Brexit means "only major crisis will focus ministers on to NHS"

The NHS and social care are at risk of being downgraded as a priority by a government distracted by Brexit unless there is a major public health crisis, the former chief executive of the NHS has warned.

Nigel Crisp, who ran the NHS and Department of Health for six years, said the government’s need to concentrate on the economics of leaving the EU would be one of the three biggest risks to health and social care posed by the referendum vote, along with loss of staff who are EU citizens and a brain drain from medical research.

The crossbench peer issued the warning in evidence to the House of Commons health committee inquiry into the impact of Brexit on health and social care, at a time when senior politicians and medical leaders have been sounding the alarm that care for the elderly is close to collapse.

Last week, Philip Hammond, the chancellor, refused to bow to pressure to give more funding to social care or NHS at the autumn statement, prompting anger from Labour MPs and even some Conservatives.

In his evidence to the new inquiry, Crisp said the NHS and social care were already “dealing with major problems and facing an uncertain future” but the uncertainty of Brexit only makes it even more important that the government sets out a clear direction and strategy.

Listing the possible risks of Brexit in his evidence, he said: “Pressures on the economy will bring pressures on all public services, adding to existing ones. Moreover, the emphasis in government policy will of necessity be on addressing economic rather than social issues with the result that health and social care will become a lower priority – unless, of course, there is a major public crisis.”

He added: “My most immediate concern is that we haven’t yet seen any adequate mitigating strategy or actions being taken by the government. NHS England and local employers have attempted to reassure staff but we need to see a government-led comprehensive and well supported risk mitigation approach adopted and publicised.”

Whitehall sources have told the Guardian that Downing Street is well aware of the funding difficulties in the NHS and social care but believes the government’s position on funding can hold at least until after the major hurdle of triggering article 50 is out of the way at the end of March.

However, there are already warnings about the risk of a winter crisis in the NHS as cuts to social care places mean many elderly people are not being discharged from their hospital beds.

Senior figures in the medical profession, together with Tory, Labour and Liberal Democrat leaders in local government, wrote to the Observer this weekend demanding a reversal of Philip Hammond’s decision not to offer more funding for social care in last week’s autumn statement.

They argued that the safety of millions of elderly people was at risk because of an acute financial shortfall in adult social care, which is in turn putting pressure on the NHS.

On Sunday, Stephen Dorrell, the former Conservative health secretary and chair of the NHS Confederation, also said that Hammond made a mistake in failing to give more funding to social care in the autumn statement.

His voice adds to other senior Tories, including fellow former health secretary Andrew Lansley and Sarah Wollaston, the chair of the Commons health select committee, in expressing fears that social care cuts are having a worrying effect on the NHS.

Responding to the warnings, a Treasury spokeswoman said: “The government has committed to increase NHS funding by £10bn above inflation by 2020/21, going beyond what the NHS requested.

“In addition, we have given local councils £3.5bn extra funding by 2020 for social care. Many councils are already providing high-quality social care services within existing budgets.”

Labour MPs expressed anger after Hammond did not mention social care once during his autumn statement speech to the Commons.

It prompted Jeremy Corbyn, the Labour leader, to launch a national “Care for the NHS” campaign on Saturday.

Brexit means "only major crisis will focus ministers on to NHS"

In NHS management being fired means you continue working for more money

When I had to leave my role as a senior NHS manager, I discovered that the health service has a well-used but little-known system for easing people out of top jobs. And I learned that it doesn’t work well for anyone: trusts, our healthcare system, managers, patients or the taxpayer.

It’s quite common for senior leaders to have to step down, even when there are no performance issues and their actions haven’t risked patient safety. Sometimes, as in any sector, people simply end up in jobs that aren’t right for them. And just as often, managers, keen to support NHS bodies through difficult change projects, take on tasks that prove impossible to accomplish.

My case is typical. Individual hospitals are being pushed to group together in larger organisations, centralising specialist care and closing some common services with overlapping coverage. And the timetables for these ambitious reforms are sometimes built around political cycles, rather than good medical care or change management. I ended up overseeing a major change programme – but the deadline was unrealistic, and staff shortages were so acute that we couldn’t recruit enough experienced medics. After a period we got things under control; but senior management made clear that they wanted a change of leadership, believing that it would draw a line in the sand and signal a fresh start.

In the private sector, I’d have been given a fat pay-off and sent on my way. But in UK public healthcare it’s not acceptable to spend taxpayers’ money that way, and departing managers have nowhere else to go: the NHS is the only game in town. So I was summoned to a meeting, and offered a sideways move into a national role at NHS Improvement: the agency responsible for improving practice across the health service.

I soon learned that most such roles at NHS Improvement are one-year contracts, where people do useful work that is rarely followed through into delivery. Working there, some people apply for other NHS jobs and eventually move into senior roles elsewhere in the system. But many, wounded by their treatment and unsure of their chances in the job market, instead use the role as a springboard into interim work; and the NHS is desperately short of skilled, experienced leaders, so it ends up paying them £1,000 a day to plug gaps in its management structures.

