Category Archives: Good News

Midwives are right to revisit received wisdom on what counts as a ‘normal’ birth

Mothers are having fewer children later. This makes them more high risk, and most sensible ones will have whatever form of delivery gives the best chance of a normal child. 

Born Free. Times leader 12th August 2017: Midwives are right to revisit received wisdom on what counts as a ‘normal’ birth

For an event so natural that none of us can avoid it, the business of childbirth has become an unfortunately ideological battleground. Since the 1960s advocates of “natural” birth have been pitted against defenders of medical intervention. The assumption, driven in part by advice from midwives, has been that a natural birth is somehow superior. In an interview with The Times today Cathy Warwick, chief executive of the Royal College of Midwives (RCM), acknowledges that her profession has got the emphasis wrong. There are great benefits to birth without interventions, but they should be pursued in a way that is sensitive to every woman’s situation, not as an article of faith.
For 12 years the RCM, midwives’ professional and representative body, has campaigned, as a matter of policy, for births where the mother enters and completes labour without medical intervention. Avoiding epidurals, forceps, artificially induced labour or a Caesarean section, the RCM argued, was better for mother and child. Yet that orthodoxy has been criticised, on two grounds. First, it can take a psychological toll on mothers. Those who ask for medical intervention because of their own anxieties or past experiences, are often left feeling as if they have failed. The RCM has sensibly decided to scale back the use of value-laden terms such as “normal birth” in favour of more neutral phrases like “physiological birth”.
The second, and more trenchant criticism of old habits is that they risk putting patients in danger. There is some evidence to support this charge. In 2015 an inquiry into a catalogue of unnecessary deaths in a Morecambe Bay hospital found that midwives’ pursuit of normal childbirth “at any cost” was, in part, behind the failures.
James Titcombe, who brought the scandal to national attention after the death of his son, has warned that the pressure for a delivery without medical intervention is rooted not in concern for patient safety, but in ideology. There have been concerns, too, about the role that midwives’ prejudices may have played in a string of deaths at Shrewsbury and Telford Trust.
None of this means that more intervention is always better, or even that it often is. There is value in a physiologically natural birth — the touch of a mother’s skin to her child’s in the moments after delivery helps to build a bond; a profusion of tubes, doctors and medical instruments does not. Caesarean sections come with well established risks. Mothers are vulnerable to the complications of any major surgery, and researchers have found some evidence that babies born this way are more likely to suffer from asthma and obesity in later life.

However, parents are well able to understand these risks and come to a considered view on what is best for them. The dangers are greatest, in any event, when interventions are emergency measures, taken after the failure of a “normal” birth. Better that midwives speak openly and neutrally about the benefits and risks of epidurals, inductions and Caesarean sections, well in advance, to avoid eleventh-hour panics.
Healthcare in Britain mostly compares favourably to that in other countries. Childbirth, however, is the exception. Britain has among the highest infant mortality rates in western Europe. That is all the more reason for midwives to eschew ideology and focus instead on what will work best for mothers and babies.

Mums, you have a 1:200 risk of stillbirth – what can you do about it?

The long term results of rationing midwives and doctors in training…

NHS improvements lead to fewer deaths from heart failure

Chris Smyth reports in the Times 10th August 2017: NHS improvements lead to fewer deaths from heart failure

When it gets broken down I predict this improvement will be post coded…. with the rural areas doing worst.

Almost 500 lives a year are being saved by improvements in NHS care for heart failure, a review has found.
Too many people still die from the condition, however, and experts urged hospitals to make sure more get crucial treatment and see specialists promptly.
More than half a million people in Britain have heart failure, in which the heart struggles to empty and fill. It is most common in the elderly and accounts for one in 20 NHS hospital admissions.
Researchers at University College London found “modest but important improvements” as death rates in hospitals fell from 9.6 per cent in 2014-15 to 8.9 per cent now but added: “Mortality remains too high and there are large variations among hospitals.”
Sir Bruce Keogh, of NHS England, said: “This independent study shows that improvements to NHS heart failure services have had a significant positive impact . . . The progress highlighted today will be a spur for us to do even more to improve care.”

