The Thin End

Informed choice is a key ingredient of modern day medical ethics. Many patients now get a variety of information from the internet, but much of the information available can be at best confusing. We might think that leaflets used by the NHS would at least be consistent and clear. Yet this appears not to be the case. The NHS’s patient information leaflets are “inaccurate, inconsistent, and confusing – and effort is duplicated” argues GP Margaret McCartney on bmj.com . In a feature published today, Dr McCartney says the NHS is “awash” with patient information and with many trusts commissioning leaflets from external companies and others writing their own, it is difficult to know how efficient and effective these leaflets are. In a personal view, Dr McCartney says the NHS is “awash” with patient information and with many trusts commissioning leaflets from external companies and others writing their own, it is difficult to know how efficient and effective these leaflets are. Previo...

The news that NHS Direct is seeking to pull out of its 'financially unsustainable' NHS 111 contracts has received a strongly worded reaction from the doctors organisation the BMA and questions are now being asked about the tendering process and how contracts have been awarded.  Responding to the announcement that NHS Direct is seeking to withdraw from its NHS 111 contracts, Dr Chaand Nagpaul, Chair of the BMA’s GP committee said: “The implementation and planning of NHS111 has been an abject failure. “NHS Direct struggled to cope with the volume of calls it was receiving despite having years to plan for the launch of NHS 111. Other already overstretched services, such as GP out of hours providers, have had to step in and undertake the workload that was supposed to be dealt with by NHS 111. It is worrying that patients had to wait twice as long as recommended for their calls to be answered. “Sadly, many of these failures have occurred in many parts of the country. “The deci...

In preparation for the Oxford Trobadors concert for the Oxford Proms on 12th August, I have been working on Jaufre Rudel's lovely poem and song Quan lo riu de la fontana (When the water of the fountain). It is one of the medieval Occitan troubadours pieces in our repertoire . So many of the songs of the troubadours tell of the pain of an unattainable love, a love far away, or amors de lonhdana.  Amors de terra lonhdana           Those I love in a far off land Per vos totz lo cors mi dol         for you all my body aches E n'on puec trobar meizina         and I cannot find the remedy. A ccording to legend Jaufre Rudel was inspired to go on  a crusade after hearing of the beauty of Countess Hodierna of Tripoli. She was his amor de lonhdana .  Sadly he fell ill on the journey and was brought ashore in Tripoli a dying man. Countess Hodierna is said to have come down from her castle on hearing the...

UK Gross Domestic Product (GDP) is estimated by the Office of National Statistics to have grown by 0.6 % in the second quarter of 2013. Good news for the economy? I hope so; but is it enough and is it the 'right sort of growth'? The problem is that there is no sign that this growth represents any fundamental change in the structure of the economy. I make this point not to be churlish. If growth leads to recovery then that must be good, but only if it is sustainable. This is not simply a left wing  point. It is also the caveat voiced by the right-wing think tank, The Centre for Policy Studies . As their Ryan Bourne comments: "Only by raising the productive growth path of the economy with a proper supply-side agenda (to increase expected returns to businesses when planning investments) and re-aligning policies over the coming years towards more of a savings culture will we able to generate the kind of long-term sustainable prosperity which policymakers pay lip service to...

Many junior doctors are still working excessive hours, due to increasing pressures and staff shortages, and are worried this is putting patient safety at risk, a IPSOS Mori report for the BMA has shown. Ahead of potential negotiations with NHS Employers on a new contract for doctors and dentists in training, the BMA analysed feedback from over 1,600 junior doctors and final years medical students on the employment and training issues most important to them. Despite the European Working Time Directive bringing in an average 48-hour working week, the reality is that some junior doctors are working up to 100 hours a week to meet demand, with many worrying for their own and their patients’ safety as tiredness impacts on their ability to work and make decisions safely.  This comes amidst increasing concerns about patient safety in the NHS. Comments by the doctors in training reveal the problem: “My average working week may have complied [with the ETWD] but on occasion, especially on ...

