State Sanctioned Grave Robbing?

I see the Prime Minister has now backed the controversial proposals I referred to earlier this week for everyone to be placed automatically on the organ donor register.

I merely repeat the question I posed when England's chief medical officer suggested the idea last July: Do we really want to give the State presumed ownership of our body parts?

Next thing you know, Big Brother will be after our identities...!

NHS Bill of Rights

A new constitution for the NHS, proposed by the Government, would set out for the first time the rights and responsibilities linked to entitlement to NHS care. However, as we enter the year of the health service's 60th anniversary, does transforming it into "an NHS which is more personal and responsive to individual needs" really mean it will cease being free at the point of delivery for all and become a conditional provider of health services — more personal and responsive only to the needs of those who do not struggle with issues such as over-eating and smoking? Or, if the NHS is to survive, is this a necessary compromise in an age when an increasing number of patients expect their taxes to entitle them to access an ever-increasing range of expensive treatments and an ever-increasing choice of optional extras?

The English Patient

Despite last year's report by Derek Wanless urging the Department of Health to reconsider its policy of means-testing for care such as washing, dressing and cleaning, Health Secretary Alan Johnson still believes Scotland is wrong to provide free personal care for the elderly, prompting Labour MP Charlotte Atkins to accuse him of giving English patients "a raw deal" compared with those in Scotland.

Whatever happened to an NHS free at the point of use? Going the same way as the NHS dentist? Has Labour abandoned its post-war vision of "cradle to grave" welfare-state reform, of which it was until fairly recently so proud?

Cocaine's Health Time Bomb

Trends in prevalence of cocaine use among young adults (aged 15–34) in Europe

This year's annual report by the European Monitoring Centre for Drugs and Drug Addiction reveals that the proportion of young Britons who take cocaine has overtaken that of Americans and that, after cannabis, cocaine is now the second most commonly used illicit drug. 4.9% of men and women aged between 15 and 34 used the drug in Britain last year and 6% of teenagers at or below school-leaving age have tried the drug, with many users also using other substances including alcohol, tobacco, cannabis, and other stimulants.

Thus, although cannabis use in the UK has declined slightly (yet is still smoked by one in five people under 24), it has simply been replaced by a more fashionable — and significantly more harmful — alternative. The report's researchers warn that cocaine is a growing public health issue, its most common adverse effects including cardiovascular disorders, strokes, and seizures. Given that no effective medication exists to help cocaine users maintain abstinence or reduce use, more than ever we desperately need a new approach to the Government's failed drugs strategy.

NHS Independence

Criticising Conservative proposals to make the NHS independent, Health Minister Ben Bradshaw says, "It is simply wrong to suggest that taxpayers should invest £90bn in the NHS but there should be no political accountability for how that money is spent."

Indeed! In truth, what is wrong is that the Government should throw so much of taxpayers' money at the NHS but without giving the medical professionals the freedom they need to look after their patients properly. Since we learnt about the death of ninety patients from C.difficile at Maidstone and Tunbridge Wells NHS Trust, I have heard two first-hand stories revealing a life-threatening lack of care and attention to detail.

The first went in to have a kidney out. When asked to sign the paperwork authorising the operation, my lawyer friend decided to read the details of what he was about to authorise. Noticing that it stated the left kidney was to be removed, he queried surely it was his right kidney that was the problem. His question was dismissed but when he persisted, a check was made. Sure enough, they had been about to operate on the wrong kidney ... a minor detail.

The second, just a couple of days ago, was to undergo a minor procedure but was turned away because he has MRSA — something that was detected and recorded in his medical records while he was in for a hernia operation earlier in the year but was left untreated with the patient, unaware of being a carrier, discharged into the community. Again ... a minor detail.

This is what the government healthcare watchdog means when it criticised the trust for "focusing too much on balancing the books and meeting waiting-time targets, at the expense of patient care and infection control." This is the consequence of Government targets, unprecedented cuts in the number of acute hospital beds, and a shortage of nursing staff.