Many people offered a one-year job at NHS Improvement would instead be willing to take a less senior job with their current employer, if it meant a permanent job and the chance to stay in the locality. But few are offered this option, and there’s a stigma attached to dropping grades. It’s seen as a sign of personal failure, and there’s an expectation that careers only ever go upwards – which, in these days of long careers and merging organisations, isn’t realistic.

Political leaders and senior management need to recognise that, while not all appointments work out, these people still have skills the NHS needs. And they should understand that failing in an impossible job is a verdict on the job, not the person. After all, those jobs only become impossible because managers are trying to both keep their staff happy, and push through the systemic changes required by national policymakers. The NHS needs to reform, and ministers have a democratic mandate to reshape the system; but currently, the best way to protect your career is to keep your head down, build support among your staff, and resist risky reforms.

With budgets in decline, demand rising, a growing recruitment crisis, and an endless series of new policies and organisational changes, it’s easy for organisations to become over-stretched and leaders to fall out of favour. If the NHS wants people to be ambitious in these very difficult jobs, it shouldn’t push those who run into trouble into temporary non-jobs – and then into an interims market where the NHS must rent their skills back at exorbitant cost.

National leaders need to be more open about the difficulty of succeeding in these hugely challenging jobs, and do everything they can to retain good managers who’ve taken a step back – offering them permanent employment in less high-profile roles. Then people would be more willing to take on the most difficult jobs in NHS management, and there would be less gaps in management grades. That, in turn, would cut the interims bill and improve continuity in organisations that can ill afford excessive staff costs and unstable leadership.

The current system evolved to help protect NHS staff while facilitating necessary leadership changes, but it’s a huge waste of talent as well as money. Politicians and the Department of Health need to be more open, both about the flaws in redeployment processes, and about the pressures that brought us to this point. That would take courage; but if they’re ready to have that conversation, the benefits will be felt by patients and taxpayers as well as NHS managers and policymakers.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

In NHS management being fired means you continue working for more money

How a Healthy Gut Means Healthy Bones (& What To Do If Yours Isn’t)

Your gut is home to trillions of intestinal bacteria. Over 100 trillion to be exact!

These bacteria help you digest food, remove waste and circulate essential elements. It might be hard to believe, but we have more “creatures” living inside our bodies than there are stars in our galaxy!

But don’t let that scare you. Research has shown that this living system, also known as your gut microbiome, can lower your risk of inflammatory bowel disease, rheumatoid arthritis, cancer, diabetes and even osteoporosis, when healthy. 

Factors That Affect Your Gut Microbiome

Unfortunately, not all organisms are gut-friendly. Some are good and others are bad.

The key is keeping your gut flora ‘balanced’.

You see your gut flora is extremely sensitive, which means there are plenty of factors that can affect your gut microbiome. Some of them are:

• Birthplace


• Age


• Diet


• Personal hygiene


• Antibiotics and prescription medication


• Environment

Even small differences in the makeup of your microbiome can have real effects on your health. These include your risk for cardiac issues, diabetes, Alzheimer’s disease, and obesity. 

And the latest research has added osteopenia and osteoporosis to the list.

How Your Gut Health Affects Your Bones

Inflammation in the gut can lead to damage of your tissues, organs, and gut flora.

Anything that promotes chronic inflammation also promotes osteoclasts. These are known as the ‘bone-dissolving cells’ and when triggered, can affect the bone-remodeling process.

Inflammation also inhibits absorption of important bone-building minerals like calcium and magnesium, making it more difficult for you to give your bones the nutrients they need.

But there are ways to combat this inflammation…

Probiotics Combat Inflammation And Protect Your Bones

Probiotics have been studied and shown to be beneficial for an array of health problems such as immune function, diarrhea, cancer and inflammatory bowel disease. 

In particular, they have been shown to reduce systemic inflammation.

Probiotic rich foods include:

• Yogurt


• Kefir


• Sauerkraut


• Kombucha


• Miso


• Microalgae


• Pickles


• Tempeh


• Kimchi

Studies that test how probiotics and prebiotics affect bone health are in the works. Probiotics are live microbes that help move food through your gut. Prebiotics – found in such foods as raw garlic and leeks – help stimulate useful bacteria.

In animal tests probiotics improve bone mass and prebiotics increase bone density.

What do these studies reveal?

Researchers know that when you regulate the microbiome, you regulate bone health. 

Take Home Message

A healthy gut is a happy, healthy you.

To maintain and restore a healthy gut, include more probiotic-rich foods in your diet such as sauerkraut and yogurt to stimulate healthful bacteria.

Not only will your gut thank you, but your bones will too.

---

Sources:

1. Jun Sun, Eugene B. Chang. Exploring gut microbes in human health and disease: Pushing the envelope. Genes & Diseases. Volume 1, Issue 2, December 2014, Pages 132–139


2. Inna Sekirov, Shannon L. Russell, L. Caetano M. Antunes, B. Brett Finlay. Gut Microbiota in Health and Disease. Physiological Reviews Published 1 July 2010 Vol. 90 no. 3, 859–904 DOI: 10.1152/physrev.00045.2009


3. https://www.researchgate.net/profile/Reza_Darsanaki/publication/236963823_Probiotics_and_Health/links/0deec51a78ed71c361000000.pdf


4. Ritchie ML, Romanuk TN. A meta-analysis of probiotic efficacy for gastrointestinal diseases.PLoS One. 2012;7(4):e34938. doi: 10.1371/journal.pone.0034938. Epub 2012 Apr 18.