While the Prime Minister, Mr Cameron, is mired in controversy over lobbying and tobacco, having ducked the intention to introduce plain packaging, new research shows that plain, unbranded, packaging works.  Plain packaging for cigarettes seems to make tobacco less appealing and increases the urgency to quit smoking, suggest early findings from Australia, published in the online journal BMJ Open . Australia formally introduced plain brown packaging, accompanied by graphic health warnings taking up three quarters of the front of the pack, for all tobacco products six months ago.  So far, it is the only country in the world to have done so. The researchers wanted to find out what effects the policy was having in the early stages, and whether it helped curb the appeal of tobacco, emphasise its harms, and encourages quitting among smokers. They therefore interviewed 536 cigarette smokers in the Australian state of Victoria during November 2012 when plain packs were already ...

Privatisation of provision in the NHS is moving apace a new investigation has shown. One in six hospitals in England have introduced new private treatment options this year, as cost pressures tighten restrictions on some NHS services, reveals a BMJ investigation today . This includes a growing number of hospitals offering patients the choice of “self funding” for treatments and services that are subject to restrictions or to long waiting times on the NHS, such as IVF, cataract surgery and hernia repair. In these cases, treatments are offered at cheaper rates than in the private sector. The BMJ obtained data from 134 acute hospital trusts in England through freedom of information requests and found that: 119 trusts (89%) now offer traditional private care or “self funded” services 21 (16%) added new self funding or private treatment options for 2013-14, and 17 (13%) now allow patients to pay for one or more services at notional NHS rates, under the self funding scheme Provide...

A major revolution is occurring in evolutionary biology. In this voices from Oxford video the President of the International Union of Physiological Sciences, Professor Denis Noble, explains what is happening and why it is set to change the nature of biology and of the importance of physiology to that change. The lecture was given to a general audience at a major international Congress held in Suzhou China. The implications of the change extend far beyond biology itself. This video will interest economists, business leaders, politicians and others who deal with the important social questions that have been raised by ideas in evolutionary biology ever since Darwin wrote his Origin of Species. This will change your view of genes and the gene-centred view of biology, sociology and politics. Tragically for decades this 'selfish gene' view, that we are 'prisoners' of our genetics, genetic determinism has bedevilled biological thinking and influenced sociological thou...

“It’s all around us. It’s hitting us now; an afterglow of the big bang” Oxford cosmologist Jo Dunkley enthrals her audience in this Voices from Oxford video, 'measuring the universe' . We are bathed in light; not in this case light from the sun or from the stars, not light from the galaxies, not light as we know it best, but light created at the very origin of the universe, the so-called ‘cosmic microwave background’; light generated by the big bang at the beginning of the known universe some 14 billion years ago. Jo Dunkley and her team look back in time, far back, almost to the origin of the universe itself; as close, in fact, as 400,000 years. It is almost as if you could touch it. Or at least you can see its remnants. “It is a snapshot of the universe when it was just 400,000 years old” She explains as it appears on the screen. But it isn’t a warm glow, it’s a cold light, -270 degrees, the “seeds of cosmic structures; tiny ripples in the early universe that would go on to f...

There was the fanfare, not exactly trumpets, but soothing, calming, reassuring...reassuring. The date is Monday January 4th 2010. A week is a long time in politics, three years is an age, so we may not remember; and if we do we may be inclined to ask so what, who believed them anyway? It was the day Mr Cameron, launched the Tory party's draft manifesto for the NHS. It was that speech in which the then Leader of the Opposition pledged there would be no top down reorganisation of the NHS. It  was also a speech in which he said the Tories would not make the sick pay for the debt crisis. Three years on we have major top down reorganisation, £20 billion cuts in NHS funding through 'efficiency savings' which all health bodies including the BMA say have pushed the NHS to a crisis point. NHS England inform us that unless funding levels are increased the NHS in England is heading for a shortfall of £30 billion by 2020. That translates into real cuts that will affect the ability ...

