Archive for November, 2009

GPs have been hoist by their own petard over pay

By Mike Broad - 30th November 2009 11:30 am

I’ve always liked the phrase ‘hoist by one’s own petard’. Petards were an early bomb, used from around the sixteenth century to blow breaches in gates or walls. And, as you’ll know, it means to be injured by a device you’ve set up that was intended to injure others.

I can’t help but feel it’s applicable to the following story. You might remember earlier this year the Daily Mail going to town on GP salaries. After a series of freedom of information requests it suggested that some GPs were earning huge salaries (up to £380,000 per year) and were being incredibly well paid for providing out-of-hours services (up to £200 per hour).

Surely this couldn’t be true, many of us thought. Someone must defend our maligned GPs and prove to the public what a load of rubbish this is! Up stepped the BMA, and trundled out a complaint to the Press Complaints Commission. Phew…

The complaint, from Dr Laurence Buckman and Dr Nicholas Down, that the article on GPs’ incomes was inaccurate and misleading has just been resolved. The newspaper published an agreed letter from the complainants, the text of which was as follows:

“Your article (4 August) stated that GPs were ‘earning up to £380,000 a year’ and added that they are earning £200 an hour for work ‘they used to do for free’.

“While there is a single GP in North East Essex with a pensionable income amounting to this figure, this is an extreme case and the vast majority of GPs do not earn anywhere near this figure.

“In addition, GPs used to be paid night visit fees under the terms of the Old Contract so these services were never provided for free. That system left many GPs exhausted because they would be seeing patients literally day and night. Under the new contract many GPs do shifts for so-called ‘out-of-hours’ organisations which means they can plan their working hours so that patients aren’t being treated by dangerously over-tired doctors.”

Oh dear. Is it me, or does the letter feel more damning than the original story? So, A. there clearly is a GP earning £380k (380,000 ENGLISH POUNDS!) and B. rates clearly do range up to £200 per hour for out-of-hours work.

I’ve said this before, but I’ll say it again: those BMA negotiators on the GP contract were good! But the petard was always going to explode early…

At least the Daily Mail has moved on to some more palatable public sector stooges - for now.  

Demand increases for medical school in 2010

By Mike Broad - 9:44 am

More students than ever want to study medicine in the UK next year, figures released by UCAS, the universities admissions service, suggest.

Over 21,300 people had applied by the October deadline, with numbers being boosted by a significant increase in applications from overseas.

There’s an increasing trend - 11.6% in 2010 - of people generally applying for higher education. The increase in UK applicants to medical school was lower than this at 10.9%.

Applications from overseas, however, eclipsed these figures. There was a 35.3% increase to 2,148 applications from people in EU countries (40.8% growth among European women wanting to do medicine in the UK). And a sizable 18.4% increase from non-EU countries.

UCAS acting chief executive Virginia Isaac said: “Medicine, dentistry and veterinary medicine and science as well as places at Oxford and Cambridge are very competitive and this year is no different.

“Applicants to medicine are up 13.7 per cent with those from women, particularly from overseas and other EU countries, continuing to outstrip men.”

Meanwhile, the UK Foundation Programme Office has reported that all final year medical students are to be allocated a two year foundation programme.

They said there was a very close match between the number of eligible applications and the number of vacancies.

Twelve hospital trusts “underperforming”, report says

BBC Health - 29th November 2009 2:40 pm

Twelve NHS hospital trusts in England are “significantly underperforming”, a report says, despite eight recently having been rated as good or excellent.

The report by monitoring body Dr Foster also said 27 trusts had unusually high death rates.

But the Care Quality Commission, which has issued its official ratings within the past month, said it saw no need to step in at the moment.

The part-private, part-NHS Dr Foster Hospital Guide rates hospital trusts from one to five based on analysis of a range of “safety indicators”, including errors in surgery, deaths, infection rates and staffing levels.

In this year’s report 12 received the lowest score.

They include University Hospitals Coventry and Warwickshire; Weston Area Health Trust; South London Healthcare Trust; Tameside Hospital Foundation Trust; University Hospital of South Manchester and St Helens and Knowsley Hospitals Trust.

