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Health Insight October 1999
New drive to cut out-patient waiting times

The Prime Minister has announced a package of measures to tackle out-patient waiting times. Mr Blair said, 'When you ask people what they think is wrong with the NHS, what tops the list every time is the amount of time spent waiting. Most people are happy with their treatment, when they receive it, but get frustrated with the length of time they have to wait'. He said progress had been made towards the government's aim of reducing all forms of waiting. It was now time to focus on out-patients: 'The numbers waiting over 13 weeks have been growing. Some people allege this is because we are deliberately making people wait longer for an out-patient appointment, in order to slow up the rate at which patients get referred for operations and so keep down the length of in-patient waiting times. This is just plain wrong'. He said that last year the NHS treated a record number of out-patients as well as a record number of in-patients.

As well as initiating a tough new out-patient reporting structure for hospitals, the government will devote more funding to the problem, set new targets, and issue best-practice guidelines.

Reducing waiting times for breast cancer services is part of the drive on out-patient waiting times and, in April, a target was set for all women referred urgently to a consultant by their GP to be seen within two weeks. The first report on waiting times since then shows that some 22,000 women were referred during a period of three months. In most cases (about 14,000) the hospital received the referral within 24 hours; 91 per cent of the women were then seen within the specified time. However, for around 8,000 women the referral was not received in 24 hours; only 62 per cent of these women were seen within the two-week target. Overall, 75 per cent were seen in the target period. The figures show significant variation in performance between NHS regions.

Sources: Press releases (DoH)

New contract for junior doctors

After threats from junior doctors that they might strike if their conditions of service were not improved, the government and the British Medical Association have agreed on the framework for a new contract of employment. Frank Dobson said, 'I have always believed the junior doctor's contract to be out-dated and inappropriate'. The new contract would provide fair rewards and support the drive to reduce hours and improve working conditions. It would '... provide the opportunity, over a three-year period, to see that junior doctors on average work no more than 56 hours a week'. The complex system of payment for out-of-hours work would be replaced with a simpler and fairer arrangement.

Andrew Hobart of the BMA's junior doctors' committee said, 'I am delighted that an understanding has been reached on a new contract which will guarantee safe working hours .... The new contract will provide a more robust measure for bringing down the hours and a real incentive to trusts to reorganise work patterns to ensure that junior doctor posts comply with the New Deal'.

Source: Press release (DoH)

Concern over immunisation rates

Chief Medical Officer Liam Donaldson has warned of the 'serious danger' of a measles, mumps and rubella epidemic if immunisation levels are allowed to drop any further. Currently 87 per cent of Britain's population is immunised, whereas the World Health Organisation recommends 95 per cent to keep the diseases under control. A much-publicised and highly controversial theory put about in the early 1990s drew a link between the single-jab vaccine for the three diseases and autism and bowel disease. Although there was little strong evidence for the theory some parents refused to let doctors give their children the injection and immunisation rates dropped off by 10 per cent. Some doctors have suggested that the vaccine be made compulsory, considering the potentially devastating effects of the diseases. Dr Donaldson said, 'We are very anxious to ensure parents are aware of the risks of these diseases and the safe and effective protection for their children is the MMR vaccine'.

Source: BBC Online

Testing time for drug advertising

The first television commercial advertising a prescription-only drug has been broadcast in the UK. The commercial is part of a nationwide campaign designed to raise awareness of incontinence. It is hoped that the campaign will encourage people to seek help for conditions that they may never have discussed before. Until now such advertising has been banned so the outcome is being closely watched by other pharmaceutical companies who manufacture drugs used for conditions such as migraine, flu, and to help people stop smoking.

Doctors fear that this development could lead to a huge demand from patients and focus attention on a few conditions to the detriment of others. Joe Collier, Professor of Medicines Policy at St George's Hospital School of Medicine in London said, 'The NHS is an integrated whole and a consolidated campaign as powerful as this can distort provision and should not go unchecked'.

