Tag Archive: NHS


In order to get some psychiatric patients to take their medication doctors are resorting to paying them. A trial involving 68 patients suffering from either bipolar or schizophrenia was carried out and the patients received £15 for every jab of anti-psychotic drug. If they take all of their medication they could potentially get £720 a year.

However there is opposition to this proposal; the charity, Mind feel that people should take the medication for health benefits not money.

Statististics show that patients not taking their medication is a big problem and increases relapse risk and NHS costs. It is estimated 33% of schizophrenics fail to take their prescribed medication. Professor Priebe, one of the experts conducting the study explains that they chose £15 as it is a small amount which they think will act as an incentive.

It is thought that patients who miss 1-10 days of oral anti-psychotic therapy are at greater risk of a patient being admitted to hospital, they say. The statistics show that this increase is nearly double that of a patient who never misses a day.

Whilst this concept seems like a good idea to an extent, it is not without it’s problems such as patients disregarding their well being in exchange for cash. Also although the drugs are only administered to those who need them it will put more financial strain on the NHS. If a patient refuses to take the oral medication that is their choice. As the saying goes you can lead a horse to water but you can’t make it drink.
If a patient is incapable of taking the medication then measures should be taken to rectify this, but I don’t agree with paying somebody to take their medication.

On Saturday 26th September a trial began involving 1,000 children to test two swine flu vaccines before the launch of a UK vaccination. The information is limited but the trial will allow the experts to observe immune reactions and any side effects which may occur.

The children participating in this trial are aged between six months and 12 years from Oxford, Southampton, London, Bristol and Devon. Participation in the trial is voluntary and consenting parents were be briefed on the risks. The children are given two doses of the vaccine three weeks apart, then a blood test three weeks after that.

The aim of the trial is to find out if one of the vaccines is better than the other in terms of immune reactions. They also want to ensure that the side effects are minimal before launching the UK vaccination programme.

One of the main problems the study seems to be having is recruiting enough children under the age of three, getting older children didn’t seem to be a problem just the younger ones, Doctor Saul Faust suggests that the younger children don’t usually respond to vaccines as well as adults and older children but says that they need to find out how the younger children respond before the vaccine becomes available to the UK. This could be because the younger children are deemed to be one of the high risk groups because young children, especially those that are under five, do seem to be at risk of serious illness. Also flu epidemics and pandemics are spread very efficiently by children.

The Department of Health has said that they will have enough vaccine for half of the population by the end of the year and that the high risk groups which are medical staff, the elderly and the very young will be immunised first.

Some think that if the Conservatives win the next election they aim to make GP practices become practice based commissioners. This would mean that the majority of their commissioning functions would be carried through federations of GP practices that operate as consortiums. This proposal would mean a reduction in the commissioning role of PCTs in some areas.
Under the Tories:

  • The merger of PCTs would be welcomed but not forced
  • All GP practices would be expected to become practice based commissioners
  • Trusts would be expected to negotiate prices for acute care at a rate under the PbR price
  • The Conservatives would welcome such mergers as part of an organic process but stress they would be voluntary. They hope to encourage more GPs to take up commissioning by turning the currently indicative budgets into real cash budgets.

Shadow Secretary of State for Health, Andrew Lansley states that it would give practices real opportunities to save and reinvest. It would also give them control over contracts and how patients are treated. Lansley stresses that any underspends would remain for the use for patient care, not profits. Health project leader at the Social Market Foundation think tank, David Furness, said the implications of an enhanced role for practice based commissioning were “much more significant than has been [previously] discussed”.

When asked if the Conservatives wanted to see more such mergers such as those in London, the response was: “It would be perfectly reasonable to aggregate, but it will be up to them [PCTs] to decide. It would be done on an organic bottom-up way if [they] choose to do so.”

Within the NHS, sources who have been asked to advise the Conservatives on the development of their health policy, said they thought the party would ideally like to see strategic health authorities and PCTs merged to create maybe 40 strategic commissioning bodies, organised around city regions. It is thought that this would rectify the problem that PCTs are perceived as being “too small” to be able to negotiate good value from large acute hospitals.

