Editors' Blog

May 2008 - Posts

• United health and Darzi's empty chair

  If there were any doubt about how the profession was feeling about Lord Darzi's plans for the capital, it would have been dispelled by five minutes in Wednesday's BMA London council meeting. Speaker after speaker savaged the plans as expensive, ill-thought through and lacking in anything as trivial as evidence. Health minister Darzi seems to have pulled off the remarkable trick of designing a plan that offends every part of the NHS simultaneously. GPs complained that polyclinics would destroy general practice; consultants that removing A&E departments would gut hospitals. Staff and patients alike squawked that using APMS contracts for all London’s primary care would likely mean a health service dominated by United Health and its ilk. Even a spokeswoman for the deaneries stood up to ask exactly where she was supposed to train doctors if the number of acute hospitals was to be slashed by more than half. The strength of this consensus is all the more impressive given NHS London’s confident claims there was 'enthusiasm for change'. In fact, its consultation received just 3,000 responses – and only 51 per cent of them thought polyclinics were a good idea. The discrepancy between this slimmest of majorities and the health authority’s assertion that the city backed its plans led John Lister, of London Health Emergency, to quip that NHS London seemed to have the same pollsters as Robert Mugabe. In three hours, not one speaker spoke in favour of the plans. If the debate was one-sided, though, the government only has itself to blame. Ara Darzi had sent his apologies. In his place there was simply an empty chair, adorned with a rather sad looking stethoscope. Posted May 30 2008, 11:32 AM by jonn elledge with no comments

• Indiana Jones and the crystal Choose and Book

  In Whitehall it seems the idea that giving something a fancy title solves a multitude of problems reigns supreme. The latest example is the rebranding – sorry, retraining – of GP receptionists as ‘patient navigators’ as part of the DoH plans for improved access in the patient-focused NHS. The problem is ‘patient navigator’ doesn’t actually sound very patient-friendly. You know where you are with a receptionist – they make appointments, put you through to the right person to collect your test results and provide a familiar face for regular attenders. A patient navigator by contrast in impersonal. It sounds more like the terminology you find when dealing with a corporate call centre. Your customer service operative can’t help you, so you need to speak to the customer relations care supervisor, only they’re always ‘on another call, madam’ (perhaps I have spent to long on a repair line this week). Goodness only knows who you escalate your issue to is the patient navigator can’t help – NHS explorer, Choose and Book cartographer? And that of course is the other problem: is the NHS so utterly labyrinthine that it requires specialist navigators armed with DoH compasses and maps to help you through every health query. I don’t want to think of a referral as equivalent to canoeing up the Amazon. Of course, if it really is that bad, the DoH could consider a more radical approach and issue battered felt fedoras and whips to every surgery in the mode of Harrison Ford’s most recent return to the screen. It would be more exciting at least. Posted May 29 2008, 10:41 AM by Bronagh Miskelly with 1 comment(s)

• What will primary care look like tomorrow?

  When conference organisers or journal editors are a bit stuck for an item, it’s always been a nice fallback to look in to the future and ask ‘what will such and such be like in 20, or 30, or even 50 years?’. Given the constant rounds of reform and the zigzagging of NHS policy development, we are more justified than ever in asking what the consequences will be. Though now it’s probably more a question of ‘what will happen tomorrow?’. Okay, maybe that’s exaggerating a little, but how about: ‘What will primary care look like in five years’ time?’ I was talking to an ‘ordinary’ though well-informed GP this week who has always been keen to adopt new initiatives. But his view is that, in five year’s time, general practice will not exist as we know it today. Practices will need to fight to survive. Is he being unduly pessimistic? Well, we have just heard that 300 practices have expressed an interest in setting up Virgin-branded health centres. Polyclinics are on the march – representing a threat to GPs but opportunities for ambitious nurses. Some PCTs are breaking up the whole fabric of general practice to introduce their own primary care ‘franchises’. PMS contracts are being torn up and budgets unilaterally slashed. Pharmacists are being offered increasing roads into primary care provision, while dispensing practices could soon become extinct. And the list goes on… So, after all, perhaps it is best to look no further than tomorrow. Who knows, maybe the sun will shine.   Posted May 28 2008, 11:28 AM by Colin Cooper with no comments