NHS England has today called on the public, NHS staff and politicians to have an open and honest debate about the future shape of the NHS . This is set against a backdrop of flat funding which, if services continue to be delivered in the same way as now, will result in a funding gap which could grow to £30bn between 2013/14 to 2020/21. We certainly cannot have an honest debate unless  the government is willing to be transparent. A public consultation, a 'call to  action', is a little late in the day. The horse has bolted and the NHS in England faces funding and staff shortages and an ill-conceived reorganisation.  The NHS is reeling from an unwanted reorganisation and, far from being ring fenced as claimed by the government, cuts of £20 billion in so-called 'efficiency savings'. The government has delivered a mortal blow to the NHS and introduced privatisation which will  starve in-house services of much needed funding.  Responding to NHS England’s 'c...

Experimentation on premature babies has always presented ethical problems. Increasing numbers of babies are born prematurely and babies are surviving at younger gestational ages. Pushing the boundaries of intensive care often steps into the realm of the unknown. This creates problems of informed consent. In an article on bmj.com , a senior doctor today calls for an  investigation of whether parents of premature babies were fully informed of the risks of a study on the health effects of varying oxygen levels. Dr Sidney Wolfe, founder and senior adviser to the Health Research Group at Public Citizen, says it is surprising that the adequacy of consent forms for nearly identical studies in the UK, Australia, New Zealand, Canada, and other countries with similar regulation of human research, has apparently not yet been examined. He argues that there may well be “serious problems” with such risk disclosure that must be addressed. One such study, called SUPPORT, was funded by th...

The Oxford Trobadors will be performing  as part of the Oxford Proms on Monday 12th August at the Holywell Music Room, Oxford. You might think this article strays from the focus of this blog. Well of course it is in large part a promotion of my music, that much I confess. I make no apologies for that. I think my music is good, else I wouldn't perform it! But it is also an opportunity to consider the status of minority languages in Europe, and in this case that of Occitan. The Oxford Trobadors take their inspiration from the music of the language Occitan in which the 12th and 13th century Troubadours composed. It is often described as La Lenga de l'amor' (the language of love). But the language and culture are still alive today in the south of France and parts of Italy and Catalonia, and the group also perform modern, contemporary Occitan songs.  An example is Nadau ta Baptista (Christmas for Baptiste), a gently lilting Pyrenees lullaby composed by the Occitan group Na...

What the country most needs now is for an alternative to austerity to be put to voters. It is a difficult argument. Most voters buy into the narrative of cutting the deficit, and they have bought into the welfare problem.  It is a false narrative because the deficit was not and is not the cause of UK economic woe, and nor is welfare dependency part of the problem. Even the Centre for Policy Studies argues for an alternative to austerity. The right wing think tank argues for a growth strategy. Labour it seems has given up the argument against austerity. It appears to have given up arguments  for spending on growth. But now a greater danger looms. Macho politics set by the media.  Here I have t make a confession. I was a Blairite before Mr Blair. I believed if Labour was to be a credible party of power it had to change. It had to abandon false tokens, such as nationalisation, which in any event did not define socialism. But this is not a Blair moment, and Labour should ...

How convenient it is for the government that the real cause of our economic woe seems to have become a distant media memory. Better it is for the government to blame the poorest for the crisis, rather than question how it was that the capitalist edifice crumbled. The inconvenient truth is that far from it being 'social welfare' that brought us to our knees, it was middle class greed.  It wasn't the deficit; it wasn't the 'welfare dependent' poor.  It was middle class greed and a banking sector gone sour;  a banking sector willing to sell us their 'toxic' financial products pushing personal debt higher and higher, and in the UK to the highest levels in the world. No it wasn't and isn't public debt that was or is our problem; it was personal debt. Whilst the government have been on an ever failing austerity drive of cuts that are stripping services to the bone, hitting the poorest the hardest, slashing funding to the NHS with £20 billion of cut...