Sunday, December 06, 2009
Nigel Hawkes in his BMJ column notes that it is a company that has been "granted at least one sweetheart deal — and possibly two — by the Department of Health". It tied the Healthcare Commission up in knots with its results (see previous post) and may be responsible for Baroness Young's resignation from CQC (see my post today).
We need independent academic opinion to publish comment on its latest hospital mortality data. Previous analysis in BMJ paper has suggested their "Claims that variations in hospital standardised mortality ratios ... reflect differences in quality of care are less than credible".
The Mail on Sunday story says Government sources have personally attacked her for causing problems because of her strong personality. It's only someone with strong opinions that can produce the necessary reform. I think the wrong person has gone (see previous post).
Saturday, November 28, 2009
“It’s those who duck the difficult decisions, who hide in the quiet safety of their offices, or employ consultants to make decisions for them - who won’t put their heads above the parapet, not daring to engage staff and patients, putting off the inevitable for another day and not learning from others.
“These are the ones who should worry. But we will continue to support leaders and managers who show how we can deliver better care for patients”.
Managers are not used to this. They've even accused O'Brien of bullying them when he says he doesn't want them to slash and burn budgets. Managers have become more used to "top-down", centrally driven management, which could in itself become bullying when clinicians were not involved (see another previous post - Why do staff report high levels of bullying in the NHS?).
I guess the political stance must be gearing up for the election next year. It's about time Labour got it right on the NHS. O'Brien's speech even talks about looking at how a bigger proportion of budgets could be devolved to primary care trusts. This may not be that different from the Tory policy of giving GPs real budgets.
And anyway, clinicians have always said there needs to be better integration between primary and secondary care. I'm not saying that there wasn't a need to shift care from being too doctor-centred to more patient-centred, but the underming of professional values and opinions in doing this has been very damaging for the NHS.
Wednesday, November 25, 2009
For example, LGA has set an agenda for Ofsted, which says it should:
■be a voice of reason rather than feeding people’s fears
■be independent of external influence, basing its conclusions on facts and research
■use expert and knowledgeable inspectors who can offer advice and support
■assess how well children are being looked after and protected rather than measuring processes and procedures
■be focused on making services better rather than on delivering detached, public judgements
Barry Sherman MP, chair of the Children, School and Families select committee spoke out about Ofsted on BBC2's Daily Politics.
The NHS chief executive took up the comment about the NHS as preferred provider and sent a letter to SHA and PCT chief executives. He again reiterated that "Service improvement and re-design should not be something which is imposed on NHS staff but something which they own and lead." The preferred provider policy has union support eg. as Mike Jackson from Unison says in a letter to the Guardian, "NHS services will not be improved by wholesale tendering, fragmentation and privatisation."
Sunday, November 22, 2009
This issue is complicated if medical students playing loud music or having a messy kitchen in halls are regarded as being unprofessional. In fact, doctors can be defensive about their income, style of practice, prestige, and power. It's actually the conscientious doctors that can be seen as different and difficult by their colleagues in this context.
The article mentions a roadshow to engage medical students in the issues round professionalism. This project by the King's Fund and others has already produced a report Understanding doctors.
This isn't the first article that Norman Lamb has written for Mail Online. The other describes his successful investment in Tinchy Stryder via his son.
Sunday, November 15, 2009
Observer story about Father and Sun highlights how James Murdoch, Rupert's son, is steering the Sun, together with Rebecca Brooks, previous editor, and now CEO of News International.
There must be a question as to whether James can really step into Rupert's shoes. Rebecca Wade (as she was) has a lot to answer for in Sun campaign against Sharon Shoesmith, and previous misdemeanours as Sun editor.
Has David Cameron backed the right horses?
Tuesday, November 10, 2009
We do expect a Prime Minister to be able to dot the i's. And he shouldn't have to repeat the word "sincere".
It's serious that young British soldiers are dying in Afghanistan.
Friday, October 23, 2009
Patient experience can't be the be-all and end-all of NHS care. After all, doctors have always been easily able to please patients with quackery.
However, medicine has tended to be more doctor-centred than it should be, so an emphasis on patient experience may help to right the balance. An editorial in the BMJ discusses the use of patient experience within pay for performance (P4P) programmes. This sounds as though it has more merit that service-line reporting and management (SLM) promoted by Monitor, although the way SLM has been implemented locally where I live in Norwich has focused on the patient experience (see Monitor example of SLM implementation).
Friday, October 09, 2009
Tuesday, September 08, 2009
Friday, August 28, 2009
My chief executive retires today (see EDP story). Her legacy is said to be a Norfolk's first NHS provided psychiatric intensive care unit (which is locked) whereas her "biggest goal has been to keep people with their families and out in the community wherever possible".
