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Archive for January, 2011

Cameron strongly defends healthcare reform plans

BBC Health - 31st January 2011 10:21 am

David Cameron has strongly defended the coalition’s plans for a major overhaul of the NHS in England, as MPs prepare to hold their first debate on the bill.

Writing in The Times, the Prime Minister said the health service was heading for crisis if it failed to modernise.

Under the plans, GPs will get control of £80bn of the NHS budget from 2013.

Health unions have denounced the changes and health workers from around England are protesting against the government’s bill in London today.

The general secretary of the union Unison, Dave Prentis, said: “This titanic reorganisation threatens to sink the NHS. The government should step back from the brink and pronounce this bill DOA - dead on arrival.”

In the newspaper article, Mr Cameron says he wants to address the myths that have emerged about the controversial plans to re-organise the NHS.

He warns that the growing number of people needing health care and rising costs of drugs mean that if the NHS fails to modernise, it is heading for crisis.

Liberate surgeons while on-call, study suggests

By Mike Broad - 10:10 am

Almost three quarters of consultant surgeons work more than their contracted hours, a survey reveals.

Seventy per cent also report they are expected to undertake elective operations while they are supposed to be on-call for emergencies.

The Surgical Workforce Report 2010 is the first of an annual survey of surgical consultants working practices and which will provide the NHS with accurate figures to inform long term planning of the surgical workforce.

The research, by the Royal College of Surgeons, shows that nine out of 10 consultant surgeons who responded work on-call at weekends and evenings providing 24-hour care - this compares favourably with other disciplines which struggle to provide consultant cover out-of-hours. Most of these surgeons work in on call rotas between 1 in 4 and 1 in 8.

Only 6% report working even more intensive rotas of 1 in 3 or less - however this figure is higher in some specialties (for example it rises to 19% for urologists).

RCS guidelines state that during an on-call period a surgeon should be readily available to deal with emergencies - but 70% of respondents report they are expected to undertake elective operating lists during on-call time. This is a significant barrier to improving emergency surgery in some specialties in the UK.

A third of consultants who responded indicated a wish to work part-time at some point in their career - but less than 10% actually do.

John Black, president of the RCS, said: “This survey demonstrates the high level of commitment to patients that exists in surgery. Our members routinely work far beyond what they are formally contracted to and patients should be reassured to learn that experienced consultant surgeons are routinely on call at night and at weekends if needed - the RCS believes that patient care is safest when led by consultants.

“It is a matter of concern that so many surgeons are being expected to undertake elective operations while on call - other studies have shown this leads to delays in them getting to emergencies as they cannot be in two places at once.”

While three quarters of respondents work above 10 Pas, only 20% of consultants have formally opted-out of the Working Time Regulations.

The survey shows that only 7% of surgical consultants are women, despite the graduate output from medical schools being 55% female.

This picture varies across the specialties with oral and maxillofacial (3.8%) and orthopaedics (4.6%) reporting the lowest proportion and plastic surgery (13.1%) and paediatric surgery (20%) showing the greatest progress.

Black said: “Although there appear to be very few women consultant surgeons this reflects the fact that very few women went to medical school at the time the present generation of consultants entered specialty training. We expect to see far more female surgeons in the future.”

Bob Greatorex, RCS council lead for the workforce survey, said: “For a long time there has been a boom-and-bust cycle in surgical service workforce provision in the NHS. Either there were acute shortages of skilled surgeons or an excess number who could not secure appropriate posts.

“Uneven distribution of workforce resources has repeatedly presented a significant obstacle to the delivery of the best possible care for the needs of the population so this new annual survey will provide all those planning for the future with the means to make sound decisions.”

Read the full survey results.

Tags: Surgeons, WTD
Posted in Hospital Dr News | 17 Comments »

Respiratory: biomass smoke is a major cause of COPD worldwide, study says

Evidentia - 28th January 2011 12:54 pm

One of the most common and most harmful sources of air pollution is also one of the most under-recognised and under-researched. Although smoke from domestic biomass fuel stoves constitutes the world’s most important source of indoor air pollution, it is only recently that this problem has become the subject of epidemiological study and larger-scale prevention efforts. The worst affected are women and children in developing countries, and lung disease is by far the predominant morbidity.

