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Health Insight April 2000

Health in the news

The government has had some bad headlines on healthcare issues this year but the substantial increase in NHS funding announced in the budget has won considerable acclaim. Observers of the NHS are divided as to whether the package announced by the Chancellor will lead to the UK catching up with its European neighbours on health expenditure, but the budget has made clear the government's commitment to a publicly-funded NHS and its seriousness about driving up standards. In a number of recent public statements, the Prime Minister has emphasised the importance he attaches personally to the health sector.

Reform of the way in which healthcare is delivered is also key to government thinking, and some of the new initiatives intended to improve standards have been seen, during March, to be progressing well - see our story 'Clinical guidance'.

One government initiative which has not proved popular with most doctors, is the NHS Direct helpline. This is to be expanded. The Prime Minister himself has urged doctors to embrace the new service, and to 'modernise' their entire approach to delivering healthcare. General practitioners see NHS Direct as a threat to their role in providing primary care. The government sees it as an effective way of improving the quality of the service.

The public's faith in doctors has undergone a few knocks in recent months with the Shipman case and other incidents. The GMC has in consequence been given increased powers - see 'Protecting patients - restoring confidence'.

Meanwhile, the NHS in Scotland is facing up to a number of difficulties - see 'Scots surgeons call for an overhaul'.

Budget boost for healthcare

The NHS was one of the chief beneficiaries in this year's budget. To quote The Daily Telegraph, 'The NHS is to be the main recipient of the copious amounts of cash in the Chancellor's war chest'. Gordon Brown announced that the health service would receive all of the #300 million generated by an increased tax on tobacco, and then pledged an additional #1.7 billion. He unveiled a four-year package giving the NHS increases averaging 6.1% above inflation until 2003-04, taking annual spending to #68.8 billion. The Treasury says this is equivalent to 7.6% of GDP, bringing the UK closer to the average European figure (variously estimated at 8.0-8.9% of GDP), in line with a pledge made earlier this year by the Prime Minister. By 2004 the UK will be spending #2,800 per household on the NHS.
Mr Brown stressed it had only been possible to increase expenditure on health thanks to 'prudence' in the running of the economy as a whole.

The increase in funding has been widely welcomed by professional and consumer groups and by the anti-smoking lobby. (The price of a packet of cigarettes has gone up by 25p.)
The Secretary of State for Health has given details of how the money will be spent. #660 million will, controversially, go directly to hospitals and GP services, by-passing health authorities. Mr Milburn said, 'These new resources have to make a real difference to patient care right the way across the country. They have to be spent on real services'.

Sources: Daily Telegraph 22nd March, Health Service Journal 23rd March, BBC Online, Press release (DoH)

Clinical guidance: hearts, strokes, teeth

One of the government's prime objectives has been tackling variations in treatment within the NHS. During the last few weeks, doctors (and dentists) have received clear guidance on the treatment of several conditions.

The government aims to transform the prevention, diagnosis and treatment of heart disease in England through its newly-published national service framework (NSF) for coronary heart disease (CHD). The aim is to cut CHD and stroke deaths by 40% by 2010. This would involve saving up to 20,000 lives a year. Twelve standards have been set, together with details of how these can be achieved and progress monitored. Local plans for implementation must be in place by October this year. The government has also announced a #50 million package to kickstart the programme. A priority will be hospitals in deprived areas with poor cardiology services.

The NSF has been welcomed by the President of the Royal College of Physicians, Sir George Alberti, who said, 'We needed a framework because we haven't got it right yet. Provision of coronary heart disease services is a disaster area that needs to be gripped with a coherent logical programme that goes across the board, from prevention through to rehabilitation'. However, the whole programme is seen by some as too ambitious. Steven Thornton, NHS Confederation Chief Executive, said it would only succeed if supported by substantial and sustained investment in staff and services.

The framework may be seen on the DoH website - www.doh.gov.uk/nsf/coronary.htm

A key figure in the development of the NSF, Dr Roger Boyle who is a cardiologist in York, has been appointed National Director of Heart Disease and will work with health professionals and managers in the implementation of the NSF.