• It's vital we tackle teenage binge drinking

  The number of teenagers getting drunk on a regular basis is increasing at an alarming rate, official figures revealed last week. According to the NHS Information Centre the number of under-18s ending up in hospital through drink was 8,494 in 2007 – or 23 a day. This represents a rise of 50 per cent over the last decade. Meanwhile, a survey published with the report shows that 11- to 15-year-olds who admit drinking consume an average of 11.4 units a week. Doctors and campaigners are warning of a future liver disease epidemic, which the NHS will be ill-equipped to tackle. And specialists say they are treating people in their 20s and 30s for liver failure and cirrhosis. The Daily Mail profiled a 14-year-old who had suffered liver failure as a result of her drinking. She said at 13 she was drinking 'up to three litres of wine a day, followed by two bottles Lambrini and perhaps a litre of vodka'. This is shocking and highlights a huge problem that needs to be tackled. The government is currently running a campaign to raise awareness about the number of units in different drinks, but this is clearly aimed at adults. Young people don’t necessarily care about units – they are drinking just to get drunk. So what can the government do? Surely putting an end to cut-price drink promotions in supermarkets and off licences is one place to start, along with cracking down on those shops that sell alcohol to under-18s. Adequate funding for educational campaigns aimed at teenagers is also vital. It is inevitable that many teenagers will go out and get drunk at some point or another. What’s important is making sure that this doesn’t become a regular part of their every day lives. Posted May 27 2008, 02:46 AM by Emma Bower with no comments

• To use HRT or not to use HRT?

  Another week, another research about the safety of hormone replacement therapy (HRT) that challenges the previous one.  Last week, it was a report from the International Menopause Society which warned that safety fears over HRT were overhyped, arguing that some of the concerns were not backed by any clinical evidence. The report said that HRT did not increase the risk of heart disease for women aged between 50 and 59, and that its effect on breast cancer risk was small. Scientists voiced their concerns over a research published by the Women's Health Initiative (WHI) several years ago saying the study - which showed that women taking HRT had a higher risk of breast cancer and heart disease - was misleading. But now a group of French researchers found that menopausal women who use HRT double their risk of blood clots. The findings have been contested by - you guessed it - the International Menopause Society... The society's view is that the absolute risk is very small and that shouldn't put women off taking HRT... It's a mystery to me how GPs and nurses manage to make a choice as to whether they should prescribe HRT to women with menopause. Posted May 23 2008, 09:23 AM by Emilie Reymond with no comments

• Virtually healthy

  Should I share my latest MRI scan pictures on Facebook or Flikr, or detail my up-coming knee surgery in a personal blog? Or a video on U-tube. Before we know it we’ll be using social networking sites such as MySpace and Facebook to share health information in ways that will force a rethink of how healthcare is delivered, according to a report from e-Health Insider. According to the report, increasingly people will publish feedback about treatments, doctors and hospital online through social networking sites and information about chronic disease management. Of course health providers will be able to take control of some of these interactions. For example hospitals offering patient feedback forums, or websites that support patient managed care in chronic disease or support groups. One of the most interesting examples already in operation is a virtual clinic launched by Spanish health authorities on the Second Life website. The service is intended help young people too embarrassed to speak to a doctor about sexually transmitted disease or a drug problem. Instead their avatars can visit a real doctor online to seek help. The group has plans to offer chronic disease clinics in the future. But while some people may feel more comfortable visiting the doctor disguised as a 7-foot elf with scarlet hair and striped wings, the risks surrounding health and the web continue. What is there to stop someone else setting up a bogus Second Life clinic and the rise of social interaction will inevitably promote a linked rise in poor or downright misleading health ‘information’ being passed about. In real life we have social signs and conventions to help us tell the real from the charlatan (well most of the time) and monitoring systems to protect us. Perhaps the real issue with the rise of Web 2.0 health applications is the question of how we regulate the virtual world. I don’t think I’ll be seeking a second opinion from a virtual blue troll or a Facebook group just yet. Posted May 22 2008, 10:50 AM by Bronagh Miskelly with no comments

• The future of surgeries lies in... robotics?

