One in the eye from Musgrove hospital.

This exclusive report from The Guardian does a valuable service – it’s the secret NHS report into the scandal at Musgrove Hospital where the NHS contracted out Cataract operations to a profit making private company which then subcontracted out as much of the contract as possible.

The operations were going wrong at an alarming rate, eventually (far too late) the contract was suspended and then cancelled.

There is no conclusion about what went wrong, so I’ll tell you; too many operations carried out too quickly with too few staff who were inadequately trained.

Who foots the bill? The NHS – who do they sue out of the four companies?

Who takes the profit?

                                                   

Leaked report into cataract surgery revealed

 

Complications at Musgrove Park hospital in Taunton were ten times the number that might have been expected.

 

 Steven Morris  

 The Guardian, Thursday 16 October 2014    

 

Musgrove Park Hospital in Taunton, Somerset outsourced eye surgery to a private company.

 

NHS patients who suffered complications during eye surgery outsourced to a private company felt the procedures were rushed and complained they endured pain during the operations and were shouted at by medical staff, a confidential report obtained by the Guardian has revealed.

 

The report, which health bosses are refusing to publish, says that the private company agreed to perform 20 cataract operations on patients a day, at least six more than the hospital’s own surgeons would usually undertake.

 

In addition, the report suggests that the combination of staff, equipment and facilities had not been tried before. It says that training was still going on when the first patients arrived at the mobile operating theatre at Musgrove Park hospital in Somerset. Concerns are also raised that the operations were not halted as quickly as they could have been when it became clear that patients were suffering complications. Rather than stopping procedures and finding out what had gone wrong, they pressed on.

 

By the time the operations at the Taunton hospital were stopped, 62 patients had undergone surgery. Of them, only 25 had a “normal recovery”.

The report says the complications reported were ten times the number that might have been expected.

 

Among the complications were burns caused by the machine used to break up cataract and loss of iris pigment. Some were left with microscopic metallic fragments in the eye, others had to have further surgery because cataract fragments were left in their eyes.

 

The report, marked “strictly confidential: not to be disclosed to any other party”, also gives a rare insight into how contracts between NHS hospitals and private operators work. Musgrove Park drew up a contract with the global health giant Vanguard Healthcare Solutions. It in turn sub-contracted the provision of surgeons and equipment to another private company, which in turn sub-contracted the provision of some equipment to a third company.

 

It raises worrying questions about how a private healthcare company and an NHS trust work together. The decision not to publish the report seems to fly in the face of the government’s commitment to openness about mistakes following the Mid Staffs hospital scandal Musgrove claimed it wanted to publish the report but was advised not to do so for fear that it would be defamatory and open the hospital up to legal action.

 

Mike Rigby, an independent Somerset county councillor, who has been trying get answers about what went wrong since the problems happened in May, said many unanswered questions remained. He said: “I have long been concerned that this sort of problem could occur following the fracturing of comprehensive patient care caused by the government’s reorganisation of the NHS and the huge involvement of private health firms that it invited.”

 

Rigby said the report did not get to the “root of the problem”, adding: “Many questions are left unanswered.”

 

The report says that in spring 2014 Taunton and Somerset NHS Foundation Trust needed a “decisive” solution to a backlog of cataract cases to meet government waiting list rules.

 

The trust drew up a contract with Vanguard to treat 400 patients during May 2014. The final contract was agreed on 1 May and operations began next day.

Operations were carried out on 2, 3 and 4 May.

But on 6 and 7 May, according to the report, concerns were raised by Musgrove consultants regarding three patients who had attended the eye casualty department with problems following surgery at the Vanguard facility.

No issues or concerns had been raised by Vanguard. Following discussions between

the trust and the private companies involved, it was decided that products – drugs and chemicals – used during the operations rather than surgical problems were likely to be the problem. It was decided to change the products and carry on with surgery as planned on 9 May.

 

Concerns were still being expressed by hospital staff but operations began again at 9.48am on 9 May. By 11am it was clear that other patients were reporting complications and operations were stopped. The contract was suspended and cancelled on 12 May.

 

The report found that the two surgeons had “significant relevant experience” and both were working in NHS consultant posts. But the combination of staff, equipment and facilities had not been brought together before.