Source: BMJ 4 September

Scots look at access to emergency contraception

A two-year research project has been launched in Lothian, Scotland to see if improving the availability of emergency contraception will reduce unplanned pregnancies and lower the abortion rate. GPs will offer all suitable women aged 1629 years up to five packs of 'morning after' pills for use in the event of unprotected intercourse. At the end of two years, the change in the abortion and unplanned pregnancy rate of women attending the 100 general practices will be compared with any change in rates at all the other practices in the region.

Both the BMA and the Royal College of Obstetricians and Gynaecologists have supported moves to make emergency contraception available over the counter in pharmacies, as now happens in France. This has always been strongly resisted in Britain by anti-abortion groups and the Catholic Church. It is hoped the project in Lothian will reduce the 1800 abortions performed there every year by about 15 per cent.

Source: BMJ 11 September


The annual World Food Prize has gone to the UK for the first time. The recipient for 1999 is Dr Walter Plowright, who has been awarded the prize for his work on the development of a vaccine to rid the world of rinderpest, the most lethal of all cattle diseases. The widespread use of the vaccine has led to the virtual elimination of rinderpest, considered to be a disease of high significance to world food security.

Source: Press release (World Food Prize Foundation)

Professor Roderick MacSween has been appointed Chairman of the Unrelated Live Transplant Regulatory Authority (ULTRA) until the end of July 2002. Professor MacSween, whose main professional interest has been in liver diseases, will take up his unpaid post this month following his retirement from the Chair at the University of Glasgow. He also completes his Presidency of the Royal College of Pathologists in December.

Source: Press release (DoH)

Nigella Lawson has been appointed as a non-executive board member to the National Institute for Clinical Excellence (NICE), which will advise the government on what treatments should be available on the NHS. The 39-year-old journalist, writer, and broadcaster was picked partly because of her experience with her husband, who is being treated for cancer. Also appointed to the board is Frederick George, a 55-year-old Baptist minister who has worked in the voluntary sector for over 30 years and has been an active member of the local Community Health Council for four years.

Sources: Press release (DoH), Evening Standard 7 September

In brief

The Universities of Leicester and Warwick have come together in a unique partnership to establish a large medical school. A new degree course has been set up which will enable biological science graduates to become eligible for provisional registration as medical practitioners within four years, rather than the five normally taken.

Source: New Scientist 4 September

A letter in the Lancet from the Imperial School of Medicine in London suggests that there has been little change in the number of babies being born with neural tube defects (NTDs) such as spina bifida during the 1990s. This is despite publicity campaigns to encourage women planning to start a family to take folic acid supplements. The Health Education Authority's folic acid project manager, Lucy Thorpe, said, 'It is important not to be complacent. We need sustained and persistent campaigning to maintain awareness, but we can't do it alone'.

Source: BBC Online

NHS trust managers in Scotland have become the first in the UK to agree pay deals for Millennium Night (31 December). After months of wrangling, agreement has been reached with hospital trusts that all NHS staff will be offered three times their basic rate of pay and a day off in lieu.

Source: BBC Online

An estimated 85,000 multiple sclerosis sufferers in the UK are being urged to come forward and help the case for the controversial drug beta-interferon to be available on the NHS. The MS Research Trust has until only the beginning of November to tell the National Institute for Clinical Excellence (NICE) why beta-interferon (and another as yet unlicensed treatment called glatiramer acetate) should be funded by the state. The Trust is asking patients who feel they could be benefiting from the drug to help them complete a survey which will be sent on to NICE.

Source: BBC Online

The UK has a huge backlog of patients awaiting a suitable donor for a transplant, and doctors and charities are seeking ways of encouraging more to come forward. However, the government rejected a recent call by doctors for the introduction of a system of presumed consent. Under such a system all dead patients would be assumed to have given permission for the use of their organs in transplants unless they had lodged an objection in advance. In an innovative scheme in Taunton, Somerset, the Borough Council sent out donor forms, plus a letter encouraging residents to sign up, with its 44,000 electoral registration documents. So far 2,500 people have opted to become organ donors from the 4,500 documents already returned, and the Council estimates the scheme will attract 12,000 new donors in total.