Mid Yorkshire Hospitals Trust; Blackpool, Fylde and Wyre Hospitals Foundation Trust; and Hereford Hospitals Trust are also among the 12, which are completed by Basildon and Thurrock; Lewisham; and Scarborough and North East Yorkshire.

Of these St Helens and Knowsley was rated excellent by the CQC and three others - Mid Yorkshire, Weston Area and Scarborough and North East Yorkshire - were rated fair, with seven of the remainder achieving good ratings.

Read more at BBC Health.

Monitor sacks another foundation trust chairman

The Telegraph - 27th November 2009 6:25 pm

The chairman of Colchester Hospital University NHS Foundation Trust has been removed from his post over a series of failings, regulator Monitor has announced.

Richard Bourne was reappointed as chairman of the Trust in September, after chairing it for four years.

But Monitor has used its regulatory powers to force him to step down over concerns about patient safety, leadership and waiting times.

A statement from Monitor said: ”Regulatory action has been prompted by the trust’s failure to comply with healthcare standards, its failure to exercise its functions effectively, efficiently and economically, and serious and wide-ranging concerns as to overall governance and leadership at the trust.”

The news comes after Monitor intervened at another foundation trust, Basildon and Thurrock University Hospitals NHS Foundation Trust, after a damning report found poor hygiene and standards of care.

The foundation trust status is a supposed marker of excellence and allows NHS organisations greater financial freedom and control over their own affairs.

Bourne’s removal came as the head of the healthcare watchdog said the system of rating the NHS should be scrapped in the wake of revelations about hundreds of avoidable deaths at one hospital.

Baroness Young said that the current inspection regime which rates hospitals from “excellent” to “poor” was simplistic and should be replaced by a “much more sophisticated” process.

Read more at The Telegraph.

 

The challenges for Iraqi doctors in working abroad

By Shatha Al Juburi - 6:12 pm

Figures suggest the number of Iraqi doctors in Britain has exceeded 5,000, with more than 3,800 living in London alone. They can count former minister Lord Ara Darzi, whose real name is Ara wartikis Tarizian, among their number. He was born in Baghdad in 1966, eventually moving to Britain from Ireland.

Some Iraqi doctors fled Iraq under Saddam’s regime, and a large number have come to Britain after becoming the targets of criminal gangs in the aftermath of the 2003 invasion. According to reports from the Iraqi Physicians Union, more than 500 of Iraq’s leading medical professionals have been assassinated and over 7,000 have been forced to leave the country after receiving death threats.

Poor equipment and a shortage of medicines, together with a lack of text books, make life difficult for the doctors, who are desperate for change. Iraqi doctors had expected life to improve after the fall of Saddam’s regime but, unfortunately, they were disappointed. In Iraq, lives have been lost on a daily basis because of a lack of basic medicines and equipment.

London has always been a centre of enlightenment for Iraqi doctors. Recently, a group of Iraqi doctors visited London under a two-year training programme offered by the government. They are of different specialties, including orthopaedics surgery, paediatric surgery, cardiology, vascular surgery, maxillofacial surgery and emergency medicine, among others. According to the GMC, more than 1,900 Iraqi-trained doctors are registered in Britain.

Nonetheless, a large number of Iraqi doctors - estimated to be approximately 250 - arrived in Britain as refugees and have faced challenges in passing language and training tests. Many are stuck on benefits, despite possessing skills that the NHS urgently needs.

Following the terrorist attack on Glasgow airport and the failed attempt on a central London nightclub, in June 2007, concerns have been raised about muslim doctors working in Britain, particularly Iraqis, because the prime suspect was an Iraqi doctor. Bilal Talal Abdullah, who was convicted of conspiracy to murder in connection with the two attacks, was born in Buckinghamshire, where his father, also a doctor, worked. He qualified in Baghdad in 2004 and was first registered as a doctor in Britain in 2006. His motive has been reported as to avenge the destruction of Iraq during the 2003 US and British invasion.

In December 2008, Abdullah was sentenced to life imprisonment. Dr Adel Mohsen, inspector-general of the Iraqi Ministry of Health, condemned the attempted attacks at the time, rejecting any notion that Bilal Talal Abdullah was representative of Iraqi doctors living abroad.

