Posts Tagged ‘health policy’

2012: What changes can we expect in the NHS?

Thursday, January 12th, 2012

Like a late Christmas present, this week the NHS Future Forum published its report with recommendations on four key issues within the NHS: integration, public health, information and education. Most striking was the proposal that HCPs should make ‘every contact count’ by questioning patient lifestyle choices at every opportunity.

The Government’s response has been to fully accept the report’s suggestions, as many tie in with the general programme of reforms set out in the Health and Social Care Bill. However, much like many of the proposals we saw outlined in the Bill and put into practice over the past year, other groups have been less enthusiastic. For example, Dr Clare Gerada, chair of the RCGP, has voiced concerns at the lack of evidence base for public health proposals, and that questioning patients at every opportunity may even be detrimental to the patient/physician relationship.

This is the first report of what will likely be many throughout 2012 both supporting reform and condemning it in equal measure. But what changes within the NHS can be expected in the coming year? Here are a few points that the Virgo HEALTH team will be looking out for…

First and foremost, the Health and Social Care Bill will receive Royal Assent, with most proposals likely to be still intact. Even so, there are lingering questions over Andrew Lansley’s position within the Cabinet. Will he continue to serve as Secretary of State into 2013? In all likelihood, yes – but nothing is certain.
As the Government progresses with the reforms throughout 2012, we will see the further dismantlement of current NHS structures and consolidation of new bodies such as the NHS Commissioning Board and Clinical Commissioning Groups in their place. However, there will continue to be plenty of debate over the composition and size of these groups, and the role traditional commissioners from PCT and SHA backgrounds can play in them. 2012 should therefore provide more answers as to the future these managers have within the new NHS.

The DH published figures at the end of December confirming that it was on track to deliver the savings required for the year 2011/12 as set out in the Budget, recording savings of £2.5 billion in the first 6 months of the efficiency challenge. Many argue that the easy cuts have been already been made, and that the NHS will be facing an increasingly difficult challenge to try and find further savings. We will see whether the figure of £6 billion for the year is achieved in the summer, and towards the end of the year, whether it is still on track to hit its final target.

Finally, ‘no decision about me, without me’ as an underpinning principle behind the reforms will begin to come to the fore. Can we expect to see patients taking more interest in their care, as more choice is provided, and information becomes available? Andrew Lansley has stated this week that ‘blacklisting’ of NHS drugs needs to be ended to stop the current ‘postcode lottery’, but also to avoid the threat of legal action from patients who know their rights.

We are sure you will be following developments in the NHS like us, during a year which will undoubtedly be crucial for the success of the reforms and economic future of the NHS.

To centralise or not to centralise? That still appears to be the question

Friday, October 28th, 2011

The NHS has gone through a number of evolutionary stages in its 60 year existence, and at each stage the argument for decision-making at a local or central level has been hotly contested. This issue seems to have reared its head again for Sir David Nicholson and Andrew Lansley as a draft of ‘Towards Service Excellence’, the Department of Health guidance on commissioning support, was leaked to the Health Service Journal last week .

A major tenant of the Health and Social Care Bill, which is still slowly working its way through Parliament, is to decentralise the decision-making process. However the guidance recently circulated to Primary Care Trusts indicates that a number of functions originally earmarked for local clinical commissioning groups will now be handed back to regional subsidiaries of the newly formed NHS Commissioning Board.

The leaked document suggests that four key functions for the smooth running of commissioning (business intelligence such as collecting or organising data, major clinical procurement, back office functions such as IT, human resources and finance, and communications services) are best done ‘at scale’ and highlights that considerable savings would be achieved by delivering these. Not only that, but these functions are also stated to be ‘at risk of becoming unsustainable if not centralised’ – a sentiment arguably at opposite ends of the spectrum to the original aims of the Bill!

The most interesting aspect of this argument is the concept of ‘at scale’. Andrew Lansley was understood to want to promote local and patient-centric decision-making by elevating GPs to powerful budgetholders, as well as scrap the existing system of PCTs and SHAs that were branding as ‘too bureaucratic’. Perhaps this guidance is a sign that practical considerations are catching up with policymakers at the Department of Health, as large organisations in any sector will tell you that it is often inappropriate and inefficient to devolve responsibility for all services to a local level.

We’ll be watching closely to see how commissioning functions will eventually be divided between clinical commissioning groups and regional arms of the NHS Commissioning Board. As the latest plans appear to suggest approximately ten outposts will be established across the country, perhaps we will never be able to escape the ‘bureaucratic structure’ of centralised bodies in an efficient and well run health service?

A review of medical regulation for patient interaction online

Thursday, September 1st, 2011

The topic has been discussed at length over the last few years, but only in the last couple of months have professional medical organisations begun to draw up online codes of conduct.

Most notably, the British Medical Association (BMA) issued guidance to its 140,000 members advising doctors and medical students to steer clear of activities that could compromise public confidence in the profession, with specific recommendations to adopt high privacy settings, reject friend requests from patients and avoid work discussions, particularly those involving patients or colleagues, online. Essentially anything that might breach patient confidentiality or, with employers increasingly using the web to screen applicants, jeopardise career prospects.