However, a spokesman for the Conservatives denied that the party were planning to merge SHAs and PCTs, saying that it was “very clear that’s not what we are planning”. He does also add that they do foresee SHAs moving their focus away from providers as more become foundation trusts. However Tory leader David Cameron and Mr Lansley have pledged they will not subject the NHS to another round of structural reorganisation.

Statistics show than in Britain one in 10 can’t sleep at night. New online treatments for insomnia could be the cure that is only a click away? Of course there are those who are critical of this new treatment such as Jim Horne who claims that: “The more personal the approach between the person who is the sufferer and the therapist, the better.”

There is help available from the NHS for insomniacs, unfortunately places are often very limited and the waiting lists are long. This new cure is free and are currently being offered on a commercial basis from the United States. Those who are critical of this new theory claim that it sounds rather like a spam email “End sleepless nights once and for all – at home.” However over the past few years, researchers have been developing internet-based courses designed to do exactly that.

Those who support the theory claim that it can be as effective as face-to-face cognitive behavioural therapy. Everyone knows the folk remedies for sleeplessness

  • Drink warm milk,
  • Take a hot bath,
  • Sip herbal tea,
  • Count sheep.

More often than not these don’t work, therefore your only option is to hope sleep will come, or to get one of the places on the waiting list for cognitive behavioural therapist, whilst putting up with the wakeful nights and groggy days while you wait.

With insomnia being one of the most common mental health problem with less than 50% of sufferers mentioning it to their GP. It is thought that many people feel that it is too trivial to mention to their GP or they believe they can manage on their own.

The online treatments may have the potential to ease this pressure due to the shortage of therapists trained to deal with insomnia, although the NHS is trying to help the situation by traning more therapists. bringing insomnia treatment to the internet.

If you are having trouble sleeping here are a few top tips from the experts:

  • Stay positive – if you worry about not sleeping, you won’t sleep
  • Good sleepers try to stay awake – don’t dwell on falling asleep
  • One bad night isn’t the end of good sleeping patterns – there’s always tomorrow

Here are a few things not to do:

  • Don’t nap – the bed shouldn’t be for anything but sleep and sex
  • Don’t stay in bed longer than 20 minutes. If you’re not asleep, get up and do something else until you feel tired
Core Skills for the Clinical Service Lead

For those of you who don’t know the term clinical director can be divided into the categories lab director, medical director, chief of service, etc. Essentially it just means that they are Top Dog of a department in terms of the medical side of things. For those of you who are familiar with the TV Show “House” the title character Gregory House is a clinical director as are Cameron and Wilson.

National clinical directors and advisors who are sometimes called Tsars are experts that supervise the implementation of a national service framework (NSF) or major clinical or service strategy. Tsars are acting advocates for the NSF or strategies within the NHS. They work with policy and delivery teams to achieve joined up action.

As national clinical directors the role also involves:

  • visiting health and social care practitioners
  • chairing task forces with health and social care professionals and health service managers
  • working with the Royal Colleges to ensure that changes in health and social services are reflected in training and education
  • chairing task forces to develop national service frameworks that bring together health professionals, service users and carers, health service managers, partner agencies, and other advocates.

Despite being at the top of the employment ladder there is still plenty of room for learning and as a result there are plenty of courses for Clinical Directors. A particularly good one is Core Skills in Finance & Business Planning for Consultants & Clinical Leaders, provided by Medicology.

Statistics show that more than £600 million is the cost to the NHS for patients failing to keep hospital appointments. That’s enough to run two medium-size hospitals! The figures show that between 2007 and 2008 6.5 million patients missed appointments which cost hospitals £100 per patient in revenue. In order to compensate for this some places are overbooking to compensate for people not attending, however there are drawbacks with this idea such as disadvantaging patients if 100% attendance occurs. Young males appear to make up the biggest portion of those that don’t attend appointments. At the opposite end of the scale people aged between 70 and 74 were the most conscientious in terms of attending appointments. However it isn’t all doom and gloom, over the past few years the attendance figures have improved slightly in England, Northern Ireland and Wales. Unfortunately the same can’t be said about Scotland where figures have increased.

