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NHS

Anne Marie Rafferty: Whose responsibility is the workforce anyway?

24 May, 16 | by BMJ

anne_marie_raffertyIt’s the workforce stupid! That is the key message of the Nuffield Report, “Reshaping the workforce to deliver the care patients need.” Workforce solutions are rarely quick fixes so policy makers often find it is more appealing to introduce new types of workers rather than grind away at trying to make what we already have work better. So it is gratifying that the Nuffield Trust report takes such a measured view of what might help to make the system work better and rightly focusses on the largest part of what we’ve got in the system, the so-called non-medical workforce (though no one likes to be referred to as a “non” anything). more…

John Appleby: New NHS inflation figures underline funding pressures facing the NHS

20 May, 16 | by BMJ

john-applebyThe latest Quarterly Monitoring Report from the King’s Fund surveying NHS trust finance directors reveals deepening pessimism about local finances and concern about the outturn for the current financial year. New NHS inflation figures from NHS Improvement reveal the true extent of the financial pressures facing the NHS this year and up to 2020/21.

How much money the NHS has been allocated over the next few years is a somewhat contested fact. It shouldn’t be of course; how much the government has decided to spend on healthcare should be —in one sense at least—an uncontroversial figure. more…

Reena Aggarwal on the politicisation of junior doctors

18 May, 16 | by BMJ

reena_aggarwalThe term junior doctor has entered into vernacular. We have become a news story with media, politicians, and satirists all using it as subject matter. Last year little was known about junior doctors and it would have seemed very unlikely that the medical fraternity would have routinely filled headline news as they do now.

I have a confession. A year ago, I would have been ambivalent, indeed indifferent about the BMA. I’ve been a paid up member for nine years, but I have rarely engaged with it other than occasionally reading The BMJ. The BMA represents four types of doctors—general practitioners, junior doctors, associate specialists, and consultants, as well as medical students. It holds a split identity between being a professional association and trade union. For me, the former role has always prevailed and I had never considered the potential power of being in a union. But how times change—on Saturday I even attended the BMA junior doctor conference for the first time to listen to the great and good from the BMA, alongside 300 junior doctors from across the country. more…

Tara Lamont and Tom Quinn: Driving better care—research and ambulance services

17 May, 16 | by BMJ

Tara_Lamont_3tom_quinnWhat do you get with twenty pigs and ten humans? Not a giant hog roast or a bad joke about xenotransplantation. No, this appeared to be the full extent of testing of one type of emergency equipment before it was widely used in ambulances. The “can do” attitude in emergency services means that new technologies have often been introduced ahead of good evidence. But that all changed when this kit became the focus of a major trial funded by the National Institute for Health Research (NIHR), the research arm of the NHS. more…

The chief executive’s tale: Exit interviews

13 May, 16 | by BMJ

siva anandaciva_picPeople always surprise you. When I started interviewing retiring NHS chief executives to support a project with the King’s Fund, I had several preconceptions that were quickly disproved. The first preconception was that my four interviewees would be tempted by the traditional exit interview traps of score settling or self-authored hagiography. Instead what I found was a group of people who were contemplative and willing to look as hard at their failures as their successes.

Like picking out a good performance in a movie it was often the small and almost inconsequential moments that stuck with me from the interviews, rather than the bold declarative statements or soundbites. To pick out just two of these smaller moments: more…

Janis Burns on the junior doctors’ dispute: How can we achieve an outcome that satisfies the majority?

10 May, 16 | by BMJ

janis_burnsAs with most things in life, the best solutions are often the most simple, and with retrospect, they were glaringly obvious. The resumption of talks between the BMA and the government was facilitated by our royal colleges suggesting nothing more complicated than a five day pause. A ceasefire called for by the natural mediators. What could have been more obvious or simple?

Now the negotiators for both parties are rising to an almighty challenge with the weight of an entire profession and the UK public resting on their shoulders.
more…

Rachel Clarke: Junior doctors’ dispute—Jeremy Hunt musn’t ignore doctors’ genuine concerns

10 May, 16 | by BMJ

rachel_clarkeIt’s ironic, isn’t it? Even as last ditch truce talks to settle the junior doctors’ dispute got underway this week, UK health secretary Jeremy Hunt has come under fire yet again for going to war with doctors on the flimsiest of pretexts.

Yesterday, a stroke physician from Oxford University, Professor Peter Rothwell, talked about research that revealed that Hunt’s spin about excessive weekend deaths from strokes is based on assumptions as spurious as they are alarmist. The large scale study shows that over a third of patients recorded as being admitted to hospital for a stroke had actually been admitted for other reasons—particularly the routine, low-risk procedures that tend to be carried out Monday to Friday. These administrative coding errors distort the mortality statistics, erroneously making weekdays appear safer than weekends. more…

Ellen Broad and Tom Sasse: Google deep in trust issues around use of UK patient data

10 May, 16 | by BMJ

We all need different kinds of medical care at different points in our lives. When we interact with our GPs and healthcare providers, we hope that our doctors and nurses know everything they need to know to help us get better. We want to get the best possible care and we want the experience to be as painless (in all senses) as possible. Better data sharing between organisations and people who are providing medical care, and better use of health data—whether in the private or public sector—is going to be a necessary part of making this happen. more…

Neena Modi: How might the junior doctors’ dispute be resolved?

9 May, 16 | by BMJ

neena_modi2After months of stalemate, a brief pause has been suggested so that both sides in the junior doctors’ dispute can take a deep breath, and get back to talking. How might this pan out?

Let’s start by being quite clear: Paediatricians have always delivered a 24/7 service and the government’s own equality assessment shows that the new contract disadvantages doctors who are parents and carers. But whatever the litany of rights and wrongs of this dispute, trust between junior doctors and government is at rock bottom. It seems to be stretching credulity to the limit to believe this is mere carelessness, so what motive could there possibly be to destroy the morale of a stable, home-grown workforce, committed and proud to serve in a publicly funded healthcare system? more…

David Oliver: A dispute played out via soundbites and spin cannot end well for services

9 May, 16 | by BMJ

david_oliver_2015I write this a few hours after the BMA agreed that it would take up the offer of renewed contract talks with the government, brokered by the Academy of Medical Royal Colleges. The government have in turn agreed a temporary suspension of imposition.

PR has coloured the whole saga of the contract stand-off. What had been a low key bureaucratic process was bizarrely hijacked by Jeremy Hunt last summer when he attacked doctors’ vocation and work ethic, insinuating that they didn’t already work evenings and weekends. more…

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