The BMA recommendations came just days after the Nursing and Midwifery Council (NMC) guidance for its 660,000 members. This guidance, which was developed in response to an increasing number of enquiries about online misconduct and the fact that some nurses and midwives have been investigated and struck off for improper use of Facebook, stresses that ‘virtual’ incidents will be treated as seriously as ‘real’ ones and urges members to make a clear distinction between their professional and personal lives online.

Interestingly, a recent poll of nearly 1,000 Nursing Times readers suggests that healthcare professionals (HCPs) themselves believe there is a need for this type of regulation. More than 40% of nurses surveyed said a colleague had inappropriately posted details of patients or colleagues on Facebook or Twitter, while 32% of respondents felt nurses were sharing too much information about work issues.

Despite the fact that HCPs are encouraged to use social media to build professional networks and patients are happy to disclose personal stories and health data on information-sharing websites like PatientsLikeMe and the IBM Patient Empowerment System, the BMA and NMC guidelines appear to be based on the age-old advice not to mix business with pleasure. In the same way that the General Medical Council (GMC) has always cautioned doctors against treating friends and family for fear that personal relationships could cloud clinical judgement, the latest recommendations seem to stem from concerns about maintaining objectivity when the HCP and the patient know one another.

While doctor-patient communication could often be improved, it is often most appropriate for this to take place face-to-face in a secure environment. But any suggestion that HCPs should not be able to discuss health issues with patients online could be missing the bigger picture. If the end goal is to improve health outcomes surely no route should be totally blocked to ensuring progress for all? Whether doctors actually want to interact with patients online is another thing altogether…

To make charity campaigns effective, take a critical approach…

Friday, June 24th, 2011

We’ve all tried to get home after work with our heads down, aiming straight for the tube station, when some gap year student wearing a florescent yellow jacket jumps out shouting “Have you two minutes to talk about child cruelty?” Granted, it doesn’t help that the sanctimonious teenager may well be the most irritating person within a 100 yard radius, but why are we so quick to respond, “Sorry, late for the train”?

I know charity is never a bad thing, but there will always be charities that are more effective and better run than others. But how closely do people scrutinise the effectiveness of charities before donating? It seems pretty tight-fisted to do so, but if you want your donation to be as well spent as possible, which most people do, it is perfectly reasonable. When we think of causes such as childhood vaccination and treatment for HIV, how can we justify giving money to a charity for stray cats? And what if the millions of pounds of food aid is simply rotting away in a warehouse because the appropriate distribution infrastructures don’t exist?
                                                                                                            
All be it on a vastly different scale, the Bill & Melinda Gates foundation weigh up these sorts of questions on a daily basis. With so much demand on their fortune, any cause wishing to benefit from their help must meet a very strict set of criteria. After all, there are significant parallels between charity and business.

For those budding philanthropists out there, don’t worry, I don’t think you need to start worrying about investment strategies just yet, but perhaps next time you decide to donate, ask yourself the following:

Does the charity produce measurable results?
Do they use preventative approaches?
Do they promise significant and long-term change?
Do they leverage support from other sources?

Once they get your thumbs up it’s the easy bit, time to get your wallet out. Oh, and of course it’s definitely worth checking that they’re genuine (as a general rule, if it seems dodgy then it probably is!)

How the Bill and Melinda Gates Foundation is shaping priorities for improving global health

Thursday, May 26th, 2011

In his address to the World Health Organisation (WHO) last week, Bill Gates shared his vision for the Bill and Melinda Gates Foundation. He began this remarkable 30 minute speech with a simple but powerful statement: “Thirty years ago, in starting Microsoft, we had a very ambitious vision: A computer for everyone. Now, I join you in seeking an even more important vision, which is good health for every human being.” Beyond being a powerful financier of global health campaigns, Bill Gates offers an essential argument that is at once accessible and inspiring…

For those who are familiar with the work carried out by Bill and Melinda it’s no surprise at the centre of their vision is vaccines. Wearing a lapel-pin stamped with ‘end Polio now’, Bill Gates recalls how in 1998 he first learnt about rotavirus – a leading cause of diarrhea in children causing 500,000 deaths every year and candidly remarks “rotavirus – we’d never heard of it because our daughter was not at risk of it.” His advocacy for vaccines could not be made clearer describing them as “elegant technology”, “inexpensive”, “easy to deliver” and ”proven to provide long term protection from disease.”

As the video highlights, eradicating polio is a tangible goal. But the headway that has been made in reducing the prevalence of the disease could be lost without continued action.

There are a number of factors working against this that Bill Gates mentioned during his speech, not least of which is price. But progress has been made as exemplified by Bihar state in India. Bihar had one of the lowest vaccination rates in the world – less than 30 per cent. The vaccination rate today has doubled due to the leadership of Chief Minister Nitish Kumar who understands the benefits of a strong immunisation system. Closer to home Bill Gates comments on how the British Prime Minister David Cameron maintains his commitment to the UK’s spending to the polio campaign despite challenging economic times. There are many more examples showcased of how collaborative partnerships with the WHO have achieved significant advances in the fight against disease – the Meningitis Vaccine Project and the 99% eradication of Polio are just some of the examples.

