Friday, 26 April 2013

BMA Ethics committee respond to Caldicott Review on information governance.

Patients give staff in health and social care personal information about themselves all the time and they trust that we will protect the information they give. As we move to a more electronic age, where information can be shared more easily, and across many more types of organisations,  there has been an urgent need to review 'information governence' and the balance between protecting patient information and its sharing to improve patient care.  Information is collected in data bases which are used in a variety of ways for research.

When I served on an NHS research ethics committee we were always concerned that information about patients in trials would be protected and that they should be able to give informed consent to the information being used.

With publication today of the Caldicott Review, the Health Secretary Jeremy Hunt has said that 

1)any patient who does not want personal data held in their GP record to be shared with the Health and Social Care Information Centre will have their objection respected; and

2 where personal data has already been shared from a GP practice to the Information Centre, a patient will still be able to have the identifiable information removed. 

But this is very much an 'opt out' rather than an 'opt in' strategy and it is difficult to see how patients can give consent to any specific use of information held about them. 

Caldicott recommends that patients should

•  have the right of access to your own personal records within the health and social
care system.
•  have the right to privacy and confidentiality and to expect the health and social
care system to keep your confidential information safe and secure.
• have the right to be informed about how your information is used.
• have the right to request that your confidential data is not used beyond your own
care and treatment and to have your objections considered, and where your wishes
cannot be followed, to be told the reasons including the legal basis.

The NHS and adult social services should also commit:

• to ensure those involved in your care and treatment have access to your health and 
social care data so they can care for you safely and effectively;
• to anonymise the data collected during the course of your care and treatment and use it 
to support research and improve care for others;
• where identifiable data has to be used, to give you the chance to object wherever 
possible;
• to inform you of research studies in which you may be eligible to participate; 
and
• to share with you any correspondence sent between staff about your care.

Responding today to the Caldicott Review -‘Information to share or not to share’ - a comprehensive report about sharing health information in England, Chairman of the BMA’s Medical Ethics Committee, Dr Tony Calland, said:

“The Caldicott Review has involved a great deal of effort by Dame Fiona Caldicott and her team, especially given the scope and complexity of the issues, so it is important that we recognise this.

“We are very pleased that there is a commitment to respecting patients’ objections to confidential data being shared as this is something the BMA has worked hard to reach agreement on. Confidentiality is the cornerstone of the doctor/patient partnership and we must do all we can to safeguard it.”

The BMA has some outstanding concerns about how “safe havens” will be implemented. These are areas where researchers and commissioners can carry out analyses under secure conditions and should be kept to a minimum, believes the BMA. The use of any information that could identify individuals, such as the NHS number, could increase a risk to confidentiality, unless robust safeguards are in place.

Dr Calland, added:

“While health data is vital to improve health services and medical research, it is essential that the strict controls described in the Review for safe havens are scrupulously adhered to and regularly audited by an independent body.”

Wednesday, 24 April 2013

Do patients need to know they are terminally ill?

Do patients have a right to know whether they are terminally ill? Or should this be a matter at the discretion of their doctor?

In this week’s BMJ, experts debate whether patients need to know they are terminally ill.

Emily Collis and colleagues at the Central London Community Healthcare NHS Trust say that decision making can only be ethically sound with a fully informed patient, saying “accurate information enables patients to make informed, realistic choices and helps achieve patient preferences of care.”

They point to General Medical Council guidance stating that information should only be withheld from terminally ill patients if it is thought that giving information will cause serious harm, specified as “more than becoming upset.” And if information is withheld, the reasons must be justified, documented, and reconsidered at a later date.

Therefore, the key consideration for doctors is not whether patients are informed that their disease is incurable, but how this information is communicated, they argue.

They believe patients “should be given the information they want or need in a way they can understand” and “ideally these conversations would occur throughout the course of the patient’s illness, enabling him or her to come to terms with the situation in their own time.”

