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David Lock

David Lock: Have NHS leaders failed to “speak truth unto power”?

11 Jan, 17 | by BMJ

This is blog is not a rant—well not too much of a rant. It is an expression of serious frustration about the way the NHS is run and about the willingness of some senior NHS managers to become complicit in something near to dishonesty.

Everyone at the frontline knows the NHS is running on empty. The more perceptive know that more money for the NHS alone will not improve services for patients. But—and this is perhaps the unpopular “but”—NHS senior managers ought to accept their share of the responsibility for the present crisis because they have colluded in pretending the NHS can deliver the impossible. Does anyone believe that NHS managers have “spoken truth unto power” about limits of NHS productivity? more…

David Lock: Who has a legal duty to fund post-trial treatment?

7 Jul, 15 | by BMJ

If someone has been in a clinical trial, do they have a legal right to ongoing treatment for as long as treatment is clinically appropriate where the clinical trial was a success for that patient? I wrestled with this problem on an individual case recently where a patient got fantastic results from an expensive drug during a trial but it was likely that there would be no NHS funding to continue the treatment after the trial ended. The question was this “was it supposed to work like this?” and if not, does the patient have a legal right to demand that the treatment is continued. Although the matter is far from straightforward, it seems to me that the answers to those questions are respectively (and probably) “No, it was not supposed to work like this” and “Yes, the patient does have a legal remedy.” more…

David Lock: Avastin and Lucentis—It’s time for NHS commissioners to act rationally by limiting the choices for wet AMD patients

26 Sep, 14 | by BMJ

The news that a Cochrane Review has concluded that Avastin (bevacizumab) is as safe as Lucentis (ranibizumab) to treat patients with wet age related macular degeneration (“wet AMD”), along with other studies that have shown the two drugs have broadly the same level of clinical effectiveness, comes as no surprise to those of us who have been involved in this debate for a number of years.

Lucentis is a “licensed” drug for wet AMD, whereas Avastin is not licensed for this condition. But Avastin is not an unlicensed drug per se; it is just licensed for a different condition, namely treating patients with certain cancers. The beneficial use of the drug for wet AMD patients seems an unintended and highly cost effective benefit. There is nothing unlawful in clinicians using an unlicensed drug to treat NHS patients, as paediatricians know because they use unlicensed drugs all the time. So why should the NHS keep paying out for a drug that is 10 times more expensive than an equally safe and clinically effective alternative? more…

David Lock: Ghana—not a smoker in sight

8 May, 14 | by BMJ

I have just returned from two weeks in Ghana, a fascinating and challenging country on so many fronts, but significant because I hardly saw a single Ghanaian smoking throughout my time in the country.

We went to Ghana because my brother-in-law (who lived out there until earlier this year) was getting married to a lovely lady from Bolgatanga, which is right up north near the border with Burkina Faso. This meant we travelled way off the tourist trail, took part in a Ghanaian wedding, and met far more Ghanaians at work and socialising than we would on a package tour. But we did not meet a single Ghanaian smoker. There were not even any puffers at the evening party (held outside) to celebrate the wedding, at which there was great music and much alcohol was consumed. more…

David Lock: Do CCGs have the power to pay out for past PCT NHS continuing care errors?

11 Feb, 14 | by BMJ

The NHS has paid out vast amounts—probably hundreds of millions of pounds—in recent years as a result of decisions that patients were not entitled to NHS Continuing Care (where the NHS meets the costs of a package of social care and accommodation outside a hospital).  Mostly these are claims by relatives of deceased patients who objected to paying nursing home fees for elderly patients who were classified as “social care” rather than being eligible for NHS Continuing Care.

Several attempts have been made by the NHS to stop new claims, but these have not been too successful because the claims, based on alleged maladministration, continue. The “liabilities” associated with NHS Continuing Care claims were supposedly transferred from primary care trusts (PCTs) to clinical commissioning groups (CCGs) in the “transfer orders,” which transferred assets and liabilities from PCTs to CCGs. The intention was that CCGs should pay out for past NHS Continuing Care errors made by the PCTs. more…

David Lock: Should accident victims who get a payout be entitled to free NHS care?

