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Richard Smith on supply-led demand—more doctors, more hospitals, more cost but not more value

19 Jan, 17 | by BMJ

richard_smith_2014I squirm every time I hear that “increasing patient demand” is driving up costs in the NHS. I squirm because demand, although a standard technical word of economists, sounds so pejorative and blaming. “Those bloody patients. If they’d only stop demanding so much the NHS would be fine.” It’s crucial to understand (but is not widely understood) that the main driver of costs in health care systems is the rising cost of medical interventions—the fact that much more can be done. This gives rise to what economists call “supply-led demand.” As one senior NHS leader once said to me, the main driver of costs in the American health system is the National Institutes of Health, the biggest funder of medical research in the US (and the world) because it keeps inventing stuff. more…

David Shaw: The implications of conflicts of interest for informed consent

18 Jan, 17 | by BMJ

david_shawThe General Medical Council (GMC) has detailed guidelines on handling conflicts of interest. These state that “You must not allow any interests you have to affect the way you prescribe for, treat, refer, or commission services for patients.” [1] But in many cases, doctors who fail to disclose a conflict of interest are not only breaching rules governing conflicts of interest; they are also breaching guidelines on consent.

When seeking consent from a patient, doctors must ensure that three criteria are met: the patient must be adequately informed and be competent to make a decision, and that decision must be voluntary. The GMC guidelines on consent state that “you must…share with patients the information they want or need in order to make decisions [and] maximise patients’ opportunities, and their ability, to make decisions for themselves” (principle 2). In addition, principle 3 states “For a relationship between doctor and patient to be effective, it should be a partnership based on openness, trust and good communication.” [2] more…

Derek Bell: A blame approach will endanger the future of the NHS

17 Jan, 17 | by BMJ

Both the news headlines and the staff working in healthcare report real pressures within the NHS. The reasons for this are multifactorial and include recruiting and retaining a high quality workforce, financial constraints, and increased demand, combined with an ever increasing availability of effective treatment and diagnostics. Add to the mix the challenge of winter and the strain on the system increases.

Today these pressures are played out in real-time on social media, in traditional media, and within governments, with the finger often being pointed at one group of professionals. Blaming one group, rather than having a systematic approach based on best evidence and practice, aggravates the problem and leads to attempts at quick fixes or unhelpful sound bites. more…

Living with tinnitus and how it’s helped me identify with my patients

17 Jan, 17 | by BMJ

My illness presented itself suddenly in the middle of a summer night when tinnitus woke me up like an unwelcome visitor. I waited a few minutes for it to go away, but it had come to stay forever. It was coming from my left ear, sounding like a high pitched metallic/whistling noise, with some low frequency humming in the background (I find it difficult to describe).

Over the next few days or so—and to my horror—I found that some everyday activities, such as chewing, yawning, and turning my head towards the extreme left, exacerbated the tinnitus for a few seconds during which I could hear it as a white noise. more…

Miranda Wolpert: We must set realistic expectations for outcomes in child mental health

17 Jan, 17 | by BMJ

The secretary of state for health, Jeremy Hunt, identified Child and Young People’s Mental Health Services as “the biggest single area of weakness in NHS provision at the moment.” Hardly a day goes by when there is not another story in the press about children and young people failing to get access to or needing to travel huge distances for treatment. Professionals and lobby groups call for more funding and greater access.

I want to be clear that I absolutely endorse the need for more funding and the calls for better access. However, I am concerned that, because of the strength and urgency of the focus on funding and access, consideration and discussion of the limits of treatment is being lost. The fact that not all provision is helpful is rarely discussed; perhaps partly out of concern that, if it were raised, what limited resources are already available would be cut further. I have argued elsewhere that this silence on the limits of treatment has potential negative consequences; in particular it can leave therapists and patients alike feeling bewildered and blamed for a lack of progress and can limit any motivation to genuinely review outcome rates and make improvements in the light of that review.   more…

Seth Berkley: The new priority in Syria is preventing epidemics

17 Jan, 17 | by BMJ

Regardless of how the current ceasefire agreement in Syria came about, it has—to a large extent—brought a welcome halt to hostilities in many parts of the country. But as one humanitarian crisis is suspended, another potentially hangs in the balance—the growing threat of epidemics. With no way of knowing how long the ceasefire will last, there is an urgent need to get vaccines into Syria before this much-needed opportunity slips away and before the suffering of people in Syria is made even worse by the growing threat of deadly infectious disease.


Samir Dawlatly: The perfect storm to distract us from a crisis

17 Jan, 17 | by BMJ

All over social media recently there has been wailing and gnashing of teeth by GPs, such as myself, at suggestions that the opening hours of general practice are in some way to blame for the crisis in hospitals up and down the country. A single paper initially led with the story that the Prime Minister was going tell GPs that they had to be open from 8 until 8, 7 days a week, according to local need. This is nothing new. This is old news. This is the part of the plan set out in the GP Forward View, with the finer details being laid out in NHS operational planning guidance (see page 53). more…

Florence Wilcock: Maternity voices partnerships—“No hierarchy, just people”

16 Jan, 17 | by BMJ

florence_wilcock“No decision about me without me” has been a key element of NHS rhetoric since 2012. It’s a great idea, however, the current reality is that as a universal principle this remains far from true.

Why is there still such a struggle to make this happen? In healthcare there is an increasing acceptance of the need to have patient engagement strategies and patient representatives at meetings, however, this attempt can be tokenistic and fall short as a genuine endeavour to find out what service users want, and to design improvements and implement changes together. more…

Reena Aggarwal: Finding a scapegoat for the NHS crisis

16 Jan, 17 | by BMJ

reena_aggarwalA year ago junior doctors in England went on strike for the first time in four decades. Jeremy Hunt, health secretary for England, used statistics on the so called “weekend effect” to justify a new contract for junior doctors. This was despite warnings from the medical director of NHS England that it would be “rash and misleading” to suggest that causation could be attributed to seemingly more deaths over the weekend. Yet this misuse of statistics persisted throughout the very protracted dispute between the medical profession and the government.  more…

David Gilbert: “What would a patient led solution to the A+E crisis look like?”

16 Jan, 17 | by BMJ

david_gilbertLike many people who spout rhetoric about the NHS, I am guilty of indulging in the blame game. Some professionals and policy makers “blame” patients for “inappropriate attendance” at A&E and we have millions spent on campaigns to urge us to “choose wisely” when thinking about heading that way (assuming that we do not make rational choices).

Likewise, I can blame professionals for thoughtless and ineffective policies and practices. Or, I can point the finger at “the system” for being professionally-centric. Note that the notion of blaming “the system” is itself a neat trick that casts a blanket of blame over others, without requiring us to be more precise about where the problem lies. It is also a familiar tactic for the traditional patient movement through which we can maintain an “us and them” attitude and an adversarial posture towards improvement. more…

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