There are still not enough medics – even with a 25% increase

The BBC news reports 9th August 2017: Medical school places to increase next year

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but this will still not be enough, and we need a realistic approach. Given that 80% on medical students are undergraduate appointments, and 80% are women, we need at least a 250% increase in medical student intake. If we change to graduate entry a 200% increase might be enough. Students can be trained in localities using the internet. Only intermittent assessments and exams need to be centralised, (if they are practical) but the theory exams can be “on line” from local driving test centres. The 2 in 11 successful applicants to medical school needs to change to 5 in 11 immediately, and to 10 in 11 if we are to accept the current drop out rate and gender bias. It is good news, but limited and unimaginative.

An extra 500 medical school places in England have been confirmed for next year by the government.

The Department of Health announced in October it planned to add up to 1,500 more places each year – a boost of 25% on current student doctor numbers – and says it will hit that target by 2020.

It is part of a plan to use UK-trained doctors to ease NHS staffing pressures.

But the British Medical Association says the plan will not address the immediate shortage of medics.

Training to become a doctor takes at least five years and currently about 6,000 graduate each year.

Diversity drive

The government wants many of the new training places to go to students from disadvantaged backgrounds to improve diversity in the medical profession…..

….Prof Wendy Reid, from Health Education England, said the extra places would help the NHS meet the diverse healthcare needs of patients “up and down the country”.
Shadow health secretary Jonathan Ashworth said: “Ministers have repeatedly announced plans to increase doctors’ training levels and in many key medical specialities they are failing to fill the places already on offer.
“The government need to get a grip and put in place a long-term workforce plan backed up with significant new investment for the number of staff needed to deliver services safely.”

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Multi-tasking GPs give Google glasses new lease of life

Kat Lay in the Times July 22nd reports: Multi-tasking GPs give Google glasses new lease of life
and since I am always looking for what could be good news, NHSreality has posted.

My mother always demanded her GP to turn the screen away from him/her and look at my Mum when they consulted. Google’s glasses seem to be able to address her concerns, without reducing the efficiency of the GP consultation. I suspect GPs are dubious and the overstretched majority will reject even attempting to work with a camera next to their eyes..

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It’s a familiar scenario: you go to see your GP but they spend more time looking at their computer than at you. Now a futuristic solution could mean more than one pair of eyes looking at you in the consulting room.
Doctors complain that they need to start typing while their patient is still talking, because consultations last only ten minutes and the next patient is waiting.
The electronic systems favoured by NHS bodies are inefficient, they say, making it harder to have a real, human interaction with the person seeking their advice. Patients too, complain, feeling they are not being listened to.
Doctors in the United States have started wearing Google Glass, the computer built into spectacle frames with cameras, while examining patients to get round the problem.
The consultation is watched in “real time” by a medical scribe working remotely — often in India or Bangladesh — using a platform developed by Augmedix. They type up the notes for the doctor to later amend or approve.

The glasses can also display information from a patient’s notes.

Google Glass was launched in 2013 as a consumer device but failed to take off and production stopped in 2015.

Google has now quietly reinvented it for business use. Glass Enterprise Edition has longer battery life and is said to be more comfortable. Ian Shakil, the chief executive and co-founder of Augmedix, told Wired magazine that the new use was the polar opposite of Glass’s original launch.

He said: “When you hear the word Glass, you think dehumanisation, social disruption. We’re the opposite — being close to the patient; being able to put your hand on his or her shoulder to comfort them.”

Davin Lundquist, chief medical officer at Dignity Health, uses Augmedix when he sees patients. He said that it had cut the time spent typing up notes from 33 per cent of the day to 10 per cent and that interaction with patients had risen from 35 to 70 per cent.

In an interview with Popular Science Mr Shakil said that 98 per cent of patients consented to the use of Glass, and the device displayed a green light when it was recording and could switch to audio-only mode.

As well as doctors’ consulting rooms, the technology is being used on factory production lines.

NHS doctors and nurses do not yet use the devices. The technology is not completely alien to the UK, however. Queen Mary University of London’s medical school started using Google Glass in 2014. Its surgeons wore the devices as they removed cancerous tissue from the liver and bowel of a 78-year-old man in a teaching session watched live by 13,000 people around the world.

Drugs giants challenge NHS rationing plans in court. If the government wins the case should be appealed to the European Court before it no longer has the right to judge – after Brexit.

