FrontPoint Systems Ltd

Clearly determined to squeeze the most out of a dying market before hospitals give in & allow the free use of mobile telephones, Patientline have increased call charges while adjusting the price of television. I cannot see how they can remain viable. And I can understand even less the machinations that allowed them to get into this position in the first place.

The mixed sex wards that are intensely disturbing for many patients come under attack again.

Labour’s 1997 manifesto included a commitment to “work towards the elimination of mixed-sex wards”, and the 2001 manifesto stated: “Nightingale wards for older people and mixed-sex wards will be abolished.” But the latest figures from the Healthcare Commission’s 2005 survey of patient experience showed that a fifth of patients (22%) had shared accommodation with the opposite sex at some time during their hospital stay. In London teaching hospitals, one in four patients had been in a mixed ward and in some hospitals, in London and beyond, the proportion was well over half.

A separate Healthcare Commission census of mental health establishments in England and Wales published last month found that 55% of inpatients had to share sleeping accommodation or bathrooms with members of the opposite sex. A survey of 2,462 patients in 128 hospital trusts, carried out in February and March and published last week by the Commission for Patient and Public Involvement in Health, showed that a quarter of patients had been required to share a bay and toilet with the opposite sex.

PFI was sold as the best chance of building new facilities that were suitable for patients but the ensuing costs that have spiralled out of control have meant that the new hospitals have fewer beds & are not as well designed. And the NHS will have to pay for them for 25 years, so no, am not a fan.

David Stout from the PCT Network is profiled in the Guardian responding to the recent salvo from the LGA about social care budgets.

Stout will today issue the results of a parallel survey of 59 PCTs showing cost-shunting in the opposite direction. More than half the PCT chief executives said the local council had tightened the eligibility criteria for providing social services. This meant fewer older and disabled people got home visits to help them dress, wash and eat. The condition of some who did not get help worsened, so PCTs spent more on emergencies and hospital admissions.

Paul Corrigan gets profiled in Public magazine:

As special adviser to successive health secretaries Alan Milburn and John Reid before No 10, Corrigan has been associated with the most radical version of commissioning. One of his stated ambitions is to introduce more competition into primary care, challenging incumbent GPs by contracting with private companies.

As I have said before, the economics of healthcare is a world away from the actual business of caring for people & this half baked plan suggests that they are still working by game theory. I heartily recommend a viewing of the Trap & a re-examination of Nash. Plans made by people who do not have to live with the consequences somehow never seem to work out.

The OFT are apparently to look into the distribution arrangements for pharmaceuticals in a move brought on by Pfizer’s recent exclusive distribution arrangements with Alliance Boots but with the shake-up continuing, as AstraZeneca and Swiss drug group Novartis have both invited wholesalers to tender for a similar direct-to-pharmacy model, and US company Eli Lilly is also looking at changing its supply chain in the UK.

Letters in the Guardian about that patient survey. Depression in pregnancy gets a mention as well.

Maternity Matters gets skewered in both the Times & the Telegraph. Some more coverage.

And writing in the Times, another group of senior doctors sets out to hole the MMC / MTAS appointments.

Sir, The chaos of the new appointments system for junior doctors, which left one third without interviews at the beginning of March, returned to the news with the resignation of Alan Crockard from his position in the Department of Health as principal architect of the attempt at Modernising Medical Careers (MMC). “From my point of view, this project has lacked clear leadership from the top for a very long time,” he says in his resignation letter. His departure and Parthian letter appear to hole beneath the waterline the edifice he created, and underline the folly of senior doctors struggling to keep it afloat by “following orders”. Whose orders?

We recognise the need for evolutionary changes in medical training, always adapting to patient need and taking into account changes in supply and demand for doctors in the UK and Europe.

However, there are two principles that cannot be compromised. One is that entry into specialty training programmes is based on the use of objective criteria which recognise scholarly and clinical achievement. The other is flexibility in training programmes, so that patients do not find themselves cared for by disillusioned doctors working in specialties for which they lack enthusiasm or aptitude.

MMC enforces premature choices by doctors only two years out of medical school, and expects candidates to sign over five critical years of their career without being told the detailed specification or location of the training and mentorship they will receive.

As for the much trumpeted concept of MMC as saviour of “the lost tribe” of senior house officers (SHOs) — the group of doctors two to four years postqualification — salvation seems hard to square with the random carnage of at least 8,000 doctors, mainly SHOs, who will shortly drop out of the NHS after costing the taxpayer £2 billion to train to their present level.

The legality of restricting the number of job applications for specialist training posts is being seriously questioned. Remarkably, the review body established in early March is seeking to impose a reduction in choice from the four that were advertised to just one interview per candidate. Because the preinterview shortlisting process has been abandoned (after costing tens of millions of pounds), more taxpayers’ money is to be thrown at interviewing all applicants without selection, including the possibility of repeating under new rules thousands of interviews already conducted.

The royal colleges recognise the burden this places on consultants and trusts, including cancellation of clinical activities that are bound to have adverse effects on patient care. In every poll conducted, more than 80 per cent of several thousand doctors have declared against continuation of the new Medical Training Application System (MTAS), in favour of an immediate return to the previous selection system for this year. If the review body will not listen, this is the week for grassroots democracy to act. MTAS cannot progress without participation by individual consultants in interviews. We hope they will say no, that individual trusts will ballot their consultants, and that medical directors and chief executives, putting patient care first, will say no.

