The Thin End

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 Informati

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 informatio

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 o

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 Parli

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 par

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 findi

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

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 c

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

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

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

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 Co