 

Investigators looked at whether poor surgical technique was to blame. But the report says this “cannot be the whole explanation” or such problems would have been picked up by the surgeons’ own hospitals or while working in private practice. Patients were affected following operations by both surgeons.

 

But the report says the “pressure of operating on 20 patients each day may have contributed to the possible deterioration of surgical quality and reduction in patient experience.”

 

it says some patients reported the procedure felt “rushed”. Several reported experiencing pain during the procedure and being “shouted at” for moving.

 

The report concludes that “no single cause was identified....the trust has not been able to identify any clear cause that explains all the complications.”

 

It says: “From the first session on the first day of operating, the number of cases was fixed at 20 per day. “This did not allow for significant on-site training time....Patients were arriving at the Vanguard facility while training was going on, creating pressure to start the lists promptly and shorten training.”

 

The report said that “in retrospect” the products identified as the possible reason for complications were unlikely to have been the cause for complications.

It suggests that “clearer escalation processes” could have led to an earlier decision to halt operations.

The report says that by the time it was written, of the 37 patients who did not have a “normal recovery”, 32 had now been discharged and five were still receiving follow-up treatment.

 

In a statement released before the report was obtained, Musgrove said: “We have now concluded a thorough investigation. The purpose of this was to try and establish what happened to cause the complications that the patients operated on in the Vanguard mobile theatre experienced, and how we could learn from these events to minimise the risk of recurrence in the future.

“As with similar ophthalmic incident clusters there is no clear single cause for the range of problems our patients appear to have experienced.

Instead we have identified a number of factors which may have led to the unusually high level of complications seen. The detail of the investigation has been shared with patients.”

 

Ian Gillespie, Vanguard’s chief executive, said: “Our focus remains first and foremost on the patients and their care, and I’d like to personally convey my sympathy for any patients who have experienced discomfort or distress.

 

“This was a collaborative contract, and we have been working closely with the trust throughout this investigation. The investigation does not identify any one cause, but instead points to a number of different factors which may have led to the complications experienced by patients. No issues have been identified with the Vanguard mobile theatre facility itself; however, there are clearly lessons to be learned by all parties. We are working with the trust to ensure that measures are put in place to prevent this happening again.”

As usual, when private companies take over NHS work they take the profits but the NHS is accountable for the mistakes and it’s us who pick up the bill.

 

Neil Harris

(a don’t stop till you drop production)

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Contact me: neilwithpromisestokeep@gmail.com

 

Another kind of 'Victory'.

This is a kind of ‘victory’; a recognition that car park charges at hospitals are a tax on staff, patients and their visitors. The only fair system is rationing spaces on need and using revenues from car parking to help those using public transport get to hospital.

 

BBC News 23 August 2014

Hospital car parking guidance to reduce some charges

Hospitals in England have been told to cut the cost of parking for certain groups under new government guidelines.

Ministers said relatives of people who were seriously ill or had to stay in hospital for a long time should be given free parking or reduced charges.

Concessions should also be offered to people with disabilities and NHS staff whose shift patterns meant they could not use public transport, they said.

Labour accused the coalition of dropping plans to scrap the charges.

Hospital parking policies are set by individual NHS trusts.

The Department of Health guidance made it clear trusts were responsible for the actions of private car parking contractors running facilities on their behalf.

'Rip-off' costs

 

The guidelines also recommended hospitals should use "pay-on-exit" schemes so motorists pay only for the time they use in a hospital car park.

And they say trusts should waive fines if a visitor or patient overstays through no fault of their own, for example because treatment took longer than planned, or when staff have to work beyond their scheduled shift.

 

“Hospital parking has become a stealth tax on the vulnerable”

Robert Halfon, Conservative MP for Harlow

 

Health Secretary Jeremy Hunt said: "Patients and families shouldn't have to deal with the added stress of unfair parking charges.

"These clear ground rules set out our expectations, and will help the public hold the NHS to account for unfair charges or practices."

Mr Hunt had come under pressure from Conservative backbenchers to put an end to "rip-off" costs.

As part of that campaign, Harlow MP Robert Halfon sent Freedom of Information requests to almost 400 hospitals in England. The data he collected shows big differences in average costs across the country.

London had the highest charges, with an average of £20 a day and more than £130 a week.

The lowest charges were in the East Midlands, where parking costs were £3.50 per day and £11 per week.