“Case for NHS reform has been exaggerated”

By Mike Broad - 12:20 pm

The coalition government’s case for dramatic healthcare reform - claiming the NHS is the ‘sick man of Europe’ - has been overstated, according to a leading health economist.

Health secretary Andrew Lansley has said the reform is needed because the country’s health outcomes are among the poorest in Europe. But John Appleby, chief economist at the King’s Fund, says a review of data suggests the UK is in better health than Lansley suggests.

It has been claimed that despite spending the same on health care, we suffer twice the rate of deaths from heart disease than France.

The latter is true, says Appleby, but what this claim doesn’t show is that the UK has actually had the largest fall in heart attack deaths between 1980 and 2006 of any European country. And if trends over the last thirty years continue, the UK will have a lower death rate than France as soon as 2012, he writes on bmj.com.

These trends have been achieved not only with a slower rate of growth in healthcare spending in the UK compared with France, but at lower levels of spending every year for the last half century, he adds.

England’s apparently poor comparison with other countries on cancer deaths has also been a key argument for reforming the NHS. Appleby points out that outcomes in this country are improving, although comparisons are not straightforward and some of the data often cited should be treated with caution.

Breast cancer deaths in the UK have fallen by 40% over the last two decades to virtually close the gap with France. Again, if trends continue, it is likely that the UK will have lower death rates than France in just a few years, he says.

And despite headlines that the UK is the ‘sick man of Europe’, trends actually show improvements in survival rates for the UK, he adds.

Appleby said: “Comparing health outcomes across countries is complex and not simply down to healthcare spending, but these trends must challenge one of the government’s key justifications for reforming the NHS.”

The Department of Health said there was a wealth of research that demonstrated that UK health outcomes are relatively worse than they could be, and the reforms will ensure that the NHS is comparable to world’s best performing health systems.

Tags: Health policy
Posted in Hospital Dr News | 1 Comment »

Time to get radiotherapy into the thick of it

By Sarah Burnett-Moore - 11:25 am

On Tuesday I went to a briefing by Cancer Research UK, in the House of Commons, about radiotherapy services, and I was struck by three things.

Firstly: MPs are spectacularly fond of having their photograph taken. They were queuing up to take turns posing with a megaphone. This is therefore the end of my lingering desire to stand for Parliament, I hate having my picture taken. Did I think some of them were there just for the photo op? Well, you might think that, but I couldn’t possibly comment.

Secondly: how realistic The Thick Of It is. I urge those of you who haven’t seen this biting satire to seek it out on DVD or the iPlayer, it’s like Yes Minister, but infinitely more sweary.

Thirdly, and most importantly, I realised how little I knew about radiotherapy. My mother had some 26 years ago, and I share a Royal College with radiotherapists, but that’s about it. So I wasn’t surprised that public awareness of the benefits of radiotherapy is so low. If you are similarly ignorant about radiotherapy, here’s a few stats, if you’re in the know, stick your fingers in your ears and go la-la-la until the numbers stop.

Around 120,000 cancer patients benefit from radiotherapy each year, and 40% of those cured will have had it. More patients are cured by radiotherapy than by chemo. 50% of patients with cancer could be helped by it, but shortages in equipment and staff mean that the uptake is much lower.

Unsurprisingly, the best availability is in Scotland, at 43%, but in Northern Ireland it is a woeful 32%. A third of patients could benefit from Intensity Modulated Radiotherapy, yet less than a tenth get it. Patients needing Proton Therapy have to go abroad to get it.

Radiotherapy services seem to have lost out to the more ‘dramatic’ chemotherapy. Patients having chemo are often very obviously undergoing intense treatment, but patients having radiotherapy can feel just as awful. Travelling to appropriate units can be as gruelling as any dose of FEC. It’s all very well to give chemo at your local branch of Boots, but I don’t see the ASDAs of this world lining up to get a linear accelerator installed, unless they thought it was a way to get people through the checkouts faster.

