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David Zigmond: Depression needs more than formulaic treatment

29 Jul, 14 | by BMJ

david_zigmond2An eminent academic psychologist, Professor David Clark, recently broadcast on the BBC’s Today programme (1 July) authoritative hope to the many sufferers of depression. He informed us how current scientifically formulated, measured, and monitored cognitive behaviour therapy (CBT) is positively transforming the efficiency and economy of care.

To me, this picture is a misleading exaggeration. I know this from several decades of working in the NHS with the mentally anguished. Yes, CBT certainly has much to offer in terms of apparent clarity, comprehensibility, reproducibility, and thus mass production—little wonder then, that it has ready allure for service designers, economists, and politicians. more…

Neal Maskrey: Feeling the force of the QOF

28 Jul, 14 | by BMJ

neal_maskreyIt’s the season for graduation ceremonies. Proud parents and partners, relieved graduates, and a lump in everyone’s throat as that enormous rite of passage is eased by impressive ceremony, thoughtful words, cheap university wine in plastic glasses, and finally by long, late, cheerful family lunches.

My generation began their medical careers in a different world, where competence was implicit. After several decades of serial NHS disappointments, disasters, and scandals, new doctors—fresh and eager, but apprehensive—enter a brave new world. more…

Billy Boland: Life after the NHS Leadership Academy

23 Jul, 14 | by BMJ

billy_bolandIs it nearly over? Putting the final touches to my portfolio seems all wrong somehow. The outcome of my time at the NHS Leadership Academy depends on this submission, and while it’s now due, I feel I’ve only just started. Come to think of it, this experience has been one of the key features of my learning on the programme: the way I feel about something isn’t always the best guide to what is actually going on. And let me tell you, as someone who can tend to draw on emotions to help make decisions, that can be pretty confusing at times.

As I reflect on this latest stage in my leadership journey, it seems like a good time to share some of the highlights of my learning since my first blog in October last year: more…

Bijal Chheda-Varma: Bariatric surgery is unsustainable

22 Jul, 14 | by BMJ

Bijal Chheda-Varma2Obesity is widely recognised as one of the greatest health threats of the 21st century across the developed world, with about a third of the global population now obese or overweight.

While the evidence of the problem is undisputed, there is little agreement as to how to solve it. Many solutions are being brandished about in terms of both prevention and cure; in the UK, for example, a sugar tax has been suggested, and NICE has issued its headline grabbing draft recommendations that patients with a BMI of 30 or more should be given bariatric surgery. From my experience of treating overweight and obese patients, it seems clear that, as standalone solutions, these are not sustainable as they do not address the root causes of obesity. more…

The BMJ Today: Coca-Cola . . . for real?

10 Jul, 14 | by BMJ

Coca-Cola tackling obesity might sound surprising, not least if we consider the close relationship the soft drinks manufacturer enjoys with the rotund Father Christmas.

But the company recently announced that it was extending its scheme to tackle obesity (piloted last year in Birmingham) to 50 parks in three English cities, committing £20m to help local councils set up activities such as running, cycling, rounders, tai chi, and bushcraft.

In her column in The BMJ this week, Margaret McCartney casts a trademark critical eye over proceedings, arguing that while the move is allowing Coca-Cola to tick the box for corporate social responsibility, the company is unduly benefitting from the advertising space its products are being afforded. more…

Claire Severgnini: Why we need more fracture liaison services

4 Jul, 14 | by BMJ

ClaireAn estimated three million people in the UK have osteoporosis, and a recent survey of the National Osteoporosis Society’s members revealed that a fifth of women who have fractured bones sustain three or more breaks before being diagnosed.

That must change and osteoporosis must be diagnosed sooner. At the National Osteoporosis Society, we believe that everyone over 50 who suffers a break should be assessed for osteoporosis. This is why we are setting out our ambition to increase the number of fracture liaison services across the UK. more…

David Wrigley: Privatisation behind an invisibility cloak

26 Jun, 14 | by BMJ

david_wrigleyI was a guest speaker recently at a packed meeting in central Newcastle, where we discussed and debated the changes to the NHS. Everyone in the room was very concerned and indeed very angry at what they heard. A lot were unaware of the scale of the issue over privatisation in the English NHS.

Time and again I hear, “We didn’t vote for this at the last election—it wasn’t in any manifesto,” or “The coalition have no mandate to make such huge changes to our NHS—no single party won the election.” And I agree with them. The coalition has been very clever in making out that GPs were on board with the NHS changes (they weren’t), that it was what the NHS needed (it wasn’t), that the NHS is in a massive hole (it isn’t), and their coup de grace is that they are selling off many services to the private sector hidden behind the well trusted and well respected NHS logo. It is privatisation behind an invisibility cloak. more…

Hugh Alderwick: NHS performance—are we really getting it right?

24 Jun, 14 | by BMJ

hugh_alderwickAccording to the Commonwealth Fund, in the UK we’re getting it (mostly) right—or, at least, we’re getting it more right than our international counterparts. In their comparative study of health system performance in 11 countries, the UK ranks first across a range of measures covering quality, access, and efficiency of care, while the United States comes in last place.

While it’s nice to be told that the NHS is performing well, there are limits to how much we can learn from comparative rankings.

Firstly, different rankings by different people can tell us different things. The UK moves up and down in various international scorecards depending on which indicators have been included, and how different dimensions of performance have been weighted. Secondly, the Commonwealth Fund’s study is primarily designed to highlight poor performance in the US system. As we’re good at a lot of things the US isn’t—like access to care—we come out particularly well. more…

Simon Capewell: Spending NHS funds on weight management services—naughty or NICE?

20 Jun, 14 | by BMJ

Interior block 3I have been asked to write about the recent NICE (National Institute for Health and Clinical Excellence) recommendations on weight management services. I didn’t want to, I am already crazy busy as a public health academic. And I am usually a strong NICE supporter, previously describing it as a global exemplar. And I must confess an interest, having spent many days in hot stuffy rooms advising NICE on diverse issues.

However, few will read the full weight management report and appendices. So instead, read this first: NICE’s proposed list of new guidelines on the most effective interventions to prevent the major burdens of obesity, cardiovascular disease, and common cancers. NICE genuinely tried in 2010. But the UK government put a red pen through the 19 best proposals, effectively preventing NICE from looking at these more powerful, “upstream” policy interventions. more…

Billy Boland: The power of “systems” in healthcare

11 Jun, 14 | by BMJ

billy_bolandI looked down at my name badge. Although it said chief executive officer, I felt like an impostor. Across the table sat a suitably intimidating panel. The members of the Health Overview and Scrutiny Committee (HOSC) wanted me to justify why we were keeping open a crumbling hospital with poor outcomes, while the community was crying out for more resources. Expectant faces were staring at me, waiting for my presentation. A presentation? No one told me about that. I looked down at my notepad searching for something to say. It was blank.

This scenario was all part of a simulation, and one of the many training experiences I’ve undertaken at the NHS Leadership Academy.* The truth was, two days earlier, I’d never heard of the HOSC. Yet in this particular exercise, our trust board had come up with an options appraisal to tackle its ailing services and financial problems. Now it had to convince all and sundry, including this committee of councillors, that they were doing the right thing. The HOSC is an operation of the council in England and Wales, and has a role in independently reviewing and holding health services to account.

Such experiences are gravely familiar at the NHS Leadership Academy, which I am a part of. I have grown used to being dropped into difficult situations, and having to rely on my burgeoning skill set to figure out what to do. more…

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