Average patient and visitor parking charges in England

      Per hour Per day Per week

      Source: Freedom of Information requests compiled by Robert Halfon MP

      East of England  £2  £8.50  £25

      East Midlands    £1  £3.50  £11

      London                £2  £20     £131.50

      North East          £1  £3.50  £20.50

      North West        £2  £5.50  £19

      South East          £2  £9.50  £29

      West Midlands  £2  £6.50  £22.50

      Yorkshire            £1  £4.50  £29

 

Mr Halfon described the announcement as a "massive step forward" but said he wanted to see charges scrapped altogether, at a cost of £200m.

"Hospital parking has become a stealth tax on the vulnerable," he told BBC Radio 4's Today programme.

"The stories that we've had of people not being able to use the machines so they haven't been able to see their dying relatives is quite horrific and we have to make a change."

 

'Extortionate'

 

Ben Ruth, who received two parking tickets as he visited his dying father in the Royal Lancaster Infirmary, said the experience left him feeling "sickened".

"The second one was stuck on the windscreen when I left the hospital ward just after my father passed away," he said.

"I've rarely felt such rage as I felt right then. After the exceptional kindness of the medical staff in my father's ward, I felt grievously assaulted."

Macmillan Cancer Support said some patients were paying "extortionate" charges "in order to access treatment for a life-threatening illness".

Welcoming Mr Hunt's announcement, Duleep Allirajah - head of policy at the charity - urged hospitals not to ignore the guidance.

"Hospitals must... commit to implementing the guidelines as a matter of urgency so that cancer patients do not continue to pay unfair hospital parking charges," he said.

 

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

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A leak in the west London Birthing pool.

This Evening Standard article highlights the cioncerns in West London over the wholesale closure of Accident and Emergency and Maternity departments.

The argument is that the creation of ‘super hospitals’ specialising in particular disciplines will result in better patient outcomes and economies of scale.

The problem is that A and E and maternity actually need to be local – it’s the complicated cases that need specialisms.

Any way things aren’t going well and they will get worse – lose either you’re a and E or your maternity department now – kiss your hospital goodbye in the next round of cuts;

 

Women giving birth in west London hospitals ‘face poor care and potential risks’

'Potential risks': a warning was issued about “inadequate” maternity care in

 

West London

Ross Lydall, Health Editor

Evening Standard

20 August 2014

A warning was issued today about “inadequate” maternity care in west London — ahead of services coming under further pressure with the axing of a busy unit.

Hospital inspectors said women giving birth at Northwick Park hospital, in Harrow, could not always summon help and the slow “pace of change” created “potential risks”. Caring was rated inadequate while the department, responsible for 5,600 births a year, “requires improvement” overall.

 

The Care Quality Commission’s report comes amid concerns at the wider impact of closing the maternity unit at Ealing hospital next summer. Most of its 2,800 births are expected to be split between Northwick Park and West Middlesex, in Hounslow, though emergency and complex cases will transfer to St Mary’s in Paddington.

 

Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, said senior staff had to be empowered to make changes in maternity and the A&E at Northwick Park, the biggest of three hospitals within North West London NHS trust.

Women told the CQC and reported in surveys that care fell below expectations.

The environment and equipment on paediatric wards also needed to be improved, inspectors said after their announced visit in May.

 

Sir Mike praised the trust’s “caring and compassionate” employees but said staff shortages made it difficult for them to meet individual needs. He added:

“Ongoing improvements to maternity services also need to be sustained, and further changes made at a much greater pace.”

 

The daytime-only A&E department at Central Middlesex hospital, in Harlesden, was rated “good” — weeks before it is due to be shut down. The leader of Ealing council today called on the trust to halt the closure on September 10.

 

Julian Bell said the report raised “serious questions” about the plan and said it would “push patients to a poorer service at Northwick Park”.

 

The CQC report ordered trust bosses to improve staffing levels in the A&E, surgery and critical care departments at Northwick Park and St Mark’s hospitals.

Overall, the trust “requires improvement” but its hyper-acute stroke unit was praised for providing a “gold-standard service”.

 

David McVittie, chief executive of the trust, said: “A significant amount of work is already under way to improve safety and effectiveness of care in our maternity unit. In addition, a new £21million A&E department will open at Northwick Park in the autumn.”