3 Feb, 14 | by BMJ

At a time when NHS bodies are under more financial pressure than ever before there is one anomaly which is worth highlighting. Personal injury victims can be paid damages on the basis that they will claim the cost of private medical care, but then such a person is entitled to keep the damages and demand free NHS care.

This anomaly arises because patients who are injured in a road traffic accident, an accident at work, or as a result of negligent hospital treatment (or any other personal injury claim) are entitled to seek the future costs of their medical care as part of a damages claim. As a result of an act of Parliament passed in 1948 when the NHS was created, a defendant (whether the NHS litigation authority [NHSLA] or an insurer) is not allowed to insist that the tort victim uses NHS services instead of seeking private care. The NHSLA or insurer has to pay the cost of future medical bills on a private basis. Hence an NHS Trust can be forced to pay damages for a clinical negligence victim to be provided with future care funded by BUPA. more…

David Lock: Inconsistent CCG legal duties—can the circle be squared?

2 Jan, 14 | by BMJ

There are times when, as a lawyer advising NHS bodies, I get close to advising that the law is unworkable. An example emerged the day when I had to deal with the fact that clinical commissioning groups (CCGs) have legal duties to “promote the involvement of patients and their carers in decisions made about healthcare services” under section 14U of the NHS Act 2006. They also have a legal duty to “act with a view to enabling patients to make choices with respect to aspects of healthcare services provided to them” under section 14V of the NHS act. However, CCGs also have precise legal procurement obligations under the snappily titled “National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013,” which require CCGs to take decisions concerning the placing of healthcare contracts in accordance with a specific set of factors guiding the decision. more…

David Lock on the landmark case concerning the future of Lewisham Hospital

18 Dec, 13 | by BMJ

The problem of how to tackle poor performing NHS trusts has dogged the NHS for many years. Companies that fail can be put into liquidation, factories close down, and people lose their jobs.  However, a failing hospital is not a factory.  An overspending hospital cannot “fail” and be closed because that would leave local people without acute health services.

Traditionally the NHS has changed key management roles at failing hospitals in an effort to turn them around.  However that model has its limitations, and so a new structure of “trust special administrators” was brought in by the Health Act 2009.  That introduced a new chapter 5A into the National Health Service Act 2006. more…

David Lock: Suicide, refusing treatment, and consent in the dying process

28 Jun, 13 | by BMJ

This is an anonymised story about how a doctor’s misunderstanding of the law around managing the death of a patient with capacity appears to have caused unnecessary suffering. It is a salutary tale about the need for doctors to understand the subtleties of the law on consent to treatment and, in difficult cases, the need to seek legal advice. But it is also about the importance of doctors respecting a capacitous patient’s right to refuse treatment, even if this leads to the patient’s death.

Paul (not his real name) suffered from a progressive degenerative disorder which was in its advanced stages. He lived at home with a package of care which was funded by the NHS. His sister had suffered from the same disorder as well. She was younger than Paul and tragically had died. Her death came in hospital after she had contracted pneumonia. Paul was well aware that he was dying and had full capacity to make his own decisions about receiving or not receiving medical treatment under the Mental Capacity Act 2005. He was very clear that he did not wish to die in hospital. more…

David Lock: Should GPs aspire to run medical services businesses?

30 May, 13 | by BMJ

It is hardly surprising that hard pressed GPs have reacted angrily to unjustified criticisms by the secretary of state for health that they are to blame for faults within the NHS. It is a gross simplification to suggest that removing responsibility for out of hours care from GPs is the main cause of increasing attendances at A & E. Apart from anything else, prior to the changes in the GP contract in 2004 most GP practices used “deputising services” to cover their practice obligations out of hours. For many practices, the only real change in 2004 was that responsibility for managing the out of hours contract moved from individual practices to the primary care trust. more…

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