Economics

Margaret McCartney

I am confused. The Robert Francis inquiry is a the response to the Healthcare Commission’s investigation into the higher than expected mortality rate at the Mid Staffordshire NHS Foundation Trust.

The enquiry says “many staff” expressed concerns, but were “ignored”. Nurses complained there were not enough beds to cope with the demands placed on the service, and that they were expected to deal with a workload far above what could be safely managed.

Pressures to meet waiting time targets compromised care – for example patients were moved out of A&E regardless of their clinical state and how much monitoring they needed.

There were not enough senior and skilled nurses.

Wards were made more mixed to contain more different types of cases, despite objections from clinical staff that it would compromise care.

Trained staff numbers were reduced in ward reorganisations which went ahead despite opposition from clinical staff.

Why were the savings being made? The hospital was in debt, and this is what drove staff cuts.

Alan Johnson, then health secretary, has said there was a ”a complete failure of management to address serious problems and monitor performance”. But management had in fact been doing an awful lot of what they had been told to do: sort out the financial problems, meet the targets.

We are now coming round to thinking that it isn’t just individual mistakes that should be seen as problems, but the system, which allowed them to occur.

Blaming the managers is an easy option. Isn’t it the case that the system that managed this Trust – the political structure that told it what ‘good outcomes’ were – is the one to blame?

By Rebecca Knight

Most of the time blogging for FT.com’s health section is a lot of fun. I get to write about cool breakthrough technologies and therapies that might change the way our bodies fight disease. I get to learn about the latest studies that could have a practical impact on nutrition, fitness and family health. And plus I get to read comments from readers all over the world about how they view health and wellbeing. It’s not a bad gig.
 
But every once in a while I come across a piece of science news that is rather depressing. That happened this week. 
 

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.

Andrew Jack, the FT’s pharmaceuticals correspondent, talks to Armin Fidler, lead adviser, health policy and strategy at the World Bank

Andrew Jack, the FT’s pharmaceutical correspondent, talks to Rifat Atun, director; strategy, performance and evaluation cluster; the Global Fund to fight Aids, TB and Malaria

Andrew Jack

At a gathering of European health policymakers, one delegation with a high profile at this week’s Gastein forum rather stands out: Taiwan. Ministers and officials are in attendance, and have even sponsored one of the main sessions, on the sustainability of health systems.Just over the border in Switzerland, the World Health Organisation in the past has had to rebuff Taiwan’s requests to attend its annual world health assembly because of pressure from China. Under a truce brokered by Margaret Chan, the agency’s Hong Kong head, it is now able to attend.

Diplomatic rapprochement is obviously spreading but there is no sign of the Chinese at Gastein.

Taiwan may have some lessons for Europe. It has used the crisis as an excuse to redouble investment in electronic medical records. And it is helping guarantee medical care for the poor with a tobacco tax and money from the national lottery fund – simultaneously dampening and using the proceeds of two vices.

Read the FT Healthcare and the Recovery report 

• Political interests and lobbying vie with economic pressures
• After a decade of growth, austerity looms in the NHS
• The financial crisis is redefining the Gates Foundation’s priorities

In recent days the momentum of Barack Obama’s drive to reform US healthcare - see US health reform Q and A has seemed to fade. Congressional committees have produced bills which broadly follow White House specification. Yet these proposals remain unfinished work because the crucial questions – who pays, and how? – await answers. Raising the stakes of his own personal commitment to the project, the president went on television this week to persuade the country that the reform was needed, and still on track.

Contine reading “Healthcare reform needs bolder action”

Andrew Jack

With the UK government warning employers to prepare for up to an eighth of their employees to be absent from work because of swine flu in the coming weeks, some businesses could be stretched to the limit.

There again, things could get worse still if current discussions lead to recommendations to keep schools closed after the summer holidays until a swine flu vaccine is prepared and given to children. That would mean more staff staying at home to look after them - just when business is picking up after the break.

So how is your business coping with the swine flu outbreak? Is it a serious threat to the recovery of the UK economy? What is the impact of the on the workplace, and your ability to operate? Share your views by clicking here or on the link below.

Margaret McCartney

The Fair Access to the Professions report is just out.

The bottom line is that there are not many students studying medicine or law from lower social classes. According to the British Medical Association, just 4 per cent of medical students are from lower social classes.

I for one am not convinced that it therefore all about “raising aspirations”. A longer course means more tuition fees, as well as less time to take on a part-time job: medical students currently graduate with debt of about £19,000, estimated to increase to £37,000 once changes in tuition fees have filtered through to those starting their course after 2006.

Nor can doctors assume to walk into a job on graduation – thanks to the NHS Medical Training Application Service (MTAS), doctors have been entirely unsure where, or if, their next training job will start. I would not expect anyone – at least anyone without a family to bankroll their career choice – to think that medicine would be a secure option.

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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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