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Dear NHS England and Mr Jeremy Hunt ,

We are assailed every few days by prescriptions from Mr Hunt.  There must be many professionals or retired ones who know the facts or analysis are faulty.

I served in OUR NHS as a doctor and orthopaedic/trauma surgeon for 40 years.  My interest in the service is as vital now as it was say 30 years ago.

Of many efforts to improve the standards of care at Torbay Hospital, I recall writing in the early 80s about the staffing of the ladies' fracture ward – Ainslie, at night.  There used to be 2 staff nurses - ie SRNs.  There were 25 patients (always 'full up'), many were bed bound and a few would be demented to varying degree.  I pleaded for more nurses.  An enrolled nurse (SEN) would have been a distinct help.  The excellent staff nurses could not take a meal break.  Nothing happened except that the care of some patients would have been second rate.

I also wrote about the poor nutrition of our elderly lady patients.  When they were admitted with their fractures, they were often in negative calorie and nitrogen balance.  (Eyes sunk into the orbits and masseter muscles in the temples wasted.)  I knew that some were discharged in a worse state.  The reasons were multiple but staffing levels were central.  Some of the frail ladies needed help to eat their lunch.  That was usually down to sister and an enrolled nurse, whilst the SRNs had theirs.  Smart women in smart navy blue suits would come round with the menu options for the days following.  But some patients would not even know what month it was.  I pleaded that at least the navy blue women should assist feeding.  Nothing happened.

My sister has recently undergone an incomplete excision of a thyroid cancer.  It has been followed by radiotherapy giving rise to serious complications.  She comments - ' One night there was one staff nurse and two health care assistants for the 19 surgical ENT beds including the two mouth flap patients who needed a lot of attention.'  I saw how busy the ward was, and how there were 'overflows' from other specialisms - one being diabetes with dementia, and another with likely cured ascending cholangiitis.  At home she is on a 'virtual ward' run by Mr Branson.  The 'community matron' could offer leaflets and platitudes but no care.  More illusion.

Here are a few 'mistakes' at Musgrave Park Hospital, Taunton. The facts are obscure but the amount of damages will be large.

But the most telling example of the lack of provision of staffing and beds, as well as the diffusion of responsibility and its total abrogation, is the tragic death of George Werb in East Devon and under a train.  This lad had persistent depression having been a very bright and ebullient child before

I inquired as to which authorities might be responsible and gleaned these from internet source:

The 'Devon Partnership Trust' (Mental Health Trust) is the provider of services Devon County Council and the NHS (CCG) in Devon are joint commissioners.

The Care Quality Commission checks on/inspects and reports its findings about the services delivered/provided and identifies failings.

There was an inspection of the DPT in February with a report and a follow-up report in July - website.

There is also the 'Health and Wellbeing Scrutiny Committee' of Devon County Council. The Chairman is Cllr. Richard Westlake.

I intend to ask him/his committee how they have overseen/scrutinized the Devon Partnership Trust's work  and if/when they knew about poor services and lack of beds etc. in Devon for Devon's young people with mental illness.

There is a department within the CCG and the DCC who are 'contract monitoring' the services provided by those organisations contracted to provide the services.

The joint Commissioners for Mental Health Services ?including children, are Mr. Gavin Thistlethwaite and Mrs. Jennie Stevens  Head of Social Services.

It could be that the responsible body for Children's Services  (CAMS) comes under 'Ofsted' but it  might now be contracted out to Virgin Healthcare.

I understand that Devon failed the inspection of their CAMS service and they were put under special measures

This confirms my use of the nouns - diffusion and abrogation.
One most outrageous fact that emerges, among many, is that the 'case review' is to be carried out by the Priory Group.  This is owned by a US based investment group, Advent International - assets $25 billion.  It also owns Poundland among many other revenue streams. A nightmare is presented to the people.

Finally, I read the account in the Times by Chris Smyth, Rachel Sylvester and Alice Thomson headed 'NHS reforms our worst mistake, Tories admit.'

"The prime minister and the chancellor both failed to realise the explosive nature of plans drawn up by Andrew Lansley, when he was the health secretary **, which one insider described as unintelligible gobbledygook."