How a Healthy Gut Means Healthy Bones (& What To Do If Yours Isn’t)

Medical professional Pay out Hits $232,000 As Top quality Gains A lot more Which means In Obamacare Era

Major care doctor pay rose somewhat to more than $ 232,000 while specialists’ compensation rose to far more than $ 402,000 as insurers paid them primarily based a lot more on high quality of care offered rather than volume.

The most recent data from the Health care Group Management Association, the largest organization of medical professional practices in the U.S., stated median compensation rose to $ 232,989 in 2013 for primary care medical professionals although a similarly slight increase for specialists to $ 402,233. By comparison, MGMA’s 2013 report showed median main care compensation in 2012 at $ 220,942 and expert pay at $ 396,233.

However doctors are even now working largely in a charge-for-support atmosphere, that is quickly shifting as insurers , employers and government wellness packages underneath the Affordable Care Act move medical professional compensation away from a standard method that rewards companies with costs no matter the end result to rewards based mostly on high quality, transparency and accountability.

MGMA said primary care doctors who “indicated they had been not portion of an accountable care organization or a patient-centered healthcare home” reported an average of 5.96 % of their compensation in 2012 was primarily based on top quality measures. Meanwhile, professionals reported that 5.7 percent of their compensation was primarily based on high quality metrics.

“Physicians are providing good quality care to their patients, so it is not surprising that compensation methodologies are evolving to incorporate these metrics,” mentioned Dr. Susan Turney, president and chief executive of the Health-related Group Management Association, said of the group’s report that seems to be at data from ore than 66,000 medical care providers.

However the MGMA evaluation of good quality metrics demonstrates a subset of medical professionals not nevertheless component of an ACO and patient-centered medical home, it is only even more evidence that fee-for-service medication is taking a hit.

Across the nation, doctors and hospitals that are component of bigger practices, clinics and systems are more and more forming ACOs and other arrangements which put suppliers below one umbrella, contracting with industrial and government insurers to give care to a population of patients. The medical professionals and hospitals agree to be measured and their pay is based on high quality and outcomes, typically divvying up cost savings with insurers as a reward for the far better care they supplied.

MGMA executives stated the data displays medical professionals are more and more ready to report their high quality measures.

“They are realizing . . . they have to report that (high quality) data whether it be to commercial payers or the federal government,” explained Todd Evenson, vice president of consulting companies and information solutions at MGMA. “They are going to have to supply this data and be reviewed upon this information. Doctors recognize that this is going to impact them in the future.”

All significant insurers like UnitedHealth Group UnitedHealth Group (UNH), Aetna Aetna (AET), Humana Humana (HUM), Cigna Cigna (CI) and Blue Cross and Blue Shield programs are dramatically escalating the quantity of contracts through accountable arrangements.

Medical doctors, meanwhile, are seeing such contracts come at them in all forms.

“They are all in distinct stages,” Evenson said of physician practices.

Questioning how Obamacare will influence your overall health care? The Forbes eBook Within Obamacare: The Fix For America’s Ailing Health Care Program answers that query and more. Obtainable now at Amazon and Apple.

Medical professional Pay out Hits $232,000 As Top quality Gains A lot more Which means In Obamacare Era

Good medication is realised as a lot by means of art as science | Peter Thomas and Sam Guglani

Good medicine is about more than a set of technical decisions or interventions involving drugs, operations and tests. It demands identification with another’s suffering, moral deliberation, wisdom and insight.

The arts can illuminate this view of medicine. But it is not enough to expose doctors training in medical schools to the humanities, and there’s more to it than the idea of empathy being “stewarded” by the arts. Art does not simply tick a box within medicine. Good medicine is realised through art as much as it is through science.

The Medicine Unboxed Creative Prize reflects this belief, and looks to champion a less reductive, less consumerist view of illness and medicine, and the human fragility that underlies them both. Our intention is, in the words of Francis Bacon, “to deepen the mystery”, by celebrating an authentic creative connection between art and medicine.

Tom de Freston’s entry for the Medicine Unboxed Creative Prize 2013. Copyright: Tom de Freston

Since 2009, the Medicine Unboxed project has been bringing together the public, health professionals, politicians and artists to engage in a discussion about the values, beliefs, language and voices that inform medicine.

The conversations that have followed have been challenging, inspiring, sometimes funny and often moving.

In anticipation of this year’s annual Medicine Unboxed event – Frontiers, on 22-23 November – we launched an arts prize that aims to amplify the resonance between art and medicine. This year the prize, worth £10,000 for the winner, has attracted 80 entries from around the world.

The prize is unusual in that it is open to creative works in any discipline. It is also unusual in that, instead of simply entering their work, we asked artists to send expressions of interest to help our judges understand more about them and how they engage with our theme of the interface between arts and medicine.

