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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…

Sophie Yelland: In praise of primary care physicians

23 Dec, 16 | by BMJ

If someone told you the world was ending and gave you ten minutes to fix it, you’d probably express some mild expletives.

This is a complete exaggeration to vent my frustrations at the expectations we have of primary care physicians.

My point is primary care physicians are amazing. They can deal with almost every situation from extremely minor to life threatening. They know what to do, whom to ask, and what the next steps should be. more…

Jan Filochowski: No room at the inn—the NHS today?

22 Dec, 16 | by BMJ

jan_filochowskiThe NHS’s critical problem today is not that things are bad, it is that they are getting much worse at a very fast rate across the board.

In 40 years involvement in managing NHS services I have never known a time when they haven’t been under pressure from rising demand or when governments haven’t said they are giving more to cope with the rise. That’s the official narrative today too, in response to weekly stories of increased pressure and longer waits. more…

Nick Hopkinson on Steve Biko, the NHS, and the mind of the oppressed

21 Dec, 16 | by BMJ

nick_hopkinsonIt would have been Steve Biko’s seventieth birthday this weekend. The anti-apartheid leader was beaten to death by the South African Police in a jail cell in 1977. His death was a medical scandal too—doctors acquiesced in his being driven, semi-conscious and chained, the 700 miles from Port Elizabeth to Pretoria. Developing his program of Black Consciousness, Biko had famously written, “the most potent weapon of the oppressor is the mind of the oppressed.” He astutely identified that much half-hearted opposition to apartheid was more the “liberal appeasing his own conscience” than a serious attempt to change the system and abandon privilege. more…

Kushal Patel: Pay inequity spells a winter of discontent for junior doctors

20 Dec, 16 | by BMJ

kushal_patelThis past year has been particularly turbulent for junior doctors nationwide. Mired in a public standoff with the government and with lacklustre stop-start plans for industrial action, it has rendered them a workforce that feels at best confused and at worst abandoned by its union. It is safe to say that morale has sunk to a new low.

Yet another thorn in the already well pierced side of the junior doctor cohort is the dilemma of pay protection and the resulting pay inequity. Pay protection, a short-term measure allowing for financial stability during contractual changeover, safeguards employees, enabling them to plan and maintain fixed term outgoings such as rent and mortgage payments.   more…

Saffron Cordery: Reasons for winter pressures—flying under the radar

16 Dec, 16 | by BMJ

Saffron Cordery_2016For your average Joe Blow it must be hard to work out why, every winter, there is such a commotion about pressures in the health service and particularly in A&E. Surely, after so many years, it could be sorted out? I think that puzzlement is also widespread amongst those of us working in or alongside the health service. After all winter pressures continue to be the focus of substantial policy, political and frontline thought, effort and initiatives.  more…

Penny Pereira: Dr Flow—the role of the medical profession in improving flow

12 Dec, 16 | by BMJ

HF: Staff & Board PortraitsPacked waiting rooms, delays in getting results, ambulances queuing, patients and results getting “lost” in the system: the daily frustrations facing people using and working in the NHS have become so familiar, it’s easy to start to accept them as inevitable. Or, even if these obstacles are not seen as inevitable, the effort needed to keep often ill designed systems moving is such that there’s little time to systematically dig deeper and diagnose the underlying causes.

As explored in a new guide from the Health Foundation and AQUA, many of these problems are symptoms of poor flow. more…

Elizabeth Anderson and Simon Bennett: Are we serious about changing culture?

5 Dec, 16 | by BMJ

Healthcare education has enormous capacity to equip future practitioners with the right mindset to promote supportive team-based cultures within the NHS. By this we mean that during training all practitioners should develop skills needed to work in a community that is then manifest when working in clinical and other care situations. They should know how to: form a team; use each other’s skills appropriately; place patients and families at the centre of care; and support colleagues. Proactive, forward-thinking team players stand the best chance of identifying latent errors (incidents and accidents-in-waiting). [1] Foresight and proaction reduce the risk of death and harm. Following the Francis report there have been numerous initiatives within the NHS, some of which, like the rise and recognition of quality-improvement activities, are reactive, while in contrast, education is proactive. [2,3]


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