Cognisant of the short time that ministers are in post, Jeremy Hunt, decided when he became Secretary of State of Health, that to make a difference he should have only four priorities. They are, he told the Cambridge Health Network on Wednesday night, improving the quality of care, putting dementia higher on the agenda, reducing mortality from conditions like cancer, and embracing the revolution in information technology. The last, a process improvement, is, he has realised, very important for achieving the first three. more…

Last week prime minister David Cameron announced a series of measures to improve nursing standards and care, including a “friends and family test” (FFT). To me, it appears more of a political gimmick rather than a clinically meaningful mandate for the NHS. The FFT proposes that every patient will be able to give feedback on the quality of their care after undergoing treatment:

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This blog reports on a workshop held by the Department of Health on 28 November 2012 under Chatham House rules, that is the discussion can be reported but not attributed.

This workshop aimed to provide a framework for “a part of the government exploring use of QALY weights” in value based pricing (VBP), specifically:

• Burden of illness: does the social value of a QALY vary by size of unmet need (“QALYs lost per patient with current best practice treatment”)?
• Therapeutic innovation and improvement: does social value vary with “magnitude of QALY gain provided by a treatment?”
• End of life (EOL): does social value vary by “patients life expectancy with current best practice treatment?” (quotes are from the Department of Health briefing papers). more…

A running joke about revalidation is that its roll out is and always will be 12 to 18 months away. What will mandarins in Whitehall and the colleges chuckle about now that revalidation has finally started? Almost as important, will revalidation work and what impact will it have on the working lives of doctors, standards of medical care, and the safety of patients? Will it be worth the cost?

The answer is not completely clear. Revalidation is a form of assessment and so it should have high validity and reliability, it should be acceptable to stakeholders, and it should have a positive impact on the behaviour of those undergoing the assessment. It should also be low cost. How revalidation scores on all these criteria isn’t clear at present because it hasn’t started. However working from first principles there are some things that we can say about the utility of revalidation. more…

On a recent rainy Saturday in November an estimated 15,000 people marched through the centre of Lewisham in response to a call to protect their local hospital whose A&E department, children’s and maternity services are all under threat of closure. The march took an hour to file past and was remarkable for its heterogeneity, with a range of ages, social class, and ethnic mix that is rarely seen on protest marches. Many looked as though this was the first time they had taken to the streets and while the crowd was good natured and well behaved this did not disguise an underlying anger. People were angry at the politicians who had lied yet again about the NHS. They felt betrayed and without a voice when it came to one of the things that matters most to voters—the fate of the NHS, both nationally and at local level. more…

As an NHS GP I learned that healthcare is fundamentally locally provided and delivered through fostering long term relationships. However, the convergence of mobile technology and big data have the potential to profoundly change the way care is delivered. Should existing power brokers see this as an opportunity or a threat and what does this mean for the NHS?

This week, we were privileged to receive a delegation of UK health leaders at MIT’s shining temple of innovation, The Media Lab. In a brilliant white conference room, myself and four other MIT affiliated engineers and physicians discussed technology and health. We discussed a question that stuck in my mind and has inspired this post, “is it best to leave the Americans to do the trial and error and then take what works back to the UK?” more…

Do doctors and judges inhabit different worlds? A judgment handed down this week makes me feel they do. I do not think justice has been done in the case of Sean Maguire. Dr Maguire was the GP who, on 29 August 1993, saw a two year old child with a runny nose, which he diagnosed as an URTI. A month later, on 30 September, another GP saw the same child, again with a runny nose, and made the same diagnosis. more…

In the Department of Health’s guidance Developing the NHS Commissioning Board, David Nicholson stated: “CCGs (Clinical Commissioning Groups) will be the engine of the new system and things will only be done at a different level of the system where there is evidence that this produces better results.”

However, there is wide spread concern that the NHS Commissioning Board (NCB) will replicate more of the same “micromanagement” that has dogged this coalition government. Even the most enthusiastic cheerleaders of commissioning see the NCB as their greatest risk, and they too fear that CCGs will be pawns in the strategy of implementation rather than designing regional and local services. more…

At the end of November the government will give its response to last year’s sickness absence review led by business leader David Frost and healthcare expert Dame Carol Black.

A key recommendation of the review was the establishment of an independent assessment service (IAS), to which GPs could refer patients who have been off work for more than 4 weeks. If this recommendation is accepted it will be a major step towards appropriate and timely assessment of long term sickness absence. more…

Newspapers these days have a steady stream of stories about the alleged failings and dirty dealings of private companies who are providing services to the NHS. Saturday’s Guardian (10 November 2012) has a story about Harmoni, the UK’s biggest out of hours provider that has recently been sold to Care UK for £48m. According to the Guardian report, the five GPs who are directors of Harmoni will each receive payouts of more than £1m.

Good journalists always ask the companies to defend themselves and a typical defence usually reads something like this (taken from Saturday’s Guardian): “In a statement to the Guardian, Bruce Websdale, Harmoni Group medical director, said: ‘As the largest provider of out of hours urgent care in the country, we pride ourselves on offering the highest levels of patient care and satisfaction. Any patient concern with our service is treated very seriously and thoroughly investigated.’” more…