They acknowledge that estimating prognosis “can never be completely accurate” but say this “should not obscure the clarity that the illness is incurable.” They add that no one can make decisions on behalf of patients who have capacity, and that unless a patient refuses information, withholding information at the request of a relative is not ethically justifiable.

“Breaking bad news is challenging in any context, but the consequences of neglecting this duty may directly affect the trust between doctor and patient, the patient’s autonomy, and ultimately his or her quality of life,” they conclude.

But Leslie Blackhall from the University of Virginia believes that insisting on prognostic disclosure to facilitate “patient choice” regarding end of life care “is a failed paradigm for medical decision making that creates more suffering than it relieves.”

She thinks the concept of “terminal illness” is not clearly defined and that prognoses can never be certain. For instance, she asks, does telling someone that they are terminally ill mean telling them how long they have to live (hard to know for any individual)? Does it mean telling them that they will eventually die (true for all of us)? Does it mean telling them there is “nothing we can do” (never true)?

This lack of precision … “indicates an underlying failure of the medical profession and wider culture at large to consider how the fact of human mortality should be accounted for in the practice of medicine.”

The real question, she says, is not whether patients should be told that they are “terminally ill” but how can we provide excellent care to patients with incurable, progressive illnesses?

Blackhall believes that to make decisions about care, patients with life limiting illnesses do not necessarily need to know how long they have to live or be informed when they pass some ill defined threshold of “terminal illness,” or choose to accept death. Instead, she says, they need “to understand the limitations of disease modifying therapy for their condition; what medical care can do for this disease; what side effects treatments might have; and what may happen as the illness progresses - or to delegate that task to a trusted surrogate.”

“This is not an argument for deceiving patients, or for reverting to a paternalistic mode of care. On the contrary, it is an argument for honesty about the efficacy of various types of medical care throughout the spectrum of life limiting illness,” she concludes.

Tuesday, 23 April 2013

UK 'woefully underprepared' for ageing population says new Ready for Ageing Alliance


Last month’s ‘Ready for Ageing’ report by the House of Lords Public Service and Demographic Change Committee argued that there has been a lack of vision and coherence in the ageing strategies of successive governments. The Committee accused the Government of “woeful unpreparedness” for our ageing society.

Now six major national charities: Age UK, Anchor, the Centre for Policy on Ageing, Independent Age, the International Longevity Centre-UK and the Joseph Rowntree Foundation have today formed the Ready for Ageing Alliance to urge the Government and all political parties to face up to the major changes and challenges from our rapidly ageing society.

The Ready for Ageing Alliance believes that living longer is potentially a great gift but that politicians must do more to make the most of this huge societal change. The Alliance believes that Government failure to respond to demographic change will have significant and major negative impacts on the future of the UK, not just in terms of health, care and pensions, but also in relation to the future success of the UK’s economy. A failure to respond adequately now could also foster unhelpful intergeneration tensions and division into the long term.

The Ready for Ageing Alliance will be launched today at a major public debate, to be attended by over 350 people , which will consider how Government should respond to our ageing society.

The Ready for Ageing Alliance has come together to:
 
Urge Government to respond positively to the House of Lords’ ‘Ready for Ageing’ Report and set out a plan for addressing the policy challenges of demographic change. 

Urge political parties to ensure that the challenges of our ageing society are prominent within their election manifestos. 

Urge the political parties to work together to deliver cross sector/party agreement on Commissions on “income and pensions” and “health and social care” in an ageing society. 

Urge Government to contribute and support a broader societal debate, actively engaging all relevant stakeholders about the need to reform public policy in the light of demographic change. 

The increase in the number of older people will have a profound impact on a wide range of public services

Michelle Mitchell, Charity Director General at Age UK said: “Some policymakers may think they can afford to put off addressing the long term trend towards ageing, but the challenges and opportunities longevity brings are already with us and effective responses need developing now. Age UK is pleased to be working with the Ready for Ageing Alliance to encourage politicians right across the spectrum to engage positively with the fact of an ageing society, from which potentially we have a great deal to gain.”