Planned deferment or delay is another form of rationing. Once a new drug has passed all the hurdles, in a non rationed system it should be released for general use. The plan to defer and delay the right for doctors to use a new product is rational rationing, and perfectly appropriate. This case will depend on the use of the English language, and exclusions, prioritizations and deferments will all be referred to. There is plenty of precedent: occasions when a drug has been discouraged or disallowed until it’s patent is nearly over (usually 12 years), and in the USA delay of Salbutamol spray for asthmatics was responsible for many deaths. One can only speculate at the US reasons for delaying such a life saving drug. In a mainly private and insurance based system there could be few reasons for the delay, other than a political one. The delay allowed copycat products to be ready and waiting when salbutamol (Ventolin) was allowed. 

Fortunately, in a small state run mutual such as Wales, there is no meaningful disincentive other than overtly rationing because we need to control costs. By being honest all the different jurisdictions can help to reduce costs, reduce expectations, and treat the taxpayer and citizen as partners in their own health mutual. (Good News?) NHSreality hopes the ABPI wins it’s case, as it will make the politicians take on the dishonest language of covert rationing. If the government wins the case should be appealed to the European Court before it no longer has the right to judge – after Brexit.

In the near term there is no doubt that rationing should be legal. Without it we will go bust. The pace of technology advances faster than our ability to pay. Demographics mean we live longer and need more care, and The Information Age  means that we want to know the truth… But remember, the government and the politicians duty is not to individuals but to populations…. They must start listening to public health doctors instead of Single Interest Pressure Groups such as the APBI.

Chris Smyth reports in the Times 10th July 2017: Drugs giants challenge NHS rationing plans in court

The pharmaceutical industry is taking the NHS to court in a highly unusual effort to block “wrong and unnecessary” rationing plans.
Drugs companies argue they are acting in patients’ interests by trying to kill off powers that allow health chiefs to delay or restrict medicines to save money, even if they have been ruled to be cost-effective by experts.
However, the sight of pharmaceutical giants dragging the NHS through expensive litigation will be uncomfortable for an industry that is trying to build bridges with the government over Brexit and industry strategy.
The Association of the British Pharmaceutical Industry is seeking judicial review of changes that allow NHS England to delay or restrict treatments if the total cost to the health service exceeds £20 million a year.
The rule applies to medicines already judged good value for money by the National Institute for Health and Care Excellence (Nice) and has been condemned by patient groups after it emerged that one in five new drugs could face delays. The threshold came into effect in April but has yet to be trigged.

Richard Torbett of the ABPI said: “We are talking about cost-effective medicines and the idea that the best medicines that help more people are going to be captured by this contravenes the fundamental right to access to cost-effective medicines . . . To arrive at this position where it’s the most important new medicines are the ones that get delayed, that seems back to front.”
He said that legal action was the “absolute last resort” but argued that NHS England had refused to consider options that would affect fewer people.
“We think the legal case is so strong that if we hadn’t taken this action given the strength of feeling somebody else would have looked to do so, possibly an individual patient,” he said.
“I believe we’re doing the right thing in terms of getting patients access.”
Rachel Power, chief executive of the Patients Association, said: “NHS England’s decision not to fund new medicines recommended by Nice was an astonishing admission that our NHS can no longer afford to keep up with scientific breakthroughs. This is a direct result of the government’s decision to under-fund the NHS. Patients throughout England will hope that this legal action forces a re-think.”
Baroness Morgan of Drefelin, chief executive of the charity Breast Cancer Now, said she hoped the legal case would “provide clarity on the issue of timely access to drugs in England”.
She said that the £20 million threshold would be a “major hurdle” for cancer drugs, adding: “We remain extremely concerned that the budget impact test could see NHS patients experience delays in accessing vital and cost-effective drugs.”
Simon Stevens, head of NHS England, has taken a tougher line on such spending, saying there is no reason why new drugs should “crowd out” spending on extra nurses, mental health staff or other effective ways to treat people.
NHS England and Nice declined to comment, but senior health officials are irritated that public money will have to spent to defend the action. Last year NHS England won a similar challenge against its decision to cap how many people would be treated each year with a breakthrough hepatitis C medicine.
Mr Justice Blake wrote in that case that “it is undesirable that the defendant as a public authority devoted to healthcare should have its budget for health provision reduced by irrecoverable legal costs it has incurred to meet a failed challenge”.
Mr Torbett insisted that all drug companies were behind the decision, expressing hope that the action would not disrupt recent efforts to build goodwill with minsters, which include handing over £250 million to the government this year to plug a hole in the drugs budget.
“Of course we would rather not be here but it’s not going to get in the way of collaboration with government and we hope it won’t prevent them from doing that as well,” he said.
A High Court hearing is expected in the next few weeks.