  Hardly a week goes by when we don't hear another crystal ball-gazing description of all the marvellous things that doctors and nurses are going to be able to do in the future - and all in the flick of a switch. This week we have the thrill of a whole, heaving great vision of the UK in 2030, as predicted by an IT company. ‘But why can't anyone fix my computer today?', I hear you ask. Don't worry about that now - it's not important. Quicksilva (cool name) is forecasting that ‘traditional surgeries will be augmented by robotised systems that carry out regular tests for ongoing patient conditions and automatically prescribe treatments based on test results'. This sounds fantastic, especially as the robots will be open 24 hours a day. Who needs humans? Likewise, all prescriptions will be handled totally electronically and fulfilled by the NHS online. Regular prescriptions will be delivered in the post (bit boring) or through a cashpoint-style dispenser (more like it) which is open (you guessed it) 24 hours a day. So what are the implications for doctors and nurses? Will they still be needed? Obviously the switches will still need to be flicked, but will they have to flick switches 24 hours a day? Could robotised health professionals flick the switches instead? Actually, this is a perfect job for pharmacists because the prescribing process will have completely bypassed them by 2030, and it will be perfect timing for them to take on the work of doctors and nurses (again). In other words, the end of human health professionals is definitely nigh. But hang on a minute, what's that note at the end of the report? Quicksilva is apparently already working with the government on Connecting for Health - tackling access to the NHS spine and that old favourite Choose and Book. Sorry, but there's no way that the new robotised world is going to be sorted by 2030. Maybe they should just give up now and start fixing our computers... Posted May 21 2008, 02:20 AM by Colin Cooper with no comments

• Can Parky restore dignity to the NHS?

  The DoH will unveil Sir Michael Parkinson as its new celebrity dignity ambassador today. The move will mark the start of a six-month nationwide tour by care services minister, Ivan Lewis, to promote dignity in care. Apparently, the DoH will also be recruiting 3,000 local dignity 'champions' who will help to raise awareness of the issue. While I think this is all very admirable and that ensuring older people are treated with dignity is vital, am I the only one who finds it a bit disheartening that it has come to this? Surely it shouldn't be necessary for a celebrity to tour the country telling healthcare professionals and those working in care homes that they should treat older people with dignity? This should be completely fundamental to what hospitals, nursing homes and community services do. However, as many of us know from the experiences of friends or relatives that this isn't always the case. We hear stories of staff on wards too busy to help patients at mealtimes, or older people with dementia routinely medicated with antipsychotics because they are too difficult to deal with. This can't be right and surely reflects a wider problem in our society about how we value older people. Part of the problem is down to individuals' behaviour and attitudes, but part of it is also about making sure staffing levels and skill mix ratios on wards and in nursing homes is right. And its not just frontline staff and organisations that we should consider, the DoH also needs to get its house in order. Labour pledged to put an end to mixed sex wards in its 1997 election manifesto, but figures released today suggest two-thirds of NHS trusts are failing to meet guidelines in this area. I suppose we should at least be pleased that the government is trying to do something positive to influence attitudes on the ground, though. And, maybe Sir Michael will be able to help - he certainly has massmarket appeal and a gravitas that will no doubt inspire people to listen. But, we must hope this plan doesn't go the way of the DoH's last high-profile celebrity partnership - anyone remember Lloyd Grossman's attempts to transform hospitals food? Another admirable endeavour, but one that didn't seem to achieve very much at all.   Posted May 20 2008, 02:30 AM by Emma Bower with no comments

• Covering a medical conference the French way

  In a taxi driving to my hotel in Nice for the annual European Stroke Conference, a more accurate prediction of my visit to France could not have been provided. ‘Ah, la tête!' said my taxi driver, who spoke as much English as I do French, tapping her temple. I assumed she knew, for one reason or another, why I was here. Attending an annual academic conference always gives a little insight into a country's psyche.  In America, delegates are there by 7am, whizzing around expansive conference centres on electronic scooters. In France, priorities are different. Delegates meander around the conference centre sipping espressos and beer. Research presentations and symposiums on innumerable aspects of stroke take place till 12.30, before a mammoth lunch break spanning out until about 4pm. And lunch for the academics and medics attending the conference from as far afield as Australia and Japan seemed very important. Not in a leisurely way, but like a scuffle for a winning lottery ticket, they all ran to tables stuffed with brown paper bags of booty at 12.30 on the dot. I learned how valuable this technique was on my first day at the conference. Going for lunch at 1pm after a look around the posters, I was apologetically handed a box of soggy lettuce and a chocolate brownie. The delegates' search for culinary, and other delights, on the Cote d'Azur didn't stop there. On an evening you could spot them a mile off; suited packs of mostly men wandered through the old town of Nice, unsuccessfully shaking off the distinguished air of academia. My eyes were elsewhere, trying to spot any A-list movie stars attending the Cannes festival down the road.  But a George Clooney or Brad Pitt was not in sight (although I gather the latter is nested in some part of France waiting for the next addition to the Brangelina clan). But all hopes of celebrity spotting were not lost. Sitting outside a traditional niçois bar called the King's Head, who would walk past but the bloke who plays Minty from Eastenders. ‘Oh, I love you! Our Brenda will be so jealous!' screamed the UK blonde at the next table. ‘You don't mind, do you?' she said, whipping her digital camera from her handbag and handing it to her hubby. Either because he's a good bloke or these types of request are few and far between, Minty (otherwise known as actor Cliff Parisi) leant in for a photo with her, baring his trademark cheeky grin. ‘She'll be so jealous, when I get home,' said the blonde to her husband, as Minty went on his way, totally unrecognised by a pack of delegates out for their last night of conference fun. But I knew she'd be the one who was jealous. After all, just a couple of days before I'd met Nick Ross of Crimewatch fame in Nice. That must be true Côte d'Azur glamour. Posted May 19 2008, 06:46 AM by Rachel Liddle with no comments

