Sunday, December 21, 2008

Failure to consult

Local NHS bodies are not fulfilling their legal duty to consult the public according to a new study by the NHS Support Federation.

Darzi-inspired health centres are being introduced nationwide, but a survey of Primary Care Trusts found that plans have gone ahead without meeting legal obligations to inform the public and include their views.

Given the scale of the failures the report recommends that the Department of Health should drop its 31 December deadline for contracts to be signed (outside London), allowing more time to ensure that the public has been given full information about the plans and a genuine opportunity to influence them.

PCTs have also been given specific advice from Department of Health lawyers on how to consult, but the report compares this with what PCTs actually did and found that many fell short of these recommendations. Examples from the study are being sent to the DH with a request for them to investigate.

Part of the report contained a study of 40 PCTs that were consulting and found that:

- 2/3 of PCTs do not ask local people whether they agree with the overall plan for a GP-led health centre
- 42% make no reference to the fact that a new health centre could be run by a commercial or voluntary sector provider. Legal advice issued by the DH clearly states that consultation should cover “the approach to selecting the preferred bidder and the proposed contractual mechanism”
- 16% provided less than 12 weeks for responses - the minimum set out in the cabinet code on consultation
- only 16% of PCTs asked about the importance of the distance of travel to the new health centre

“The public must be given a genuine influence over their local NHS. There is real danger that the public will become cynical about consultation and not take part. The public can help to develop better services and their support is crucial for the future of the NHS and its funding.

“Major change is occurring to primary care without public knowledge or consent. We are very concerned that the introduction of commercial interests to run health centres will be damaging, but this and other important aspects has been missing from public consultations.”

- said Paul Evans NHS Support Federation director

full report -

The NHS Support Federation is an independent organisation that works to protect and promote a comprehensive NHS, with equitable access and active public involvement. Our supporters and affiliated organisations are drawn equally from the health profession and the general public.

Friday, December 19, 2008

EU working time directive

I have no idea what the Lib Dems were up to with the opt out vote on EU working time directive.

The Tories voted to keep it, i.e. they are happy for people to work ridiculous hours, much of it unpaid - I'd expect nothing less from them.

Labour MEPs rebelled against Gordon Brown who also wanted to keep it and voted to end the opt out.

Obviously Green MEPs voted to end the opt out!

But I don't understand what the Lib Dems were playing at by voting to keep the opt out. The comment in the Guardian was a euro skeptic, 'who do they think they are telling us what to do?'. Personally I think the EU has every right to protect the people of Europe against bad employers and practices. Claiming that the opt out is essential in a downturn is equally bizzare. Why should we employ someone to work for 50 paid hours each week plus 10 unpaid hours when we could employ two people?

The implications of the end to the opt out are probably the greatest in the NHS. It will give managers a bit of headache when trying to cover rotas, but the solution is to grown more clinicians, not work them into the ground. Of course that takes money and time, but so be it.

I also think it is important that the unions take note about what LDs did.

Thursday, December 11, 2008

Safe as airlines

Lots in the press about the NHS killing people through errors. This is from the Torygraph and this from the BBC after the head of the Healthcare Commission has said that the NHS in England and Wales is failing to ensure patient care is "as safe as it reasonably could be". Cue lots of tabloid headlines and industry rebuttals.

Richard Branson complained that the NHS doesn't have air industry safety standards a few months back. Well that is hardly suprising given that it isn't the air industry.

The National Patient Safety Agency have claimed that the actual number of deaths due to errors last year was around 3500. Whatever the number we all want healthcare to be as safe as possible, however with the vast number of humans working in it, it will never be as safe as the air industry.

For me, governance is key. Multiple providers all running as independent companies don't lend themselves to slick processes where patients cross company borders (as is almost always the case in health care). Commissioners have a much harder time governing the safety through contracts rather than through direct management. Patients fall between contractual gaps. Ending the market is not a panacea but it would help.

Wednesday, December 3, 2008

To vaccinate or not to vaccinate

The recent measels outbreaks in Manchester and London, which include the death of one child, have prompted calls for compulsory vaccination and the BMA has a very useful piece on this.

The benefits of vaccination to the individual are well established and should those benefits just sit with the individual, I suspect calls for compulsion would fall on deaf ears. The issue gets heated for four main reasons:

1. The benefit of immunisation is even greater for society than for the individual - herd immunity is a major goal of immunisation programmes.
2. Scare stories have abounded about side effects, most notably with MMR. While it is possible for most medical interventions to have side effects, vaccines are considered very safe and the autism and crohns links have been discredited.
3. Personal choice on how children are raised and treated. Nobody likes to be told what to do, and compulsion of this sort is felt to be an infringement of human rights.
4. Profit driving vaccination programmes, both profit for BigPharma and for GPs who get paid for high vaccination rates.

Personally I think that the human rights issue is the key. We must not make vaccination compulsory, but we must promote it as much as possible. Vaccination should, once again, become part of the routine of bringing up children - that is not to say that it should not be questioned. Parents should be able to make decisions on their child's health, but the information that they base their decisions on must be clear and unbiased. Promotion is the key to herd immunity.

Monday, December 1, 2008

Compulsive vaccinations

Rumours abound about compulsive vaccinations for children. There is a number 10 petition which closes today. Compulsory vacinations are completely wrong. While I think that every effort should be to promote vaccinations, forcing them on people is immoral. It is a fundamental infringement on our civil liberties and yet another step towards the medicalisation of life.

Psychotic pharmaceuticals

The European Commission have slated Big Pharma for blocking cheap medicines by using legal action and multiple patents. But who can blame them, they are in the business to make a profit and they are clearly good doing this.

The NHS spends £10 billion each year on medicines, all of which are produced by companies that exist to make a profit. They have backed pressure groups against NICE's decisions (Remember that NICE are there to make independent decisions about the efficacy of medicines). But who can blame them? These companies are designed to make the biggest profit that they can. Joel Bakan described corporations as psychotic. Maybe the government will nationalise, like the banks, them when they get into trouble...