The new National Institute of Clinical Excellence (NICE) has issued its first guidance, which concerns the removal of wisdom teeth. Around 140,000 impacted wisdom teeth are removed in the UK every year. NICE has concluded that 20-30% of these operations are 'inappropriate', resulting in a waste of #5 million annually. It recommends that healthy wisdom teeth should not be removed as there is no evidence that the practice is of benefit to patients and the operation exposes patients to risks - pain, infection, bleeding, damage to other teeth etc. The British Dental Association claims, however, that dentists have, in recent years, avoided the unnecessary removal of wisdom teeth and that 'very few' such operations now take place. The next guidance from NICE is expected to deal with artificial hip joints.

The Royal College of Physicians (RCP) has published a set of clinical guidelines for stroke. Services for stroke patients in England, Wales and Northern Ireland have frequently been criticised as disorganised and haphazard. The RCP guidelines cover all aspects, from diagnosis through to rehabilitation. In particular, the RCP advocates that patients should be treated in specialist stroke units rather than on general wards. At present only 20% of stroke patients in the UK receive treatment on stroke units. The recommendations, which are graded from A to C depending on the strength of the evidence available in their favour, may be seen on the RCP's website - www.rcplondon.ac.uk/ceeu_stroke_home.htm

Sources: Press releases (DoH, Consumers' Association), BBC Online, BMJ 11th and 25th March, Health Service Journal 9th March

Scots surgeons call for an overhaul

The NHS in Scotland is 'broken' according to Professor Arnold Maran, President of the Royal College of Surgeons of Edinburgh. Many hospital trusts are heavily in debt and waiting times for many treatments have increased substantially during the last few months. The College hosted a conference to look at the present situation, which many participants described as 'a crisis'.

Professor Maran said, 'If we don't get more money, then there must be rationing'. The meeting was in agreement that the delivery of healthcare in Scotland required a 'radical overhaul'. Some speakers called for more and better managers and for a programme of hospital closures, with an expansion of primary care.

Source: Health Service Journal 16th March

NHS Direct: does it make it a difference?

One of the pillars of the government's health reforms has been the establishment of the NHS Direct telephone helpline, which is staffed by nurses. The service, still not available throughout the entire country, has proved popular with callers, despite the reservations expressed by doctors. It was particularly well used during this winter's flu epidemic and a survey conducted during this time found that 90% of callers were satisfied with the service. There is also an Internet version of the service.

On the second birthday of the launch of NHS Direct, Health Minister Gisela Stuart announced that non-urgent 999 calls would now be transferred to the helpline. A Department of Health spokeswoman explained: 'It's all about giving people a more appropriate service. The kind of things that will be transferred would be sore throats and so on'. Nurses at NHS Direct will be able to arrange an ambulance if they decide the problem is more serious than the 999 operator had thought.

However, doubts have been cast on the effectiveness of the service by a study at Sheffield University which found that it had 'no discernible impact' on accident and emergency services. GPs also say that NHS Direct has had no effect on their workloads. An average call to NHS Direct costs the NHS around #8; a GP visit costs #10.55 and a visit to Accident and Emergency (A&E) #42.

The government remains committed to the service, to which will soon be added a number of additional features, including monthly on-line discussions with leading figures in medicine. The budget for training NHS Direct nurses is also to be increased.

Sources: BBC Online, Health Service Journal 2nd March, Press release (DoH)

Carry on nurse

An extra 1000 nursing and midwife training places are to be created as part of a massive recruitment drive for the NHS. Health Secretary Alan Milburn announced a #120 million training programme after figures were released showing a large rise in nurse recruitment. The number of nurses working in the NHS has risen by 4500 to 304,560 in the past year. Prime Minister Tony Blair said, 'The figures are very encouraging but we are under no illusion. We have got a lot more to do and we need to build on these figures'. Mr Milburn also announced a reform in the way nurses work, giving them more responsibilities for treatments such as chemotherapy and endoscopies which are traditionally carried out by doctors. This announcement was not welcomed by Dr Laurence Buckman, GP representative for the British Medical Association, who said, 'It's like getting a stewardess to fly a plane'.

Nurses themselves are not too impressed with NHS reforms, according to a Nursing Times poll. Seven out of ten nurses surveyed said they knew of no benefits to patients following the introduction of primary care groups (PCGs) - groupings of GPs and other healthcare professionals in local areas. Underlining complaints by GPs, 92% of the nurses on PCG boards said they were struggling to do the extra work and were doing so in their own time. Defending the PCGs, Dr Mike Dixon, chairman of the NHS Alliance, which represent GPs, said 'PCGs have been a silent revolution - a lot of it has been about organisational structure unknown to patients and those not involved. Part of the disillusionment among nurses may be because they feel they have not had their say. I think that is changing'.

