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Showing posts from March, 2013

BMA and RCN call on government to take urgent action on competition regulations for NHS services.

As the NHS in England faces the biggest shake-up for a generation, and with only days to go until new commissioning arrangements for NHS services come into force, doctors’ and nurses’ leaders are today (28 March 2013) calling on the Government to amend controversial regulations to make it absolutely clear how competition will be managed amidst continued confusion and anxiety about the changes. There are increasing concerns from doctors and nurses that competition will be enforced. The BMA and RCN say clarity in the legal framework is crucial, placing beyond doubt the limits of competition.

Regulations laid before Parliament last month provided greater details about how aspects of patient choice and competition would operate under the Health and Social Care Act, which takes effect on 1 April. They were intended to ensure good procurement practice, but prompted widespread concern and uncertainty about the apparent requirement for competitive tendering for most health services.

Althoug…

Launch of NHS 111 must be delayed as crisis worsens, warns BMA

GP leaders today (Thursday, 28 March 2013) called for Sir David Nicholson, Chief Executive of the NHS Commissioning Board, to delay the launch of NHS 111 as the crisis affecting the system threatens to put patient safety at risk1.

NHS 111, a telephone triage service designed to direct people with non life threatening conditions to the right part of the NHS within the appropriate timeframe, has been trialled in England ahead of a nationwide launch on Monday, 1 April2. At the same time, Clinical Commissioning Groups are scheduled to assume responsibility for commissioning services in the NHS and oversee the NHS 111 system in their region3.

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

“The BMA has written to Sir David Nicholson and asked him to delay the launch of NHS 111 until the system is fully safe for the public. We cannot sacrifice patient safety in order to meet a political deadline for the launch of a service that doesn’t work properly.

“There have been wides…

Will 1 April mark the beginning of the end of England’s NHS?

Today on bmj.com, two professors debate whether the NHS reforms, which come into play on 1 April, mean the end of the NHS.

David Hunter, professor of health policy and management at the School of Medicine, Pharmacy and Health at Durham University believes that the “NHS will never be the same again” and that the changes, which are like nothing seen before, “should not be underestimated”.

Professor Hunter writes that once the Section 75 regulations in the Health and Social Care Act 2012 are passed they will allow competition to “freewheel” as more and more services will be put out to competitive tender, consequently “embedding market competition as the driving force in the NHS”. As such, he believes the NHS will begin to run under a different set of values which will “not be in the public interest”.

He says following a “marketization” programme in Sweden, profit-driven health services increased inequities with big cities and high income earners being favoured over rural areas and l…

BMA comment on Government Response to Francis Inquiry

Commenting on the Health Secretary’s initial response to the Francis Inquiry report today, Dr Mark Porter, Chair of BMA Council, said:

“We share the Health Secretary’s commitment to greater openness and respect for the dignity of individual patients.

“Creating a culture of zero harm will depend on staff feeling able to speak out freely about poor care. Doctors already have clear professional duties to raise and act on concerns about patient safety. On the rare occasions when they do not, it is often because they are afraid of harassment by employers or colleagues. We share the Health Secretary’s concerns that the threat of criminal sanctions for individual staff would be counterproductive and risk creating a new climate of fear.”

Commenting on plans for a new inspection regime and ‘Ofsted-style’ ratings, Dr Porter said:

“The purpose of the inspection regime should be to ensure that NHS organisations are focusing on their primary mission – to provide safe, high-quality care. We nee…

Should 'Ofsted-style' ratings be used for NHS? BMA comment on ratings review

Commenting on the Nuffield Trust review into whether the Government should introduce ‘Ofsted-style’, performance ratings, Dr Mark Porter, Chair of BMA Council, said:

"It’s important that patients have access to meaningful information about the quality of services, and the Nuffield Trust has adopted a refreshingly thoughtful approach to a possible new ratings system.

“It is particularly welcome that the Trust has taken on board concerns about ratings for entire hospitals. As the BMA and many others pointed out, hospitals are highly complex organisations and their ‘performance’ cannot be measured in any simplistic way.

“However, there are always going to be problems constructing indicators that measure quality in any meaningful way, and do not result in a target-driven culture.

