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David Wrigley: Manchester—the birth and death of the NHS

12 Mar, 15 | by BMJ

david_wrigleyOn 5 July 1948, in Manchester, Labour Secretary of State for Health, Aneurin Bevan announced the birth of the NHS.

On 27 February 2015, in Manchester, Conservative Chancellor of the Exchequer, George Osborne signed a piece of paper that would bring about the end of a National Health Service.

There is no longer an NHS in Manchester—it is now the MHS—the Manchester Health Service.

These two events are 67 years apart but signal huge differences in how healthcare will be provided to the population. more…

Playing the percentage game: the arts of playing football and practising medicine

11 Mar, 15 | by BMJ

martin_marshallI’m proud to be working among a group of GPs in east London who, against all the odds, are delivering a remarkable level of clinical performance.

Ninety two per cent of our patients with cardiovascular disease have their blood pressure controlled, despite our practice serving one of the most socio-economically and ethnically diverse communities in the country. Ninety per cent of children are immunised at 2 years of age, despite more than a third of the whole population in Newham changing every year. And most of the patients at high risk of hospital admission have completed care plans, despite inadequate premises, and massive problems with recruiting and retaining GPs and practice nurses.

Yes, I’m proud, but sometimes it feels like a hollow kind of pride. more…

Samir Dawlatly: Sabre-toothed tigers and the lottery

10 Mar, 15 | by BMJ

The other day an older gentleman* was brought to the GP surgery where I used to work. He was feeling nauseous, and his concerned family had initially taken him to the local pharmacy to see if there was anything they could buy over the counter to ease his symptoms. As he was on a number of medications, the pharmacist was reluctant to sell them anything and advised them to see a doctor, so he was squeezed into my morning surgery as an emergency appointment. more…

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…

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