Only 14% of the public know about the potential benefits of radiotherapy, so the aim of the briefing was to ask MPs to lend their voice to the campaign.

Around 30 MPs found time to attend, which wasn’t a bad turn out considering that the questions in the House were on health. Many stayed for the entire event, and some even asked quite informed and intelligent questions of the panel. So if your MP isn’t asking direct questions about how good your local radiotherapy service is, give him (or her, I’m not going Andy Gray on you) a nudge.

And for those of you who have been reading about the packed cellars at the Palace of Westminster, I didn’t get offered any Pétrus.

Tags: Cancer
Posted in Sarah Burnett-Moore | No Comments »

Unions all reject a freeze to pay increments

By Mike Broad - 9:31 am

Unions have unilaterally rejected any proposal to freeze pay increments in an official response to NHS Employers.

NHS Employers recommended that trusts should be allowed to freeze incremental pay progression for all groups of staff from April for two years in return for guarantees on job security. The government said it would consider the proposal.

The BMA said members had already been required to accept a two-year pay freeze during a period of increasing inflation.

BMA council chairman Hamish Meldrum said: “While bankers are to be allowed to continue to receive massive bonuses, it is perverse to penalise the dedicated and hard-working staff who keep the NHS running.

“There are many other areas where savings could be made in the NHS, such as the bureaucratic costs of the market, the private finance initiative and the huge returns for commercial organisations on investment in new pharmaceuticals.”

Peter Finch, assistant director of employment relations at the Chartered Society of Physiotherapy, said unions would work with each other to “ensure a consistent approach”.

“If employers at local level try and start discussions on a pay increment freeze, we advise stewards to work with other unions locally to reject this,” he said.

RCN general secretary Dr Peter Carter said: “These proposals are divisive and an unwarranted attack upon hard-working nurses. Asking staff to give up their increments when in return only some will have a guarantee of no-compulsory redundancy is, frankly, just not on.

“We are also highly sceptical that employers would be able to deliver their part of the bargain with job security. After all, the RCN has already identified 27,000 jobs earmarked to go in the NHS.”

Other health unions, including UNISON, GMB and Unite, have also rejected the proposal.

NHS Employers warned the rejection would result in more redundancies and job losses than would otherwise be the case.

Tags: Pay
Posted in Hospital Dr News | 2 Comments »

Health Bill holds opportunities for consultants too

By Stephen Campion, chief executive of the HCSA - 27th January 2011 11:25 am

The following blog is a personal view and not the HCSA’s.

The Health and Social Care Bill signals one of the most far reaching reforms in the history of the NHS. This is not merely organisational re-structuring but a fundamental difference in approach. In this brave new world, the focus in the NHS will change. Management within, and indeed of, the NHS will be driven by GPs acting in what they believe will be in the best interests of their patients.

There may be some GPs who may not have the skills, time or desire to take this leading role. There are others who can’t wait to take on the mantle of GP commissioning. But that will be a matter for the GP leaders to work through themselves.

The fact is that GP commissioning is government policy. The risks associated with that policy are for the government to take and ultimately to be held accountable for. But it does give doctors, both in our hospitals and primary care, an opportunity to break free from the shackles of what has, at times, proved to be an oppressive, if not aggressive, management regime.

Far from sitting on the fence, we should not wasting time hypothesizing on what may or may not happen, or worry about political risks. Every doctor in the country will have their particular view and the chances of reconciling them are pretty remote. That is the nature of democracy.

But the Health Bill does open opportunities which hospital doctors might use to the advantage of their patients and to the profession. Just as in the case of GPs, some may want to use these opportunities, others less so.

The Health Bill cannot succeed through GP’s alone. GP commissioning will need senior hospital doctors to work in partnership - as part of a team - to be effective. That seems preferable to non-clinical managers taking clinical decisions, and getting them wrong as all too often reported.

And as that partnership develops we will begin to see professionalism return to the profession; a profession that has been so damaged by an organisational culture dominated by management edict and control.

Yes, there are risks. But there are benefits to be gained if senior hospital doctors take this chance to be freed from the managerial dominance that has so damaged the profession.

