2009 December » Hospital Dr

Archive for December, 2009

Foxed by a surge in injuries to elderly ladies

By Katherine Teale - 31st December 2009 10:46 am

My sister-in-law is wearing a dead fox on her head. It’s Boxing Day and, despite ten years of Christmases at the in-laws, I have forgotten to give the local town a wide birth and am confronted by the Hunt.

Unfortunately in my anxiety to buy the last remaining copy of The Guardian in Yorkshire, I forgot that the whole place would be swarming with red coats, including most of my husband’s family. On closer inspection, I discover that what appears to be just a dead fox is in fact a dead fox fashioned into a hat, but retaining all the bits, such as paws, eyes and teeth.

She has started a cottage industry making head gear out of fox pelts - an obvious niche in the market, if you want to make a statement with your hat. I’m sure Lord Sugar would approve, although I wonder how plentiful the supply of dead foxes is these days, what with hunting being illegal. My sister-in-law seems strangely coy on this subject…

Other than that, it’s been a good Christmas, enlivened of course by the snow. On Christmas day we took the kids sledging - it was the most fun I’ve had on Christmas day for many a long year. At least it was for my husband and me, the kids just whined because their feet were cold.

Of course their generation isn’t used to the cold and, sad to say, doesn’t really know how to enjoy itself unless there’s a screen involved. After two days breaking up squabbles over the Nintendo, I’m quite glad to be back at work.

Only a few years ago, hospitals used to wind down over Christmas and New Year. In fact, for two weeks hardly anything happened anywhere except for emergencies and repeats of Only Fools and Horses.

How things have changed - now Christmas is just a super-duper shopping opportunity, with half the country logging on to the sales at midnight on Christmas Eve instead of hanging up their stockings.

Now hospitals too are businesses and can’t afford to stop - we are supposed to work as normal, with elective lists planned up until 7pm on Christmas and New Year’s Eve.

In fact, Christmas is completely incompatible with the current business model. As it turns out, not all our patients are on-message with the new system (or perhaps they’re just anxious not to miss the sales) so we haven’t filled all our elective lists this week. This is just as well, as we have 12 elderly ladies waiting to get to theatre with fractured wrists.

I assume that they all slipped on the ice but I am wrong. One of them has another classic Christmas injury - she fell over her slippers. She had been given some of those novelty ones with big stuffed Scooby Doo’s on the front, and the next thing she knew, she was on the floor. We now have a small series of these and I’m composing a short publication.

I might have also identified another lucrative area for expansion of the family dead-fox business…

Posted in Katherine Teale | 3 Comments »

Writing blogs when wearing rubber pants

By Bob Bury - 30th December 2009 2:17 pm

Hello, it’s good to be here. No, really, it is. I was sorry to see the print edition of Hospital Doctor fold in 2007. It was the only topical and occasionally light-hearted magazine for hospital doctors (unless you count the BMJ, but I’m never sure if they mean to be funny).

GPs still had Pulse and GP, but us toilers at the secondary care coalface had nowhere to go for a bit of news, comment and light relief, so I was glad to see we have an online successor to the old redtop.

I was even happier when asked if I’d like to contribute. I’m now approaching the bottom of the inexorable downward spiral that ends in retirement, rubber pants and driving very slowly in the middle of the road, and I’m going to need something to keep me occupied when I finally stop working. It’s either this or start talking to the wife, and I fear that a sudden burst of conversation might be a bit of a shock for her after 37 years.

So, anyway, I had a look at the other contributors to this section to see what sort of stuff I was going to be expected to produce and, frankly, to assess the competition. You’ll have noticed that I’m a radiologist and, being perceptive people, you’ll also have noticed that at least one of the other bloggers is similarly afflicted: the one I’m thinking of is Sarah Burnett-Moore.

Now this gives me a bit of a problem - not the fact that she’s a radiologist - but the fact that she’s Sarah Burnett-Moore. I was hoping to adopt the role of class clown, but Sarah’s funnier than me (I was going to say even funnier than me, but I don’t want you to think I’m full of myself, not on the first date).

I know she’s funnier than me because she occasionally contributed to the RCR newsletter when I was editing it and it really used to irritate me. And there’s a witty anaesthetist to contend with as well, not to mention all the other erudite contributors. So, I might be reduced to casting around for a serious topic occasionally, but luckily there’s no shortage of those at the moment.