In an interview with Radio Sawa, Mohsen said: “We condemn these barbaric acts; this doctor does not represent Iraqi doctors. There are more than 3,000 Iraqi doctors living in Britain, most of them have children born there. They practise their profession in the areas where they live.” He pointed out that the Iraqi Ministry of Health “does not have any relationship with this doctor. We do not know him. He must be one of the new doctors as he is not known in our medical community. All we know about him is that he migrated to Britain seven years ago to demand political asylum.”

At the time, Iraqi doctors working in Britain expressed anger that a fellow doctor was involved in the London and Glasgow bombing plots. They feared that the two attacks could generate a backlash and harm their reputation.

Faris, an Iraqi doctor whom I first met in Iraq in 2006, moved to Britain two years ago and is now working in London and studying at University College London. He belongs to a Sunni Arab tribe originating in Mosul, Ninewa province, in the north of Iraq. His family has a good reputation and all its members pursued higher education.

Faris used to have a private clinic in Baghdad and was working at Al-Kazimiya hospital, north of the capital. During the first days of the US-led invasion in 2003, Fariswitnessed the looting of his hospital by mobs and thieves. The Shiite Mahdi Army militia of the radical cleric Moqtada al-Sadr took control of the hospital and threatened Faristo leave the hospital for being a Sunni. At first, he was defiant and continued to work there, but after the militia tried to assassinate him twice, he eventually fled the country to save his life.

The revelation that the prime suspect behind the Glasgow and London bomb plots was an Iraqi doctor affected him deeply. “I am very upset and disgusted,” he said at the time. “This is the sense of all Iraqi doctors I know in Britain. These perpetrator doctors were supposed to treat patients and help people - not kill them. The fact that the prime suspect is an Iraqi doctor makes me very angry.

“We Iraqi doctors who fled the country after the invasion have already suffered a lot in our country, lived with threats and spent much of our time dealing with the victims of bombs. We want to live in peace here in Britain, but now we are concerned that the terrorist attacks of Glasgow and London will harm our reputation.”

Would he return to Iraq after the Iraqi government passed a law allowing doctors to carry arms for self-defence? He said he would not go back to Iraq because guns could not protect him from militias and criminal gangs who had killed hundreds of doctors and had not been brought to justice.

Ahmad is another Iraqi doctor working at a hospital in Liverpool. He left Iraq to escape the injustice of the former Iraqi regime. Commenting on the failed attacks and their implications for the situation of Iraqi doctors in Britain, Ahmad said that the attacks will damage the image of Iraqi doctors who came to Britain because they were victims of injustice under the former Iraqi regime and, more recently, to escape the violence after the invasion of Iraq in 2003. “I still do not understand how could doctors, who were supposed to save people and to not let them down, can do such shameful and criminal acts,” said Ahmad. “The involvement of the UK in the war on Iraq does not justify terrorism and indiscriminate killing of innocent people. These terrorists have betrayed their oath to help people in need. They brought shame on their community and Islam. I do not blame people here if they treat us differently or if the police come to ask us questions. But I really hope they realise that Bilal Abdullah does not represent Iraqi doctors in Britain.”

Many Iraqi doctors living in the UK feel guilty for enjoying the good lives of NHS doctors while their fellow doctors back home are being threatened and are contending with severe shortages of medicine and medical equipment in a country with overflowing casualties on daily basis. Some hope that the security situation in Iraq will improve so that they can be repatriated, while others say they may never return and instead seek asylum.

This article was originally published in the independent online magazine www.opendemocracy.net

Basildon is more pressing than climate change

By Mike Broad - 4:24 pm

A long time ago, I studied a bit of meteorology. My abiding memories are not about occluded fronts and cumulonimbus clouds, but a general wonder at the complexity of the discipline. 

Every prevailing weather system is the product of an incredible range of influences from solar cycles and jet streams to ocean currents and the shape of land masses.

There aren’t many things more complicated than a human body, but the weather is probably one of them.