City Hospitals Sunderland trust welcomes IT self check-in solution

GPs have been using self check in for some years now. Finally at least one Trust follows the leaders. If only the Trusts would allow GPs on their boards, and put one shared IT system at the top of their agenda. Are there unrecognised risks in impersonation? Has not happened yet…..

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City Hospitals Sunderland trust welcomes IT self check-in solution

City Hospitals Sunderland NHS Foundation Trust has deployed an IT self check in solution to help improve efficiency and reduce patient queues.

The patient self check-in kiosks, provided by Intouch with Health, are interfaced with the trust’s fully integrated Meditech electronic patient record solution and is now live across the organisation. The trust’s director of information management and technology Andy Hart said the self check-in devices have been extremely well received by patients and staff, and are allowing the trust to not only realise internal efficiencies, but introduce a solution which works well for the patients themselves.

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A fundamental dishonesty is behind almost all the Health Services System news… and our failure to respond appropriately and improve.

There are many signs that the rivets have popped (The NHS: have the rivets popped? ) and those of us in the professions know this. The reasons include poverty, perverse incentives for commissioners and trusts, covert rationing, and lack of choice. These can all be covered by “dishonesty” in the language of health and the way information is given to the public. We all need to know what is not available in our particular health care cohort. A lack of honesty is behind almost all the Health Services System news… It is similar to the lack of open honesty in London after the Grenfell Tower. The Independent 29th June 2017: Grenfell fire: Kensington council cancels meeting after High Court lets journalists attend. It is the same with Trust and Commissioner Boards: all the important decisions are taken in private. Even the National Health Executive is at odds over integration of Health and Social Care… (NHS and council bosses at odds over divisive Better Care Fund targets

If silence is dishonesty, then dishonest politicians and administrators have resulted in dishonest doctors and nurses.

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The small amount of “good news” is in “Learning from Scotland’s NHS” – from the Nuffield Trust (particularly mental health) but does not comment on the financial state of their health service, or choice limitation. May needs to put young people’s mental health at the centre of policy.

This report looks at Scotland’s unique health care system, and explores how other parts of the UK might be able to learn from it. But remember what is lost in Scotland: Analysis: Why is Scotland not doing more to offer stem cell treatment … Herald Scotland30 Jun 2017

and on 6th July: BMJ investigation: NHS ‘postcode rationing’ on the rise

Clinical Commissioning Groups (CCGs) in England are increasingly rationing treatments amid growing financial pressure, an investigation by the BMJ reveals.

Freedom of Information data from 169 CCGs shows a 47% rise in the overall number of individual funding requests (IFRs) submitted to CCGs by doctors over the past 4 years, with substantial variation across the country.

Cataract removal, hip and knee replacements, and mental health care are among the top 10 most commonly requested treatment areas….

and

Chris Smyth in the Times 5th July 2017:  Patients forced to beg for routine operations

( and Council revolt over NHS chief Simon Stevens’s ‘secretive’ social care reforms – see below)

Patients are having to beg for treatment that was once routine as the NHS rations procedures ranging from hip replacements to cataract removal.

Requests by doctors for exceptional funding have surged by almost 50 per cent in four years as health trusts restrict what they will automatically pay for, an investigation has found.

Patients are left in pain because of long delays even when permission is granted, in the latest sign of the impact of cost-cutting. In Buckinghamshire, every patient referred for hip and knee surgery must have their request scrutinised by a panel. The local health trusts that pay for care have been ordered to make savings in order to help the NHS balance the books after years of hospitals running deficits. An investigation by the BMJ has found that doctors seeking common treatments for their patients are increasingly forced into individual funding requests — pleas for discretionary approval for procedures.