It is time the NHS was freed from political tinkering. Let us hope that Gordon Brown is still happy to adopt Conservative proposals as he formulates his "vision" and that the Conservatives' draft NHS (Autonomy and Accountability) Bill becomes Government policy.

Teenagers Looking For Love?

Teenage Pregnancy Rates (%)A new report by Population Action International, A Measure of Survival, confirms that Britain has the highest teenage pregnancy rate in western Europe. It also concludes that our maternity services are worse than those in Hungary, Slovakia and Cuba and ranks us just 17th out of 29 European countries on health services overall.

Anybody else remember the Government's Teenage Pregnancy Strategy, which not only failed to stem the rise in teenage pregnancies but has fuelled record levels of STIs and, where implemented most heavily, has resulted in the biggest increases in underage pregnancies? Anybody else think there might be a correlation with British children having the worst physical and emotional well-being and the worst relationships with family and friends among the world's wealthiest nations?

Treating Symptoms Not Causes

As anyone who has seen today's news will know, following the deaths of 90 hospital patients from Clostridium difficile, Maidstone and Tunbridge Wells NHS Trust has been seriously criticised for focusing too much on balancing the books and meeting waiting-time targets, at the expense of patient care and infection control.

If Kent police have launched an investigation into whether the trust should be prosecuted for the deaths, who is going to challenge the Government for imposing its misguided and distorting targets in the first place? It's time the state stopped interfering in our public services and returned power back to the professionals who work in our local communities.

<exasperation>!</exasperation>

A Question Of Convenience

As with the over-medication of children and euthanasia, I find myself asking to what extent convenience is the driving factor behind the request of Alison Thorpe, the mother who has asked doctors to give her 15-year-old daughter Katie a hysterectomy to stop her from starting menstruation — on the basis that Katie suffers from cerebral palsy and "would be confused by periods and they would cause her indignity."

If Mrs Thorpe's doctors are granted legal approval, a dangerous and disturbing precedent will have been set. And if anyone has difficulty understanding why that might be so, perhaps it's time to re-read Ken Kesey's "One Flew Over the Cuckoo's Nest" (or to re-watch the 1975 film starring Jack Nicholson)

NHS Needs Competition

"Healthcare right now in America - and I think it has been true of your experience of socialised medicine in England - is not only very expensive, it's increasingly less effective. I had prostate cancer seven years. My chance of survival in the US is 82%; my chance of survival if I was here in England is below 50%. Breast cancer is very similar. I think there's something to the idea that there are many more private options driving the system that create altogether better results."

Nothing quite like a reality check from the Republican presidential front-runner Rudy Giuliani, former mayor of New York ... Wonder what Gordon Brown made of that?

A Sense of Belonging

Discussing today's Public Services Improvement Policy Group report on Radio 4 this morning, Baroness Perry suggested that the tendency for school size to increase over the last ten years has been a disaster "very much at the root of some of the bad behaviour that we have seen":

"It's a sense of belonging more than anything else which children lack in very large schools. They feel that nobody knows them and if you are not known you can get away with anything. The sense of being part of a smaller community where people do know who you are, where you have a real sense that you belong in the community and it matters what you do, makes a huge difference."

She went on to praise experiments in America where big schools have been broken down into small units — what they call "several small schools under one roof" — resulting in reduced truancy rates and improvement in both performance and discipline. She was also critical of the increase in the number of repeating exclusions — almost a quarter of a million a year — which she described as "just a recognition of failure":

"I want to see much more positive attempts within the school to keep these children engaged, interested and excited in what's going on. I think we are failing them by giving them a curriculum which is only really suitable for about half the children in our schools — the other half are being failed by what we're offering them."