Source: BBC Online

Just what the nurse ordered

Health ministers have decided to allow nurses to prescribe more medicines, in response to recommendations from an expert review panel. Patients with chronic conditions (e.g. asthma) and those with minor injuries, for example, could have their medicines prescribed by a nurse. There will be considerable savings in doctors' time.

Health minister Lord Hunt said: 'At present highly-skilled nurses are prevented from prescribing for common conditions because prescribing has always been seen as the role of the doctor... For example, a specialist asthma nurse treating a boy with asthma can give him a check-up and advice on exercise and diet but cannot write a prescription for an inhaler... Nurse prescribing is limited to district nurses and health visitors, working from a limited list of medicines. We will start identifying circumstances where nurses with the right training can prescribe from a wider list of medicines'. Legislation to allow the changes will be considered by parliament when time allows.

Source: Press release (DoH)

Protecting patients - restoring confidence

The General Medical Council (GMC) will be given expanded powers to protect patients from poorly performing doctors. Public outcry following the Shipman murders is, in part, responsible for the government's decision to act. Media reports say the inadequacy of the GMC's current procedures have made Health Secretary Alan Milburn 'incandescent with fury'.

Health minister John Denham said, 'Recent events have highlighted that the current system is inadequate. It is vital that the government and the GMC act quickly to restore public confidence'. The GMC will be empowered to impose immediate suspension or specify conditions under which a doctor is allowed to work. The employers of doctors whose fitness to practice is under review by the GMC must be notified. If a doctor is struck off the medical register it must be for a minimum of five years. The DoH says the changes will '...give practical meaning to the presumption that when a doctor is struck off, it is for life, save in the most exceptional circumstances'. In the period 1998-99, 150 doctors were struck off but one in four of these were very shortly reinstated.

Sir Donald Irvine, GMC President, has said, 'The medical profession needs to embrace a new approach to regulation. One that is based on a true partnership between professionals, the public and the NHS'. His comments appear in the Consumers' Association's bimonthly publication Consumer Policy Review, in which the Association says that self-regulation must, in future, play a reduced part in the regulation of the medical profession. It calls for consumers to have a greater say and for 'accountability not autonomy of professionals'.

  • The inquiry ordered by Health Secretary Alan Milburn into the murders by GP Harold Shipman is to be headed by Lord Laming, a former chief inspector of Social Services. It will examine: how best to safeguard patients, safeguards for single-handed medical practices, access to restricted drugs, the role of the NHS tribunal, and the accountability of the General Medical Council.

Sources: Press releases (DoH and Consumers' Association), Daily Telegraph 18th March, BBC Online

UK's vaccination success

Cases of the C strain of meningitis have fallen by 75% in the UK, among babies and teenagers, following a vaccination campaign. The immunisation programme, launched last November in England and Wales, has so far been restricted to the highest-risk groups - babies under a year and young people aged 15-17. The figures were released on the day public health experts in Scotland sought to reassure parents that a 14-year-old boy, who died four days after being inoculated against the disease, could not have died from a medical reaction to the injection. Health Minister Yvette Cooper said, 'We are the first country in the world to have this new vaccine. It puts the UK in the forefront of tackling this devastating disease'.

Immunisation has been restricted, because of short supplies of the vaccine, but is set to be extended to all children under five by this summer. Chief Medical Officer Professor Liam Donaldson said, 'The health departments have worked closely with manufacturers to ensure that the vaccine was made available as fast as it was produced - ensuring that the programme keeps on course to immunise all under 18s by the end of the year'. There is still no vaccine against the group B strain of meningitis, the most common form of the disease.

Source: BBC Online

Passport please - for pets

For the first time in over 100 years, cats and dogs are being allowed into the UK without having to go into quarantine for six months. A new pets' passport scheme means dogs and cats from 22 countries in western Europe will now be able to skip quarantine, if their owners can show documents proving the animal has been vaccinated against rabies, and has a microchip implanted with their own unique identification number. At immigration controls the chip is scanned and checked against records.