Jane Ashcroft, Chief Executive, Anchor said: “The policy issues that affect older people are wide-ranging and complex; and being made more so by demographic change. They span almost all government departments and several Ministers’ portfolios, yet individuals are being let down by a collective failure to address the needs of our growing older population. It is crucial that long-term solutions are developed and there is accountability within Government for action, to drive improvements for current and future generations of older people.” 

To make a success of the demographic shifts, major changes are needed in our attitudes to ageing.

Gillian Crosby, Director, Centre for Policy on Ageing, said: “We live in a diverse and ageing society and our attitudes need to change to reshape our approach to the changing demographics. Public policy and service provision should encourage partnership, co-production and take heed of the evidence base of ‘what works’ and ‘what does not’ so that ageing becomes a positive experience rather than something to be feared.” 

Radical changes to the way that health and social care is delivered are needed to provide appropriate care and to address future demand. The quality of healthcare for older people is not good enough now. Social care and its funding are already in crisis

Janet Morrison, Chief Executive, Independent Age said: “We have known about the demographic changes to our society for a long time. There is no excuse for delays in preparing for these changes - engineering a fundamental shift in societal attitudes, tackling ageism and ensuring independence, choice and equal voice for all our citizens whatever their age.” 

The House of Lords committee report warns that successive governments have simply not grasped the task ahead. The current Government is no exception and is not doing enough to ensure our country is ready for ageing

Baroness Sally Greengross, Chief Executive, ILC-UK said: Our society is in denial of the inevitability of ageing. Yet this issue is one of the biggest public policy challenges facing our society. We have put off the difficult decisions for far too long. Government must begin to take the ageing of our society seriously. Demographic change is an issue for all of us not just those interested in older people. If Government fails to act to respond to demographic change, the long term impact on today’s younger people will be severe. 

Claire Turner, Head of Team (An Ageing Society), Joseph Rowntree Foundation said: “The question - are we ready for ageing? - is one for all of us. Our ageing society provides opportunities as well as challenges for individuals, communities and government and it is vital that we don’t ignore, but celebrate ageing. As part of this, we need a bold, broad and long-term vision on how best to respond to demographic change.”


Thursday, 18 April 2013

NHS commissioning competition regulations should be withdrawn and replaced, says BMA

Doctors leaders have today (Thursday, 18 April) called for controversial competition rules to be withdrawn and replaced ahead of a crucial House of Lords debate next week.

In a new briefing paper sent to peers ahead of the debate, the BMA calls for the withdrawal of the regulations that detail how aspects of patient choice and competition operate under the Health and Social Care Act in England.

They should be replaced with new regulations that unambiguously reflect previous Government assurances that commissioners will not be forced to use competition when making their commissioning decisions. The BMA is pressing for this principle to be explicitly stated in the regulations.

The BMA has long argued that mandatory competition for all services risks fragmentation of services and creates unnecessary transaction costs, making it harder for the NHS in England to deliver high quality, cost-effective and integrated care to patients.

Regulations, which were first laid before Parliament in February 2013, set out how competition and patient choice would work under the Health and Social Care Act. They were intended to ensure good procurement practice, but have continued to prompt widespread concern and uncertainty about the apparent requirement for competitive tendering for most health services.

Dr Mark Porter, Chair of BMA Council, said:

“The absence of expected guidance on how the competition regulations would operate in practice, and the lack of satisfactory guarantees in these regulations, has created great uncertainty and anxiety for clinicians and patients.

“Only explicit wording in the regulations would allow patients, doctors and commissioners to be absolutely certain that clinicians will have the freedom to act in the way they consider to be in the best interests of patients.”

Dr Laurence Buckman Chair of the BMA’s GP Committee said:

“GP commissioners now have responsibility for making critical decisions about how best to provide services to patients in their locality.