Susan Aldworth’s entry for the Medicine Unboxed Creative Prize 2013. Copyright: Susan Aldworth

In this way we hope to understand, encourage and explore not just the finished creative work but the wellspring of inspiration that links the arts and medicine.

We also opened up the creative process, and the prize process itself, by following shortlisted artists on their path towards their final submitted work. Tom de Freston, one of our judges, will be creating a documentary that tells the story of the prize, the artists and their interpretations of medicine.

You can follow the prize, and the Medicine Unboxed project, at medicineunboxed.org. The shortlist will be published in July and the winner will be announced at our Frontiers event in November.

Dr Sam Guglani is consultant oncologist at Cheltenham General Hospital and curator of Medicine Unboxed. Prof Peter Thomas is COO of the Leasing Foundation and creative director of Medicine Unboxed

Hugh Turvey’s entry for the Medicine Unboxed Prize 2013. Copyright: Hugh Turvey

Good medication is realised as a lot by means of art as science | Peter Thomas and Sam Guglani

Government failing on violence reduction scheme by means of A&E departments

A violence reduction sheme involving A&ampE departments sharing anonymised data with police has not been fulfilled. Photograph: Bethany Clarke/Getty Images

Ministers are failing to fulfil a coalition pledge to roll out a violence reduction scheme that has been proven to reduce attacks by as much as 40%, top accident and emergency surgeons claim.

The Tories and Liberal Democrats agreed in 2010 to introduce the nationwide scheme, which involves A&ampE departments sharing anonymised data about violent incidents with police forces, enabling problem spots to be targeted.

But as handful of as a third of A&ampE departments in England have completely adopted the programme, which was pioneered in Cardiff 20 many years ago and has been copied as far afield as South Africa and the US.

Department of Wellness officials have created it clear that A&ampEs ought to share info with police, but a spokesperson admitted it basically did not know how a lot of hospitals have been working the model. It is undertaking a assessment this summer season to discover out.

Dr Adrian Boyle, chair of the good quality in emergency care committee of the University of Emergency Medication (CEM), said he was annoyed at the lack of progress. “The implementation is not functioning as effectively as we would have liked,” he mentioned. “It is aggravating.”

Boyle, an A&ampE consultant who has worked closely with the Division of Wellness and NHS England to get the system up and running, referred to as for the government to give hospitals incentives to introduce the scheme. He mentioned there was a wariness within hospitals about workers to liaising with experts “out of their silo”. The reorganisation of the NHS may possibly also have hampered the programme, he said.

An audit two years in the past discovered two-thirds of A&ampE departments were not sharing information to the standard advisable by the CEM. Boyle mentioned he did not feel the new audit would present any progress.

The architect of the unique Cardiff scheme, Jonathan Shepherd, professor of oral and maxillofacial surgery at the Cardiff school of dentistry, expressed concern at the slowness of the adoption of the model.

He mentioned there was even now as well great an acceptance of “schedule” street violence. “Folks grow to be immune to the concern and the social catastrophe it represents. For health-related personnel, police and local authority employees it becomes a schedule portion of what transpires when you’re on shift at the weekend.

“Pros are used to getting reactive, suturing folks up and arresting offenders rather than taking a a lot more preventative approach. I’m not shocked it is taking some hospitals so prolonged [to adopt the Cardiff model] and others aren’t doing it properly.”

Shepherd’s thought stemmed from research he did in the 1980s which located only a quarter to a third of violent incidents resulting in a journey to A&ampE come to the interest of the police. He realised that for forces to have a full image of what was happening they ought to know about all situations of emergency treatment.

His scheme – the Cardiff violence prevention programme – launched in 2003. Hospital personnel recorded anonymised information of where, when and how a victim had been attacked. This info was shared, making it possible for maps of violence hotspots to be developed and the organisation of operations to tackle the problem.

The outcomes were striking. Inside 5 years there had been an estimated 42% fewer woundings in the Welsh capital in contrast with similar cities.

There was a 35% decrease in the number of sufferers seeking emergency treatment method and one particular study place the savings in economic and social expenses at just below £7m a 12 months. For every £1 invested on the scheme, £82 was saved.

Shepherd mentioned he realised the scheme was working when the price of violence in Cardiff, a well-liked get together city, dropped to amounts noticed in towns this kind of as Eastbourne and Harrogate. Shepherd advised the government essential to do more to fulfil its coalition agreement guarantee. He explained: “In the runup to the 2015 election I feel people will want to be reassured that this government commitment has come to fruition.”

Shepherd’s model or variations of it are in place in Amsterdam and the Western Cape in South Africa. Milwaukee in the US has also been investigating it.

Alun Michael, a former Labour minister and now police commissioner for south Wales, was also surprised that a lot more hospitals had not adopted the model. “Analysing incidents which brought victims of violence to A&ampE has led to considerable and sustained reductions in the variety and seriousness of violent incidents,” he said.

Gary Smith, the director of Cardiff Street Pastors, which assists keep revellers safe in the city centre on Friday and Saturday nights, said he had noticed a big difference in the city in excess of latest many years. “It feels a secure, area to be now. I feel that’s partly because everybody performs collectively so nicely now.” Michael and Smith each explained the programme in Cardiff had led to a wider cultural shift with companies far more utilised to functioning closer and better together.