Is this mixed? I'm still working at the NHS Trust.
Sunday, August 23, 2009
Saturday, August 22, 2009
Monday, August 17, 2009
More on the anti-rational opposition to the Obama health reforms (see Guardian article).
"We cannot stop until this attempt to open what could be one of the biggest gates of hell into our country is stopped", says Rick Joyner. His fear is rationing and the collapse of "the whole system". He goes on, "Through this crisis, we may be looking at the ultimate form of controlling people, which the present Administration is obviously trying to do in many ways. This has to be stopped."
Betsy McCaughey says the proposed legislation is a "violation of your rights and a threat to your health".
Monday, August 10, 2009
The Obama health plan has created emotive language. See Sarah Palin's post on Facebook. Must be powerful vested interests involved.
And yet PhRMA (Pharmaceutical Research and Manufacturers of America) is supporting health care reform, although it still believes the "best way to expand coverage and reduce the number of uninsured is through private health insurance with businesses and families having a range of private options".
We need to be cautious, though, about Barack Obama's apparent support for personalized medicine and innovation - see Innovation.org (a PhRMA project) welcoming the nomination of Dr Francis S Collins as NIMH director and the Personalized Medicine Coalition case. Let's hope the President is not going to stuff PhRMA's mouth with silver to get his health care reforms through.
Sunday, July 26, 2009
Monday, July 20, 2009
If the last wicket had fallen at Cardiff, things would have been very different for Ponting's reputation. His captaincy would have been acclaimed. He plays to win. He would have succeeded in getting the most out of a side without as much talent as previous Australian sides he has captained.
As it was, he just became a target for his pressurising tactics. When he complained about England's time wasting, it seemed like something he would have done himself.
Congratulations to Andrew Strauss, although I'm not convinced he's the best captain in the world. Surely he should have had more of a plan than waiting for the new ball when Clarke and Haddin took control on Sunday evening (I was there). Let's look forward to the rest of the series.
Friday, June 19, 2009
The criminal case against Andrew Breeze and Dominic Wilson has collapsed - see EDP story. See Andrew's video statement and read Judge's closing remarks.
There must have been envy motivitating this trial, mustn't there? And I'm not just talking about from the two witnesses whose statements did not agree.
There has been an issue, if not scandal, about the way in which difficult to manage and place psychiatric patients have been shipped out of the NHS to private care (eg. see my comments on National Director of Mental Health's 10 year report). The problem is that it has been easy to make money out of this situation, not that there has been any fraud involved. Tony Chancellor, who set up the company that owns Cawston Park, made millions of pounds out of his business over a short time (although the Times story overstates how much he made - as Andrew Breeze himself pointed out at the time).
Good luck to Andrew in trying to find out what was behind this. Both Dominic and he were dismissed by Chancellor Care, so I imagine this story has got some way to run legally. Who was advising the NHS Counter Fraud Service?
Sunday, May 31, 2009
Nigel Hawkes understands the current situation in the NHS. Would Neil McKay do a better job than David Nicholson? McKay was Deputy Chief Executive for the NHS Executive. Following Nigel Crisp's appointment as Chief Executive/Permanent Secretary in November 2000, Neil McKay became Chief Operating Officer for the Department of Health and Chaired the NHS Operational Board. He became Chief Executive of the Leeds Teaching Hospitals NHS Trust in April 2002. He's now at the Strategic Health Authority in the East of England.
Sunday, May 24, 2009
Saturday, May 23, 2009
The judge found the mother a credible witness. I am not saying she wasn't credible. To lose a son through him hanging himself is a tragedy. However, I don't understand why child protection is not a medical matter. Maybe the judge finds it difficult to appreciate what people can do to their children. Isn't this what the shock about baby Peter case is all about?
The danger is the polarisation in the debate. There needs to be open discussion about the issues. Our best hope is the Social Work taskforce. However, the position of Ed Balls, as secretary of state for children, schools and families, is compromised by his legal battle with Sharon Shoesmith, ex-head of Haringey's children's services. Hopefully, Balls will get moved in the cabinet reshuffle, but he can't go to chancellor yet, as he would like, I'm sure, if only because of his involvement in the MPs' expenses fiasco.
Wednesday, May 20, 2009
Malcolm Law, Professor of Epidemiology and Sir Nicholas Wald, Professor of Environmental and Preventive Medicine, at the Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, hold patents (granted and pending) on the formulation of a combined pill (polypill) to simultaneously reduce four cardiovascular risk factors - low density lipoprotein cholesterol, blood pressure, serum homocysteine, and platelet function.