“GP surgeries often have many staff and offer a range of different services, the quality of which would be difficult to reduce to a meaningful single score.

“Any system for measuring performance would a…

Chancellor meddling in NHS pay process. BMA reaction to budget

Commenting on the statements on public sector pay in today’s Budget, Dr Mark Porter, Chair of BMA Council, said:

“We’re concerned that the Chancellor is seeking to meddle in NHS pay processes. As MPs noted this week, pay restraint cannot be seen as a long term savings strategy for the NHS. Efficiency gains will be achieved by focusing on quality, not by suppressing pay.

“Healthcare workers are at the forefront of the drive to improve efficiency in the NHS. They have already undergone major changes to their pensions, and many doctors have been subject to real terms pay cuts for several years. Pay progression is not automatic for most senior doctors.

Commenting on the Chancellor’s confirmation that NHS funding will continue to be protected, Dr Porter said:

“We welcome the fact that the Government continues to recognise the importance of the NHS, and the scale of cost inflation in healthcare. However, it is not the case that health has been exempted from the financial pressures facing…

GP contract changes will undermine delivery of patient services, warns BMA

The government’s failure to listen to the concerns of thousands of family doctors about changes to the GP contract in England will undermine how patient services are delivered, the BMA warned today (Monday, 18 March 2013).

The warning came as the Department of Health confirmed a raft of changes to the GP contract in England that will come into force on 1 April 2013. The government’s proposals will see general practice facing a range of new targets and additional workload responsibilities, as well as reductions in the central funding that many practices receive.

These changes are being implemented despite thousands of GPs expressing concerns about the proposals in a BMA survey that was submitted, along with other evidence, to the government’s consultation on the changes1.

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

“GPs are committed to working with patients and the government to deliver the highest quality of care to the public.

“However, ministers have completely fa…

Unprecedented action to reduce health inequalities

It is indeed rare these days that I write something 'good' about the coalition government. Today's post is one of those rare moments. One of the major determinants of poor health is inequality. We cannot expect to break the cycle of poverty and disease unless we address this.  This is why joining up the dots between socio-economic circumstances and health care is essential. To treat poor health without regard to such circumstances is to ignore a substantial primary cause of ill-health. It is also one of the reasons I have been critical of the indiscriminate nature of the effects of the governments policies that are likely to increase poverty and inequalities. But today there is at least some good news.

Health professionals from a wide range of royal colleges and professional organisations have joined forces to improve patients’ health and reduce health inequalities by considering patients’ social and economic circumstances as well as their medical history. It is estimated…

Why the government fails to understand 'fairness'.

Why does the Secretary of State for Work and Pensions, Mr Ian Duncan Smith get the concept of 'fairness' so wrong? All his policy initiatives he claims are based on fairness. There is little wonder then that he gets so upset when told his policies are not simply unfair but unethical. Some have described them as immoral because of the disproportionate effect on the poorest. It hits him where it hurts, in his softer moral underbelly. Why then does Mr Duncan Smith and his colleagues get it so wrong? I think the answer lies in a common philosophical mistake; the notion that it is ethical to treat people 'equally'.

On so many policies we are asked to compare one group with another. For example, for the 'bedroom tax' we are told it is 'unfair' that differences should exist between those in the private rented housing and in social housing. The problem with this kind of proposition is that it misunderstands 'fairness'. It confuses  'treating people …

BMJ finds conflicts of interest "rife" on new NHS commissioning boards.

An investigation for the prestigious British Medical Journal (BMJ) published today finds 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.

The report provides the clearest evidence to date of the conflicts many doctors will have to manage from April 1, when the GP-led groups are handed statutory responsibility for commissioning around £60bn of NHS healthcare.

The BMJ used Freedom of Information requests and CCG websites to analyse the registered interests of almost 2,500 board members across 176 of the 211 commissioning groups in England.

It found 426 (36%) of the 1,179 GPs in executive positions had a financial interest in a for-profit private provider beyond their own GP practice – a provider from which their CCG could potentially commission serv…

The bedroom tax is cruel because it is indiscriminate and fails the test of justice.