The insider is not alone in thinking that.

Aside from being a sound reason for resignation, these few samples above are reason for silence from Mr Hunt and the need for him to heed the reports and to listen to the people in the service who want to do their best.  Urgent, wise action is required all round, otherwise there will be many more George Werbs.

For truth, reason and justice

Yours sincerely

David Halpin MB BS FRCS

** Drawn up well before the election and instituted in spite of Mr Cameron's assurance that there would be no 'top down re-organisation' of OUR NHS. 

Dear Mr Halpin,

Thank you for your recent emails to NHS England.

The role of NHS England is to oversee the budget, planning, delivery and day-to-day operation of the commissioning side of primary care services for the NHS in England as set out in the Health and Social Care Act 2012. This includes commissioning services such as GPs, dentists and Pharmacists. Your comments regarding staffing levels for nurses and the organisations you refer to in the case of George Werb are separate to NHS England and therefore we cannot comment. If you have specific issues regarding primary care services that you would like to bring to our attention, please contact NHS England again This email address is being protected from spambots. You need JavaScript enabled to view it..

Yours sincerely,

Anne-Marie Carr

Case Officer

Customer Contact Centre

NHS England

5W51|Quarry House | Quarry Hill | Leeds | LS2 7UE

‘High quality care for all, now and for future generations’

Dear Ms Carr,

I consider your reply, to a doctor and surgeon who served OUR NHS well for 40 years, to be both rude and oblique.

I realize that you take orders.  The nature of your response reflects the arrogance of the people above you.  There is not much listening but a surfeit of rapid actions without prior pilot studies. 

(There is nothing new in this.  I recall the Resource Management Initiative in Mrs Thatcher's time.  Pilot studies in about 8 hospitals.  'Rolled out' to all DGHs before the results were analysed.  Found to have saved little or nothing'.)

Last night, on BBC ''News'' at 10, there was a segment about urgent care in the home in order to keep people out of A&E and the DGH.  A very old and extremely frail lady had cut her head.  A 'paramedic' and nurse attended.  The footage might have been chosen by the D of H.  It showed a crass and dangerous arrangement.  They walked away from her home, with a strong impression given to the public that cleansing of the wound and application of 'butterflies' was her central need.  The lady was grossly malnourished.  As a surgeon who looked after many elderly people with fractures, I must tell you that the cause of the fall needs to be established whenever possible.  And I alluded in the attached letter to the malnutrition I saw and my inability to right it - although I was the responsible consultant and Sister Lees was the responsible nurse.  And in such people with likely cerebral shrinking, occipital sub-durals are a small but real risk.  This becomes obvious over weeks.  But Mr Hunt will not know about this.  What was shown had nothing to do with 'CARE in the home'.  I will write this up for the Lancet.

We presume her GP played no part in her care, and neither did the district nurse, social worker nor health visitor.**  Yet they are the professionals who are responsible and they are at the nub of good care.

I speak of this case, projected to millions, to show the shallowness, the ignorance and the arbitrary nature of the high speed, staccato diktats spewing out of NHS England.

You are but a small cog within the machine I am addressing.  What I have said in my attached letter, and here, must be seen by a senior officer.  There are legal implications in this but humanity must be served as well.

I have been speaking against unhelpful change in OUR NHS since c. 1988 - The Internal Market >>  I write in newspapers and speak publicly.  I say that the strategy behind the H&SC Act is               destabilise > demoralise > dismantle.  The nature of your reply underlines this strategy in the smallest way.

I will wait for a reply from a senior officer.  He/she should focus on the negligent and uncaring treatment of the late George Werb, which will be judged by a private 'contractor'.  Meanwhile, I will have the correspondence posted on my web site.

For truth  

yours sincerely

David Halpin MB BS FRCS

** We lack thousands of district nurses and health visitors.  Last December, I learned from a young colleague on the CCG here in Devon that 22% of GP posts were unfilled in the SW.  When I was in post, 2% would have high.  And you know that GPs are retiring in droves before their time.  It will soon be Mr Hunt driving the ambulance car, and Sir Bruce Keogh applying the sticking plaster.