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NHS

Hugh Alderwick: The ups and downs on the road to health service improvement

19 Sep, 14 | by BMJ

hugh_alderwickParallels between the successful transformation of the Veterans Health Administration (VA) in the United States and the changes needed in the NHS in England have been made for a number of years. But recent troubles at the VA offer some important lessons for the NHS in the future, as explored in a roundtable discussion held at the King’s Fund last week.

The story of the transformation of the VA is familiar to many. Once a fragmented and hospital centred public healthcare system, changes made in the late 1990s helped the VA to become an organisation renowned for providing high quality, affordable care. more…

Samir Dawlatly: A case of semantics

19 Sep, 14 | by BMJ

The problem lies in semantics. GP. General practitioner. Could one be more vague than that? There’s an argument that since, on the whole, we provide general medical services (in medical centres) we should be called general medical practitioners. After all, my undergraduate training was in medicine and surgery, not simply everything in general.

Around the time I completed my training to become a G(M)P, I became very downhearted by what I expected to be the likely outcomes of the Health and Social Care Act. I hadn’t been particularly politically aware in the lead-up to the passing of the bill, as I was too busy trying to cram consultations into 10 minutes and learn all the red flags that I was supposed to know. more…

David Oliver: Tails of the unexpected—could the NHS learn from vets?

17 Sep, 14 | by BMJ

david_oliverAs I sit at my keyboard, I am looking at my calm and contented 3 year old calico cat, Tilly. Apart from the shaved area on her flank, you wouldn’t know anything had ever been different. Yet last week, she came close to dying from acute kidney injury.

I had come home after a long day spent running workshops for health services in Dorset. It didn’t take my physicianly training to realise that Tilly was in big trouble. Her legs couldn’t hold her up, she was probably delirious, and she could barely lift her head to drink. more…

Richard Smith: Simon Stevens, chief executive of NHS England, live

12 Sep, 14 | by BMJ

richard_smith_2014When Simon Stevens, chief executive of NHS England, was buying his Sunday papers a few weeks ago he encountered an elderly woman complaining that her newspaper didn’t contain the television section. It did, as the newsagent pointed out to her before asking her, “Would you like me to walk you home?” Stevens was struck that this was a “dementia friendly community” in action. He followed the story by emphasising that the traditional “factory model of health and social care” will not solve society’s problems, including the rise in dementia. Without a redesign of health and social care services, the NHS will not be sustainable. “We don’t exclusively own the problem or the solution,” he said. more…

Billy Boland: A lesson in perseverance

9 Sep, 14 | by BMJ

billy_bolandIt did not feel like the end when I submitted my portfolio for the NHS Leadership Academy, and sure enough it was not. I’ve been asked to make amendments, and there is also the submission of my closing statement to do, the final piece of written work on the journey. Any celebratory talk had been premature. more…

Sally Norton: NHS hospitals—does a spoonful of sugar help the medicine go down?

2 Sep, 14 | by BMJ

sally_nortonAt last, with health secretary Jeremy Hunt’s announcement of new measures being introduced to improve the standard of food in English hospitals, we may finally see better quality food in our hospitals.

These changes will see hospitals ranked according to the quality and choice of the food they serve. They will hopefully provide some sanity, and not before time, because I was beginning to think I was going mad.

We read every week, in The BMJ and other leading medical journals, of research detailing the perils of sugar and fizzy drinks. We frequently hear laments about the cost to the NHS of the epidemic of obesity and type 2 diabetes, which is threatening to engulf us. And yet, the NHS, which I understood to be an organisation that promotes and supports health (rather than just treating disease), is actually contributing to the problem. more…

Samir Dawlatly: The slippery slope of general practice

19 Aug, 14 | by BMJ

I live at the top of a hill. One winter it snowed after a hard frost, just a thin layer of snow on top of the existing ice. The morning after the snowfall, I jumped into my car, put the radio on, and was into second gear before I knew what I was doing.

Better check the brakes, I thought. They didn’t work. I tried dabbing them, pumping them, squeezing them, praying for them, but quickly realised that I had picked up too much momentum and was simply sliding down the hill. I managed to somehow avoid the haphazardly parked cars and slithered towards the T-junction at the bottom of our road. It all happened in slow motion, either because time was playing a trick on me, or because I was actually just gently sliding. more…

Mary McCarthy: UK GPs versus EU GPs

12 Aug, 14 | by BMJ

mary_mccarthyI sometimes wonder if the UK government realises how much general practices in this country accomplish in comparison to their counterparts in Europe and the United States.

There was a time, 20 or 30 years ago, when there was not much to choose between GPs in the UK and family doctors in other countries, apart from the fact that GP surgeries were usually open for considerably longer than the two to four hours a day that was normal in Europe, and that GPs here did house calls, which were becoming a rarity in Europe and the US.

However, general practice in the UK is now very different from the practices of many of our European colleagues. In a recent report, the American think tank the Commonwealth Fund placed the NHS at the top of the countries they studied, for the excellence and cost effectiveness of its health system. more…

Chris Hopson: NHS waiting times—the long and the short of it

7 Aug, 14 | by BMJ

chris_hopsonHealth secretary Jeremy Hunt’s speech earlier this week, which called on NHS hospitals to clear their backlog of patients waiting more than a year for treatment, rightly pointed to the personal consequences of each individual case on the waiting list. While recognising that some delays are the result of patient choice or good clinical reasons, waiting for treatment if you are immobile, in discomfort, or in pain can be distressing and debilitating—the more so the longer the wait.

That’s why the Foundation Trust Network (FTN) and its members strongly welcomed the government’s pledge in June of £250m (€314m; $421m) to reduce waiting lists, and the £400m (€504m; $674m) announced at the same time to support the urgent and emergency care pathway this winter. The FTN has consistently called for extra funding to improve patient care and for any announcements to be made as far in advance as possible. We also recognise how difficult it is for health ministers to find such funding at the moment, given the need to reduce the overall budget deficit. more…

Rachael Addicott and Kieran Walshe: How do CQC hospital inspections measure up?

5 Aug, 14 | by BMJ

rachael-addicottOver the past few years, we have seen several high profile failures of care in NHS acute hospitals in England, leading many in the system to question the ability of performance management and regulatory mechanisms to identify and act on poor performance.

Last year, in response to these events and concerns, the Care Quality Commission (CQC) developed a new model for inspecting and regulating NHS acute hospitals, and commissioned a team from Manchester Business School and the King’s Fund to evaluate this new and evolving approach as they rolled it out. more…

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