“Commissioners could be put in the position of facing costly tendering processes and possible legal challenges from unsuccessful bidders because of ambiguous rules. That is why GPs want the regulations withdrawn.”

Wednesday, 17 April 2013

Water, water, but is it safe to drink?

UEA launches €9 million project to improve drinking water safety in Europe

The University of East Anglia (UEA) will launch a €9 million EU-funded research project to improve the safety of European drinking water today.

Around 330,000 cases of water-related disease such as E.coli and the norovirus are reported yearly in Europe according to the World Health Organisation (WHO). Between  2000 and 2007 there were 354 outbreaks of waterborne diseases across 14 countries. Symptoms include diarrhoea, vomiting, stomach pains, nausea, headache, and fever.

The five-year Aquavalens project will develop and apply more rapid methods of detecting viruses, bacteria and parasites in water before they can make people sick.

Scientists, engineers, policy makers and public health practitioners from 39 organizations in 13 countries will come together today to launch the project in Sestri Levante, Italy. 

The research will be led by Prof Paul Hunter from UEA’s Norwich Medical School. Consortium partners include small businesses, industries, universities and research institutes. The project is funded by the European Union’s Framework Programme 7.

Prof Hunter said: “Although most European countries are fortunate to have some of the safest drinking water in the world, outbreaks of disease do still occur each year.

“Millions of Europeans drink water from very small supplies that are currently difficult to properly monitor and which have been shown to pose a risk – particularly to children who suffer the most from episodes of illness, with greater rates of hospitalization and higher mortality rates.

“With the technologies we currently have it can take two or more days to identify infectious risks in drinking water and by then the affected water is likely to have been consumed.

“This project will develop more rapid methods so that problems can be identified earlier. It will prevent people becoming sick by stopping them drinking contaminated water.”

The project will progress through four main phases. The first phase will focus on performing cutting edge science and genome research on the microbes that cause disease though drinking water such as Cryptosporidium, Campylobacter and Norovirus.

The second phase will develop and apply state-of-the-art technologies to detect these agents in water such as gene probes, nano-technologies and bio-sensors.

In the third phase, new technologies will be used to test the safety of European drinking water in large water utilities, small private supplies and in the food industry.

The fourth and final phase will focus on understanding how these technologies can be integrated into existing practices to protect the health and safety of people in Europe from the threats of water contamination including those associated with environmental change.

Throughout the project, close cooperation will be maintained with biotechnology companies, water providers and food producers so that new technologies will meet real needs and find strong markets. Links with national and international government agencies such as the European Commission and the World Health Organisation will ensure that the project’s findings will influence European policy.

For more information, visit www.aquavalens.org

Tuesday, 16 April 2013

Smoking ban linked to annual 5% drop in emergency admissions for asthma

There are some who still question the merits of banning smoking in pubic places. Oppositin is largely on two grounds: that it infringes civil liberties of those who wish to smoke andthat it has damaged trade in public houses. Neither of these holds much credibility. Civil liberties can equally be used to justify protecting others from risks of passive smoking. Such considerations in public health are always going to be balanced judgements. Evidence is mounting that such a judgement is right for banning smoking in public places. 

New evidence now shows that emergency admissions for asthma among adults fell by just under 5% in each of the first three years after the ban on smoking in public places was introduced in England. The results come from the largest study of its kind, published online in Thorax.

This adds up to around 1900 fewer such admissions every year, the authors calculate, and confirms the value of public health interventions, such as smoking bans.

They base their findings on the number of emergency admissions for asthma among adults aged 16 and over in England between April 1997 and December 2010.

Smoking in all public places was banned in July 2007 in England, where the prevalence of asthma is one of the highest in the world, affecting almost 6% of the population.

During the study period, 502,000 adults with asthma were admitted to hospital as emergencies. As expected, admissions were higher during the winter months than during the summer, although the numbers of admissions varied widely from region to region.