I should probably warn you that contributions in subsequent weeks are likely to contain more than their fair share of variations on a ‘things are not what they used to be’ theme. That’s because they’re not, and I’m old. Deal with it, as our American cousins say.

Sorry, that sounded a bit abrupt. I’m not like that…really, I’m not. As I hope you’ll find out, if I can think of anything to write about.

Posted in Bob Bury | 1 Comment »

Watch out all ‘data controllers’ - they’re after us

By Tom Goodfellow - 1:56 pm

Now that the “Bah, humbug!” season is over, there is no more pleasurable way to embrace the New Year than with a good rant.

Without claiming sainthood, by and large, I have been a good and upright human being over the last six decades. I have not committed adultery or coveted my neighbour’s ass, and I do try to honour the Sabbath Day (easier now that I have dropped off the on-call rota). I have managed to avoid difficult dealings with the GMC and have never yet troubled my defence body. I now have a licence to practice and my CRB status is unblemished.

So, how is it that last week I was confronted with an official letter stating that I was liable to prosecution and, if convicted, I could be fined up to £5,000 in the Magistrates’ Court or receive an unlimited fine in the Crown Court!

The reason is because I had failed to respond to an earlier letter informing me that, as a doctor who sees private patients, I was required to register under the Data Protection Act with the Information Commissioner’s Office (ICO). I was deemed by the Commissioner to be, de facto, a ‘Data Controller’ under the terms of the Act and that failure to register was a criminal offence. Ignorance was not an excuse!

I rarely go the Golden Nugget these days. Consequently the reason I did not receive the earlier letter is that it was addressed to the local BMI Hospital, which I had not visited for weeks. I asked the ICO why they had not written to me at my GMC-registered address and was told, rather lamely, that they had found my name on a website listing doctors who did private practice and they were picking us off one by one (my interpretation).

The annual registration fee is not huge, currently £35, but the whole episode still leaves me hopping mad. The only electronic patient data I ‘control’ is the reporting module on a PACS system, and I naively assumed that this would be covered by the registration of the hospital, NHS or otherwise.

Apparently not! So despite the fact that I remain completely unclear as to the purpose or benefits of registration I have bitten the bullet, retracted my testicles and paid up (also the wife was not too keen on marriage with a convicted criminal).

What will be the next assault? Since I work with children, it will be registration with the Independent Safeguarding Authority to prove that I am not and never have been a paedophile. I wonder how much that will cost me?

Tags: Data protection, ISA
Posted in Tom Goodfellow | 2 Comments »

Legal challenge over juniors’ employment rights

By Francesca Robinson - 1:24 pm

A legal challenge has been issued to the government over decisions it has made which deprive junior doctors of key labour protection rights.

Lawyers employed by the campaign group Remedy are questioning the propriety of a consultation carried out earlier this year on whether to exempt deaneries from employment agency legislation.

Remedy has opposed the move because it claims that it deprives juniors of key employment protection rights.

Abuses include failing to inform junior doctors seeking work through deaneries of which rotation jobs they will be assigned to when they apply; being forced to ’stick or twist’ on jobs; and not knowing where they will be two weeks before a job starts.

Remedy’s lawyers have sent a legal ‘letter before action’ to Lord Mandelson, the business secretary, in a bid to persuade him to withdraw his decision and to start the consultation process again.

They have highlighted the way the Department for BIS justified the exemption on “potential consequences” and “evidence” - the details of which were not revealed.

They argue that the consultation came to the conclusion that the only group who could be affected by the proposed changes to the law would be the deaneries themselves. They also point out that there was no consideration of the impact this action would have on the doctor.

Remedy’s head of policy Richard Marks said: “In the short term this legal action will delay any changes which will be to the benefit of those currently going through the system. But our long-term aim is to campaign for better and fairer controls of the ways that deaneries conduct recruitment.

“We want to see the levels of protection for doctors increased, not reduced. The distant promise of a code of conduct with very uncertain powers is simply not good enough.”

In return for exempting deaneries from employment legislation the Department for BIS has proposed establishing a code of conduct to govern future recruitment and training arrangements for junior doctors.