The scheme, which is only for cats and dogs, is so far limited to Eurotunnel and ferry operators at Dover and Portsmouth. It is likely to be extended to the United States, Canada and the Caribbean in 2001. The programme costs each owner #220 for the microchip, documents, vaccination and blood tests.

The six-month quarantine is the UK's traditional safeguard against rabies. New rules require a rabies vaccination with a blood test a month later to ensure it is effective. Six months later, a second blood test is required before entry into the UK; and the animal must be treated for tapeworm and ticks by a registered vet the day before arriving back in port.

Source: BBC Online

And this little pig...

A British company has unveiled a litter of five cloned pigs. PPL Therapeutics, the company that helped produce Dolly the sheep, is seeking to develop a way of supplying organs suitable for transplantation into people, and pigs are an attractive source for transplants because their organs are of a similar size to those of humans. Genetic engineers can create pig cells by disrupting the genes that encode the enzymes which process them, but until now have not been able to turn those cells into whole animals. Ron James, managing director of PPL Therapeutics said, 'An end to the chronic organ shortage is in sight'. But the finding is bound to add to the controversy surrounding animal-to-human 'xenotransplants', which critics fear might introduce animal viruses into humans.

Source: New Scientist 25th March

Call to cut hospital outpatient clinics

The NHS Alliance, which represent GPs, wants hospitals to scrap many of their clinics because they feel family doctors could do the job better. The group says that many outpatient appointments involve only ordering further tests or booking patients for routine operations. Chairman Dr Michael Dixon said, 'GPs are highly qualified, expensively trained doctors. There is no reason why they should not order diagnostic tests themselves or directly book patients into hospital for routine procedures'. A report from the NHS Alliance suggests that several GPs, pooling different skills, could provide a community-based diagnostic service and cut out the need for long waits for clinics. At present some patients may have to wait over a year just to see a consultant or registrar in a hospital clinic - before they can even join the official waiting list for any further investigations or treatments.

But the idea has been dismissed by hospital consultants, who say GPs are simply not skilled enough to take on the role. Mr Winston Peters, a surgeon and chairman of the Hospital Consultants' and Specialists' Association, said he would not want patients joining the waiting list for an operation direct from the GP surgery. He said, 'It's important to check that they are down to have the right tests, or the right type of operation, and it's equally vital to make sure that patients are properly informed about the procedure so they can consent to it'.

  • Hospital waiting lists in England rose by 10,700 in January to 1,118,700, according to official figures. The number of people waiting for more than a year for treatment on the NHS also rose, by 2,400 to 53,700, in the first month of this year.

Source: BBC Online

Getting political?

An independent report by Public Appointments Commissioner Dame Rennie Fritchie says health bodies are appointing people on the basis of political allegiances rather than on merit. The report says three-quarters of political appointees to health authorities and trusts since the general election have been politically sympathetic to the government. In 1995-96, under the Conservative government, 81% of appointees were not politically active but, in the first two years after Labour won the election, of 343 councillors appointed, 36 were Liberal Democrats, 23 Tories and 284 Labour. When announcing her inquiry last summer, Dame Rennie said, 'It is clearly in the best interests of all concerned that the appointments process in the NHS is above suspicion'.

Source: BBC Online

Disabled 'let down'

A damning report by the Audit Commission says disabled people are facing long waits for equipment, which sometimes turns out to be outdated, uncomfortable and unusable. Patients with artificial limbs, hearing aids and wheelchairs are among those being let down by the service. The report says the current system is 'a recipe for inequality and inefficiency', with small, fragmented services lacking leadership or clinical involvement. Audit Commission controller Andrew Foster, Prime Minister Tony Blair and Health Secretary Alan Milburn held a 90-minute meeting to discuss the report. Mr Foster said after the meeting, 'There's no place for anybody to hide after today's report. Several million people depend on equipment, such as hearing aids, wheelchairs or artificial limbs, which have the potential to make or break the quality of their lives as well as the lives of the 1.7 million family or friends who care for them'. Mr Blair's official spokesman, Alastair Campbell, took the unusual step of commenting on the report. 'The Prime Minister believes this report is unacceptable and illustrates precisely why we need to raise standards across the health service and address unacceptable variations in healthcare', he said.