Since publishing my previous article on the cruelty of  the 'bedroom tax', several readers have pointed to the unfairness of people occupying houses with 'spare' rooms whilst others are in need. It is an argument repeated by government ministers. Often they cite the numbers of empty houses, as if the two could easily be matched.

But pointing to one unfairness, the shortage of suitable homes, cannot justify another, the indiscriminate injustice of forcing the poorest deeper into poverty, or for them to lose their homes. It is  particularly unjust if it is unlikely to resolve the problem, for it cannot then be justified on any utilitarian ethical consideration. It fails to give an equal consideration to the genuine interests and needs of all concerned. It neither addresses the plight of the homeless or those in overcrowded accommodation, nor does it address the problem of low pay and families struggling to pay their bills. Justice requires that people should be treated f…

The Spark of Life – electricity in the body.

What is the link between a lightning flash, the poet Percy Shelley and a cure for diabetes? It is the kind of question you might hear on a radio quiz program such as ‘Brain of Britain’. The quest for an answer takes us on an exciting scientific journey with unexpected twists and turns. It is an extraordinary voyage of discovery, beautifully navigated for us by the distinguished Oxford scientist, Professor Frances Ashcroft in her book “The Spark of Life”, which she discusses with Denis Noble for Voices from Oxford.

Since the 18th Century Italian physician Luigi Galvani showed that an electric shock can cause muscles to twitch, scientists have been fascinated by the role of electricity in life.  Modern science has discovered that electric currents flow in and out of cells in the body mediating and initiating their function.
All cells in the body in all organisms on earth, “from the simplest bacteria to the trees in the giant redwood forests of California” have tiny protein structures in…

Bankers' bonuses and the 'bedroom tax'

I have heard all sorts of interesting justifications for the size of bankers bonuses, some reasonable, others downright tendentious. But the justification I heard today just about trumps them all; we shouldn't regulate bankers' bonuses because 'they pay for welfare'!

This appears to be the new line, and the Prime Minister used it in today's PMQs; no doubt it will become a mantra and we will hear it repeated. It is the kind of justification we hear often from this government. We mustn't regulate the rich because 1) they will go elsewhere and 2) their taxes pay for welfare. Thus the richer we allow them to become, no matter how obscene and unjustifiable in terms of productivity or effort, the more we have for welfare.

So, the wealthy are allowed to hold us all to ransom with their potential tantrums and threats take their expertise abroad. It is time we called their bluff. The newspapers should have the same attitude to such ransom as they often do to train-drive…

This medieval, cruel and unfair 'bedroom tax' will push families deeper into poverty.

From next month all working age tenants renting from a local authority, housing association or other registered social landlord will receive Housing Benefit based on what the government calls "the need of their household". It sounds libertarian and just: to each according to his need. If only they had also adopted the other half of the balance: from each according to their ability. But the 'bedroom tax', as it has been called, is by its nature a medieval piece of legislation. Its aim is primarily to cut the costs of housing benefits, but also to encourage tenants to move out of their homes. It isn't 'giving according to need', it is taking away from the poorest. It isn't an incentive, but a penalty, and that is why it is unjust. It assumes 'need' can be determined solely by considering numbers of rooms and numbers of people. If only it was that simple.

The 'bedroom tax' means those tenants whose accommodation is 'larger than they n…

A budget for growth would be best to address the structural deficit.

There is little I find more frustrating than listening to Labour Party front-bench spokespersons presenting the 'case' for an alternative to coalition austerity.  It is as if they are afraid of their own shadow. They fail to explain, not simply that deficit reduction is not the only or the right objective, but also they fail to outline what the alternative is and why, even when challenged by their opponents to do so.  So what is the problem?

I suspect it is because Labour are too cautious about being labelled 'deficit deniers', which is very sinful, and because 'deficit' is poorly understood or explained. The problem is the distinction between 'budget deficits' and 'structural deficits'. Although related, they are not the same. The distinction is important.

Voters clearly see that there is a massive deficit. More problematic for Labour is that they largely blame the last Labour government for it. So it is not surprising Labour don't want to …