They argue that the motivation for the patent for the Polypill is to help ensure its development and to fund the necessary clinical trials, which are costly. According to the Independent, they have had talks with the Government's Heart Czar, Roger Boyle, and the Medicines and Healthcare products Regulatory Agency (MHRA) about obtaining a licence. Progress has been held up by a lack of funding and charitable foundations are being approached for support. I think the argument will have been that the NHS should pay for the necessary trials.
Keep up to date with the Polypill news blogspot. The blogger, Shaun Holt, is an enthusiast for the pill, not least because he's launched the polypack, which packages the polypill medicines into daily sachets. "The benefits are massive," Holt argues. He admits the polypill is several years away if it is going to produce data on mortality and morbidity, as the estimates of reduction in cardiovascular risk are predictions and projections. There's probably no money in it for drug companies as the drugs are off patent.
Other people are also enthusiasts, such as Richard Smith, the ex-editor of the BMJ, who takes the 5 pills every night. The BMJ has this week published an article by Law and Wald said to be providing evidence that everyone over 55 should take medication to reduce blood pressure. They should get their money out of the patent eventually.
Wednesday, May 13, 2009
Who were the first MPs to start the my shirt's hairier than yours competition? I think it was Andy Burnham and Ed Miliband.
I'd bet on them to do well out of the cabinet resuffle. They must also be positioning themselves for the labour leadership.
The Guardian reports that GMC statistics obtained by the Liberal Democrats show that the number of all doctors suspended in the UK has risen from 216 in 2004 to 388 last year. This is despite guidelines being introduced in 2003 called Maintaining Higher Professional Standards in the Modern NHS (MHPS), which made it more difficult for doctors to be suspended. So it looks as though the momentum to suspend and discipline doctors has not been curbed by MHPS. But without it, numbers of suspensions are likely to have been even higher.
I am someone who has been suspended twice - it's actually now called exclusion. Not many doctors get back from one suspension. According to a report from the National Audit Office in 2003, only 40% get back to work. They found the average length of suspension to be 47 weeks. This average figure is likely to have come down with MHPS - which would suggest the number of suspensions has increased.
I have gone public about my first suspension eg. BMJ letter and Times Higher Education Supplement article. I am not yet in a position to go public about my second exclusion.
What I can say is that MHPS does not place enough emphasis on informal resolution. Almost certainly the number of formal investigations is too many. This could be prevented by people talking about whatever the problem is and solving it. It may not be a disciplinary problem at all.
There is inevitably conflict between management and clinicians, but they should work together. Management should not misuse its disciplinary power to deal with what it doesn't want to hear from clinicians. As a letter in this week's BMJ says, leadership is not management.
Thursday, April 30, 2009
Friday, April 24, 2009
As mentioned in the previous post, Ian Kennedy has finished at the Healthcare Commission, which has now been taken over by the Care Quality Commission. In a farewell interview for the Heath Service Journal (HSJ), he talked about bullying "permeating the delivery of care in the NHS". He, at least partially, comes to this conclusion because 1 in 6 staff say in the NHS annual surveys that they have experienced bullying, harassment or abuse from either their line manager or other colleagues.
Why should this be the case? In the HSJ interview article, Sian Thomas, joint acting director of NHS Employers is quoted as saying that chief executives needs to take a lead in encouraging an open culture. Why have CEOs not been doing this?
NHS Trusts have been measured by targets. Believe it or not, it's only recently that reporting requirements have put quality at the top of Board agendas. It remains to be seen whether this intervention from Monitor will change the target culture, but at least they've got the focus right.
Professional staff have found it difficult to get their voice heard in a culture centrally driven by business notions and targets, which do not always relate to patient care. To speak up about how such manageralism is affecting health services is not welcomed. The Royal College of Physicians has produced a report Doctors in Society: Medical professionalism in a changing world. At least the most recent Darzi review Our NHS, our future includes a focus on clinically led services.
Wednesday, March 18, 2009
At the end of the month the Healthcare Commission gets taken over by the Care Quality Commission. In its dying pangs, it's published an investigation report criticising Mid Staffordshire NHS Foundation Trust for significant failings in emergency healthcare, leadership and management. As I've noted before in this blog, Ian Kennedy, the outgoing chairman, really does think the Healthcare Commission has improved quality of health care.
The Commission in its press release says that it began the investigation at the trust in March 2008 "in response to concerns from local people and when it became clear that the trust stood out statistically in terms of the high death rates of patients admitted as emergencies". They've produced findings from the investigation but don't say how those findings compare with other hospitals. For example, are they sure the Trust was the only hospital where A&E triage is routinely carried out by receptionists? Is A&E consultant cover any worse than anywhere else, producing inadequate supervision of juniors? Was it the only hospital to have had "dumping grounds" to avoid breaching the A&E 4 hour target? Was it really the only hospital not to have enough nurses to care for emergency patients or inadequately trained EAU nurses? Or where there were delays in operations? I could go on. At least the Commission admits the findings are potentially relevant to the whole NHS. And this is the Commission that Ian Kennedy says has improved the NHS!