While the commitment of the Bill and Melinda Gates Foundation to increasing access to vaccines is huge, it will take a global outlook beyond national interest to achieve these goals. But the leadership and aspirations of the foundation are not to be overlooked. And I can promise you today you will not read a more impactful statistic than the closing statement of Bill Gates’ speech: “We will have the chance to prevent 4 million deaths by 2015 and 10 million deaths by 2020.”

How UK Parliament is combating voter apathy with social media

Monday, April 18th, 2011

Social media is infiltrating every aspect of our lives these days, but it is also having a significant effect on the world of politics here in the UK. Guido Fawkes, Westminster’s resident gossip-mongering blogger, recently demonstrated the point:

“One Tory MP opened a CV at the start of an interview for a new researcher this week and spotted that the candidate claimed to be a ‘social media expert’. ‘So what would you bring to the job?’ he quipped, ‘…in fewer than 140 characters…’ The flummoxed young lady didn’t get the job.”

With the likely introduction of new rules allowing iPads and other small media devices inside the Chamber at Westminster following a positive report by the procedures committee, the role of social media within the sphere of politics is likely to expand. At this moment, Tweetminster shows that 266 MPs within Parliament are active on Twitter, engaging with each other and their constituents on all manner of subjects – a positive step towards the sort of open interaction that is essential to restoring confidence after the erosion of trust brought about by the expenses scandal.

But this kind of interaction and use of these resources has been present for many years for political correspondents. Dedicated tweeters, such as the BBC’s Laura Kuenssberg, constantly update to bring the latest developments beyond Westminster. The interaction across cyberspace now not only helps the dissemination of political news but has also become a crucial tool for breaking stories. Last year William Hague was forced to confront rumours about his relationship with an aide during the lead up to the General Election when they had been circulating around the internet. A story that was relatively under the radar for much of the population became a topic of national interest.

It is clear therefore that the onset of social media interaction has provided a platform for information to spread quickly about happenings in Westminster, whether they are official or frivolous. Perhaps more importantly, this revolution is providing opportunities to enhance engagement in politics, an issue often cited with reference to the apparent general apathy of the voting public.

Over the past 50 years membership of political parties has been on a steep downwards curve and turnout at General Elections, although picking up since 2001, is still well below 20th century levels. This issue is never more potent than with the youngest demographic of potential voters, a group that happen to be the widest users of social networking sites. We’ve seen in the Middle East recently the power such resources have in allowing dissenting voices to come together and exercise democracy. Within a matter of years the electorate may be casting their ballots on Facebook for a General Election. One tweet may not say much, but the system as a whole will revolutionise democracy as we know it.

Lansley’s Health and Social Care Bill clears the second hurdle

Tuesday, February 1st, 2011

In the House of Commons last night MPs voted 321 to 235  in support of the second reading of Health and Social Care Bill. While the margin of difference between the ‘Yeas’ and ‘Nays’ was a clear one, as there are 645 votes available (650 in total but of course Sinn Fein don’t take up their seats) if all the abstainers voted against it wouldn’t have passed.
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Obama’s State of the Union: Rationalising healthcare reform

Wednesday, January 26th, 2011

Every year, the President of the United States delivers the State of the Union address to Congress – and more importantly to TV viewers. It’s one of his major opportunities to set out what he sees as priorities for the next year and, hopefully, stir up public opinion in support. Last night, Obama gave his third State of the Union – and for anyone who’s watched the West Wing it was pure Bartlett! Inspirational, hopeful and encouraging cross-party co-operation. And viewers seemed to agree, with instant polling on CNN showing a rise in support for the president’s policies, with more than three-quarters of respondents saying they had a favourable view of the speech. So if you don’t have time to read the full text of the speech what is it you really need to know?

 

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Why EU restrictions on health information are good for pharma AND patients

Wednesday, December 8th, 2010

Last week a huge majority of MEP votes signalled a change to the provision of information on prescription drugs to patients in EU member states. While direct-to-consumer advertising is quite rightly already banned in the EU, there was a lack of consistency in the way rules on patient information provision were interpreted by individual countries. As a result of the vote, two key changes were proposed:

- Broadcast and print media will be banned by law from providing information on prescription medicines (though there is a caveat to this below)

- Healthcare professionals will not publicly be able to give any information on prescription drugs to patients unless they declare links with pharmaceutical companies.

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What does the new Health Service Journal power list tell us about the UK policy landscape?

Wednesday, November 24th, 2010

The HSJ100, an annual list of the most influential people in health, has been released by the UK’s Health Service Journal. Not only has the list doubled in size from 50 (in the 2006-2009 lists) to 100 this year, but it is also notable for the way the new Coalition Government health policy reforms have decided many of the contenders’ fates. In the wake of recent announcements about the changing role of the NICE, Chief Executive Andrew Dillon slips two places. In contrast, since GP commissioning is the new government’s flagship policy, there are nine GPs in the 100, including numbers 3, 8 and 11.
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