Source: BBC Online

Cancer screening for women

In a pilot scheme, to start this summer, the NHS will screen women for human papilloma-virus (HPV), if they have a mild or borderline cervical smear result. Women who test positive for the virus will then be 'fast tracked' for further investigation and treatment. A spokeswoman for the Department of Health said, 'It is this group of women who are more likely to get cervical cancer'. Women who test negative for the virus will be called back for a repeat smear six months later, as happens now, and for a second test for the virus. HPV is a group of more than 80 different types of virus, including those causing genital warts. HPV can be transmitted through sexual intercourse and has been linked to cervical cancer. Most infections disappear without treatment, and even women who develop types of the virus associated with cancer rarely go on to develop cervical cancer. Professor Jack Cuzick from the Imperial Cancer Research Fund in London said, 'The lives saved will be relatively modest, probably 50-100 a year. But it should lead to better management of cervical smears and possible cost savings, as women don't have to be called back so often'.

A major new trial will establish whether screening postmenopausal women for ovarian cancer saves lives. The results will be used to assess whether there should be an NHS national screening programme for the disease. However, complete data will not be available for 10 years. The project will be a joint venture between the Medical Research Council, the Department of Health, the Cancer Research Campaign and the Imperial Cancer Research Fund. It will be funded by the Department of Health and the Medical Research Council.

Source: BBC Online

Kidney news

Kidney specialists in London are claiming that old people are dying because of a shortage of specialists, as well as nurses and equipment. Many who might have received life-saving treatment even a year ago are being turned away. The heads of every kidney unit in London have written to Nigel Crisp, who runs the NHS in London. They say older patients who have other serious health problems are being refused treatment, as specialists are forced to prioritise and pick patients who stand the highest chance of survival. Elizabeth Ward, president of the Kidney Patients' Association said, 'Over the years things have got better ... but now we are going backwards ... it is absolutely scandalous'. Talks have now started in the London NHS region in an attempt to improve the situation. A spokeswoman for the Department of Health said an extra #10 million was being allocated for kidney services from April, providing care for an extra 500 patients.

  • The Royal College of Surgeons said it was unaware that a senior urologist it appointed to help investigate how the wrong (healthy) kidney was removed from a patient in Wales was himself involved in a claim for civil damages in relation to a kidney operation in Scotland. The patient, 70-year-old Graham Reeves, died last week, five weeks after the error and a short time before a report on the incident was due to be published.

    Source: BBC Online

Scottish NHS puts travel on the Web

A new Website, 'Fit for Travel', has been launched by the NHS in Scotland - www.fitfortravel.scot.nhs.uk It gives information on all the precautions travellers from the UK need to take when they go abroad. The site has been created by the Scottish Centre for Infection and Environmental Health (SCIEH). This service for the public is in addition to the information that SCIEH already provides to health professionals on travel.

Source: Press release (SCIEH)

PM says GPs must change

Prime Minister Tony Blair has again told doctors that they must 'modernise'. Speaking at a conference of the BMA's General Practitioners' Committee, he promised that increased resources would be provided if doctors were prepared to change.

A theme of the meeting was the excessive hours that the UK's GPs are now forced to work. However, Secretary of State for Health Alan Milburn, who also addressed the meeting, said he could not understand how GPs could complain about their workload and yet not embrace NHS Direct and walk-in clinics. Both of these initiatives are intended to reduce pressure on GPs but doctors say they are not doing so. GPs also feel that their role as 'gatekeepers' to the NHS is being comprised by the helpline and the new-style clinics. The Prime Minister has said that there does not have to be just one gateway to the health service.

Health minister John Denham has announced a national review of access to GP services outside working hours. It will look at the different ways in which services can be accessed, including GP co-operatives and deputising services. It will also examine experience to date of collaboration between NHS Direct and GPs. Mr Denham said, 'The purpose of the review is to raise the standard of services throughout the country to that of the best. Much is very good about out-of-hours services across the country. But there is clear evidence that, on occasion, the quality of services falls below acceptable standards'. The government aimed to make the NHS faster and more accessible.

Source: BMJ 25th March, Press release (DoH)

One for the boys

The difference in life-expectancy between men and women is growing, now standing at six years nationally. The disparity is most marked in lower socio-economic groups; in some deprived areas the difference is as much as 15 years. The issue is starting to attract interest and was the subject of a two-day multi-disciplinary conference at the Royal Society of Medicine. The 'macho' lifestyle, and reluctance to see a doctor, of many men were discussed by several speakers. Men are less concerned about their weight and more likely to engage in substance abuse, including alcohol abuse. Of particular concern is the rising rate of male suicide; it is the biggest cause of death in young men in many parts of the UK and has risen amongst middle-aged men.