Source: BBC Online

A new internet service has been set up which offers search services for 'authoritative' medical information. Called Medisearch and operated by the medical division of Mirago plc, the service is intended both for health professionals seeking to keep up with new research, and patients looking for medical information. Apart from a free searchable service, Medisearch offers news and topic-oriented web guides linking to thousands of useful health-related sites. The index encompasses hundreds of thousands of pages on health-related topics with the index completely refreshed every 23 weeks. Details of the service may be found at www.medisearch.co.uk/

Source: Press release (Mirago Medical Services Ltd.)

The Royal College of Surgeons has announced plans to increase the number of women consultants. Currently, only 5 per cent of the UK's 4,190 consultant surgeons are women. The college wants to double this to 10 per cent within five years and double it again to at least 20 per cent by 2009.

Source: BMJ 25 September

A leading pathologist, Professor Michael Green, has provoked controversy by suggesting that his colleagues should consider foul play when carrying out post-mortems on babies who have died. Writing in the BMJ he estimates that the level of misdiagnosis may be as high as 40 per cent and says, 'All of us involved in such deaths should approach them with suspicion, albeit cautiously expressed'. However, the Foundation for the Study of Infant Deaths (FSID), a cot-death charity, has condemned Professor Green's standpoint. Although FSID acknowledge that a small proportion of deaths diagnosed as cot-deaths are actually due to unnatural causes, a trustee said, 'What we need are open-minded, objective professionals, who come to a conclusion only after all avenues have been examined'.

Source: BBC Online

Two nurse-led, primary care practice projects in Salford and Derby have achieved high levels of patient satisfaction. The two projects, launched under the Primary Care Act pilots scheme, have each introduced their own innovative ideas, including providing access to care without appointments and offering early morning and late night surgeries. A feature of both projects is that patients have a choice of seeing a GP or a nurse as their first point of contact. About 60% choose to see the nurse, leaving the GPs with more time to spend on difficult cases.

Source: BMJ 18 September

GPs will have to prove that they are good communicators if proposals on revalidation, which are to be sent to all GPs in the UK before the end of the year, are adopted. The proposals are a response to the General Medical Council's decision that doctors in all disciplines must show on a regular basis that they are fit to practise. The proposals will be sent not only to GPs, but also to professional organisations, patients' groups, and NHS bodies, and will have to be approved by the GMC before they are implemented.

Source: BMJ 25 September

The independent review of paediatric cardiac surgery outcomes at the Royal Brompton Hospital has now been completed. The review was prompted by data sent anonymously to Private Eye magazine. However, the review team has concluded that the Brompton's results are 'similar to, and in most cases better than' results nationally. The data sent to Private Eye, which the magazine did not publish, was described as 'incomprehensible, incomplete and misleading'.

Source: BMJ 18 September

The UK media gave extensive coverage to the appearance of a tropical, mosquito-borne disease (St Louis encephalitis) in New York. There were also reports of cases of malaria in three people in Luxembourg, who had never been to the tropics but were understood to have been bitten by mosquitoes that had 'stowed away' on planes arriving from warmer climes. Many British specialists in tropical medicine were interviewed during the month. They gave their opinion that such infections were likely to increase, as a result of global warming and increased air travel.

Guardian 11 September
New Scientist 11 September (plus other media reports)

Speaking at the Liberal Democrats conference in Harrogate, the party's health spokesman, Dr Evan Harris, said Labour had increased 'the gap between expectation and delivery' and called for extra money for the NHS. Treasury spokesman Malcolm Bruce said Lib Dem MPs would vote against the next budget if it put tax cuts ahead of investment in health and education.

Source: Health Service Journal 23 September

British teeth are getting better. The number of people losing all their teeth has dropped by nearly two-thirds, this figure now standing at 13 per cent of the population, according to new figures from the Office for National Statistics. In 1998, 83 per cent of adults had 21 or more of their own teeth, compared with 73 per cent in 1978. Health minister John Denham welcomed the figures but cautioned against complacency. The government was determined to do more on oral health, including improving access to dentists. The latter is a problem of growing concern in the UK.

Source: Press release (DoH)

Back to the October 1999 Health Insight index

  Produced in United Kingdom by The British Council © 1999. The British Council is the United Kingdom's international organisation for educational and cultural relations. Registered in England as a Charity.