 

The Shaping A Healthier Future programme, which is centralising maternity and emergency care in “super-hospitals”, said: “We can give full assurance for women who are currently booked to have their baby at Ealing hospital to use the maternity unit with confidence.

Neil Harris

(a don’t stop till you drop production)

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The benefits of privatisation.

This piece from ‘The Independent’ highlights the problems that are bubbling up from government policy to force hospitals to use private healthcare providers.

Then again for the Tories it’s been a success; it’s started the process of stealing the NHS from us and it’s made a lot of profits for their business friends and sponsors;

Dozens of NHS patients have been left with damage to their eyes, including partial loss of sight, after undergoing routine cataract operations which had been outsourced to a private provider.

 

A hospital in Somerset is now facing a slew of legal claims from patients who say they were left with problems including blurred vision, pain and swelling after undergoing cataract removal operations at a unit run by Vanguard Healthcare, which operated on the hospital site.

 

The scandal will raise serious questions about the Coalition Government’s plans to expand the role of private providers working in the NHS.

 

Vanguard had been under contract to Musgrove Park Hospital, in Taunton, since May to help clear a backlog of patients. Of 62 people who underwent cataract operations, 31 reported poor outcomes, according to lawyers for the patients. Cataract operations usually have a very low complication rate, typically around in one 400.

 

Laurence Vick, head of clinical negligence at Michelmores Solicitors, which is acting for a number of the patients affected, said the case “uncovered the uneasy relationship between the NHS and the private sector”.

 

“We don’t know what arrangements are in place for Musgrove to recoup their outlay and losses on this contract from Vanguard,” he said. “From the taxpayer’s point of view, it would be totally unreasonable for Vanguard to walk away from this scandal with only their reputation, and not their [investment], damaged… It is crucial that an episode of this kind is not dismissed as an anomaly – a hybridised, public-private NHS will need to be wary of similar issues in future.”

 

Patients affected are now having their side-effects treated at the hospital itself. Lawyers for some of the patients, most of whom were elderly and vulnerable, said it was likely the NHS Trust would have to pay for any successful compensation claims – meaning that the taxpayer would be footing the bill.

 

Among those affected was an 84-year-old man, whose son, Chris Newcombe, is now calling for an independent inquiry. Mr Newcombe says his father experienced blurred vision and swollen corneas after being operated on at the Vanguard mobile surgery unit.

 

Mr Newcombe told the Somerset County Gazette: “My father is traumatised and depressed with the loss of his eyesight. Previous pleasures of gardening and watching sport on the TV have now been taken away from him. This could have been prevented if the welfare of the patients had been thought about, rather than this urgency of just getting people through.”

 

His parents had “only praise and admiration” for staff at Musgrove’s own ophthalmology department, who have since been treating his father, he said.

 

The Trust said that due to an ongoing investigation into the matter, they could not comment “in detail on the sequence of events surrounding the unfortunate complications experienced by our patients receiving cataract surgery with Vanguard Healthcare in their mobile theatre at Musgrove Park Hospital. Our first and foremost concern has always been our patients, and particularly those who have experienced complications,” the statement said. “We have been in very close contact with them since the incident to ensure they are fully informed with our progress and receive the highest quality aftercare and treatment.”

 

Chief executive Jo Cubbon said that “early into the arrangement” with Vanguard in May, “technical issues in the facility had arisen and it became necessary to cease the service arrangements in place”.

 

Ian Gillespie, chief executive of Vanguard Healthcare, said: “Patient care is our number one priority and we’re working closely with the Trust to understand and fully investigate the root causes of any complications… Operations were carried out in Vanguard’s operating theatre by highly qualified surgeons, approved by the hospital.”

 

The Department for Health was yet to respond last night.

 

Profile: Vanguard

 

Founded in 2002 and headquartered in Brockworth, Gloucester, Vanguard’s key service is the hire of mobile operating theatres, dedicated mobile endoscopy units, wards, and clinics to public and private hospitals. The company’s latest accounts show a £576,000 profit on sales of £11.3m in 2013, a rise of more than 10 per cent. Its 57 staff – 35 technical and 22 administrative – earned an average of almost £53,000.

 

Vanguard Executive Chairman and co-founder Andrew Allen, a chartered accountant, spent the past 20 years as owner/manager of healthcare businesses. According to Vanguard’s website “three of these businesses were backed by private equity, and realised returns upon exit well in excess of 30 per cent p.a. for investors”.