After taking account of seasonal temperatures, variations in population size, and long term trends in the prevalence of asthma, the figures showed that emergency admissions for the condition fell by 4.9% among adults for each of the first three years following the introduction of the smoking ban.

The percentage drop was similar across all geographical regions of the country.

Across England as a whole, the authors calculate that this adds up to around 1900 fewer such admissions in the year immediately following the ban, with a similar number in each of the two subsequent years.

The authors point out that although these figures are lower than those in other countries where smoking bans have been introduced, this might be because many workplaces in England had already adopted smoke free policies before the nationwide ban took effect.

The authors emphasise that although the association they found was significant, it does not prove that the legislation was responsible for the fall in emergency admissions for asthma. Nevertheless, they point out that their data are consistent with other research linking the smoking ban to measures of improved health, and attribute the association to a reduction in second hand exposure to tobacco smoke.

Furthermore, the size of the study population, plus the efforts to account for other underlying factors, add weight to the findings, they suggest.

“[The study] provides further support to a growing body of national and international evidence of the positive effects that introducing smoke free polices has on public health,” they conclude.


Sunday, 14 April 2013

Giving Mrs Thatcher her dues?

I didn't want to write about Mrs Thatcher at this time. I would rather her family and friends were left to mourn in peace, and indeed to celebrate a remarkable life. She was a woman of great accomplishments.

I am sick and tired of the endless discussion on radio and television and in the newspapers about whether it is fitting to criticise Mrs Thatcher at this time. I doubt whether many would wish to be disrespectful but for the fact that so many Tories, and particularly Thatcherites are making political statements about her achievements, when for so many the feelings about what she did are still raw. They should understand that opinion was always deeply divided about her premiership. They should not feign surprise that it is still so today. They should also not be surprised that people who were and are still angry about her period of office should want to express it. Judgement is not one-sided. History teaches us different lessons.

I do not approve of the demonstrations at this time; but nor do I approve of some of the ludicrous claims being made about her achievements; and nor do I approve of the near-state funeral she is being given with full military honours. It is no disrespect to her to say that. It is a criticism not of her. It is a concern that such a funeral is disproportionate and in large part politically motivated.

If her supporters wish to make  claims for her successes, and I do not doubt that there were some considerable achievements; it is equally the case that by the time she was removed by her own party from the premiership, she had created mass unemployment, had overseen a rapid increase in industrial decline and a fractured society that was much more unequal than the one she had inherited.

Poverty, particularly child poverty had increased, whole communities had been thrown on the scrap heap and all her henchmen could suggest was that they got 'on their bikes' to find work. Hers was a callous and dispiriting government. The Tory party became, in the words of Mr David Cameron a 'nasty party'. She came to office cynically citing the prayer of St Francis of Assisi , yet she left office with a more divided and fractured nation, and in the end it was her own party who got rid of her.

Mrs Thatcher was a great lady. She was the first British woman prime minister. Clement Attlee wasn't given a near state funeral, and his government set about building society and the welfare state. His was an achievement that influenced the direction of British politics for three decades. But for all his undoubted achievements at healing Britain and creating the NHS, he did not get the disproportionate funeral or adulation given to Mrs Thatcher.

Mrs Thatcher built nothing, let alone society; she considered that society didn't exist. Her view of society was that it was little other than an aggregate of self interested (and indeed, selfish) individuals. There was she said 'no such thing as society'. she set about destroying the very concept of society, and it is no wonder therefore that she left the social fabric of our society in tatters. It is time we heard less from the Tory press and her supporters. If they wish the family to be left to mourn in peace, then I would suggest the less we hear from them the better.


It is not simply what is achieved that matters in judgement. It is also the manner in which things are done. Ends alone should not be the only consideration. As politicians get more powerful, it is this they tend to forget. Their conviction that they are right becomes all persuasive, and others around them stop telling them otherwise. And, for this reason, those around them are as culpable for that which goes wrong.