Among the 156 proposals in the report, some of the other ones that stand out for me are:

Health

• We propose that the Treasury should present an annual report to Parliament which sets out the public health implications and impacts of all public expenditure programmes both within and outside the Department of Health.
• We propose that the next Conservative government should remove licences from shops prosecuted for selling alcohol and tobacco to minors.
• We propose that the next Conservative government should establish better access to mental health and drug rehabilitation services for those in the criminal justice system.
• We propose that the next Conservative government should bring forward legislation to provide for the establishment of an NHS Board which is independent and accountable to local communities and through Ministers to Parliament.
• We propose that the next Conservative government should establish a new statutory framework for NICE which clarifies the scope of its work and advice.
• We propose the next Conservative government should work with professional and patient groups to develop a new primary dental service contract that ensures equitable access to dental services.

Education

• We recommend that teachers receive full anonymity until any case against them has been fully dealt with.
• We recommend that a review of guidelines and publications are sent to schools should take place, with the aim of reducing the burden that these place upon teachers, allowing them the professional freedom to teach.
• We propose that the level of prescription set out in the Early Years Foundation Stage Profile and the Primary National Framework be slimmed down to enable early years teachers to focus their judgments on what is best for each individual child.
• We recommend that there should be far fewer national targets, as the determination of the broad outcomes would give a firm steer to the service nationally. A slimmed down structure of national tests at 7, 11, 14, GCSE and 18-19 examinations and diplomas would provide the government and public with all the information needed to monitor whether the system was delivering successfully.
• Any pupil falling behind at the age of 11 should, we believe, be given a chance to have remedial education to bring them up to the right standard in the basics, either during the summer before secondary school, or even – particularly perhaps for the summer-born – repeating the final primary school year.
• We recommend that schools should set by ability unless they can demonstrate that they can achieve higher standards using mixed ability teaching.

Social Housing

• We recommend that social and economic mobility should be cornerstone of housing policy generally, and of community housing policy in particular. The aim of community housing must be to encourage greater home ownership, with a flexibility that will cater both for those in greatest need and for those struggling to find a home.
• We recommend that tenants who move between Housing Associations retain their Preserved Right to Buy.
• We propose a review of VAT and Stamp Duty regimes that discourage private sector involvement in refurbishing the social housing sector.

Labour's Alcopops Addicts

Take a good look at the picture below comparing a normal liver with one destroyed by cirrhosis and then read the latest figures from the British Liver Trust on how serious our under-age drinking problem has become in the last five years:

Between 2001 and 2006 unit consumption for 11-13 year olds who drank alcohol had risen by nearly one hundred percent from 5.6 units to 10.1 units in a one week period.

A report published today by The Information Centre highlights the need for a change in behaviour from young people with one in five pupils aged 11-15 years admitting to being drunk in the last four weeks of the study and around a third of these pupils had deliberately tried to get drunk.

This follows news earlier in the year that the number of hospital admissions involving teenagers with alcohol-related diseases caused by "acute intoxication" has almost doubled over the past four years, including three children under the age of 18 who were treated for alcohol-related liver cirrhosis, a disease that usually takes five to ten years of heavy drinking to develop.

So much for Labour's approach to alcohol...

Darfur Blog

The Health Centre today resembles a cattle market. There are people everywhere. Children crying everywhere. I do a quick triage of women and children sitting on a large collection of mats outside. Right at the back of the queue I notice a little baby that looks very poorly indeed. I usher both mother and child through to my (grim) consulting room. My seat is a chair made of straw. It looks about 30 years old and I'm sure would provide many exciting hours of study for a Microbiologist and his petri dishes! The back of the chair consists of a grubby piece of rope holding together two wooden legs. The baby is nine months old and looks very marasmic and wasted. Just a thin layer of skin covers her ribs. I put a MUAC (mid-upper arm circumference) bracelet on her and it reads ''red- severely malnourished''. Her whole body is moist with beads of sweat. I give her one week's supply of Plumpinut. This is a high-energy ready-to-eat French product that is stuffed with calories and nutrients. In addition I give Mum a mosquito net and a prescription for a collossal dose of Vitamin A, Measles jab, rehydration solution and antibiotics. This child really needs to be admitted and watched by nurses like a hawk. But we just don't have the human resources or capacity. She has her treatment and takes her chances. I arrange to review her tomorrow and spend a great deal of time and effort giving the Mum advice. She is this baby's only nurse. I also insist that Mum doesn't sell the Plumpinut on the market or feed it to her other kids. This does, unbelievably, commonly happen. Mum gives me her word and I fast track her to the front of the pharmacy queue. Onto the next patient.......