But Dr Shree Datta, chair of the BMA’s junior doctors’ committee said they were concerned about how much teeth the code would have and whether it would be enforceable.

“We will await with interest the progress that Remedy make on this issue. Meanwhile were are putting pressure on deaneries to make sure they are aware of the feeling among junior doctors on this issue,” she said.

A Department for Business spokesperson said: “I can confirm that we have received a letter from Remedy and are in the process of considering it.”

Read a blog on the issue.

Tags: Deaneries, Jobs, Recruitment
Posted in Hospital Dr News | 1 Comment »

GPs in drive to prevent 10,000 cancer deaths

The Guardian - 1:12 pm

GPs are to start predicting whether a patient has the early symptoms of cancer using a computer program that calculates risk, under plans to prevent the 10,000 unnecessary deaths a year caused by late diagnosis.

The new approach by the NHS means that doctors will tell patients their percentage chance of having cancer, based on factors like their age, weight and symptoms such as bleeding or sudden weight loss.

Professor Mike Richards, the government’s cancer tsar, said that within five years every GP in England should be using the software as part of a new drive to reduce the huge toll of avoidable cancer deaths.

Computer-assisted cancer risk assessment will help GPs estimate whether a patient’s symptoms could indicate the presence of a cancer and decide whether they needed to refer them for urgent tests in hospital, Richards said.

The computer would assess a patient’s age, weight and symptoms - such as rectal bleeding and constant fatigue - and if the risk were above a certain level, the person would be referred to hospital for urgent exploratory tests within two weeks.

Cancer is the UK’s biggest killer after heart disease and strokes. Britain is far worse than many European countries at diagnosing cancer early, when it is more likely to be treatable and the patient has a much better chance of surviving. That is partly because some patients who develop symptoms delay seeking help, but also because GPs sometimes fail to correctly identify signs of cancer.

Free prescription review “may run out of time”

Healthcare Republic - 29th December 2009 6:43 pm

Plans to scrap prescription charges for long-term conditions may fall by the wayside in the build-up to next year’s general election, an Asthma UK spokesman has warned.

Last year, Prime Minister Gordon Brown revealed that prescription charge exemptions were planned for patients with long-term conditions. The DoH asked Royal College of Physicians’ president Professor Ian Gilmore to lead a review into how exemptions could work. Professor Gilmore’s review has yet to be published, however.

Asthma UK is leading the Prescription Charges Coalition, a group of organisations campaigning for the government to abolish prescription charges for people with long-term conditions. The charity’s director of policy and public affairs, Mikis Euripides, said the government needs to publish Professor Gilmore’s review and details of its plans early in 2010 if the changes are to take place.

“The government will need to introduce legislation,” he said. “Assuming there is a May general election, it will need to do that by February because of the time it will take. We are concerned that if nothing happens, the government won’t have enough time.”

If the election were earlier than May, it would already be too late to put legislation through, he added.

Tories say hospitals are fiddling A&E waiting times

BBC Health - 23rd December 2009 10:46 pm

Hospitals are fiddling a four-hour A&E wait target by using other wards as dumping grounds, the Conservatives say.

Data from 114 NHS trusts in England found many patients faced long waits in assessment units which did not count towards the waiting time.

Over a fifth of units reported keeping patients longer than the recommended 24 hours with the average wait being 17.

Doctors agreed the system was being abused in places, but the government said the research was “misleading”.

The Conservatives asked hospitals to provide data on their use of these wards under the Freedom of Information Act.

Shadow health secretary Andrew Lansley said: “Labour complacently claim that they have abolished long waits for patients being admitted to hospitals, but these figures show that all they have really done is fiddle the figures.”

Doctors fear private sector’s role in the NHS

By Mike Broad - 10:20 am

Eight out of ten doctors are concerned about private companies profiting from the NHS, a poll shows.

Doctors were asked whether they agreed with the BMA’s concerns that large multinational companies are making profits out of running local clinical services on behalf of the NHS.

Eighty percent of the 697 respondents said they either strongly agreed (51%) or agreed (29%) with the statement. Just 7% either disagreed (4%) or strongly disagreed (3%).