The frustration of those in Mrs Thatcher's government was always evident. They walked out of the cabinet. It was evident in the beginning of her downfall. The resignation of her longest serving minister, Sir Geoffrey Howe, was said to have come as a great surprise to her. His resignation speech was devastating. Whilst he had major disagreement over policies, it was her style of leadership that drove him over the edge.

This is the problem of believing what others and the media say about you. Mrs Thatcher as the 'iron lady' became locked into a style of leadership. The 'no U-turn' approach is all too familiar. You turn if you want to, the lady's not for turning was the root of her downfall.

Mrs Thatcher has earned her place in history. But the manner of her doing things will be left for historians to judge; and a realistic judgement won't be made until her supporters and her detractors have left the scene.




Monday, 8 April 2013

The silence of the Liberal Democrats, the silence of the lambs.

Casting aside any attempt to rescue the economy the Tory government with the connivance of the Liberal Democrats have set about a fundamental transformation of welfare and the National Health Service. It is the most right wing agenda we have seen in government. It is more ruthless than the government of Mrs Thatcher, and hers was a ruthless government.

I suspect they have abandoned any hope of pulling the economy round by 2015; they have abandoned hope of winning the general election on the economy. Their remaining strategy is to implement a divisive and profound attack on the poorest and to break up the NHS. Should they succeed, the consequences will be, at least in any short to medium term, irreversible. The damage once done will be difficult and expensive to restore.

Several readers of this blog have pointed out to me that it isn't that the government are bereft of ideas; they are ruthlessly putting their ideas into practice. That is a fair assessment.

Under the cloak of coalition they are working to an extremely right-wing agenda. It is difficult to understand what the Liberal Democrats are doing. They can hardly claim to have had much influence on the agenda. Their concerns, if there are any, or if any have been expressed, have been largely dismissed or ignored.

The Liberal Democrats act like a fig leaf, barely covering the real Tory purpose of the government. And even as a fig leaf, a token gesture to Tory modesty, they are discarded in the machismo thrusting of Ian Duncan Smith and George Osborne.

But the Liberal Democrats are trapped in a contract of their own making. I doubt they could give a significant list of how or where they have made a difference in the major areas of policy. Mr Vince Cable, grumbles from the sidelines of economic policy, but is largely ignored. He once gave a warning of the dangers of stoking up division with the 'strivers' and 'shirkers' approach to welfare.

Now he sits in silence as Osborne  and Cameron link the Philpott case with welfare scroungers. The silence of the Liberal Democrats is deafening. Their silence is a disgrace. The silence of the lambs, heading for slaughter.

Sunday, 7 April 2013

A divisive government, bereft of ideas has abandoned hope and turned on the poor.

David Cameron today continues the strategy of dividing the country between the deserving and the undeserving. It is a disgraceful strategy. He knows it is and so too, in particular do the Liberal Democrats.  Most people on benefits are hard working people. If we really want to move away from 'welfare dependency' then we should ensure that people are paid, not simply a minimum wage, but a living wage; a wage that means hard working people won't need to depend on welfare to make ends meet.

The cynical use of the Mick Phillpott case is symptomatic of the lack of ethical judgement by Mr Osborne and others in the Tory party and in the media. Are they really suggesting that Phillpott represents the mind set of those on benefits? Of course they don't, but they want the association nonetheless. It resonates in the news media. It paints a backcloth in which the public make judgements. It confirms the prejudices and misconceptions we have of the benefits system; that it is full of people 'cheating the system'.

Of course the benefits system has people cheating it; just as there are people who cheat in paying taxes. But if we were really trying to weed out the cheats then surely we would approach it in a different way than that adopted by the government. There is little or nothing in the reforms of the benefits system that is specifically directed at cheats. On the contrary, their policies are an indiscriminate attack on all people on benefits. Do they really believe that those cheating the system won't go on finding ways to do so? Cheats are liars, just as those who cheat the tax system are liars.

