Policy

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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 northern council of the British Medical Association has sent out a press release opposing the central storage of certain medical records and the fact that patients must opt out rather than in: Summary care record 

Nonetheless, preparations are now underway to get 9m or so records on to the database. I don’t like the opt-out system (and it is very hard to opt out) or the fact that so much information is stored. From what I’ve seen, the administration side also seems to overwhelm useful clinical data.

Margaret McCartney

Martin Amis has called for “euthanasia booths” on every street corner. “There should be a way out for rational people,” he told the Sunday Times Magazine.

Sir Terry Pratchett, another bestselling author, who himself has early Alzheimer’s, campaigned in a recent lecture for the right to end life with medical assistance. He has offered to be a “test case” before a “euthanasia tribunal”, saying that no one should stand in the way of someone who has decided to die. “The tribunal would be acting for the good of society as well as that of the applicant,” he said.

Continue reading ‘First, do no harm’

Margaret McCartney

Letters to the editor from a protesting group are commonplace, and fair enough – I’ve been involved in lots either as co-initiator or signatory. One slightly odd one appeared last week in the Times.

Patient wellbeing at risk from substituted generic medicines

 It seemed innocuous enough – a group of doctors, nurses and patient groups complaining about the possibility that the Department of Health may stop allowing branded prescriptions.

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?

Margaret McCartney

On February 22nd the UK government Science and Technology Committee published Evidence Check 2: Homeopathy and concluded that “the NHS should cease funding homeopathy”. Hurrah! 

It also noted that ”the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy. As they are not medicines, homeopathic products should no longer be licensed by the MHRA.” Hurrah again. 

But this is the really really interesting bit. “In the Committee’s view,
homeopathy is a placebo treatment and the government  should have a policy on prescribing placebos.”. They go on to say that placebos involve deception, and are not consistent with informed consent.

To which I say: no, no, you miss the point.

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

The NHS ”Distinction Award” Scheme was set up as a way to reward hospital consultants for being extra-good.

If they wrote books, set up services, pioneered, discovered or whatever, then there was the possibility, after the decision of a closed-door committee, of an award (at levels 1-8, then the shiny upper echelons of bronze, silver, gold and platinum).

At the top end of the scale (and I should say that these are the minority of awards) they are worth just above £70,000. That’s on top of basic wages.

Margaret McCartney

The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) has a difficult job, given that it is meant to license all medications to ensure the public are using properly tested medications safely. But it is doing a difficult job increasingly badly.

Over the last few years it has made a number of decisions which seem neither fact-based nor helpful. One of these, in 2006, was the decision to allow manufacturers of homeopathic preparations to make health claims about their products, in spite of a lack of evidence. This seemed a rather dangerous precedent. We need strong evidence and information about medicines, and the MHRA should be upholding rigorous standards.

Then we have the move to make antibiotics for eye infections, themselves of questionable value, available from pharmacists without a doctors’ prescription. And now we have another: the decision to approve the purchase of tamsulosin, or Flomax, from a pharmacist, again without the need for a prescription.

The MHRA say that obtaining the drug, which is used to treat prostatic enlargement, will “encourage men to play a more active role in their healthcare”. I find this argument utterly patronising. I fail to see how going along to a pharmacist, who will do a questionnaire, supply two weeks worth of the drug, and then, after a further meeting, four weeks more, followed then by instructions to see a GP, improves anything at all.

The thing about benign prostatic hypertrophy is that it needs to be diagnosed. That means a discussion, an examination, and, possibly, referral for further tests. NICE are due to bring out guidelines next year: but here are some guidelines from the European Association of Urology, and the NHS Centre for Reviews and Dissemination, who say much the same.

The MHRA say that the questionnaire pharmacists will use has been “developed and validated by Boehringer Ingelheim” (the manufacturers of Flomax.) They also say that they have reduced the time a man can have the prescription for, without seeing a doctor, from 10 to six weeks after consultation. I find both these decisions questionable, and the petition for pharmacy-only prescribing from Boehringer is, I think, inconsistent. They point out that NHS guidance says cases of prostate cancer are no more frequent in men with mild prostate enlargement than the general population. But they ignore guidance saying that all men should have a rectal exam in making a diagnosis. For that is the key – diagnosis.

The move does not, in reality, improve access to healthcare. Nor is there any evidence that men will take more of a role in their healthcare because of this scheme. Instead, people may have to pay more money, make more visits to healthcare professionals, and have their disorder treated outwith the usual and recommended way to a diagnosis. If this is an advance for healthcare, I think it is a very sorry one.

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This blog, part of the FT's health series, is a forum for readers interested in the science, policy, management, technology, business and delivery of healthcare.

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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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