Ever wondered what life must be like for the aid workers trying to help Darfur's refugees and internally displaced people? Médecins-Sans-Frontières doctor Neil Fletcher recently started working in Eastern Chad and is keeping a diary online at www.drfletcherinafrica.co.uk

Anyone For Presumed Consent?

England's chief medical officer, Sir Liam Donaldson, wants a system of "presumed consent" to be introduced in England to tackle organ shortages.

Do we really want to give the State presumed ownership of our body parts? Surely a better way to close the gap between the 70-90% who say they would be willing to donate their organs after death and the 20-25% who carry a donorcard or are on the NHS Organ Donor Register, and thereby combat the "transplant crisis," would be to make it easier to register? How about, for example, including a consent form as an integral part of every driving licence and passport application? Or making the forms available at every supermarket checkout, instead of all those useless offers of credit?

In the meantime, if you would be willing to give your consent but haven't done so, you can do so online at UK Transplant.

The Elderly - Who Cares?

The NHS Blog Doctor has a brilliant dissection of today's Times article, Who cares? Both the article and the good doctor's response are rather long, but here's his conclusion:

The NHS was set up and funded to deal with illness, not old age. The problem in the UK is that the Welfare State mentality has turned us into a nation of welfare payment scroungers. Why do families in this country not take responsibility for their own elderly? Why should the taxpayer pick up the bill for the social care of elderly, wealthy businessmen?

Why do we not care for our own elderly relatives? It can be done. Some British families do it. Families of Indian and Pakistani origin. I have never, in all the time I have been practising medicine, heard an Indian or Pakistani say “We cannot look after mother because we have jobs and families of our own” Somehow, they manage.

My practice looks after three large old people’s homes and an EMI [Elderly Mental Illness] unit.

There is not a single patient of Indian or Pakistani origin in any of the old peoples’ homes. There is one hopelessly demented elderly Pakistani lady in the EMI unit. She probably gets more visits than the rest of the patients put together.

There must be moral in this.

Another Alzheimer's Warning

New research indicates that the incidence of Alzheimer's disease will quadruple by 2050, at which point 1 in 85 people worldwide will have the brain-wasting disease. We in Britain were warned earlier this year that by the middle of the century, dementia is expected to affect the lives of around one in three of us, either as a sufferer, a carer, or a relative. Treatment has been hampered by the availability of drugs on the NHS and the misuse of sedatives. Yet, if these were the only problems, the disease need not present an insurmountable crisis in health care.

The bigger problem is that the disease is difficult to detect in its early stages and the impact of existing drugs is only really significant if they are prescribed early on. Progress recently made by researchers in America therefore offers us all hope. One group at the University of Pennsylvania has developed tests involving blood and brain scans that can detect early symptoms of Alzheimer's, while another at the University of California San Francisco has identified a number of factors that a family doctor could use to predict who might be developing Alzheimer's. These factors include the time it takes to button a shirt, the time needed to walk fifteen feet, not drinking any alcohol at all, and unexplained weight loss.

Once such predictive tests are fully developed and widely available, they will both help patients and their families to plan better for the future and offer scientists the opportunity to develop new treatments. Delaying the onset of dementia by five years would halve the number of deaths directly attributable to the condition each year and reduce the burden of care for both health workers and families. It is therefore a scandal that the Government places such a low priority on Alzheimer's research — it urgently needs to increase funding to levels more comparable with other diseases, such as cancer.

If you have experience of caring for someone with dementia, please do email me or share your story with us in the comments.

NHS "On Its Knees"

A year ago Health Secretary Patricia Hewitt staked her job on wiping out the NHS debt. Apparently the Government is to announce today that she has succeeded, but at what cost?