Neil Harris

(a don’t stop till you drop production)

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Waiting at the gate.

This is taken from ‘The Independent’ newspaper, based on labour party research.

Accident and Emergency departments have national guidelines limiting the time taken for patients to be admitted or discharged. They use many ruses to reduce this time; one of which is keeping patients waiting in ambulances outside.

So the clock doesn’t start ticking……

Hundreds of thousands of sick patients have been forced to wait in ambulances outside emergency units - some stranded for up to eight hours - according to new figures, because hospitals have been left "full to bursting".

Data obtained by the Labour Party show that patients are being cared for in vehicles outside A&E units for hours at a time, as “handover delays” continue to affect people up and down the country.

The new statistics, obtained through Freedom of Information requests, show that 280,000 patients suffered “handover delays” of at least 30 minutes during 2013/14, which includes 30,000 people who were forced to wait for an hour or more.

Information highlighting three areas where people were worst affected showed that patients had waited up to eight hours and 11 minutes in West Midlands to get to the emergency units.

Delays in other parts of the country showed people stranded in ambulances for seven and a half hours, while waits in London were over six hours.

 

 NHS England says ambulances could become 'more of a mobile treatment service'  Labour shadow health minister Jamie Reed told the Telegraph the figures show that under David Cameron, hospitals have become “full to bursting,” making ambulances queue at the doors for hours on end.

 

“Thousands of vulnerable people, many of them elderly and frightened, are being wrongly held in the backs of ambulances because hospitals don't have the space,” he said.

 

The figures show an 87 per cent rise in the number of people forced to wait over 30 minutes since 2010/11, and a 50 per cent rise in people waiting over an hour.

 

But the NHS England has countered the figures with its own data, claiming that the number of ambulance handover delays for the winter of 2013/14 were down on the previous year by 30 per cent. However, the data only covers the winter period.

 

An NHS England spokesperson said: “We know that demands on ambulances are rising every year, and we’re allocating a further £28 million to ambulance providers to help them deal with these pressures.

 

“However in some cases it may be the right thing to do for a patient to be cared for in the ambulance before transfer to stabilise their condition.”

NHS guidelines state that new arrivals to A&E should enter hospitals within 15 minutes, but NHS England said one of the aims of its Urgent and Emergency Care Review is to “capitalise on the skills and abilities of paramedics and the wider workforce so that ambulances can become more of a mobile treatment service, rather than just a transport service.”

Eh, no, I don’t think so – ambulances are only that; transport. It’s different to have paramedics doing triage but when the ambulance is at the hospital the patient needs to be seen by a doctor as soon as possible.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

contact me: neilwithpromisestokeep@gmail.com
amb

 

The best health provider in the world - the NHS.

I’ve been very critical of the NHS where it fails us, but on this Blog and on;

helpmesortoutstpeters.blogspot.com

I’ve always made it clear that the NHS is the best and fairest health provider in the world. It’s nice to have some independent confirmation in this Daily Telegraph article which is actually based on a Guardian Article;

Keith Perry 17 Jun 2014

The National Health Service has been praised as the world's best health-care system by an international panel of experts who said it was superior to those found in countries which spend far more on health.

 

 

The study, entitled “Mirror, Mirror on the Wall,” also described US healthcare provision as the worst globally. Despite investing the most money in health, the US refuses care to many patients without health insurance and is also the worst at saving the lives of people who fall ill, it found.

 

 

The Commonwealth Fund, a Washington-based foundation produced the report. The fund is respected around the world for its analysis of the performance of different countries' health systems. It examined 11 countries, including detailed data from patients, doctors and the World Health Organisation, the Guardian reported.

 

 

"The United Kingdom ranks first overall, scoring highest on quality, access and efficiency," the fund's researchers conclude in their 30-page report. Their findings amount to a huge endorsement of the health service, especially as it spends the second-lowest amount on healthcare among the 11 – just £2,008 per head, less than half the £5,017 in the US. Only New Zealand, with £1,876, spent less.

 

 

In the Commonwealth Fund study, the UK came first out of the 11 countries in eight of the 11 measures of care the authors looked at. It came top on measures including providing effective care, safe care, co-ordinated care and patient-centred care. The fund also rated the NHS as the best for giving access to care and for efficient use of resources.