So, to suggest we now understand the weather - for all our sophistication in modelling - is frankly ridiculous. The climate is changing. Human activity probably does have something to do with it. It’s probably worth lowering our carbon emissions, even if in the fullness of time it proves to be less significant than most currently believe. As far as I’m concerned, for the non-expert, that’s about as definitive as you can be.

So, why on earth are doctors’ representatives banging on about it? Doctors from “around the world” have launched the International Health and Climate Council to pressure governments into action over climate change. And The Lancet has backed it up with some articles on the health consequences.

Of course, we should all do our bit to reduce our carbon footprint (and I like to think I do more than most). But, is President Obama’s thinking at the upcoming Copenhagen Summit on Climate Change really going to be influenced by a bunch of doctors and their trade mags offering up sound bites on issues that are far removed from their areas of expertise?

I somehow doubt it. And yet this week they’ve taken the opportunity to pump more hot air into the atmosphere about the health consequences. 

It’s funny, but I didn’t hear many of them talking about the real health stories this week at Basildon and Thurrock NHS Trust and Colchester Hospital - not in public anyway. 

We’ve got a real crisis on our hands and there’s no nice PR opportunity in it. Standards faltered at Basildon and Colchester, as they did at Mid Staffs, despite a supposedly tight regulatory system. The consequences were severe.

A report by Dr Foster Intelligence rated a dozen hospitals as “significantly underperforming”, despite nine of them being rated good or excellent by official regulator the Care Quality Commission.

Seven hospitals were also found to have considerably higher mortality rates for the past five years.

It raises difficult questions: how do we really tell if a unit is good? Do our current targets subvert clinical priorities? How do we provide a more quality-focused regulatory system that supports learning and development?

These are the issues doctors’ leaders should be debating, not Brazilian rainforests or polar bears. While there are people better qualified for this, few are in a better position to help improve standards in our hospitals.

Doctors start to campaign on climate change

By Mike Broad - 12:20 pm

Senior doctors from around the world have come together to form a new council which will campaign for climate change - and its effects on health - to be tackled.

The International Climate and Health Council is calling for urgent government-led international action to reduce carbon emissions and promote the universal adoption of low carbon sustainable lifestyles.

Founding members include Professor Ian Gilmore, president of the Royal College of Physicians, Sir Muir Gray, director of the Campaign for Greener Health Care, Dr Hamish Meldrum, chairman of council at the British Medical Association, and the editors of the BMJ and The Lancet.

Together with colleagues from Australia, Africa, Asia, Europe and the Americas, they believe the UN’s forthcoming Copenhagen Summit on Climate Change represents a significant opportunity to take steps to avoid a global health catastrophe.

Climate change is already causing major health problems,” said Professor Mike Gill and Dr Robin Stott, co-chairs of the UK Climate and Health Council. “This is the first step towards a global network of health professionals which by speaking out has the potential to protect and improve the health of people in both rich and poor worlds.

“The public places trust in health professionals, and will listen to those who play their part in protecting human health from climate change. This is why health professionals must put their case forcefully now and after Copenhagen. We must give the world’s politicians and policy makers no room for doubt on what action they need to take.”

It coincides with the launch of a series of articles in The Lancet that explore how climate change, and policies to mitigate its effects, will affect the health and lives of populations around the world. 

Professor Vivienne Nathanson, head of science and ethics at the BMA, said: “Climate change not only contributes to disease and premature death but exacerbates existing health inequalities in the UK and globally. Today’s research shows that a reduction in emissions will have a positive effect on health in both high and low-income settings, and that lifestyle changes made by all us will have direct health benefits.

“The BMA is disappointed that, so far, health has not figured significantly on the agenda for the Copenhagen summit. We call on world leaders to move towards solutions that benefit both the environment and individuals.”

Essex hospital failings prompt calls for reform

BBC Health - 8:27 am

Calls are mounting for urgent reform to the way hospitals are regulated after a report found a catalogue of failings at two hospitals in Essex.

The independent regulator highlighted an unusually high death rate and poor hygiene, including blood-spattered kit.

Basildon and Thurrock NHS trust said concerns were not indicative of wider problems, but a taskforce has been sent in to force through improvements.