• GPs back Darzi after all

  If you've been following the open-mouthed horror which has greeted Lord Darzi's plans to impose polyclinics on unwilling PCTs, you could be forgiven for thinking GPs weren't exactly behind him on this one. But, reckons Professor Mayur Lakhani, you'd be wrong. The former chair of the Royal College, now an advisor to the Darzi review, told a meeting at the King's Fund yesterday that GPs are entirely in favour of the plan. Asked whether he'd told Lord Darzi of the widespread belief that polyclinics are a pretty stupid idea, he denied that belief even existed. "To give patients more choice and a voice you need to increase capacity," he said. "I talk to GPs frequently, and they welcome that extra capacity, because it gives their patients the opportunity to benefit. We've argued that we need more GPs and more practices, and that's a good thing." He's yet to convince the GPC, though. Its nearest member, Dr Nigel Watson, shook his head and replied, simply, "You need to get out more." Posted May 16 2008, 09:58 AM by jonn elledge with 2 comment(s)

• Alan Johnson vs Cherie Blair

  I’m still amazed at the way Alan Johnson went in to the RCN’s annual congress a few weeks ago and won over a potentially very hostile audience. He took a standing ovation at a conference which two years ago had jeered his predecessor off the stage. But maybe it’s not so strange. We take in so much of our information through short TV clips and radio soundbites that it’s easy to forget the power of oratory. Great public speakers can change mindsets, mix up emotions and start revolutions. But most of us rarely have the chance to partake in the experience. I was reading an extract from Cherie Blair’s outrageously frank autobiography yesterday and it reminded me of the time I saw her speaking at a charity function in 10 Downing Street. It was at the time of the Bristolgate scandal, when her buying of flats for Euan and connections with dodgy ‘businessmen’ were dominating the national news agenda. Accordingly, I went through that famous black door with a very low opinion of Cherie, but she was a magnificent speaker – eloquent, funny, down to earth, and at times very moving (all this in a speech about colon cancer). So I left, as I am sure everyone else did, totally bowled over by her charisma. And while I certainly wouldn’t put Alan Johnson in the same bracket, he clearly has some of that ability to turn an audience. Perhaps he should put it to test at the national conference of local medical committees next month? Posted May 14 2008, 03:18 AM by Colin Cooper with no comments

• Could new technology help smokers quit?

  According to a story on the BBC website, a Japanese company is developing a cigarette vending machine that uses face recognition technology to count wrinkles and assess skin sag so it can tell a smoker's age. If a prospective cigarette buyer failed this age test they would be asked to insert an ID card to verify their birthdate. The system is being developed by one company because, from July, vending machine companies in Japan could be prosecuted if tobacco is sold to anyone under the legal age limit of 20. I think this is a great idea - and something that could be adapted to help encourage people to stop smoking. After all, the health arguments for quitting just don't seem to work with some people, could the vanity argument be the answer? When people come into the surgery, instead of just asking about smoking status and encouraging them to quit, they could have their face scanned for wrinkles and sagginess. Comparing scans from one visit to the next, showing how their skin is deteriorating, might be the impetus they need to stop. Or maybe people could have these machines at home? They could assess how their skin ages while they're smoking and whether there's an improvement in the rate of decline if they stop. Sheer curiosity about whether there would be any difference or improvement might be enough to make some people quit. Posted May 13 2008, 10:34 AM by Emma Bower with no comments