The government has also recognised that men's health requires more attention. Yvette Cooper, Minister for Public Health, said, 'The biggest health inequality that exists is that between men and women'. She outlined areas on which the government was already taking action, which she said should reduce this disparity: improving access to primary care through NHS Direct and walk-in clinics, the national service framework on coronary disease, the development of strategies on alcohol abuse, and more research on prostate cancer.

Source: Press releases (Royal Society of Medicine, DoH)

In brief

  • The first 40 Primary Care Groups (PCG) to become Primary Care Trusts (PCT) have been announced. Health minister John Denham said he was pleased with the response from PCGs, 122 of which had bid to become PCTs. PCTs will each have a centrally-funded project manager to help them become, in the DoH's words, '...pioneers in primary care for developing and sharing best practice in a systematic way, focusing on key issues for practices and patients alike: improving access to care, tackling coronary heart disease and cutting waiting lists and times'.

    Source: Press release (DoH)

  • The number of people opting to pay for private operations out of their own savings has jumped significantly. Since Labour came to power in 1997 there has been a 40% rise in the number of people who have chosen to pay for surgery. A total of 160,000 people paid for operations last year. The number of people with private medical insurance has remained roughly static, indicating that many people are borrowing money or using their savings to pay for one-off treatments. The most common operations are those mainly affecting the elderly, such as cataract removal, hip replacement and heart surgery.

    Source: BBC Online

  • The UK has only half the number of digestive specialists and surgeons as the rest of Europe, say the profession's leaders. The shortage of gastroenterologists and gastrointestinal surgeons was revealed at the British Society of Gastroenterology's conference in Birmingham. Professor Sir Leslie Turnberg, its president, said that, while the profession was trying to streamline its procedures to cut waiting times, some delay was inevitable. The shortage could stop them from meeting the government's two-week deadline for seeing patients suspected of suffering from gastrointestinal cancer.

    Source: BBC Online

  • The use of general anaesthesia outside hospitals is to be ended in Scotland after a 10-year-old boy died in a dental surgery during a procedure to have a tooth removed. An official report on the fatal accident inquiry found a 'catalogue of failures' that led to the death of Darren Denholm, and has recommended the doctor and two dentists involved be reported to their professional organisations for disciplinary action.

    Source: BBC Online

  • The compensation bill for the NHS is forecast to rise by tens of millions of pounds a year, as a result of eight test cases heard by an unprecedented five-judge Court of Appeal this month. The court is looking at the issue of damages in response to a report last April by the Law Commission, the government's official law reform body, which decided that damages for pain and suffering were too low in England and Wales.

    Source: BBC Online

  • The number of cancelled elective operations rose to record levels last year in NHS hospitals in England. In 1998-99 more than 56,000 NHS operations were cancelled on the day they were due to go ahead, an increase of 12% over the previous 12 months. The report shows that hospitals also failed to treat over 9,000 patients within one month of their cancelled operation which was 29% more than in the year before. The report is on the National Audit Office's home page at www.nao.gov.uk.

    Source: BMJ 4th March

  • After months of negotiations the 29,000 UK junior hospital doctors who are members of the BMA will decide in a referendum whether to accept a revised pay offer. The Junior Doctors Committee which represents all 37,000 junior doctors has decided there was 'sufficient merit' in the offer to proceed with a referendum.

    Source: BMJ 25th March

  • The new Human Rights Act comes into force in October. The act means UK citizens will now be able to have their human rights enforced by British courts rather than having to go to Strasburg. A survey conducted by the Institute for Public Policy Research has found that hospitals, schools and old peoples' homes are all unprepared for the changes. More detailed advice is to be sent out shortly to help them prepare for the impact of the legislation. Home Secretary Jack Straw has urged public bodies not to panic over the introduction saying 'they should get to know what is in the Convention'.