We urge, instead, an immediate return to a regionally based appointments system led by the same expert doctors as will be responsible for the specialist training. This solution is still feasible; it will minimise the adverse impact of the hugely expensive and ill-considered reorganisation on patient care, while providing much needed breathing space for careful planning and validation of new training and appointment processes.

MORRIS BROWN, Professor of Clinical Pharmacology, University of Cambridge
JOHN CAMM, Professor of Clinical Cardiology, St. George’s Hospital Medical School
MARK CAULFIELD, Professor of Clinical Pharmacology, Queen Mary College, London
PAUL CORRIS, Professor of Thoracic Medicine, University of Newcastle
EDWIN CHILVERS, Professor of Respiratory Medicine, University of Cambridge
PAMELA EWAN, Consultant Physician, Addenbrookes Hospital
JOHN GIBSON, Professor of Respiratory Medicine, University of Newcastle
GEORGE GRIFFIN, Professor of Infectious Diseases and Medicine, Chairman of Association of Clinical Professors of Medicine
ASHLEY GROSSMAN, Professor of Endocrinology, Queen Mary, University of London
ALISTAIR HALL, Professor of Clinical Cardiology, University of Leeds
GEORGE HART, Professor of Medicine, University of Liverpool
TONY HEAGERTY, Professor of Medicine, University of Manchester
HUMPHREY HODGSON, Vice-Dean, Royal Free and University College School of Medicine
PHILIP HOME, Professor of Diabetic Endocrinology, University of Newcastle
RICHARD HUGHES, Professor of Neurology, Kings College London
KAY-TEE KHAW, Professor of Clinical Gerontology, University of Cambridge
JOHN LAZARUS, Professor of Clinical Endocrinology, University of Cardiff
JOHN MONSON, Professor of Surgery, University of Hull
STEPHEN O’RAHILLY, FRS, Professor of Clinical Biochemistry, University of Cambridge
BRIAN ROWLANDS, Professor of Surgery, University of Nottingham
NEIL SCOLDING, Professor of Neurology, University of Bristol
ROBERT SUTTON, Professor of Surgery, University of Liverpool
ROY TAYLOR, Professor of Medicine & Metabolism, University of Newcastle
NICK WRIGHT, Warden, Queen Mary College, London

This is the first of the fallout from Alan Crockard’s resignation. Let us see what the Review Group can come up with.

This comes of course on top of this letter from Bernard Ribeiro at the Royal College of Surgeons.

To Fellows and Members of The Royal College of Surgeons of England

I have attempted over recent weeks to keep you fully informed and up to date as discussions have proceeded about the debacle caused by the MTAS arrangements and the steps that have been taken by the review group with a view to resolving this.

This is a very complex issue. It has been clear from the outset that the arrangements have broadly served general practice well while the position with hospital medicine has been much less satisfactory. Across various specialties and in some deaneries, there has been recognition that good candidates have been selected for, and performed well in, interviews. Elsewhere, however, it has been clear that well qualified and experienced candidates have not been identified. The prevailing view in surgery is that the arrangements are seriously flawed. Our survey of Fellows and Members, with about 80% of respondents considering MTAS so fundamentally flawed that it is incapable of continued operation and should be abandoned for 2007 with a return to the deanery appointment processes that were in place last year, was a significant indicator. The recent ASIT meeting in Belfast, where I could gauge the views of a significant number of trainees, reconfirmed this widespread dissatisfaction. There was some feeling that an extension of choice to applicants, to be interviewed for two or more of their MTAS selections, would improve matters but there remain grave logistical concerns that this is impractical. The Scottish Executive announced on 30 March 2007 that “eligible junior doctors applying for specialty training jobs will be offered interviews for all posts applied to in Scotland”. It has been particularly unhelpful that a lack of coherent and consistent thinking amongst ministers and officials in Edinburgh, Cardiff and London has led to an utterly inequitable situation where trainees in parts of the United Kingdom appear to have been offered multiple interviews against their preferred choices while others will not, or cannot, be treated on a similar basis.

There will be a further meeting of the review group tomorrow (i.e. today 4.4.07) and I will attend once more to outline my grave concerns about the general situation and these recent developments and to assess whether there is any prospect of finding a satisfactory solution. I have to say that I am not optimistic and I assure you that I will dissociate myself from these negotiations if I see no recognition of the gravity of the situation generally, and particularly for surgery. There must be adequate transitional arrangements put in place to support those able trainees who fail to be appointed at this stage. I will not see a generation of highly qualified, experienced and committed surgical trainees exposed to the vagaries of an untested and clearly flawed system, effectively participating in a professional lottery.

I will write to all of you again following this meeting tomorrow. Having acted until now in what I believe to have been the best interests of everyone, given the range of opinions I have heard and the practical constraints of which I have been conscious, I am not prepared to leave you, and those who share your concerns, in further uncertainty. If there is no significant and expeditious move tomorrow towards a satisfactory solution, I and my colleagues on Council will seek, independently if necessary, a resolution of this situation that meets now your reasonable expectations and ensures for the longer term our patients’ absolute right to the safest and highest-quality care.

Bernard Ribeiro CBE

President

This is covered in the Guardian as news filters out that the actual number of training posts available is 18518 & not the 23 thousand that the govt maintain. This is before the FTSTA’s are separated out as well.

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This entry was posted on Wednesday, April 4th, 2007 at 8:55 am and is filed under Clinical, Management, NHS. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.