The day after
So has anything changed in the MMC / MTAS landscape after the opposition sponsored debate in parliament yesterday?
Well, we know now the terms of reference for Sir John Tooke’s review. We still don’t know if he had any previous connections to MMC (hard to see how not due to his role as Dean) though he did write to the BMJ to complain about its impact on academic medicine and there has been no word on members of the panel. The terms again are ok, but it depends on whether they go looking for trouble or wait for it to come to them in which case not much can be expected.
There has been very little coverage in the press with just a mention in the Guardian in the same breath as the mauling Andy Burnham received at the Unison conference in Brighton. There was a mention in Channel 4’s evening bulletin with a doctor ready to put his point of view across but no one willing to take the flak from the side of the govt. The Telegraph has a brief mention as well.
The government was confronted with a double-headed protest over its NHS reforms yesterday by junior doctors and health workers.
As a minister was heckled over pay at a union conference in Brighton, doctors’ pressure group Remedy UK held a rally in Westminster to back up an opposition debate on a new computerised recruitment system for specialist training.Labour MP Ian Gibson joined the shadow health secretary, Andrew Lansley, and the Liberal Democrat health spokesman, Norman Lamb, in addressing the protest amid warnings from the British Medical Association that thousands of doctors could be forced to leave the UK unless the government fixes the Medical Training Application Service.
From Michelle Tempest at the Psychiatrist’s blog.
As the Opposition tore into government policies during a special Commons debate, junior doctors broke into spontaneous applause in the public gallery - earning an official warning from the Speaker Michael Martin. Amid heated exchanges, Mr Martin was forced to intervene to restore order.
Andy Burnham, the health minister, endured half an hour of jeers and heckling at the annual conference of Unison, the public service union, as delegates protested at the government’s decision to withhold part of this year’s pay increase until November. Nurses, paramedics and healthcare auxiliaries, who are preparing to ballot for a strike, waved handwritten posters telling him: “Low pay. No way. NHS here to stay.”
But after a plea for restraint from the conference chairman they allowed the minister to finish his speech. Mr Burnham gave no ground on pay, but promised to abandon plans to privatise the Prescription Pricing Department, an NHS agency that administers the dispensing of medicines in England.
The Department of Health had been working on a scheme to cut costs by sending the work offshore, but Mr Burnham said: “While we have further work to get better value for money, there will not be any outsourcing or offshoring.”
The minister tried to win over delegates by promising to reduce the flow of centrally-set targets. He said there would be no more boundary reorganisations or upheavals in the short to medium term.
But delegates shouted in dissent when Mr Burnham said he was “defending to the hilt the fundamental principles of the NHS”.
When he appealed to staff to avoid playing into the hands of critics of the health service, they yelled back: “We are your critics.” When he asked for a constructive dialogue with the unions, they laughed derisively.
Jeremy Lawrence in the Independent finally acknowledges the anger over MMC but manages to get a dig in about doctors banging their own drum. His analysis & prescriptions are rather too kind to the changes introduced over the past 10 years.
Nick Robinson discusses the stick the govt is taking on the NHS on his blog at the BBC.
Tony Blair has long complained that people’s own experience of the NHS - which is generally good - is not matched by their perceptions that the NHS nationally is failing. He has tended to blame media reporting. What he’s ignored is the fact that those who should be his ambassadors - the NHS’s staff - are telling anyone who’ll listen what a mess it is.
To hire thousands more nurses and doctors whose pay you increase substantially but who nevertheless attack you is quite an achievement. Gordon Brown knows that his first task when he takes over is to woo them, not the public.
The CEMACH report for 2005 is out & stillbirth rates do not seem to be going down. There is coverage from the BBC, the Independent
The Confidential Enquiry into Maternal and Child Health (CEMACH), found there were 3,600 stillbirths in 2005.
One in 200 pregnancies ends in a stillbirth, a figure which has remained unchanged since the early 1990s, in sharp contrast to the survival rate for premature babies. In the past decade the proportion of premature babies born at 25-weeks’ gestation who lived for more than four weeks has risen from below 60 per cent to 77 per cent.
Overall, the stillbirth rate was 5.5 per 1,000 births. A third of stillbirths occurred when a baby had reached full-term.