But it is all part of the Tory strategy of making the poorest pay the most for the financial mess; a mess the poor did not create. On the contrary it is a mess created by greedy bankers, those who took from the system and gave nothing back. They are the real cheats.

Meanwhile, the governments financial strategy is in ruins. As the right wing think tank the Centre for Policy Studies says, Plan A has failed; but the government is bereft of a plan B. They say there is no alternative; no alternative to a strategy that is failing. Yet there are several alternatives that have been put forward. The government is so incompetent, lost in a maze of its own making, still shouting the mantra of cutting the deficit when the deficit is rising and is set to continue to rise; some £600bn will be added to the net debt by the end of this parliament.  They have no policy for growth. They are a failed government who have abandoned the economy. They have abandoned the poor; they are floundering around with attacks on the poorest. They give no hope. They are left with their divisive comments.

Saturday, 6 April 2013

A government bereft of ideas abandons the economy for a pint of beer

Budgets come and budgets go; they rarely live up to their headlines. Much of a Chancellor's budget is flim flam, but they can set the tone, and they are often revealing more for what they don't do than for what they do. They are also best judged later rather than in the immediate aftermath of their delivery.

I am impressed by how few of us can recall very much of significance in the last budget. It must stand in history as one of the most frivolous budgets. While the country trundles along in  recession, Osborne takes a penny off a pint of beer. The Tory backbenches cheered, but they must now wonder what it was all about, and where the Chancellor is heading. As the right wing think tank, the Centre for Policy Studies has said, 'Plan A is dead', but the government is bereft of a Plan B.

The government still chants its mantra that there is no alternative. But not only are there alternatives, there are several, the government no longer has a coherent financial strategy. It has lost its way. Its policies have failed in their declared objectives, and yet they still argue that theirs is the only way.

Government ministers still like to peddle the sound bite about getting the deficit down. They claim erroneously to have done so. I have discussed this nonsense in previous articles. I won't rehash the arguments. But whatever their claims once were,  the reality is that the deficit is now rising. Over £600 bn will be added to public sector net debt during the course of this parliament. This is a truly staggering sum given that the government has no plan for growth. It is symptomatic of failure, because they claimed their policies would cut the deficit. The pain would be for the gain of cutting it. We have the pain, but none of the gain.

Another reality check is that, whilst the cuts in benefits are hurting people they are not contributing much to the declared aim of getting the deficit down. The poorest are being hit the most but for very little gain in the country's finances. And far from having a strategy for growth, the government has cut 'investment spending' by a staggering 67%.  It is a flawed and bonkers strategy.

The government, bereft of ideas, has abandoned the economy for the price of a pint of beer.


Mr Ian Duncan Smith doesn't understand fairness

What is it that the government doesn't understand about being 'fair'? Mr Ian Duncan Smith calls his reforms of benefits fair. He and the government repeat the mantra. The current system is 'unfair' and needs changing, ipso facto their reforms must be fair. It is a profoundly flawed argument.

I will spell it out for Mr Ian Duncan Smith because it is increasingly clear that he doesn't understand it. You do not create less misery by making more people suffer. I don't know what kind of ethics Mr Duncan Smith works with, but it certainly isn't utilitarian which at least seeks to achieve the greatest benefit for the greatest number.

Mr Duncan Smith says the new 'bedroom tax' is 'fair' because it brings those in social sector housing in line with those in the private rented sector. Gosh, that sounds fair, I hear you cry. Why should one group be treated any different from another?

But lets consider another question. Does it really help those in the private rented sector to impose a 'bedroom tax' on those in the social housing sector? The answer is no, it does not. So we don't actually make the situation fairer by imposing it, we simply make more people suffer. It is a bloody ridiculous argument to consider it fair. Fairness doesn't work like that. If we see a group of people being hurt, we don't address the problem by harming others to 'make it fair'.