Most inpatient care is provided at Basildon University Hospital, which has 777 beds, and outpatient care at Orsett hospital in Grays.

The Care Quality Commission (CQC) rated the trust as “good” overall in October. But a new report from an unannounced inspection team carried out by the CQC found evidence of sub-standard care.

The inspectors reported: floors and curtains stained with blood; badly soiled mattresses in the A&E department with stains soaked through to the foam filling; blood-splattered on trays used to carry equipment; items that should only be used once still in use; and, equipment in the resuscitation room that was past the use-by date.

The inspectors criticised a poor care environment in A&E, in particular a lack of privacy for patients. They also highlighted inadequate arrangements to treat children, with few specialist paediatric staff.

The CQC has asked the regulator of foundation trusts, Monitor, to take action.

An expert taskforce will be sent into the trust with a remit to drive rapid improvements in patient care.

Read more at BBC Health.  

Experts slam plans for patients to buy homeopathy

Pulse - 26th November 2009 2:26 pm

Government plans for patients to have the freedom to buy homeopathy on the NHS as part of its personal budgets scheme have come under fire.

The plans include cash for patients to buy ‘non-traditional’ treatments, such as homeopathy, but have been attacked as “ill-conceived” by academics and top NHS managers.

The comments came during an evidence session of the House of Commons Science and Technology meeting which is looking at the use of homeopathy on the NHS.

Answering a question on whether homeopathy should be included as an option in the personal budget pilots, Dr James Thallon, medical director of NHS West Kent, said the plans could lead to NHS money being used for “ineffective” treatments.

There are issues about whether or not they should be able to choose a treatment without any evidence of benefit and that happens when that treatment doesn’t work and the patient has to then have treatment on the NHS,” he said.

Also speaking at the session, Professor Edzard Ernst, professor of complementary medicine at Peninsula Medical School in Exeter, said it was an “ill-conceived notion” that patient choice had to dominate in healthcare.

“If the NHS commitment to evidence-based medicine is not to be anything more than lip-service, then money has to be spent on something else.

“I would argue that it is unnecessary, unreliable and unethical for homeopathy to be available on the NHS,” he said.

Read more at Pulse.

Cardiologist will fight libel case to defend free speech

The Times - 10:35 am

A consultant who is being sued for libel after criticising an American company’s research has pledged to turn the action into a test case for freedom of speech.

Dr Peter Wilmshurst, a consultant cardiologist at the Royal Shrewsbury Hospital, said he aims to use a public-interest defence to fight the claim from NMT Medical and establish the principle that scientists may engage freely in academic debate.

He said he was prepared to risk losing his home to take the case to trial because victory would set a precedent protecting other scientists from “legal bullying”.

Wilmshurst said: “I have got a responsibility to fight this. There is a fundamental principle of science at stake here. People have to be free to challenge research.”

There is growing concern about the use of England’s draconian libel laws to stifle expert scrutiny of scientific evidence. Simon Singh, the science writer, has been sued for libel by the British Chiropractic Association over an article in which he questioned the evidence that spinal manipulation could treat childhood conditions such as asthma and colic.

A petition to keep libel laws out of science has been signed by nearly 19,000 supporters, including Lord Rees of Ludlow, the president of the Royal Society; Sir Mark Walport, the director of the Wellcome Trust; and Sir David King, a former government chief scientist.

Jack Straw, the Justice Secretary, who spoke to Dr Wilmshurst last week, said that he was preparing reforms to the libel laws. “What concerns me is that the current arrangements are being used by big corporations to restrict fair comment, not always by journalists but also by academics,” he said.

Wilmshurt’s case began with his involvement in a study of a medical device made by NMT called Starflex, designed to close a type of hole in the heart known as a patent foramen ovale (PFO). The study investigated Starflex as a potential treatment for migraine, which is significantly more common among people with a PFO, but failed to find benefits.

At a cardiology conference in Washington in 2007, Dr Wilmshurst criticised NMT in relation to the research. His comments were reported by Heartwire, a website, prompting NMT to sue him.

Read more at The Times.