South Wales police created it clear it believed the scheme was worthwhile. A police spokesperson mentioned the scheme had produced a “important contribution” to the reduction in violent crime. “It is an superb illustration of how partnership perform in Cardiff is producing a genuine big difference to retaining our communities protected.”

There are examples that display the scheme has worked nicely in other places the place it has been adopted. In some, violent crime has fallen by 40%. In Cambridge, for example, analysts realised foreign college students had been being injured on Monday evenings after Addenbrooke’s hospital shared info. Officials found that drinks promotions aimed at foreign students were currently being offered by bars. The premises have been told they must end such promotions.

In the south-east of England, people began attending an A&ampE having been hit by planks of wood and bricks. The information was passed on and council officials realised an open skip had been left close to a nightclub. Such skips had been banned from the area.

Mark Bellis, who advises the World Wellness Organisation on violence prevention who has implemented a productive info sharing scheme in the north west of England, said there remained a reticence in some locations to take it up. “It can function phenomenally well but some are reluctant since of the investment and the time.”

Caroline Shearer, of the anti-knife campaign group Only Cowards Carry stated the government essential to do a lot more to tackle violent crime – like generating sure hospitals shared information.

“The government talks challenging, it demands to act difficult,” she said.

A spokesperson for the Department of Overall health mentioned: “We have been clear A&ampE departments should share details with police and we are about to assessment compliance ahead of the rollout of a new legal regular which all key A&ampEs will be obliged to meet. We’re also supporting hospitals to train nurses to specifically champion this.”

Government failing on violence reduction scheme by means of A&E departments

Abortion medical doctors can consult girls on cellphone or by means of Skype: advice

It could indicate that the consultation was performed through a webcam, it explained.

The advice said: “Though there is no legal necessity for at least 1 of the certifying medical professionals to have noticed the pregnant lady ahead of reaching a choice about a termination, the Department’s view is that it is very good practice for this to be the situation. It is recognised even so that, with technological advances, this could nicely suggest that a doctor does not physically see the girl, e.g. there could be a discussion by mobile phone or more than a webcam.”

Josephine Quintavalle of the campaign group, Comment on Reproductive Ethics, explained: “A telephone consultation to guarantee authorisation – presumably with a professional-decision doctor – totally ignores the existence-taking nature of abortion, can make a full mockery of the authentic Act and would absolutely not be tolerated in any other branch of medicine.”

Also medical doctors ought to not pre-signal kinds approving terminations, the advice mentioned.

It said: “The clear intention of the Act is for every physician to consider the woman’s situations in forming a excellent faith viewpoint. This is reflected in the recognition that the medical professionals could discover that diverse grounds are met (though they should the two locate the same ground is met for the abortion to be lawful).

“Treating certification by one particular or both physician as a ‘rubber stamp’ exercise is for that reason contrary to the spirit of the Act and calls into question regardless of whether that medical doctor is in reality delivering an viewpoint that they have formed themselves in very good faith rather than relying solely on a colleague’s viewpoint, however trusted that colleague’s judgment may be.

“DH considers the signing of kinds with out consideration of any info relating to the girl to be incompatible with the requirements of the Abortion Act.”

Ann Furedi, chief executive of the British Pregnancy Advisory Services which carries out the majority of abortions in Britain, stated: “This advice endorses our practice at bpas.

“One in 3 ladies will require an abortion since their contraception fails, their lifestyle circumstances abruptly alter, or a problem is identified with a considerably needed pregnancy.

“Not too long ago, doctors providing abortion services have felt under intense political scrutiny, and this document need to give them the reassurance that neither the law nor regulations have altered to accommodate those who think their operate is wrong.

“The law impedes best practice.

“There is no clinical want for two doctors to certify a woman’s causes for abortion, in addition to acquiring her consent, it merely leads to delays. Bpas trusts girls to make accountable options and Bpas physicians comply with the law.”

Public Health Minister Jane Ellison explained: “This brings clarity to abortion care. During its improvement we’ve worked closely with healthcare skilled bodies and consulted the Crown Prosecution Services to give clear advice to clinicians about their roles and responsibilities below the law so that they can continue to offer the very best feasible care for females.”

Abortion medical doctors can consult girls on cellphone or by means of Skype: advice

Dr Richard Hughes: "I saw them by means of the ideal and worst times"

He started out his medical occupation in London, qualifying at Guy’s Hospital in 1977, and came to Portsmouth to operate in common medication 3 years later on, aged 25. Having made the decision hospital daily life wasn’t for him – “I wasn’t sufficiently confident of my personal viewpoint to be a consultant” – he trained at Hanway in 1981, utilized for a complete-time vacancy there the following 12 months, and has been working at the surgical treatment ever given that.

The healthcare occupation, indeed the entire NHS, was very various then, he recalls. “We have been less nicely-organised. We didn’t know how several individuals we had we certainly did not know their names and we did not have a correct grasp of their overall health needs. We were one particular of the 1st practices in Britain to get up computerisation in the mid-Eighties, however, and that manufactured a planet of difference.”