One respondent, a consultant urologist, said: “The NHS no longer exists. There are a number of health services in England, Wales, Northern Ireland and Scotland, all different, no longer national in a UK sense. We are at a time when foundation trusts have become businesses, motivated by profit and loss.”

A BMA report, listing the amounts of public money being wasted as a result of market-driven reforms, estimates that £1.54bn might have been overpaid to Independent Sector Treatment Centres in England. It suggests the NHS in England spent around £350m on management consultants in the last financial year.

Dr Hamish Meldrum, chairman of BMA council, said: “This is more evidence of the medical profession’s concerns about commercial values being imposed on the NHS. There are countless examples of taxpayers’ money being wasted because of the drive for services to be provided by profit-making companies rather than traditional NHS providers.

“When politicians talk about cutting waste they should consider the fact that the bureaucratic costs of a market are hitting the taxpayer hard. We’d like to see the NHS in England restored to a publicly provided, publicly funded service, driven by the needs of patients, not shareholders.”

Forget mince pies, don’t mince (or mangle) your words

By Mike Broad - 22nd December 2009 10:18 pm

Ho, ho, ho. Tis the season of good will, and a chance to laugh at the NHS’ inability to express itself. I was dismayed to see health services featuring prominently in the Plain English Campaign’s Golden Bull Awards.

One patient explains: “I arrive at my GP, only to be told that I haven’t until I converse with a screen that invites me to ‘Touch the screen to arrive’. My electronic check-in is completed by touching a virtual button labelled ‘arrive me’.”

Oh dear, it seemed such a good idea at the partners’ meeting…

But the Department of Health tops it on their website with some wise words on prevention.

“Primary, secondary and tertiary prevention: primary prevention includes health promotion and requires action on the determinants of health to prevent disease occurring. It has been described as refocusing upstream to stop people falling in the waters of disease.”

But not even our health bureaucracy can compete with the King of Spin, Lord Mandelson, on MPs’ expenses. “Perhaps we need not more people looking round more corners but the same people looking round more corners more thoroughly to avoid the small things detracting from the big things the Prime Minister is getting right.”

Tags: Humour
Posted in Messy Business | No Comments »

New safeguarding quango can ban doctors

By Francesca Robinson - 21st December 2009 6:41 pm

The government’s new safeguarding authority - which will have the power to remove doctors from their jobs - is creating an unnecessary and “burdensome” layer of regulation, warns the BMA.

NHS jobs are now covered by the new Vetting and Barring Scheme (VBS) and all children and adults receiving any form of healthcare are categorised as “vulnerable”.

Launched in October, the scheme replaces existing arrangements for spotting potential abusers with much stricter controls for protecting vulnerable people.

The Independent Safeguarding Authority (ISA) which runs the scheme will be able to automatically bar doctors accused of the most serious offences without any right of appeal.

If the concerns are less serious the individual will have the right to make representations as to why the bar should be removed. They will also be able to appeal to an Upper Tribunal but only on the grounds that the ISA has made an error on a point of law or fact in making its decision.

The VBS is the government’s response to the Bichard Inquiry set up after the murders in Soham of Holly Wells and Jessica Chapman by Ian Huntley. It operates in England, Wales and Northern Ireland.

Employers face fines of up to £5,000 if they fail to refer to refer an employee whom they have concerns about.

Doctors must start registering with the VBS from July next year. There will be a one-off fee of £64 for the criminal records and other background checks. Once registered individuals will be continuously monitored. As many as nine million people could be required to undergo the checks.

The scheme has already received widespread criticism for being overly prescriptive because it will extend to parents who transport their friend’s children on behalf of a sports or social club.

Paul Flynn, deputy chairman of the BMA’s consultants committee, said: “One of our concerns is that this scheme will create a whole new dimension of scrutiny of patient safety incidents which are not necessary and it will add considerably to the burden of regulation.

“Another concern is that the ISA will have the power to take away a doctor’s ability to earn a living with no right of appeal. While the GMC and other bodies can question a doctor’s fitness to practise and remove them from their job there is always a right to appeal their decisions.

“This is a very blunt instrument for dealing with a serious problem.”

An ISA spokesman said: “The scheme offers a common sense, proportionate approach to safeguarding and it is what we believe the public would rightly expect.”