8.30 that morning she cooked him a fry-up. Of course she did. He is her son and it is what we do. Give them meals. Make them a coffee. Pay attention to their looped anecdotes. Mop up their self-hatred. Reassure them. Support them.

The unkind phone this enabling. I get in touch with it caring. Simply because what else are we to do? What is the very best response to stepping in urine due to the fact you made it to the toilet in the quiet of night but they had not? How are we to respond when we hear a thud and it is them on the stairs? Or when they burst into our bedroom raging?

I did not know what to do when one of the alcoholics I lived with left the front and back doors open (a billboard advertisement for burglary in north-east London). I did not know what to do when all the reasoning ran out and the investigation ran, rather inaptly, dry. Try out to locate an NHS rehab bed for an individual. Attempt to find totally free counselling. Try out even to get them sectioned. It is virtually extremely hard. At this stage there is not even water for the dead plant.

Some recommend Al-Anon, the organisation for those affected by alcoholics, and no doubt they are superb, but what I needed was a working, capable NHS and social care method that requires addicts off our incapable hands.

Alcoholics talk of “rock bottom”: theirs, not ours. I reached mine in October 2007, not since I couldn’t cope any much more, but due to the fact he was drunk on a Sunday morning and my then 4-yr-outdated niece was due to come round. No little one ought to see that. But, in accordance to Alcohol Concern, two.six million young children are living with mothers and fathers who drink “hazardously”. How are we to respond to that gutting, jeroboam statistic other than to conclude: we do not care about these kids.

The privileged – by which I imply not just the John and Jean Gurdons but any grownup who, unlike youngsters, has options – can at rock bottom go nuclear: kick them out or telephone the police. I did the former, grabbing his keys, bagging up his belongings and dumping them on the street. But what are you left with?

Guilt for sure. More fear – will they die? And, in my case, a bedroom reeking of the dozens of vodka bottles stashed inexpertly. There wasn’t even anyone to support me clean it up.

If you want to know how to help an alcoholic, you are asking the wrong question | Patrick Strudwick