Time passed and his knowledge broadened. He noticed babies born, develop up, then turn out to be dad and mom themselves. He watched households nurse loved ones at the brink of death, and mourned the reduction with them. He held hands, wiped tears and delivered lifestyle-modifying information. 1 elderly gentleman, who came on Saturday in his wheelchair, has had “more illnesses than a medicine textbook” – and survived. “It’s because he’s loved by so several individuals, rallying around,” he says. “That, for me, is the essence of family medicine.”

Dr Hughes’s favourite memories are happy ones. “I’ve observed houses total of caring family members, all sharing joy or sharing grief – and that is humbling,” he says. “It’s been educational watching people cope with really tough doses of what lifestyle has to throw at them, and pop back up like corks. At times, between consultations, I’d see somebody with a really sad story, followed by a very wonderful story. You’d nevertheless be in tears from the final 1 when the following one would stroll in, and you’d have to smile and be there in the identical way.”

And it was this, his selfless commitment of time and an ever-listening ear, which created Dr Hughes so popular with individuals. He went out of his way to do house visits by no means turned any individual down, even on his days off. He was a GP of the kind that Jeremy Hunt, the Wellness Secretary, called for far more of final 12 months in his overhaul of healthcare for the more than-75s. Maureen Baker, chair of the Royal University of GPs, warned in March that this kind of individualised, patient-centred care is vital to the survival of loved ones medical professional services, but is threatened with extinction from increasing demand.

It is a threat Dr Hughes is aware of properly. “We always felt stretched in my practice,” he admits. “I utilised to get to the surgical treatment at six.45am and would depart among 8pm and 10pm. 5 days a week. And it was in no way adequate time – you constantly went property realizing that you left some factors undone.”

What does he think of Labour leader Ed Miliband’s calls for sufferers to be guaranteed a GP appointment inside of 48 hours? “The actuality,” he says, “is that individuals would like accessibility to somebody they know and trust, but they could have to wait to see them. We’ve never ever been able to square that circle. If you went to an A&ampE division, you’d want to see the physician who could make you far better – not necessarily the one particular you know. I realize why it is a criticism of the recent program, but I don’t believe it is fairly justified.”

And Labour has much to do to restore its reputation for NHS “reforms”: Dr Hughes says medical professionals are nonetheless recovering from its 2004 contract method, which enabled GPs to opt out of night and weekend function by sacrificing element of their salary. “That was a extremely soft contract – a lot of folks on the outside noticed it like that,” he adds. “I’ve done my share of nights, weekends and bank holidays, and it just comes with the task. You either get on with it, or do some thing else.”

Other adjustments since he began – the introduction of the National Institute for Well being and Care Excellence (Great) in 1999 and the rise of female GPs – have been positive, he says. “It’s no shock that females are dominating general practice. There are specific areas the place there is no query that female doctors are much better. But we’re going to have to accommodate their needs or the system will fall apart. There are some extremely talented female medical professionals who also need to have to be great mothers.”

It is clear the occupation was far more a vocation than a profession for Dr Hughes. But last yr he was diagnosed with Parkinson’s Condition – and decided it was time to retire ahead of the illness took hold. “I would have gone on longer if I could,” he sighs. “At the moment, it’s not affecting me specifically badly, and I’m not sorry for myself in any form or form, but I really do not believe it’s compatible with prolonged-phrase health-related practice. I wouldn’t want to make a blunder simply because I wasn’t working properly.”

He hopes retirement will enable him to devote a lot more time with his loved ones – his wife, Theresa, a teaching assistant near their property in Fareham, and his 3 young children, Chris, 34, a maths teacher David, 33, an officer in the Merchant Navy and Katie, 22, a lawyer in Bristol. Weekends will be spent on his favourite pastime, conservation and wildlife appreciation but most of all he’s searching forward to “taking stock of almost everything and obtaining a bit of a rest”.

For now, Dr Hughes’s outdated work at Hanway Healthcare Practice remains vacant. “It’s a genuine shame that they haven’t been capable to locate a replacement but – there just are not sufficient people interested in carrying out previous-fashioned general practice any much more,” he says. Would he recommend it? “Absolutely. I’ve acquired no regrets. It was my existence and I loved it. The method, like all British institutions, is a bit crickety and rickety, but it looks to be limping along. Just like I did for all those years.”

Dr Richard Hughes: "I saw them by means of the ideal and worst times"

The New Yorker Claims Biotech Accomplishment Means Drug Growth Now Significantly less Risky: Say What?

Biotech researchers and traders – to say absolutely nothing of the patients waiting desperately for new medicines – may possibly conclude from the latest New Yorker that their difficulties are more than.

According to a new, otherwise thoughtful piece about drug pricing by James Surowiecki, the recent run-up in biopharma stocks (preceding the even-more current promote-off of same) belies the industry’s assertion that aggressive pricing is needed to justify the risk of drug advancement.

“Biotech companies declare that charges require to be higher to reward risky and high-priced innovation, but the truth that they are churning out medicines and earnings so regularly would seem to undermine that declare.” (emphasis extra)

It’s unclear how stock industry fluctuations, coupled with a number of prominent successes, change the standard, and quite brutal odds of drug growth.   The huge majority of candidate compounds fail, and the vast vast majority of biotech startups struggle to acquire traction, and attain profitability.