    Source: BBC Online

  • Health minister John Hutton has announced a #4 million pilot project to provide digital hearing aids on the NHS. NHS Trusts are being invited to put forward proposals to take part in the scheme. There will be 20 pilots in total. The scheme will evaluate the costs and benefits of the digital devices and how they can be supplied as part of a modern hearing aid service for the NHS. The Royal National Institute for the Deaf (RNID) will collaborate in the scheme. RNID Chief Executive James Strachan said, 'Literally millions could have their lives transformed by the recent advances in hearing aid technology'.

    Source: Press release (DoH)

  • A survey by the British Association of Surgical Oncology casts doubts on the ability of cancer services to meet government targets on waiting times. In 1997-98 only 43% of women with suspected breast cancer received diagnostic surgery within the recommended two-week period. This was 7% fewer than the previous year. Provisional results for 1998-99 suggest the situation is not improving. Men with prostate cancer fare worse, with 90% facing an average of 292 days for treatment. (The government has set a two-week target for breast cancer outpatient appointments and 96% of women are now being seen in this time according to official figures, but many oncologists doubt the value of the outpatient target, considering that the waiting time for treatment as an in-patient is more important.)

    Source: Health Service Journal 16th March

  • The BMA, in a new discussion paper, has attacked the league tables, based on just six clinical indicators, published by the government last June to facilitate comparison of individual trusts and health authorities. The paper says the data are too complicated for the public and insufficiently specific for clinicians. Speaking for the BMA, Dr Vivienne Nathanson commented, 'We are not saying the patients shouldn't have information. What we are saying is there are problems, with presenting it as a true league table'.

    Source: Health Service Journal 16th March


Leaders of the Health Professions meet the Prime Minister

The following paragraphs are taken from an extraordinary letter from the President of the Royal College of Surgeons of England.

The Prime Minister issued a statement on the day following the budget in which he referred to the wide variation in service provision that exists between different Trusts. Examples quoted include:

  • Some Health Authorities and Trusts carry out four times more hip replacements than others. Why?

  • The proportion of operations done as day cases varies from 75% in some places to less than 30% in others.

  • Why is there a two-fold difference in the cost of care between the best and the least efficient hospitals?

  • Some hospitals use physiotherapists to help reduce waiting times for orthopaedic appointments, and others do not. Why?

He acknowledged that the reasons for these variations are sometimes complex but pointed out that some will be due to professional failures which must be confronted, analysed and solutions found.

The Prime Minister went on to set five challenges:

  • Partnership Challenge for all parts of the health system, to work together to end bed-blocking, reduce unnecessary hospital admissions, and to provide the right level of beds and services for each level of care

  • Performance Challenge to ensure that using information, incentives and inspection all Trusts and Primary Care Groups(PCGs) come up to the standard of the best, and that systems are in place to identify and root out poor clinical practice

  • Professional Challenge to remove unnecessary demarcations, introduce more flexible training and working practices and ensure that doctors do not use time dealing with patients who could be treated safely by other healthcare staff

  • Patient Care Challenge for hospitals and PCGs to ensure that they all adopt best practice, reduce delays and introduce convenient booking systems so that patients with the most serious conditions get treated quickly and no-one has to wait too long for the operation they need

  • Prevention Challenge to persuade more people to play their part in achieving better health by adopting a more healthy life style

The President continued:

"On Budget Day itself I was invited, with the President of the Royal college of Physicians and representatives of other Royal Colleges, the BMA, and the NHS confederation, to Downing Street to meet the Prime Minister, the Chancellor, and the Secretary of State for Health. We met in the Cabinet Room and were given an advance outline of the Prime Minister's statement. We were then asked if the Colleges and NHS organisations would work with the Government over the next four months to help solve the five challenges and thereby, hopefully, enable the restoration of the first-class NHS, which we all desire.

It seemed to all of us present that this was a constructive and sensible way forward. For government to offer to collaborate with the professions, rather than dictate to them, is something long overdue and something very welcome."

He concluded:

"As a result of these events, I believe the profession has a unique opportunity to shape the future of the NHS for the better. It will not be easy, and it will almost certainly involve uncomfortable decisions. Changes in working practice are never achieved without opposition. However, I firmly believe that it is better to be on the inside with the opportunity of influencing events rather than on the outside and a mere looker-on."

With that encouraging note we leave for a month when we will bring you up to date with developments.

Source. Extraordinary letter from Mr Barry Jackson President of the Royal College of Surgeons of England to Fellows and Members 25th March 2000

Back to the April 2000 Health Insight index

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