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Tim Rudin: Ethical Sourcing—how organisations can learn from other public sector bodies

12 May, 14 | by BMJ

tim_rudinTransport for London (TfL) has been implementing ethical sourcing into our procurement practices since the launch of the Greater London Authority (GLA) Responsible Procurement Policy in 2006. When we first started, very few other public sector bodies in the UK were looking at ethical sourcing. It had traditionally been the preserve of the private sector, where ethical sourcing practices can be a pressing business need because of the possibility of negative publicity and the threat of consumer boycotts. The drivers in the public sector are different—generally, if you live or work in London, it would be very difficult to avoid TfL’s services. However, TfL’s brand is exceedingly high profile, and protection of that brand through mitigation of potential reputational risks is of great importance. That is by no means the only driver though.

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Tim Ballard: The wider consequences of healthcare delivery

9 May, 14 | by BMJ

Tim_BallardIn January we saw the launch of the NHS Sustainable Development Unit’s (SDU) strategy for the NHS. Since its inception, the SDU has tirelessly promoted the wider responsibilities that we have when providing healthcare and social care. At its heart, this strategy reminds us that we need to act if we wish to decrease the environmental impact of healthcare, and, consequently, minimise adverse health effects both now and in the future. This strategy launch was reinforced by the recent IPCC statement, which underlined the effect that anthropogenic climate change will have on health.

In a similar way, the Medical Fair & Ethical Trade campaign asks us to think about the wider consequences of healthcare delivery in our Western democracy. The collapse of the garment factory in Bangladesh in 2013 brought the activities of the fashion industry into the spotlight; the workers who sadly lost their lives worked in unsafe conditions that would simply not be tolerated in the UK. Now it is time to shine the spotlight on the activities of the NHS. more…

Chris Ham: Wanted—an even Better Care Fund

7 May, 14 | by BMJ

The King’s Fund’s new analysis of serious and growing financial pressures in the NHS should serve as a wake up call to politicians of all parties. As the analysis shows, with an increasing number of providers in deficit, and the prospect of a further seven years of no growth in funding, the NHS is rapidly approaching a major crisis.

The arrival of this crisis has been accelerated by the transfer of almost £2 billion into the Better Care Fund in 2015/16. The purpose of the Fund—to support moves to integrate health and social care—is well intentioned. If it is used to support the kind of interventions we summarised in our recent evidence based guide, it should deliver benefits to the NHS as well as to social care. However, it will put additional stress on an NHS already struggling to balance the books and maintain acceptable standards of patient care. Acute hospitals will be particularly affected by the requirement to find even higher levels of efficiency savings than they have achieved to date. more…

Arthy Santhakumar: Shining a torch on medical supply chains—the great paradox

7 May, 14 | by BMJ

arthy-santhakumarHave you ever found yourself wondering where the equipment used by the NHS comes from? Maybe, maybe not. If you are in the latter category, then you may find that the answer makes for an uncomfortable truth.

Healthcare is a big business, and navigating through the NHS, its organisations, and supply chains is no easy feat. This industry spends nearly £40 billion per year on the procurement of goods and services, serving more than 63 million people. The supply chains that provide these commodities are global—employing millions of people worldwide, and elevating the NHS to the fifth largest employer in the world. This brings us back to our opening question—as, with such vast sums of money spent and human resources involved, we should question the circumstances under which such goods are produced in. more…

Jonathon Tomlinson: “Four problems”—a typical day for a GP

2 May, 14 | by BMJ

jonathon_tomlinsonI had only three patients left to see at the end of my morning surgery. It was 12.30. I had started at 8am, taking urgent phone calls for an hour before starting face to face appointments. It had been a typically challenging morning. Many patients had complicated mixtures of physical, mental, and social problems which is typical of all general practice, especially in deprived areas like Hackney. As a result I was running about half an hour behind and feeling pretty harried.

My next patient was a young, healthy looking, smartly dressed woman, in contrast to my previous patient, an elderly Turkish man with depression and chronic back pain who didn’t speak a word of English and came without an interpreter. The young woman was cheerful and friendly. “This shouldn’t take too long,” I thought as I called her in. more…

Azeem Majeed: General practitioners should give up their independent contractor status and become NHS employees

2 May, 14 | by BMJ

Azeem_majeedGeneral practitioners (GPs) have worked as independent contractors since the NHS was first established in 1948. However, we now need to review whether this model of general practice is what the NHS needs in the 21st century, and consider an alternative model in which general practitioners become NHS employees.

In many ways, GPs are already de facto ‘employees’ of the NHS. Much of the independence that GPs once had has been taken away by the government over the last decade. GPs’ workload and funding is now largely determined by the contract that their practices have with the NHS. more…

Richard Smith: Why doesn’t the obvious happen?

1 May, 14 | by BMJ

Richard SmithIt’s obvious to me that all scientific research should be available free to everybody everywhere, the polypill to prevent heart attacks and strokes should be offered to all those over 55, and patients not health institutions should control their records. Why don’t these obvious things happen?

The core arguments for making all research free are that most of it is funded with public money and that ideas unlike physical objects can be shared infinitely, increasing their value and the chance they can be exploited. Something like 20% of scientific studies are now available free to everybody, but most are not. Vested interest is the main barrier: the profits of many organisations, many of them scientific societies ironically, and the jobs of many individuals depend on the present limited access model. As Maynard Keynes observed, it’s impossible to convince somebody of the value of an innovation if his or her job depends on not being convinced. more…

Kailash Chand: The survival of general practice is the survival of the NHS

16 Apr, 14 | by BMJ

Kailash ChandGeneral practice in England is under intense pressure at the moment from a variety of sources, including the plan to keep surgeries open from 8am to 8pm, seven days a week. These are combining to overstretch practices in an unsustainable manner.

A key factor is that patient demand is constantly increasing because of an ageing population. By 2011 the number of people aged over 65 had surpassed 10 million, and by 2031 it is predicted to hit a new peak of over 15 million. As many of these patients enter their 70s and 80s, they will develop increasingly complex health needs that require longer consultations and more intense, complicated care from their general practice. By the beginning of the next decade, there will be one million people living with dementia alone, while many more will have other conditions such as heart disease, diabetes, and additional degenerative conditions. In the majority of cases an older patient will have a number of these conditions at the same time. more…

Vidhya Alakeson: What will personal health budgets offer the NHS?

4 Apr, 14 | by BMJ

vidhya_alakeson2From this month, adults and children eligible for continuing healthcare will have the right to ask for a personal health budget. Five years on from the start of the national personal health budget pilot, awareness among doctors of this new approach remains low, and scepticism at times, high. But rather than being seen as something to confine to the margins of the NHS, personal health budgets could make a significant contribution to important priorities. There are three areas where personal health budgets could help deliver: increasing the self management of long term conditions, reducing demands on acute care, and integrating care across the NHS and social care. more…

David Wrigley: Standing up against the fragmentation of the English NHS

28 Mar, 14 | by BMJ

david_wrigleyOn a little known website an advert popped up recently that didn’t catch the eye of many people. Those that did see it realised the implications of it when they read the details.

The website is called Supply2Health and is the location for all outsourced tenders for services in the English NHS. It is a veritable goldmine for the private sector wishing to take over profitable services and get their hands on a piece of the juicy NHS £120bn pie. more…

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