In his 2006 book Science Business, HBS professor Gary Pisano talked about how couple of biotechs (at the time) attained profitability, and made the important stage that biotech can seem to be much more profitable than it is simply because of ascertainment bias – the winners are evident, even though the losers (and there are several of them) tend to fade away.

It is also why it’s effortless to miscalculate the value of drug improvement when comparing big organizations versus modest ones, as a lot of biotechs tend to be.  The value of failure demonstrates up on the books of large firms, while a drug growth failure can kill a startup, properly burying the value if you really do not remember to account for it.

Regrettably, biology stays difficult, discovering new medicines stays a profound and risky challenge, and as Merck Merck’s Roger Pearlmutter told my colleague Matt Herper last yr, “it’s a bloody miracle” when you discover one thing that really functions.  If anything at all, business specialists fret that the reduced-hanging fruit has been picked, and the search for new therapeutics has grow to be progressively far more challenging — and much more pricey.

To recommend that all of a sudden biotech businesses have stumbled upon a way to overcome historically brutal odds misrepresents the recent state of drug advancement, and the underestimates the profound difficulties drug developers (and recall that I am a single) encounter when attempting to create new medicines, and that traders wrestle with when determining whether to fund this essential but exceedingly higher-risk endeavor.

Note: For a much more thoughtful perspectives on issues about drug pricing, I’d recommend Bernard Munos get in Forbes, David Grainger’s Drug Baron publish here, and Megan McArdle in Bloomberg See right here.

The New Yorker Claims Biotech Accomplishment Means Drug Growth Now Significantly less Risky: Say What?

Half of nurses function by means of breaks or beyond their shift

Half of nurses are working by way of breaks or past their shift, revealing a health services beneath “significant strain”, a new report has warned.

A survey of almost three,000 nurses by Unison showed that two thirds believed they did not spend enough time with individuals, which most stated impacted care.

The report, Operating on Empty, stated half of nurses had been not confident about raising any issues they had with their local managers.

Gail Adams, Unison’s head of nursing, explained: “1 of the most damaging findings of this survey is how tiny has transformed given that final year. Despite all the government rhetoric, in spite of the Francis, Keogh and Cavendish reports, the spectre of one more Mid Staffs still looms big over the NHS. Progress on safe staffing amounts has been glacial and that signifies poorer care and patients nevertheless at risk.

“It really is clear that in spite of nurses doing work through breaks and past their hours, they merely do not have ample time to give patients the care and attention they want. That is distressing for patients and for the personnel trying to care for them.

“The Government requirements to encounter up to the damage it is inflicting on patients and staff, by not introducing legally enforceable nurse to patient ratios, and take urgent action.”

The union claimed that the survey also exposed an “in excess of use” of agency staff in the NHS.

In one more review final week, Unison said the ambulance support was on the verge of breaking down due to the fact of anxiety levels between employees.

The concerns will be debated at Unison’s overall health conference in Brighton, which opens these days.

Half of nurses function by means of breaks or beyond their shift

Ban Ki-moon backs campaign to tackle FGM by means of training

UN secretary common Ban Ki-moon, stated: ‘It has been deeply inspiring for me to hear that a 17-yr-old has attracted effectively over 200,000 signatures to her petition demanding action to end FGM.’ Photograph: Lucas Jackson/Reuters

The UN secretary basic, Ban Ki-moon, has backed Fahma Mohamed’s campaign – which is supported by the Guardian and anti-FGM campaigners – to place education at the heart of tackling female genital mutilation. Ban praised the 17-yr-old’s campaign – which has now attracted a lot more than 212,000 signatures on adjust.org – calling it “deeply inspiring”, and applauded her call to enlist headteachers to assist reach every woman who is at chance of FGM.

As a consequence of the campaign – which calls on the training secretary, Michael Gove, to write to every headteacher in the country asking them to inform teachers and mothers and fathers about the horrors of FGM – the Scottish government has presently said that it will create to heads all through Scotland, and following sustained public stress Michael Gove agreed to meet with Mohamed to examine the problem.

Ban praised the move in Scotland, stepping up stress on Gove to adhere to that lead. “It has been deeply inspiring for me to hear that a 17-yr-previous, Fahma Mohamed, supported by the Guardian, has attracted nicely above 200,000 signatures to her petition demanding action to end female genital mutilation,” wrote Ban in a comment piece for the Guardian. “Headteachers – and governments – have a crucial role to play in assisting to persuade households not to send their daughters abroad and aid these girls, some 24,000 in the United kingdom alone – considered to be at danger. The selection of the Scottish government to write to every single headteacher asking them to train workers and educate dad and mom is a key stage forward.”

Mohamed, a pupil from Bristol and a trustee of the charity Integrate Bristol, stated she was honoured to acquire Ban’s support. “It truly is wonderful that our campaign has had this kind of a broad reaching influence and I’m truly honoured by Ban Ki-moon’s support and praise,” she mentioned. “If he can help us persuade Michael Gove and the Division for Education that they need to have to act, and now, then all of us in my Integrate Bristol group would be delighted.”