I really wonder why I have to say this. The bedroom tax isn't fair because it makes families poorer; it makes them suffer, and many of them are unable to move into smaller accommodation because there is a shortage of available housing. It harms people and doesn't solve the problem it is supposed to address. Therefore it is a flawed strategy. Simply pointing to other people who suffer in a similar way doesn't make it fair. If we are concerned about fairness then we should address the problems of those living in private rented accommodation; that might be fair.

Friday, 5 April 2013

Concerns grow about GP conflicts of interest on new clinical commissioning groups

The concern about conflicts of interest for GPs serving on the new clinical commissioning groups (CCGs) continues. Last month an investigation for the prestigious British Medical Journal (BMJ) found GP conflicts of interest “rife” on the new NHS commissioning boards.More than a third of general practitioners on the boards of new clinical commissioning groups (CCGs) have a conflict of interest due to directorships or shares held in private companies providing services for the NHS.

Now the Medical Protection Society has published the result of a survey showing that 59% of GPs had concerns about conflicts of interest. Now the BMA, the body representing doctors, has suggested that GPs with conflicts of interest should seriously consider whether it is appropriate for them to serve on a CCG,. 

Responding to the findings of the Medical Protection Society’s survey of GPs and practice managers about the introduction of Clinical Commissioning Groups (CCGs), Dr Mark Porter, Chair of BMA Council, said:

“While the vast majority of GPs have no involvement or connections with private sector companies, the BMA has repeatedly called for strong measures that guard against possible conflicts of interest during the newly formed commissioning process.

"It is not surprising that a number of GPs and practice managers are concerned about this issue given the scale of the government's intended changes. It is important that everyone involved in the commissioning process understands clearly how to act if they are faced with any situation that could result in a conflict of interest.

"The BMA believes that any GP who has financial interests in a private sector company that might be awarded contracts in their area should consider seriously whether they should be a member of a (CCG) governing body.

“Given the tough economic climate facing the NHS, there is a widespread concern amongst GPs that the introduction of CCGs will coincide with reductions in budgets for general practice. CCGs will also inherit a situation where GPs are facing an unnecessary increase in administrative box ticking and a decline in funding following enforced and ill-advised changes to the GP contract.

“Ministers must ensure that CCGs have an appropriate level of resources so that they can meet the needs of their patients."

This conflict of interest is a scandal waiting to happen. It is unclear how the public can be reassured that it would not affect the proper running of the CCGs. It is also unclear how breaches of conflict of interest will be dealt with. What, for example, would be the penalties for failing to declare an interest? What would be the boundaries of declarable interest in relation to families or friends? A code of conduct, should it exist, should be published along with any procedures to monitor it. It should not be left to individual CCGs to sort this out.

The template Code of Conduct issued by the Department of Health suggests the following:

"Where certain members of a decision-making body (be it the governing body, its committees or sub-committees, or a committee or sub-committee of the CCG) have a material interest, they should either be excluded from relevant parts of meetings, or join in the discussion but not participate in the decision-making itself (i.e. not have a vote). In many cases, e.g. where a limited number of GPs have an interest, it should be straightforward for relevant individuals to be excluded from decision-making."

Where all or most of the GPs have a 'material interest' it suggests: 

1) refer the decision to the governing body and exclude all GPs or other practice representatives with an interest from the decision-making process, i.e. so that the decision is made only by the non-GP members of the governing body including the lay members and the registered nurse and secondary care doctor;
2) consider co-opting individuals from a Health and Wellbeing Board or from another CCG onto the governing body – or inviting the Health and Wellbeing Board or another CCG to review the proposal – to provide additional scrutiny, although such individuals would only have authority to participate in decision-making if provided for in the CCG’s constitution; and
3) ensure that rules on quoracy (set out in the CCG’s constitution) enable decisions to be made.

It is in short a total shambles.