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The chief executive’s tale: Exit interviews

13 May, 16 | by BMJ

siva anandaciva_picPeople always surprise you. When I started interviewing retiring NHS chief executives to support a project with the King’s Fund, I had several preconceptions that were quickly disproved. The first preconception was that my four interviewees would be tempted by the traditional exit interview traps of score settling or self-authored hagiography. Instead what I found was a group of people who were contemplative and willing to look as hard at their failures as their successes.

Like picking out a good performance in a movie it was often the small and almost inconsequential moments that stuck with me from the interviews, rather than the bold declarative statements or soundbites. To pick out just two of these smaller moments: more…

Janis Burns on the junior doctors’ dispute: How can we achieve an outcome that satisfies the majority?

10 May, 16 | by BMJ

janis_burnsAs with most things in life, the best solutions are often the most simple, and with retrospect, they were glaringly obvious. The resumption of talks between the BMA and the government was facilitated by our royal colleges suggesting nothing more complicated than a five day pause. A ceasefire called for by the natural mediators. What could have been more obvious or simple?

Now the negotiators for both parties are rising to an almighty challenge with the weight of an entire profession and the UK public resting on their shoulders.

Rachel Clarke: Junior doctors’ dispute—Jeremy Hunt musn’t ignore doctors’ genuine concerns

10 May, 16 | by BMJ

rachel_clarkeIt’s ironic, isn’t it? Even as last ditch truce talks to settle the junior doctors’ dispute got underway this week, UK health secretary Jeremy Hunt has come under fire yet again for going to war with doctors on the flimsiest of pretexts.

Yesterday, a stroke physician from Oxford University, Professor Peter Rothwell, talked about research that revealed that Hunt’s spin about excessive weekend deaths from strokes is based on assumptions as spurious as they are alarmist. The large scale study shows that over a third of patients recorded as being admitted to hospital for a stroke had actually been admitted for other reasons—particularly the routine, low-risk procedures that tend to be carried out Monday to Friday. These administrative coding errors distort the mortality statistics, erroneously making weekdays appear safer than weekends. more…

Ellen Broad and Tom Sasse: Google deep in trust issues around use of UK patient data

10 May, 16 | by BMJ

We all need different kinds of medical care at different points in our lives. When we interact with our GPs and healthcare providers, we hope that our doctors and nurses know everything they need to know to help us get better. We want to get the best possible care and we want the experience to be as painless (in all senses) as possible. Better data sharing between organisations and people who are providing medical care, and better use of health data—whether in the private or public sector—is going to be a necessary part of making this happen. more…

Neena Modi: How might the junior doctors’ dispute be resolved?

9 May, 16 | by BMJ

neena_modi2After months of stalemate, a brief pause has been suggested so that both sides in the junior doctors’ dispute can take a deep breath, and get back to talking. How might this pan out?

Let’s start by being quite clear: Paediatricians have always delivered a 24/7 service and the government’s own equality assessment shows that the new contract disadvantages doctors who are parents and carers. But whatever the litany of rights and wrongs of this dispute, trust between junior doctors and government is at rock bottom. It seems to be stretching credulity to the limit to believe this is mere carelessness, so what motive could there possibly be to destroy the morale of a stable, home-grown workforce, committed and proud to serve in a publicly funded healthcare system? more…

David Oliver: A dispute played out via soundbites and spin cannot end well for services

9 May, 16 | by BMJ

david_oliver_2015I write this a few hours after the BMA agreed that it would take up the offer of renewed contract talks with the government, brokered by the Academy of Medical Royal Colleges. The government have in turn agreed a temporary suspension of imposition.

PR has coloured the whole saga of the contract stand-off. What had been a low key bureaucratic process was bizarrely hijacked by Jeremy Hunt last summer when he attacked doctors’ vocation and work ethic, insinuating that they didn’t already work evenings and weekends. more…

Junior doctors’ dispute: pause is welcome but fundamental problems remain

6 May, 16 | by BMJ

tom_moberlyA five day pause in work to introduce a new contract for junior doctors could be a welcome opportunity for both sides to engage meaningfully on the outstanding issues of disagreement. But it would do little to quell the anger that led junior doctors to the first all out strike in the history of the NHS.

Meaningful talks could undoubtedly go some way to closing the gap between the government and the BMA. The government says that the substantive areas of disagreement relate to pay, the most significant being around pay for Saturdays and antisocial hours. The BMA argues that there are at least seven areas of disagreement, including safeguards and protection against working excessive hours. more…

How do the healthcare systems in the UK compare with others internationally?

3 May, 16 | by BMJ

sarah-gregoryTwo years ago I wrote about how health systems in other countries were grappling with the problems of how to support an ageing population with high rates of comorbidities. I was interested in the fact that the same policy problem can generate different solutions depending on the context in which it sits—so while it may appear that there is a sort of “free will” in decisions about policy, in reality decisions will always depend on the limitations of funding and political structures. more…

Thomas Macaulay: Senior doctors’ opinions on the junior doctors’ strike

29 Apr, 16 | by BMJ

tom_maccauleyThe letters pages of British broadcasts last week were inundated with the views of doctors on the strike of their junior colleagues.

Most were united in their criticism of the misleading media coverage. Writing to The Guardian, Dr Michael Maier described the reporting as “sensational and inaccurate” with particular reproval reserved for the description of a 48 hour withdrawal of emergency care that was “actually between the hours of 8am and 5pm on 26 and 27 April.” more…

David Oliver: Are we recreating the conditions that led to the Mid Staffs scandal and Francis inquiries?

28 Apr, 16 | by BMJ

david_oliver_2015I am worried that we are heading right back to the very conditions that led to the Francis inquiries, losing any progress we have gained on the back of them. In health, as in many industries, it often takes a major incident or scandal to prevent more from occurring in the future. But let’s not go back to it.

It’s now six years since the report of the independent inquiry by Robert Francis QC into events at Mid Staffordshire NHS Foundation Trust from 2005-9. It’s still a powerful testimony of a hospital whose culture was broken. more…

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