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NHS

Reena Aggarwal: Finding a scapegoat for the NHS crisis

16 Jan, 17 | by BMJ

reena_aggarwalA year ago junior doctors in England went on strike for the first time in four decades. Jeremy Hunt, health secretary for England, used statistics on the so called “weekend effect” to justify a new contract for junior doctors. This was despite warnings from the medical director of NHS England that it would be “rash and misleading” to suggest that causation could be attributed to seemingly more deaths over the weekend. Yet this misuse of statistics persisted throughout the very protracted dispute between the medical profession and the government.  more…

Keith Pearson: “I hear and share doctors concerns about revalidation”

13 Jan, 17 | by BMJ

When the General Medical Council (GMC) commissioned me to carry out a review—Taking Revalidation Forward—I considered revalidation’s primary function was to assure patients about the quality and safety of doctors.

I still believe that, but I have also gained a greater appreciation of the benefits revalidation brings to healthcare organisations and to doctors themselves. People have told me how revalidation underpins and evidences the professional standing of a doctor. more…

Martin McKee: A Shared Society? Interpreting Theresa May’s revolutionary vision

13 Jan, 17 | by BMJ

mcKee_martin

Theresa May is an unlikely revolutionary. Yet, on the day she entered 10 Downing Street, this was how she defined herself. She spoke of the need to tackle shorter life expectancy of those born poor, the harsher treatment of black people in the criminal justice system, and low educational attainment among white working class boys. Six months later, in a speech entitled The Shared Society, she restated this commitment. [1] The British public had, we were told, voted in the EU referendum for a “quiet revolution” that would “change the way our country works.” There is, of course, the minor detail that this was not the question on the ballot paper so how could she know what type of change voters wanted? But, even if she could know, it’s far from clear how she would address these issues. more…

Andrew S Al-Rais: How to avoid handover hostility

13 Jan, 17 | by BMJ

Arriving in resus the tension was palpable. A familiar interplay was evolving in the Paediatric bay. The “Handover Standoff.” On one side stood a fatigued transfer team accompanying an intubated toddler with intracranial pathology. The last couple of hours had been spent performing complex tasks in a stressful environment whilst simultaneously organising beds, personnel, and transport. The critical care transfer ballet that is so frequently staged in a district hospital. From my viewpoint the transfer team appeared to have done an excellent job and were now well placed to receive our plaudits. Perhaps even a cup of tea. Instead they faced a wall of various healthcare professionals. Stern questions were being fired at the transfer team—staccato clippings barely disguising the receiving team’s apparent annoyance. The transfer team swiftly adopted a back foot stance, aggrieved at the apparent insinuation that they had not performed to the highest possible standards. “Who told you come to resus?”, “We were told the child was three, not two.” “You’ll just have to wait—this isn’t what normally happens.”

more…

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…

Arnie Purushotham: Multidisciplinary team meetings in cancer care need to change

11 Jan, 17 | by BMJ

arnie_purushothamMultidisciplinary team (MDT) working is one of the cornerstones of our cancer services. MDT meetings are vital for exemplary patient care but it is becoming increasingly clear that they need to be refreshed.

Despite the rising incidence of cancer, an ageing population and huge improvements to cancer services and treatment regimens, the format of MDT meetings has not changed since their introduction over 20 years ago. We now see more patients, with more co-morbidities, and far more treatment options to discuss. more…

Nick Hopkinson: NHS humanitarian crisis denial

10 Jan, 17 | by BMJ

nick_hopkinsonWhen I qualified as a doctor in 1993, trolley medicine was completely routine. Post take ward rounds would typically visit people who had been waiting patiently in corridors overnight or longer. I’m ashamed to say it never occurred to me to think of this as a “crisis”—it was just the way things were. The cause was obvious—chronic under-resourcing of the healthcare system. The Wanless report estimated that the UK’s cumulative underspend between 1972 and 1998 was £220 billion (the annual NHS budget in 1998 was ≈£35 billion). The remedy, bringing the proportion of GDP spent on healthcare in the UK funding up to the European average, was largely effective—adequate resources allowed system changes too and trolley medicine seemed to have been consigned to the past. more…

David Oliver: Closing more hospital beds—the policy zombie they couldn’t kill

6 Jan, 17 | by BMJ

david_oliver_2015During the silly season over Christmas and New Year, NHS England Chief Nursing Officer Jane Cummings gave an interview to the Daily Telegraph. She advocated better investment in community and primary care services to allow more people to stay well, remain in their own homes, and return home sooner after acute illness or injury.

Amen to that. Who could disagree with that view? There’s a pressing need to reverse social care cuts; provide adequate capacity in community, intermediate, and end of life care; and adequately resource the primary care medical and nursing workforce.

The headline (then picked up by other mass media) was “NHS must cut beds for better care.” more…

Mary E Black: New Year’s resolution—a smoke-free NHS

30 Dec, 16 | by BMJ

maryeblack copyMy doctor father used to regularly set his trousers on fire. Born in 1924, he started smoking cigarettes as a teenager. He died of a smoking related cancer in 2003. My doctor grandfather served in the Royal Army Medical Corps in the first world war and died, when my father was 14, of smoking related cancer (and possibly some damage from mustard gas). I never met him.

My father tried but failed to stop his tobacco use. As public and medical attitudes to tobacco changed, he reduced his tobacco consumption. He almost broke the habit at home and when caught out would stuff his still smouldering pipe in his pocket. I perfected my darning skills aged 10 fixing singed holes in his tweedy jacket. At work was the worst, as there was no ban on smoking and no pressure on him to cut back. more…

Daniel Sokol: The ethics of the on-call rota

30 Dec, 16 | by BMJ

daniel_sokol_2016A colleague is sick. Someone is needed to cover him tomorrow. There are no locums and no volunteers. Who should be selected?

Few issues generate more passion and cause more heartache to doctors than filling a gap in the rota. Over the Christmas period, it is likely that tears have been shed and friendships lost over who would cover the absent colleague.

So what is the fairest way to choose? more…

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