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Saffron Cordery: Enhanced tariff offer—what’s left for mental health?

27 Feb, 15 | by BMJ

Saffron CorderyThe big national health “system” story of the past week has been the surprise announcement of a voluntary tariff. This is one part of a solution put forward by NHS England and Monitor to resolve the current impasse, which arose from an objection mechanism to the proposals being triggered by those it affects—providers of NHS care.

As we all know, the annual setting of the tariff, and the process of balancing what can be afforded with what providers of NHS care need to be paid to stay afloat, is always a big deal. But this year it has been bigger than ever. Although this detail in the NHS’s arcane internal processes will pass most patients by, the quality and availability of their care could be profoundly affected by it. more…

Samir Dawlatly: Burnt out or boiled alive

25 Feb, 15 | by BMJ

The cleaner popped his head round the door, “You nearly finished, doc? Or are you happy to lock up?” The GP glanced at the bottom right corner of the glowing monitor that he had been looking at for the last two hours since the last patient left.

“No, I’m fine thanks,” he answered, “I’m happy to lock up, I’ve done it enough times,” which was true enough. Two hours previously he had had to weigh up finishing off reading the patient letters and reviewing patients that weren’t hitting blood pressure targets in the surgery, or getting home in time to kiss the children goodnight and peering at a laptop with remote, yet slower, access to the surgery computer system. more…

David Zigmond: The extinction of care by treatment—our healthcare’s heart failure

24 Feb, 15 | by BMJ

david_zigmond2At the end of last year, the media had a brief frisson over another dark story from our NHS: seven recent suicides and one homicide involving people who were acutely mentally ill. The transient newsworthiness came from the probability that the deaths were preventable: psychiatric beds were sought for these patients, but none were available. Typically, the media story has rapidly passed from view and memory, but the vast problems it signifies are still very much with us. What are these problems? How have they arisen and what can we do about them? more…

Samir Dawlatly: Can we have our (political) football back please?

20 Feb, 15 | by BMJ

With the budget of the NHS being over £100 billion, coming from taxpayers’ money, it is inevitable that health is overtly political. How such a large chunk of the nation’s budget is spent is the interest of those in government, as well as those who are governed. One of the consequences of this is that health becomes a political football for politicians to kick, discuss, debate, and accuse each other over. more…

Ciara Bottomley: Whistleblowing in the NHS—there is no room for complacency

19 Feb, 15 | by BMJ

Ciara BottomleyOut of the harrowing and often tragic cases that were highlighted by the Mid Staffordshire NHS Inquiry, Sir Robert Francis has started an extremely important conversation about whistleblowing with his follow-up review of the reporting culture in the NHS. The recommendations from his report, depending on how they are implemented, could have a far reaching impact in the NHS and beyond.

Our research echoes some of the trends identified by the Francis review. Evidence from the whistleblowing advice line we operate demonstrates that concerns raised in the health sector too often remain under protracted investigations that yield fewer resolutions, with more whistleblowers subjected to formal sanctions than in other sectors. more…

Jim Sherifi: I am an antibiotic resistance denier

19 Feb, 15 | by BMJ

Jim Very Good[2]I write as a humble jobbing GP incapable of sound clinical practice without instruction, guidance, and supervision from the National Institute for Health and Care Excellence (NICE), my clinical commissioning group, my colleagues, or by reading today’s newspapers. Despite practising medicine for 40 years, it is apparent to all that I am still incapable of differentiating a minor viral infection from a potentially more serious bacterial one.

I am profligate with my antibiotic prescribing, and am personally responsible for “antibiotics resistance being as grave a threat as terrorism” (Sally Davies, chief medical officer for England). I’m the go-to guy to blame for this threat to the “survival of the human race” (Mark Baker, director for clinical practice at NICE). more…

John Appleby: The cost of reform

13 Feb, 15 | by BMJ

john-applebyAsked in 1972 whether the French Revolution had been good or bad, the then Chinese Premier Zhou Enlai said that it was “too early to say.” As it turns out this was not an extreme example of the Chinese long view: Enlai was apparently opining about events that happened four years previously—in 1968—and not that other (somewhat more momentous) revolution that occurred more than 180 years earlier.

So, the coalition government’s reforms of the NHS: good or bad? As part of our review of the reforms of the NHS in England, the King’s Fund has argued that the changes introduced by the 2012 Health and Social Care Act led to a top-down reorganisation that has been damaging and distracting; structural change that is complex and confusing; and a new, fragmented system of leadership that is seen as a barrier to much needed change in services—such as integration across care and organisational boundaries. In short, the reforms were likely to turn out to be a costly diversion. more…

Mohammed Bahgat et al: Is the friends and family test a true feedback tool of NHS services?

12 Feb, 15 | by BMJ

The NHS friends and family test (FFT) was launched in April 2013 to support the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. [1] The results are submitted to NHS England monthly. When combined with supplementary follow-up questions, the FFT provides a mechanism to highlight both good and poor patient experience. more…

James Buchanan: Genomics, the data revolution, and health economics—the 2015 Astellas Innovation Debate

2 Feb, 15 | by BMJ

James BuchananIt’s early days, but 2015 is already shaping up to be another exciting year for researchers in genomics. In his State of the Union address last month, Barack Obama launched a new $215m Precision Medicine Initiative, which aims to collect genomic sequencing data for one million individuals. In the UK, we’re slightly further down this road: the pilot phase of the 100 000 Genomes Project is coming to an end, and full scale recruitment of patient samples begins today (2 February). more…

Guddi Vijaya Rani Singh: What matters—medicine, culture, and the space in between

16 Jan, 15 | by BMJ

guddiMy grandfather passed away last year. Surrounded by travel weary loved ones (from an extended family that also extends across continents), this man from rural India was promised a peaceful death in dignity.

Except that he died in 2013 in one of Delhi’s largest private hospitals, with every medical test and procedure made available by his anxious progeny. In the last 42 days of his life, he sustained two chest drains, urinary catheterisation, daily blood tests, and repeated intubation and ventilation; he became a pin cushion for Delhi’s doctors. more…

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