Delivery

Margaret McCartney

The past few years “whistleblowing” in the NHS has been seen as a dramatic act somewhat separate to the common activities of the clinical day.

The truth about how unnecessarily high-risk situations are brought to the attention of management is rather more complex and subtle. You observe that your community child clinic is overworked to dangerous levels, and you note that notes are not arriving: you tell management.

There are meant to be 4 paediatricians in clinic; however, during the period 2006-2008, one was off sick, one was on special leave, and two resigned. Juniors were left to take on tasks that would normally have been done by consultant staff. During this time baby P was seen.

Kim Holt - Support for Baby P clinic whistleblower Dr Kim Holt – a consultant paediatrician, was one doctor who raised these concerns, well before baby Peter was seen.

Her observations were not acted on: instead, cuts were made to the service. Dr Holt was off sick when baby Peter attended - Great Ormond Street Hospital – senior management must take responsibility over Baby Peter – and while it is easy to blame a single doctor for not picking up his problems, it is more realistic to view this failure in the context of more generalised problems within the clinic structure.

Dr Holt remains on full pay but has not been allowed back to her job. A report has recommended that she should be allowed to return: regardless, she remains in an extra-numerary part time position while the shortage of paediatricians remains. A petition to support her is here: Support for Baby P Clinic Whistleblower Dr Kim Holt. Whistleblowing should not need to come at such personal cost.

Margaret McCartney

An excellent piece by London GP Iona Heath: Do not sit on the bed in this weeks BMJ.

Hospitals are forbidding doctors from sitting on the bed, in the name of infection control. But no link has been made between sitting on the bed and increased rates of infection and as Dr Heath concludes:

“can we not campaign for home within hospital and encourage flowers and sitting on the bed and every other informality, unless there is robust evidence to deter us? ‘Do not sit on the bed’ and ‘No flowers’ are injunctions that are all too similar to ‘Do not walk on the grass’ and ‘No ball games’ rules that mostly diminish the joys of life rather than enhance them, and such rules, unless absolutely necessary, have no place in hospitals, where joy is too often in short supply.”

Having seen many ward rounds conducted from a standing position at the end of the bed, I have to agree.

Margaret McCartney

The politician in the internet chat room: Gordon Brown made a few interesting pledges the other day in a Mother’s day web chat on the forum Netmums.

“So this week, for example, Andy Burnham will be setting out new plans to really change and reform maternity services. Over the next few years we want to see a legal right for mums to choose where they give birth, including home births for anyone who wants one. And we want to see services changed so that not just mums but dads can have a bed if they need to stay in hospital overnight after the birth of their baby. We have also set a goal to recruit an extra 4,000 midwives by 2012.”

A legal right to give birth where you want? Is this really a good idea? Starting a discussion about where best to book in to doesn’t seem to get off on the right foot when a clinical decision has been taken by a politician and there is a legal ultimatum.

Margaret McCartney

I am ashamed at how late I run, some days, at work. I have gaps built in to my appointment times for catch up (resulting in a longer overall clinic) but it is never enough. Sometimes I try and reflect on what I could do faster, but I can’t usually come up with much that I could myself control and that I think it’d be a good idea to do.

Various studies have suggested that the average number of items a GP deals with in one appointment is 3. A ten minute appointment, then, is rather stretched.

Margaret McCartney

Dr Ann McPherson saw the need for DIPEx – now called Healthtalkonline- not from the doctors’ chair, but from the patient point of view. “Basically, 15 years ago I had breast cancer and although I’d been a GP for a long time, what I wanted was not to hear glamorous or extraordinary stories – you know, climbing Mount Kilimanjaro or whatever – but just the great variety of ways in which people dealt with things. I got talking to Dr Andrew Herxheimer – and he had just had a new knee. Well he was also a doctor, and knew a great deal about medicine and the way the body worked – but he wanted human stories as well. You want to know how other people with this are doing. And we thought – how can we get this working? How can we do this?”

Margaret McCartney

So what, exactly, has the private sector in the NHS done for us? The governments’ much spun “Choose and Book” scheme is alleged to offer patients greater choice in the venue of their care – including private providers – when booking hospital appointments.

It has been unpopular with GPs because the software has been slow, because it has been difficult for a GP with expert knowledge on the local patch to know as much about more far-flung equivalents and because it costs a lot to do something that there seems little clinical reason or particular desire for.

And so, to a recent BMA News report that a GP in Yorkshire had tried to access a hernia repair for one of his patients at a private hospital run by Spire Healthcare. Hernia repairs are usually one of the more straightforward operations, and are commonly performed.

Margaret McCartney

In 2005, and quietly, chloramphenicol eye drops started to become available for sale by pharmacists and without a doctor’s prescription. This was heralded at the time as a great advance for patients, who could get treatment for conjunctivitis faster, and for pharmacists, who could be more autonomous.

What is far less clear is whether or not this is actually good for patients. In the same year as the drops were made available, several pieces of research came out questioning whether or not they did much good: they seemed to shorten the time of infection slightly, but overall the usefulness of them as a routine treatment was rightly questioned.

What conclusions can we now draw? A study, by the Department of Primary Health Care at Oxford University reports in this month’s British Journal of General Practice.

By Ross Tieman

France’s vociferous Committees for the Defence of local Hospital and Maternity Units are getting their marching boots back on after the country’s Health Ministry confirmed it will announce a raft of hospital operating theatre closures by the year end.

The Ministry says the decree will target about 180 theatres which each carry out fewer than 1,500 operations a year. Theatres that carry out fewer than 100 gynaecological operations a year are also thought to be threatened, though the Ministry wouldn’t confirm it.

National opposition to closures of this sort began back in 2004, at the instigation of defenders of my “local” hospital in Saint-Affrique, southern Aveyron. Although it’s not much bigger than a cottage hospital, it still seems to be functioning, five years on, though I’d never dream of going there.

By Rebecca Knight

My daughter woke up three days ago with a runny nose, a fever of 101, and a wheezy, puffing cough that made her sound as though she’d smoked a pack a day for the past thirty years. My girl – age 22 months – is precocious, but I was confident that she hadn’t been sneaking cigarettes.

So I did what any novice mother in my situation would do: I went straight to the internet. I logged on to my favourite medical site and dutifully typed in her symptoms. Immediately I got a diagnosis: croup.

“Croup is a condition that causes an inflammation of the upper airways, and it often leads to a barking cough or hoarseness especially when a child cries,” the site said. “Most cases of croup are caused by viruses, and it is most common in children 6 months to 3 years old, but can affect older kids, too.”

Margaret McCartney

I have been interested to read Ezekiel Emanuel’s writing about the state of healthcare in the US in the medical press over the past couple of years. I have been trying in vain to read (or hear) the lecture he gave a couple of days ago in Denver, on  High Touch Medicine, the future of the Physician-Patient Relationship

He means, I think, pro-activeness, especially with managing chronic disease, more access to care, and better use of technology, better use of primary care, and nursing staff.

He is also mindful of how a consumer culture can damage healthcare. I’m interested in this too because I think healthcare reforms in the UK are leading to a more US based model – competition between providers, and little value on follow up or continuous care. But Mr Emanuel rejects much of this and describes potential improvements which sound very like how the NHS does/or should work.

I do think this paper he wrote in The Journal of the American Medical Association -  The perfect storm of overutilization - is a very good read.

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Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog: www.margaretmccartney.com/blog

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow

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