The trust’s data on outcomes for patients had caused the Dr Foster Unit at Imperial College, London to bring concerns to the attention of the trust and the Healthcare Commission. Dr Foster’s Hospital Guide showed that the trust had a hospital standardised mortality ratio (HSMR) of 127 for 2005/06. For the three years from 2005/06 to 2007/08 that the Heathcare Commission examined, the trust’s SMR for patients admitted as emergencies aged 18 and over varied between 127 and 145, statistically significant at the 5% level. There are trusts with a higher HSMR. Dr Foster says it has the fourth highest HSMR for 2003-6. Where are the inquiries into those Trusts with a higher HSMR? I'm not saying Mid Staffs is a particularly good Trust but someone's got to be at the extremes of a distribution of HSMRs.
Sunday, February 22, 2009
Still Gordon Brown is putting people before bankers. "In short, we need stronger business banks, mortgage banks and savings banks." And there's nothing wrong with getting rid of more than 100% mortgages.
Saturday, February 21, 2009
Watching someone dieLenrie Peters
Watching someone die
is a fraudulent experience
The deep significance is felt
the meaning escapes
like a child's first punishment.
The dying ravish your strength
whether by throttle of convulsive gasp
or tideless fading away
like ancient familiar sounds in sea shells
the moment is the same
reinforced brutality to life
a rugged cliff bloodstained
with the agonising rhythm of many heads.
A cold demise; each
successive moment a banishment.
The terror is in leaving behind
the ache is in departing.
Humming fantasies crowd their stings
to seize and record the moment
the hands curl in spasm
to hold it back; this life, this infidel.
It is too late. Everything and nothing
has happened. A huge machine
the earth, grinds to a bolt-knocking halt.
It is the changing of the tide
at the boundary hour
Life like handful of feathers
engulfed by cliff winds
one like yourself swept
Oh so swiftly into the anchorage of history
Tears and sighs; sighs and tears
stamping the leaden feet
the solid agony of years
they all abound.
One life or a million
contrived by nature or by man
greatly obscures the issue.
Face to face with dying
you are none-the-wiser
Yet it seems most ignoble epitaph
'He was a man and had to die; after all.'
Lenrie Peters was born in Bathurst (Banjul), The Gambia, in 1932. He studied medicine at Trinity College Cambridge and later trained as a surgeon. He currently practises in The Gambia. He has been Chairman of the West African Examinations Council. He has published one novel, The Second Round, and four volumes of poetry - Poems (Mbari Press, 1964), Satellites (Heinemann, 1967), Katchikali (Heinemann, 1971) and Selected Poetry (Heinemann, 1981). He is the Officer of the Republic of the Gambia.
Tuesday, February 17, 2009
Friday, February 06, 2009
Summary of a Prescription for Partnership. "Clinical engagement depends on effective communication and good working relationships." As I said in relation to the Ian Kennedy interview "[C]reating a manageralism that fails to provide the organisational infrastructure to support doctors in the exercise of their responsibilities is not the way forward." Eminent bodies seem to be agreeing with me.
Sunday, February 01, 2009
Good description by Andrew Rawnsley of the fear, resentment and anger.
Fear for your job if you still have one and fear that you may not see work again if you are already unemployed.
Resentment that the agony is not being evenly shared and that some will profit from the miseries of others.
Anger with the unapologetic financiers who made billions from their follies and left less affluent folk to pick up the bill.
If Henry Porter was 20 years younger he would take to the streets.
Saturday, January 31, 2009
Saturday, January 17, 2009
Friday, January 02, 2009
Interview with Ian Kennedy in BMJ in which he defends use of health indicators. Measurement of quality is not easy and failure to recognise how indicators can create perverse incentives is not helpful. In fact, focus on indicators can paradoxically make quality worse.
For example, I've just looked at the first core standard in the safety domain in the Annual Health Check for mental health trusts. This is that trusts self certify that they have a system for learning from patient incidents. It doesn't matter how well the Trusts do this - just that they have a system. In fact, undertaking a root cause analysis is extremely difficult, often mistakes and misinterpretations are made leading to recommendations which are never fulfilled, even if they were appropriate.
People forget Kennedy upset the medical establishment when he gave the Reith lectures in 1980 "Unmasking medicine". He answered his critics. Medicine does need to be more patient centred. But creating a manageralism that fails to provide the organisational infrastructure to support doctors in the exercise of their responsibilities is not the way forward.