• Life and death and Harry Hill

  There are two huge debates beginning this week that span the breadth of human existence, just like the NHS. But in this instance it’s not quite ‘cradle to grave’, more like ‘embryo to nursing home’. MPs are going to be grappling with the human fertilisation and embryology Bill in parliament, giving them some very difficult questions to answer. Many of the MPs are still undecided on how to vote, so expect this topic to dominate the airwaves this week. Meanwhile, health secretary Alan Johnson has launched a six-month consultation on the funding of social care for older people, forecasting a ‘£6 billion black hole’ within 20 years unless someone can come up with new funding sources. There are no easy answers to this problem - unless, of course, the environment deteriorates so badly by then that we all start dying a lot younger. But the DoH has suggested a more positive solution, involving the ‘telecare’ of older people, whereby they are monitored in their homes and make a phone call if they need help. This reminds me of a Harry Hill joke. Harry said he’d bought his old grandma an electronic communication device to wear around her neck, in case she fell or collapsed while alone. The gadget would be automatically activated, and immediately send a message to the local estate agent, instructing him to put her house on the market. If only life was really that simple... Posted May 12 2008, 02:30 AM by Colin Cooper with no comments

• Medical records at the tip of my elbow

  Even as GP’s resident techie geek, I might think twice about the new uses of my medical records suggested in an OfCom report on wireless technologies. I could apparently consider having my medical records on a wireless chip that could be embedded in my watch. Then if I was involved in an accident paramedics would only have to scan the chip to have instant access to my notes. Doesn’t sound too bad. But would the technology catch on? Think of the wrangles over the security of ID cards, chop and PIN and Connecting for Health’s shared care record. As soon as the technology was launched, the Daily Mail would be carrying its first story of shifty foreign illegal organ dealers secretly scanning passers-by for the correct blood type and then kidnapping them to be transplant fodder. However, that wasn’t my main objection. My first thought was more practical – being a girlie, techie geek, I have more than one watch. I have been known to change my watch in the course of the day: equally shoes, earrings, glasses, etc. So would my chip be with me at all? But it’s all right, because apparently I could have the chip implanted in my body where it could also monitor my vital signs – the ultimate in SOS bracelets. This is where I think I might draw the line unless I really needed the technology. For a start it smacks of unnecessary surgery. But it also reminded me of Professor Kevin Warwick who has had various electronic chips implanted in his arm for his human cyborg research. While some of Prof Warwick’s research is contributing greatly to the development of technologies for the physically disabled, some of it is just pure sci-fi. When I interviewed him some years ago he told me he liked the idea of being able to switch on the kettle by thinking at a wireless implant in his body. But he is perfectly capable of crossing the room to do it himself. Some of the content of the Ofcom report is exciting and interesting but we should not be running out on mass to be ‘chipped’. Let’s sort out e-records, etc, first and leave chip implants for those people who really need them. Meanwhile I’ll at least try to always carry something useful with an in case of emergency number. Old fashioned tech is sometimes the most practical. Posted May 08 2008, 04:48 AM by Bronagh Miskelly with no comments

• Do medical graduates deserve jobs?

  Alan Maynard is at it again. Professor Maynard seems to have made a career out of hammering the medical profession and after 25 years he is clearly not ready to stop now. Writing in the BMJ, he argues that medical graduates cannot expect to be guaranteed jobs in the NHS on completion of training. He says that they should be forced to compete for jobs just like any other graduate who finishes their studies, and simply move out of medicine if they cannot find employment. In a way, I can see his point - why does the state owe medical students a job? But it’s a difficult argument to accept when the UK spends hundreds of thousands of pounds on training each doctor, and the graduates commit so much of their own time and money, to then see it all wasted. Having said that, surely the state has to take greater responsibility for effective workforce planning? We saw how badly this could be mismanaged with the MTAS debacle. And a recent GP survey revealed a new generation of young GPs who were finding it almost impossible to find posts, or even locum work to sustain them while jobseeking. The government really has to start taking its workforce planning role seriously, developing long-term strategies that match the training places to the healthcare needs. Posted May 07 2008, 11:00 AM by Colin Cooper with 1 comment(s)