Schemes such as sending text message reminders are being rolled out by the Department of Health. Whilst some say that missing appointments is unforgivable Unison is saying that the patients are not to blame when appointments are arranged months in advance. Other initiatives such as the choose and book scheme have also been introduced in order to reduce the number of missed appointments.

It is common courtesy to inform the doctor that you won’t be able to make the appointment or that you no longer require their services. Obviously this can’t be done if you forget but simply not attending is just rude and also selfish as not only is it wasting health professionals’ time and money but it is also impacting on others such as those who are on waiting lists or need to make an appointment but are unable to get one because the doctors are fully booked.

Daniel Hannan, a Tory MEP (Member of European Parliament) who criticised the NHS on American TV was accused of being “unpatriotic” by Andy Burnham, who is the Health Secretary. He claimed that the NHS is unfair and outdated and should be scrapped. Hannan made a series of appearances on American television over several weeks, and was quoted as describing the NHS as “60 year mistake” and he “wouldn’t wish it on anyone”. This rather brutal attack on the NHS came about following Obama’s proposal to introduce a similar system in America. Mr Hannan has repeatedly stressed that the views he expressed on U.S TV were his own and not those of the party but that Roger Helmer, a fellow Tory MEP who reports claim he said on BBC Radio 4′s PM programme: “I think Dan has done us a service by raising these issues which need to be looked at”. Burnham said: “What has happened within the last 48 hours is what Cameron has feared most because it lays bare the Tories’ deep ambivalence towards the NHS.”

Daniel Hannan claims that: “If 80% of Americans are getting better health care than we are in the UK then we ought to ask why, and we ought to ask how are we going to deliver equally good results.” For those who are not particularly familiar with the current health care system in America see The Difference between USA healthcare and the NHS

Tory leader David Cameron, vows to protect health from spending cuts that have been predicted for 2011 if he comes to power, he reiterates his commitment to the NHS and has made it clear that he does not share Hannan’s views and has distanced himself from Hannan. Cameron claims:”We are the party of the NHS, we back it, we are going to expand it, we have ring-fenced it and said that it will get more money under a Conservative government, and it is our number one mission to improve it.” He goes on to say: “He (Hannan) does have some quite eccentric views about some things, and political parties always include some people who don’t toe the party line on one issue or another issue.”

There are some who feel that Daniel Hannan should be disciplined for his comments about the NHS. Mr Hannan’s words have been seized on by Labour and the Liberal Democrats who have questioned the party’s commitment to the NHS. His critics state that Hannan’s words were an “insult” to the 1.4m NHS workers and “he should not be voicing those views in the foreign media in my view”. John Prescott has recorded a message accusing Mr Hannan of “misrepresentation of the NHS here in Britain”. Even the Prime Minister has publicly joined those who support the NHS by joining the welovetheNHS Twitter campaign, that was set up defend the health service from US attacks.

It would seem that Hannan’s comment has stirred alot of unrest within the British public and alot of people are pledging their support to the NHS. One of those is the physicist Professor Stephen Hawking, who claims that he would not be alive without it: “I have received a large amount of high-quality treatment without which I would not have survived.” Hawking, who has Lou Gehrig’s disease, was in Washington to be awarded the America’s highest civilian honour, the Presidential Medal of Freedom. An American newspaper subsequently used Prof Hawking as an example of the deficiencies of the NHS. “People such as scientist Stephen Hawking wouldn’t have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless,” it claimed.

As with any big institution there will be a few that oppose it but for the vast majority of people the NHS does work and saves millions of lives. For those that don’t like the NHS the UK also has the option of private healthcare so if you don’t want to use the NHS go private. Simple.