 

The only serious criticism of the NHS was its poor record on keeping people alive. On a composite "healthy lives" score, which includes deaths among infants and patients who would have survived had they received timely and effective healthcare, the UK came 10th. The authors say that the healthcare system cannot be solely blamed for this issue, which is strongly influenced by social and economic factors. Although the NHS came third overall for the timeliness of care, its "short waiting times" were praised. "There is a frequent misperception that trade-offs between universal coverage and timely access to specialised services are inevitable. However, the Netherlands, UK and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to speciality services,", the report added.

 

The NHS also outperforms the other countries – which include France, Germany and Canada – in managing the care of people who are chronically ill, the report said.

 

Dr Mark Porter, leader of the doctors' union, the British Medical Association, told the Guardian the fund's findings were "clear evidence that our much-maligned NHS is one of the top-performing healthcare systems in the world.

 

"We should not be complacent as we are facing pressures that are threatening the high-quality care that the Commonwealth Fund has rightly praised. A combination of rising patient demand, staff shortages and falling funding is undermining the very foundations of the NHS, as is the constant short-term interference from politicians of all colours."

 

Dr Peter Carter, chief executive of the Royal College of Nursing, said: "I'm absolutely thrilled to see this because it reinforces that this is a very good NHS, despite the fact that it has such a low level of funding relative to other countries."

 

Jeremy Hunt, the Health Secretary, who has been criticised by some senior doctors for painting an unfairly negative picture of NHS staff and the quality of care provided, welcomed the report. "NHS staff work incredibly hard to care for patients and these encouraging results pay testament to that," he said.

 

Neil Harris

(a don’t stop till you drop production)

Home:  helpmesortoutthenhs.blogspot.com
Contact me:   neilwithpromisestokeep@gmail.com

What we really think about the NHS.

NSee?

It’s easy………when you know what you are doing!

You would think that everyone agreed with the Government and the managers of the NHS.

Static budgets at a time of high inflation means real cuts to the NHS.

At the same time the cost of care for the elderly and the cost of new drugs soars.

That means real cuts in services.

That’s what we all want, isn’t it?

Eh no, here’s a Guardian report on an IPSOS/MORI opinion poll in May 2014 which shows what we all feel about the NHS and it’s future;

 

 

Denis Campbell, health correspondent

 

   

The Guardian, Thursday 8 May 2014 20.43 BST     

 

 

Four out of five people in Britain believe the NHS should be protected from government spending cuts, according to a survey which reaffirmed the high level of affection in which the service is held.

 

Asked which two or three areas of public spending should be exempt from more austerity, respondents identified the NHS and healthcare (79%), schools (51%), care for the elderly (51%), the police (39%) and social services (21%).

 

Some 49% agreed that the NHS should be given more money "so that it can continue to provide services in the same way it does at the moment", while only 7% backed further rationing of care, in research undertaken by Ipsos MORI. Asked to name the biggest problem facing the NHS, 38% said lack of resources, 27% identified understaffing and 24% mentioned long waiting times.

 

Despite a series of care scandals such as Mid Staffs, Morecambe Bay and Winterbourne View, the NHS remains the thing that makes most people proud to be British. In all 52% identified the NHS as that institution, more than the armed forces (47%), royal family (33%), Team GB (26%) and the BBC (22%). That 52% is 7% up on 2012, when Ipsos MORI last asked that question.

 

But concern about the NHS's future is rising. One in four (24%) said it was one of the most important issues facing the country, a higher figure than in 2012.

 

Some 67% rated the quality of their healthcare as good, with another 17% describing it as very good. But 73% believe that the problems uncovered at Stafford Hospital, scene of the service's biggest scandal in years, exist in some, most or all other hospitals.

 

Britons are also among the most negative internationally about how sustainable their health services are, given the NHS is facing rising demand and further years of tight budgets. In the survey of public opinion in 20 countries only 9% said they expected the quality of healthcare on offer to improve, while in the UK 43% said "get worse".

So now we know how everybody feels about the NHS, we need to make our voice heard.

 

Neil Harris

(a don’t stop till you drop production) 

Home:  helpmesortoutthenhs.blogspot.com

Contact: neilwithpromisestokeep@gmail.com