Ban explained Mohamed was a important part of a around the world campaign to bring an end to FGM, which is estimated to impact much more than 125 million girls and females across 29 nations in Africa and the Middle East, in which FGM is most prevalent. An estimated 60,000 women and women have been victims in the United kingdom alone.

He stressed that there was no developmental, religious or well being cause to minimize or mutilate ladies and females, creating: “Although some would argue that this is a ‘tradition’, we should recall that slavery, so-known as honour killings and other inhumane practices have been defended with the same weak argument. Just simply because a hazardous practice has extended existed does not justify its continuation […] FGM triggers grave harm. The wellness consequences include depression, insecurity, ache, infections, incontinence and at times deadly problems in pregnancy and childbirth. Mothers should not be terrified of giving birth to daughters.”

The UN secretary common pointed to progress being created in Uganda, Kenya and Guinea-Bissau, which have recently adopted laws to end FGM. Arrests have been produced in Ethiopia, in Sudan a campaign has been launched against FGM, even though in Kenya elders have imposed a fine on any person carrying out or abetting the practice.

Every single country in Africa had sponsored the UN’s global day of zero tolerance for FGM on 6 March, he stated. “The result on men and women will be profound, sparing them horrible suffering and discomfort. So, thank you Fahma for what you are doing to aid make this occur.”

Ban Ki-moon backs campaign to tackle FGM by means of training

This Weblog Is "Not Suitable For Dissemination By means of The Internet"

The editors of the prestigious European Heart Journal have determined that this website, or at least one latest submit, “is “not ideal for dissemination through the internet.”

I beg to differ.

In an EHJ editorial, Is the panic about beta-blockers in perioperative care justified?, the authors, the editors of the journal, led by editor-in-chief Thomas Lüscher, repeatedly criticize a submit I wrote a few weeks ago with an intentionally provocative headline, “Medication Or Mass Murder? Guideline Primarily based on Discredited Analysis Might Have Caused 800,000 Deaths In Europe Above The Final 5 Years.”

Their editorial starts:

Controversial problems require correct discussion, the two in science and clinical medication. Occasionally the interpretation of the offered data is complicated and not suitable for dissemination by way of the net.one

That reference at the finish refers to my earlier report. They go on to think about the unfavorable results of my blog, writing that the “the feasible consequences… grew virtually exponentially” right after it was published. But they never ever spell out what individuals consequences actually were.

The exact same editors also unpublished (retracted? withdrew? disappeared?) an EHJ post by Cole and Francis that had been the topic of my site post. That article talked about the feasible damage induced by medical professionals in Europe following recommendations that have been partly based on discredited studies from the disgraced Dutch researcher Don Poldermans.  The new EHJ editorial contains a comprehensive rebuttal of the Cole and Francis article. The astonishing thing right here is that  they have published a substantial response to the Cole and Francis write-up, but simply because the authentic post has been withdrawn it is, rather decidedly, a one particular-sided debate.  EHJ readers are entirely unable to make any independent judgement for themselves about this problem.

This is constant with the paternalistic tone of the editorial. The editors adopt the tone of fathers who know greatest, telling their kids what they can read through and what they should believe and feel. Of program, they are very confident that they are performing this for the standard good: the editorial office, they publish, was “aware of its obligation and reacted accordingly.”

But since they really do not spell out the negative consequences of the write-up it is impossible to assess the dangers versus the rewards of publication. Could it be that the only actual consequences have been that they have been embarrassed by an inconvenient or controversial viewpoint?

And, I wonder, exactly where was their decisive action when this affair had its actual origins, a number of years in the past when the Poldermans scandal 1st emerged? The EHJ editors withdrew the Cole and Francis report only hours following it 1st appeared. But when the Poldermans affair 1st broke there was no comparable instant action. It would look that they are a lot more concerned by poor PR than by poor science or even possibly dangerous medication.

I will not now evaluation all the  complicated concerns involved in this controversy. Like others I will be interested to read through the revised edition of the Cole and Francis post, if it is ever published. But for now I stand by my earlier post, which initially ended with this explanation for its provocative title:

…there are very good reasons to think that this kind of provocation is essential. There is, it has now turn into clear, a general lack of concern and response to proof of scientific fraud and misconduct. Journal editors, deans, division chairs, and others seem much more concerned with guarding the track record of their respective institutions than aggressively upholding the integrity of science and investigation. Of program, defending science and keeping the track record of an institution need to not be opposing alternatives. But considering that they are, possibly a little provocation is in order.

A single last note, for connoisseurs of scandal. It seems from the editorial that the EHJ editor-in-chiefhas actually apologized to Poldermans for the harsh criticism his research, and the ESC tips derived from that study, acquired in the disappeared Cole and Francis post:

…the Editor-in-Chief informed the writer of 1 of the beta-blocker trials, who was heavily criticized in the post, that the European Heart Journal does not support the conclusions of this inadvertently published function.

Censorship (Photograph credit: IsaacMao)

This Weblog Is "Not Suitable For Dissemination By means of The Internet"