Under a new Strategic Health Authority Initiative nurses will be able to compare the quality of patient care against other trusts in England. The initiative ‘Energise for Excellence in Care’ is designed to improve fundamental nursing care, it is hoped that the tool should be available on website for the NHS Institute for Innovation and Improvement after it has been adapted.

The new tool is based on the ‘acuity/dependency’ tool which was developed by the Association of UK University Hospitals, which helps to categorise patients depending on their conditions (for example ‘stable’ or ‘unstable’) which can then be used to help inform staffing levels, skill mix and workforce development needs.

It is hoped that the new tool will enable nurses to deliver evidence-based care, that will include the development of new services where appropriate. In order to improve quality patient care indicators are key according to Lord Darzi’s Next Stage Review of the NHS, which was published summer 2008. In May 2009 a list of over 200 indicators that could be used to improve services across the NHS was published by the Government.

The Chief Executive David Nicholson will take personal responsibility for the ‘quality, innovation, productivity and prevention’ (or QIPP). It is also the focus of the DH management board. The Department of Health funded initiative; “Energise for Excellence in Care” is being led by senior nurses. Although it is hoped that this initiative will help the QIPP initiative it is important to stress that it also has wider goals, such as getting the nurses to focus on the things that really matter to patients. The initiative is also designed to give nurses permission to say what needs to be done and encourage nurses to reflect on the quality of the care that they are providing.

If nurses are consistently providing high quality care it may reduce costs for the NHS as fewer mistakes will be made and morale will improve as it is well known that low morale is detrimental to productivity and in this case patients. For more information see How morale levels affect the workplace

We all know that good communication is key but it is not always practised as the coroners reports are showing, there seems to be a high number of deaths which could have been avoided. Since the rules were changed last year, coroners have been able to write detailed reports following inquests that highlighted a risk of more deaths occurring. Coroners reported that better communication could reduce the number of deaths occurring in hospital.

Out 207 reports between July 2008 and March 2009, 58 arose from hospital deaths, 19 were classed as mental health related, 19 were associated with community healthcare and emergency services and 11 were linked to drugs and medication.

So what is good communication?
Good communication is sharing information is a clear and concise manner with everyone who is involved in the care of the patient, it is also ensuring that the patient fully understands what is going; obviously in emergency situations this is not always possible at the time but after the emergency has passed they need to be told what is going on. This will minimise the chance of the patient possibly taking the wrong medication or committing suicide because they become depressed.

There are a number of courses available which are designed to help improve communication skills. One particularly good one is done by Medicology, Communication Skills for Doctors.

The government is planning to ban all private transplants of organs from dead donors in the UK. The ban comes as a result of media reports of patients from countries such as Greece and Italy paying to get on waiting lists for organs from British people, so due to the fact that organs are scarce the general consensus is that to ensure NHS patients don’t miss out no one should be allowed to pay for transplants. At present the ban is only been approved in England but is expected to come into place across the rest of the UK by October.

An enquiry carried out revealed that over 700 transplants, most of which were liver transplants, had been carried out on non-UK patients over the past 10 years. Of the 700 transplants 631 of those transplants used organs from dead donors and, of those, 314 were from outside the EU. It is worth pointing out that the enquiry uncovered no evidence of wrongdoing with regards to the allocation of the organs but came to the conclusion that no one should be able to pay for such operations. According EU law, some patients can receive treatment in other countries, if approved by their healthcare system, which then foots the bill, however the NHS should be more cautious when assessing patients’ eligibility as it is possible that some patients are receiving treatment when they should be refused. Some say that the NHS should work with other EU countries to help develop their own transplant scheme.

The ban only applies to transplants from dead donors private transplants can still be carried out using organs from living donors. Critics of the ban claim that the only reason people pay for transplants is the NHS takes so long that you will probably be dead before you get it. They also point out that it is illegal to sell your organs so why should hospitals be allowed to sell organs to the highest bidder, especially when there are not enough organs available for citizens of the UK. The organs should be allocated on the basis of who is in the greatest need instead of who can afford to pay.