For women under 20, the rate is 6.6 per 1,000 and for those over 40 it is 7.2 per 1,000 births.
Black and Asian women are up to twice as likely to have a stillborn baby when compared with white women, the report said.
Deprivation appears to be a major contributory factor, with mothers in very poor areas twice as likely to have a stillborn baby or to have babies who die in the first month of life.
In 1993, 58% of stillbirths and deaths in the first four weeks of life after birth resulted in a post mortem, but the figure fell to 39% in 2005.
NICE has apparently recommended that smokers be given paid time off work to quit smoking. The Times, the Telegraph & the Guardian cover it.
People who smoke should be allowed to take time off work to attend smoking clinics to help them give up without any loss of pay, according to new public health recommendations issued by the National Institute for Health and Clinical Excellence (NICE) which claims that the proposal will cut the £5 billion annual cost of lost productivity, absenteeism and fire damage caused by smoking.
It believes that a business with five smokers could spend just £66 on providing advice, including the cost of lost employees’ time, and see an overall saving of around £350 in improved productivity.
It is the first time that NICE has issued guidance that applies beyond the NHS, effectively including every workplace in England. The recommendations come as all workplaces, from offices to factories and pubs, prepare to go smoke-free on July 1.
I do not know the statutory basis for this & just how practical it is but I do not imagine businesses will like it though I do acknowledge the arguments for it.
On the first anniversary of the Wanless report, Sir Derek Wanless writes in the Guardian bemoaning the lack of progress. The Telegraph joins in too with details of the postcode lottery.
Little has changed one year on from the publication last year of my review for the King’s Fund health thinktank of social care for older people, except, perhaps, a greater awareness of the depth of the crisis. The challenges it posed have not been taken up with necessary urgency, and social care has missed out as attention and money have been directed elsewhere.
At the heart of last year’s analysis lay the worrying observation that social care for older people had come to mean whatever a particular year’s budget could be stretched to provide. Budget increases - which have not even kept pace with demographic change - have squeezed care services, and people with moderate needs have suffered most. Those assessed as needing care and support are told only months later that help is withdrawn because eligibility criteria have changed. New needs go unmet, together with a dramatic fall in the number of people with less severe difficulties receiving home care services, such as meals-on-wheels or home helps. With little or no support, people’s chances of staying healthier for longer are reduced.The system survives only because of the huge contribution made through informal care by families and friends, who need more than the minimal help and support they get. The funding system penalises people with moderate savings, a shock to many just when they are most vulnerable. If left in place, it will discourage hundreds of thousands from receiving the support they need.
The postcode lottery is alive and well in social care, with large inequitable differences in local authority charging. And there are perverse incentives encouraging excessive use of care homes rather than care at home. High charges levied by some local authorities make it hard for less-well-off older people to stay in their own home. Local authorities can get more money from people if they sell their home and move into residential care. Poor people with assets of less than £21,000 are left with £19.60 a week personal allowance after care costs. It is the exact opposite of the rhetoric about independence and dignity.
Today, up and down the country, relatively few older people are eligible for NHS continuing care. The benefits of “free” social care have been replaced by means testing. This shift began more than 20 years ago, but it is a policy largely introduced by stealth, noticed only when people need help.
I do not support the current methodology of means testing. The thresholds need to be set far higher but then it might very well become uneconomical to test compared to the savings possible.
There is a follow-up report on hospital acquired infections in the Telegraph with case reports.
WPA get more publicity for their policy offering to pay for chemotherapy.
The lack of information available to patients suffering from chronic conditions is considered by a new study.
The Picker Institute said patients with chronic conditions and their carers often came up against “brick walls” when looking for help.
Researchers said councils, charities and the NHS struggled to give accurate and adequate information. They consulted focus groups and carried out mystery shopper exercises whereby people contacted different bodies with fictional, but typical, queries.
It said charities, councils and primary care trusts, which are in charge of local services, often pointed patients in the wrong direction or did not have the information available.
Not a huge surprise there but most clinicians can’t get hold of the information either. What we do not need though is a huge edifice to promote information sharing. There are enough quangos already. Cost effective means can & should be deployed.