When buses in Glasgow started to come with posters asking if people were “Concerned about diabetes?” with an image of an older woman, a freephone number, and webpage for people “to find out about our health screening programme,” I wondered what was going on. Another bus advert said, “Do you have asthma? Register for a complimentary health check today and you could be part of our research into the future of asthma.” more…

This is a serious blog about death, about what can go wrong in the dying process and how it can be put right. It arises out of an inquest where I represented a family member who found the medical and caring profession had misunderstood what was meant by a “duty of care” and tried to impose futile treatment on a dying elderly woman when she ought to have been allowed to die in peace and dignity.  I urge you to read on if you have the time because this is a case which shows what should not happen and, as a result of the decisions of the coroner to write formal letters under Rule 43 of the coroners rules, it might lead to changes in practice in this vital area of care. more…

The prime minister has picked a new health advisor, Nick Seddon, who poured cold water on the creation of clinical commissioning groups and appears to be focused on moving NHS management away from public bodies and into the private sector. Whatever the rhetoric might suggest, changing the NHS into a commercial insurance model appears to be the dominant thinking in No. 10.

In July 2010, Nick Seddon, who was then the deputy director of the right wing think tank, Reform, was fairly damming about the white paper which proposed the creation of clinical commissioning groups. He said: more…

Reading the Francis Report for many of us is like looking in a mirror. The mirror is at an angle, magnifying the perversities in the picture, but it is all recognisable. We see our NHS reflected back at us, the NHS in England in the early years of the 21st Century.

As the weeks since it was launched pass and the Francis Report fades rather too rapidly from the news headlines, there is little cause for cheer and much to dishearten. True, the concept of compassionate care is being bandied around in evangelical fashion and squeezed into every document possible. But frankly, there is an Orwellian touch to the way the word is being used and a real danger that the concept will be rendered trite and meaningless. Over the last few weeks, I have listened to an operating department assistant describe how he was dragged away from looking after a patient three times by an anxious manager wanting him to amend a form ticking boxes saying he was providing compassionate care to the patient; I have heard someone from the workforce planning department moaning about how busy he was having to amend job descriptions to include the word compassionate; and I have been approached by someone in medical education asking me to invent some exam questions that tested for compassion! more…

It is now more than a month since the BMA first blew the whistle on the gathering failures bedevilling the government’s flagship NHS 111 service—and regrettably the problems show no sign of abating. In many areas of the country, such as Greater Manchester, NHS 111 was overwhelmed by call demand during its pilot phase before Easter to such an extent that it was suspended before it had even been launched. Similar problems hit the service in South London and in other regions, forcing suspensions or part suspensions of NHS 111 as Easter came and went. Where it was operational NHS 111 limped towards the May bank holiday with little sign of improvement. more…

The mood among clinical commissioners less than a month into the new system is characterised by a determination to move care out of hospitals, frustration at legal and financial impediments to making change happen, and considerable confidence that they can make a difference.

At the first conference of NHS Clinical Commissioners—an independent group launched by the NHS Alliance, NHS Confederation, and National Association of Primary Care—introspection was refreshingly absent. While there were concerns about workload and the risk of conflicts of interest as commissioners invest in primary care, the focus was very much on the big picture of their new role. In particular, fears voiced by the BMA that commissioning could lose GPs the trust of their patients did not surface as a major issue. more…

Amongst the issues in the in-tray of CCGs, the issue of funding for assisted conception (typically either intrauterine insemination or IVF) for lesbian couples is not highest on the agenda, but it is an interesting and difficult problem, and different PCTs came up with different solutions. The problem is easy to state, but is a touch harder to solve.  Should the NHS fund assisted conception services to allow one of a lesbian couple to have a child with sperm donated by a male friend (or possibly anonymously donated)? I suspect that if the public were asked for their views, funding for this treatment would get a definitive thumbs down. CCGs are required to consider the public’s views when setting priorities under section 242 of the National Health Service Act, but the outcome of public engagement does not bind a CCG. If NHS commissioning was driven solely by public consultation outcomes then no popular local hospital would ever be scaled back and no money would ever have been spent by a PCT on prison health. There are other factors that must be considered, including the need to tackle health inequalities, and the need to ensure that services are not refused on a discriminatory basis. more…

 Last month the UK government released its amended regulations on NHS procurement after considerable outrage from health organisations, trade unions, and parliamentarians, over what appeared to be clear breaches of agreements. Is it a merely  a cosmetic re-write of regulation 75 again that seeks merely to better disguise the true privatising aim of these regulations, or does it help to address the concerns that many had – this is the million dollar question? The legal situation is highly complex and health commentators gave different interpretations of what the  revised regulations would translate to in practice. more…

 Good Friday is an excellent day for thinking about death, but I think about death every day. I find it energising. As I write this blog on Easter Sunday, I read that Bruce Keogh, the medical director of NHS England, thinks that the first priority if the NHS is to stop us dying.  Minutes after reading that I read in The Atlantic a piece entitled “The coming death shortage: why the longevity boom will make us sorry to be alive.”  Who. I wonder, is on the side of the angels? more…

The fact that 1 April is “April Fool’s day” ought to be enough to warn governments of all shades that it is a bad day to make major changes to government services, but that is the day that the latest batch of NHS reforms comes into play.

It is the day that CCGs will take over responsibility for NHS commissioning and is also the day when the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 come into force.  I have written before about the way in which these regulations will not work in the interests of patients.  However, an unintended side effect is that they will also prevent the efficient discharge of patients from hospital, even when beds are needed for other patients. more…