• Deficits of £1,300,000,000 run up by a third of hospitals and primary care trusts hidden by making cuts and taking money from elsewhere.
• The recent loss of 22,300 health jobs
• Almost three-quarters of newly-qualified nurses unable to secure jobs
• The complete failure of the new online job application system for junior doctors, the Medical Training Application Service (MTAS).
• A reduction of 9,000 beds in hospitals.
• A record number of injuries and deaths in maternity care.
• A steep rise in hospital infections.
• Two-thirds of dentists turning away patients as two million patients are now without access to an NHS dentist.

Patricia "the NHS has just had its best year ever" Hewitt may be right that 90% of patients are happy with the service they receive from NHS staff. However, that does not mean that 90% of patients — let alone 90% of NHS staff, or even 90% of the general public — are happy with their local accident and emergency departments, community hospitals, and maternity units being forced to close. No wonder the leader of Britain's 33,000 hospital consultants is claiming the NHS is "on its knees" and warning that only if doctors are given the authority to organise a recovery will the NHS be saved from its current crisis.

Big Brother Hoax

BREAKING NEWS: The Dutch kidney transplant reality show was a hoax!

Dutch kidney transplant reality show was a hoax

A Dutch reality television show in which a supposedly dying woman had to pick one of three contestants to whom she would donate a kidney was a hoax, the programme makers said on Friday.

The show, produced by the public broadcaster BNN, was condemned by Prime Minister Jan Peter Balkenende of the Netherlands ahead of transmission and sparked controversy worldwide.

Identified only as "Lisa," the 37-year-old woman who had been said to have a brain tumor, was to base her selection on the person's history and conversations with the candidates' families and friends.

At the last minute, she was revealed as a healthy actress. The contestants were also part of the deception.

BNN said it wanted to draw attention to the growing shortage of organ donors in the Netherlands.

Reality TV: Get A Life

I suppose that I have never understood the voyeuristic urges that have so popularised reality TV shows. However, the latest such show from Holland truly seems like something out of science fiction - somehow reminiscent of Schwarzenegger's Running Man, where lives of contestants are involved. For Dutch viewers will be phoning in to vote for which of three patients will receive the donated kidney from a terminally ill lady called Lisa.

Making money out of the televised modern equivalents of beauty and popularity contests is one thing. Doing the same to resolve ethical questions of medical need seems like a dangerous first step towards the legal sale of body parts.

NuLab's NHS 2

Much has been said and written about the death of Penny Campbell, who consulted eight doctors over Easter in 2005 before dying of blood poisoning following a routine operation. Much of it appears to direct blame at the out-of-hours service provider Camidoc. However, as Wat Tyler makes clear at Burning Our Money, the real blame lies with the Department of Health and the new GP contract negotiated by the Government three years ago, which allowed GPs to opt out of their former responsibility for night and weekend healthcare cover but provided patients with no adequate alternative.

What should be done now to prevent further unnecessary tragedy? We could see what ideas the incoming Prime Minister, the man who has been in charge of British domestic policy for the past 10 years, has: "The health service has got to be there for people when they need it and we need to do better in the future." Then again, we could listen to the experts — This is what the NHS Blog Doctor suggested earlier in the year:

Here is the Crippen “back of envelope” plan for improving primary health care. Scrap all the targets. Use the money to pay incentives to GPs who provide wide availability.

• a “before work” surgery from 7.00 am to 9.00 am
• an “after work” surgery from 7.00 pm to 9.00 pm
• a lunchtime surgery from 12.00 to 2.00 pm.
• surgeries on Saturday and Sunday through-out the day

Any other thoughts anyone?

Super Thursday 2

Prompted by the anonymous comment about the latest 13% increase in the projected cost of ID cards, due to become compulsory for everyone applying for a new passport from 2009, I am opening this thread for any other readers who spot items of "bad news" being buried today.

I'll add to the list with this morning's government admission that 28 NHS trusts are failing to ensure non-emergency hospital patients are kept in single-sex accommodation — incidentally also yet another of Blair's broken promises, as he committed himself to end mixed-sex accommodation in the NHS in his original 1997 general election manifesto.