In 2016-17, doctors made 73,900 such requests, up 20 per cent from the year before and 47 per cent from 2013-14, when 50,200 were made, according to data gathered under Freedom of Information laws. About half the requests are granted, often after months of delay.

The requests are most commonly used for fertility treatment or cosmetic procedures but an increasing proportion are now for treatment that was once routine. Three years ago just 49 such requests were for hip and knee surgery. This rose to 899 in 2016-17.

The Times also reported July 5th: Doctors send scans by social media to bypass ‘backward’ NHS systems

Georgie Keate, Fariha Karim report6th May 2017: Bosses knew about groping surgeon for years

and Chris Smyth: Antibiotic factory waste water was as toxic as drugs

Council revolt over NHS chief Simon Stevens’s ‘secretive’ social care reforms

Councils have turned on the NHS over “secretive, opaque and top-down” reforms that they say will fail patients.
Simon Stevens, chief executive of NHS England, has staked his tenure on co-ordinating care more effectively and has said that local authorities are crucial to the process because they oversee public health and social care for the elderly.
However, only a fifth of councils think the plans will succeed amid widespread complaints that they have been shut out of the process by the NHS, according to a survey by the Local Government Association.
Not one councillor who responded said they had been very involved in drawing up plans and nine out of ten said the process had been driven from Whitehall rather than locally. Cultural clashes with a “command and control” NHS that did not trust elected councillors meant that more local authorities believed the process was harming social care than helping it.
Mr Stevens has created 44 “sustainability and transformation partnerships” (STPs) where hospitals and GPs are meant to plan with councils on how to improve care and help close a £22 billion black hole in the NHS budget. However, four out of five councillors said the system was not fit for purpose and criticised the NHS for prioritising cost-cutting and closing hospital units over preventing illness.

Izzi Seccombe of the Local Government Association said: “Many councillors have been disappointed by the unilateral top-down approach of the NHS in some of the STP areas. As our survey results show, the majority of local politicians who responded feel excluded from the planning process. If local politicians and communities are not engaged then we have serious doubt over whether STPs will deliver.”
Half the 152 councils with social care responsibilities responded to the survey and 81 councillors with responsibility for health contributed. “The way in which the STP has been handled (top down, secretive, lack of engagement) has harmed relationships between the council and some NHS colleagues,” one said.

Another said: “It is entirely driven from the top, via budget pressures. The process has been overly secretive and opaque. It has got in the way of closer working between councils and health.”
Councillors criticised STPs as “complex and full of jargon”, saying “the NHS simply does not understand the decision-making of local government”.
Ms Seccombe said that in a centralised NHS, managers often did not want to share information with party political councils accountable to local voters, saying that the process was “trying to mix oil and water”.
Chris Ham, chief executive of the King’s Fund think tank, said: “This survey suggests worrying numbers of council leaders are still frustrated by the process and lacking in confidence in their local plan. A huge effort is now needed to make up lost ground.”
A spokesman for NHS England said: “By creating STPs we have issued a massive open invitation to those parts of local government willing to join forces, while recognising that local politics can sometimes make this harder. The fact that public satisfaction is more than twice as high for the NHS as it is for social care underlines the real pressure on councils. It should serve as a wake-up call to every part of the country about the importance of joint working.”

(NHS and council bosses at odds over divisive Better Care Fund targets)

St Albans Advertiser 7th July: St Albans patients could have to pay for hearing aids and IVF under new NHS cost-cutting proposals

Walesonline 14th May 2017: Shortage of GPs causing waiting times ‘crisis’ for patients in Wales …      

Sarah Marsh in the Guardian 6th July 2017 reports: More patients waiting longer than a week for GP appointments – Annual survey shows that in England 20% must wait at least seven days and many are unable to get an appointment at all

In Chester the Jez Hemming for Daily Post 4th July 2017 reports Health council slams system delaying new GPs coming to work in Wales – Geoff Ryall-Harvey, chief officer of North Wales Community Health Council, says GPs wait up to 12 weeks to get on Welsh NHS Performance List

Dishonesty about open government is not restricted to London:  Labour revolt spreads as councillors barred (The Times May 19th 2017)

Governments can do a great deal of harm in health… Aneurin Bevan’s dream is being replaced by a greater fear…

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