Tags: Health policy
Posted in HCSA | 2 Comments »

Questions raised over GPs’ performance targets

BBC Health - 9:08 am

The GP bonus system has been called into question after research suggests it has had no real impact on the treatment of high blood pressure.

Family doctors are paid bonuses - worth up to a third of their pay - for hitting certain performance targets.

An international team of experts looked at high blood pressure measures, but found “no discernible” benefit, the BMJ reported.

Doctors said it was too early to judge the scheme.

The bonus system was introduced in 2004 as part of a new contract. It has proved controversial as it has helped push average pay through the £100,000 barrier.

Doubts cast on ‘Big Society’ and nudging tactics

The Guardian - 26th January 2011 7:40 pm

Most councils have not started introducing the government’s ‘Big Society’ agenda and do not understand what it is, a study reveals today.

A report by the consultancy firm Deloitte reveals that 80% of councils have not made any progress on the localism agenda. Many claim they are faced with Whitehall “intransigence” and resistance to the plans and that there is “no common understanding” across government about what the big society actually is.

“Given the magnitude of localism as an initiative, there is now an urgent need to build understanding of the challenges around localism, and address systemic dislocation between central and local government,” it says. “But the real test of localism in modern government will arrive when things start to go wrong.”

Jon Trickett, shadow minister for the Cabinet Office, said: “There is institutional resistance locally and nationally to the reckless pace at which the government is trying to press what is a wide-ranging and ideological reform.”

Meanwhile doctors warn in the BMJ that the government’s strategy of “nudging” people to adopt healthier lifestyles will not solve major public health problems such as obesity, smoking and alcohol misuse. They say the use of nudges to affect human behaviour is based on “weak” evidence and could ultimately prove harmful if it means ministers ignore other tactics.

BMA organises a crisis meeting on Health Bill

By Mike Broad - 7:12 pm

The BMA today responded to growing concern among doctors over the NHS reforms in England and called a Special Representative Meeting to debate the issues.

BMA council agreed that a special meeting of the BMA’s representative body was appropriate at this time to discuss the planned changes to the NHS now that the details have been laid before Parliament in the Health and Social Care Bill.

There has been growing unease about the scale and pace of change in the NHS and the BMA leaderships’ approach of ‘critical engagement’ with the government over reform.

Dr Clive Peedell, co-chair of the NHS Consultants’ Association and BMA council member, and Hospital Dr blogger, recently wrote to the BMJ warning that the Bill has become even more pro-market and the BMA is acting as though the policy proposals are a done deal. The letter was supported by 118 doctors and called for a Special Representative Meeting (SRM).

Writing on Hospital Dr, he said: ‘The white paper is designed to fulfil a long standing Tory dream - to dismantle the NHS and replace it with the private sector, which will receive its profits from the UK taxpayer.’

The BMA leadership responded by defending its position. Dr Hamish Meldrum, chair of BMA council, said at the time its approach of ‘critical engagement’ was an accurate reflection of its members’ views and existing policy.

He said: “The majority of feedback that we have received from members supports the stance taken by the BMA, endorsed by its council, following several debates on the issue. We intend to increase our activities even further ahead of the publication of the Health Bill when the BMA will lobby strongly on all aspects of the reforms proposed.”

Doctors opposing reform almost brought an about face by the union. Eleven council members were in favour of a motion opposing the Health Bill altogether, and only lost by four votes. A motion to demonstrate alongside the TUC was also narrowly defeated. There was a significant majority in favour of calling on the government to stop further implementation of the reforms while legislation is still going through Parliament.

The BMA said a SRM will ‘provide a further platform to debate the implications of the government’s plans on the NHS, patients and the profession’. It will take place on Tuesday 15 March 2011 and further details will be available shortly.

BMA council also reaffirmed the union’s position on the reforms, particularly its concerns that the potential benefits of clinically-led commissioning and greater public and patient involvement will be put at risk by the enforcement of competition through Monitor’s new role as the economic regulator for the NHS and the introduction of price competition.

Read more on the BMA’s concerns about the Bill.

Tags: BMA, Health policy
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