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Gareth Iacobucci: Jeremy’s firm hand casts a shadow

2 Dec, 16 | by BMJ

gareth_iacobucci2Jeremy Hunt caught a few people off guard at this week’s NHS Providers conference when he unexpectedly announced a flurry of new policies.

Those who have heard the health secretary give dozens of speeches over the past four years had their usual game of “Jeremy Hunt bingo” (key watchwords: patient safety, technology, Virginia Mason [The award winning Seattle hospital that Hunt loves to name check]) interrupted by a spate of new announcements geared towards addressing the low motivation and morale among NHS staff and enhancing leadership and flexible working opportunities.  more…

Jonathan Glass: Irrational numbers in surgical training

2 Dec, 16 | by BMJ

jonathan glassI enjoy numbers. I enjoy the accuracy they provide; the guidance they give in the practise of clinical medicine; and, though very far from being a mathematician, I like reading of their discovery throughout history, their quirkiness, and I like being shown their logic even though I know I won’t be able to remember or explain all I hear.

Just as I enjoy numbers, I get distressed when numbers are used to distort facts. It distresses me when they are misinterpreted to imply one football manager is better than another, when they are used erroneously to suggest one country’s healthcare outcomes are better than another’s, or when they are used by politicians to lie to the population. more…

Delan Devakumar et al: Politicians need to first do no harm

28 Nov, 16 | by BMJ

It’s been a monumental year. The UK’s decision to leave the European Union and the Chilcot report on the Iraq war prompt us to wonder why these self-inflicted problems ever happened. The legacies of David Cameron and Tony Blair will be dominated by Brexit and Iraq respectively. Different in many ways, but each was a self-inflicted political wound, with profound consequences for us all. Why cause these problems?


Amar Mashru: Passports, smokescreens, and the vanishing NHS budget

25 Nov, 16 | by BMJ

amar_mashruChris Wormald, senior civil servant at the Department of Health, has suggested that patients should prove their eligibility for NHS care by showing their passport to receive treatment. The proposal was presented as a solution to “health tourism,” a problem which may be responsible for around 0.5% of the total NHS spend.

The cost of deliberate abuse of the NHS in this way is estimated at around £200m per year. This is a cost that the NHS can’t afford. Recovery of such money, however, is itself expensive. Passports do not confer NHS eligibility. The issue creates intrigue, discussion, and controversy. Intentionally so.  more…

Clare Marx: Give sustainability and transformation plans a chance

24 Oct, 16 | by BMJ

clare_marxThe NHS is treating record numbers of patients with better outcomes, but it is now facing some of the biggest challenges in its history.

Against this backdrop, Sustainability and Transformation Plans (STPs) will be unveiled over the next few weeks.  These are being designed by local NHS and social care leaders, working together across 44 patches of England, to find ways of transforming care and making their local NHS more sustainable within the current budget. more…

Andrew Furber: Should local government run the NHS?

21 Oct, 16 | by BMJ

andrew_furberA white paper published by the Conservative government in 1944 proposed that a new National Health Service should be managed by local authorities. [1] The Labour Party was split on the matter, but after their general election victory in 1945 Bevan proposed a plan favouring nationalisation of all hospitals. And so the NHS was born.

Nearly 70 years later the role of local government in the NHS is once again being debated. The integration of services delivered through local authorities and the NHS is underway in every part of the UK. In England there are now several NHS Clinical Commissioning Groups being led by local government officers. So should the NHS be run by local authorities, and would it be better? more…

Rammya Mathew and James McGowan: The role of shared decision making in a value based NHS

13 Oct, 16 | by BMJ

rammya_mathewjames-mcgowanLast month a controversial proposal was made by Vale of York clinical commissioning group (CCG) to deny obese patients access to elective surgery for up to a year. The headlines were alarming and the approach felt wrong. The CCG defended its position by saying that it was “the best way of achieving maximum value from the limited resource available.” The suggestion is now under review in the wake of the outcry it caused, but is this a sign of the kind of care rationing we will increasingly start to see?

As the Carter review of productivity in hospitals explained at length, the NHS must make better use of scarce resources. There is a strong ethical rationale for doing so; money spent on the care of one patient is money unavailable for the care of another. more…

Anna Miller: Asking all pregnant women for a passport before giving birth is simply wrong

13 Oct, 16 | by BMJ

anna_millerSt George’s University Hospitals Foundation trust is reportedly devising a pilot scheme to ask all pregnant women to show a passport to prove their right to NHS care before giving birth.

Although in some ways this does not mark a policy change—undocumented migrants are already charged for maternity care—it marks a departure from NHS guidelines to protect the most vulnerable women in our society.

The medical charity I work for, Doctors of the World UK, runs a clinic in London where we see pregnant women in the late stages of their pregnancy who often have not had any antenatal care. Some don’t think they are entitled, or don’t know how to access the NHS, or are too afraid to. Almost all the women we see do not have passports and are not able to prove their eligibility to NHS care. This is not because they are “visitors” in the UK. On average our patients have been living in the UK for over six years and usually they are unable to return to their country of origin. They include the most vulnerable women in our society—trafficked people, those trying to claim asylum, and people living and working in exploitative situations. It is these women who will be impacted by routine passport checks to access antenatal care. Only this week our clinicians spent close to an hour with a pregnant woman trying to persuade her to attend antenatal care and not just go to A+E during labour. more…

Laurence Gerlis: Is private medical practice that bad?

12 Oct, 16 | by BMJ

laurence_gerlisDuring my 30 years as a private GP I have become used to being insulted by other doctors. Some see us as mercenary quacks, with little genuine interest in patients’ needs, who overprescribe and bombard NHS GPs with useless health screening reports.

NHS doctors are not volunteers, they are paid. All patients pay for NHS treatment, even the poorest who pay via taxes including VAT. The money just takes a more circuitous route than it does in our clinic. So there is no moral discrepancy. My patients pay again, mainly because they cannot get an NHS appointment soon enough and they work in Central London where I am based. My average patient is not a rich oligarch, but a 30-something working person on a slightly above average salary. I don’t see this as vicious queue jumping, just being practical. I have never had any income apart from what I can earn in fees from individual patients, whereas NHS doctors have a guaranteed patient flow and income plus pension. One NHS GP confided to me, “I wish I had the nerve to take a chance as you did, but I need to know that I have regular income.” more…

Richard Thorley: Exception reporting—let’s show Jeremy how hard we really work  

11 Oct, 16 | by BMJ

richard_thorleyThe day we have all been dreading in obstetrics and gynaecology has arrived. Some trusts started to roll out the new contract for junior doctors last week. The cancellation of strike action recently left a select few determined strike activists fuming, but while it seems most of us welcomed the decision, it has left us bereft of any plan to stop Jeremy Hunt’s new contract for junior doctors in England. We await further announcements from the JDC, who remain firmly opposed in principle to the imposition. They talk of further action not based around strikes, but there is no indication of what this might be or how it could possibly halt the juggernaut that is the 2016 deal. The regrettable failure of Justice for Health to win a favourable outcome in the High Court recently means that with just days to go before the first tranche of us sign on the dotted line, any remaining fight to prevent the new conditions being introduced is futile.  more…

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