Results Demonstrate Improved Patient Outcomes and Support UK’s NHS Mandate for Zero Pressure Ulcers
Category : World News
MILLBURN, NJ–(Marketwired – Apr 16, 2013) – Dr. Harold Pollack, a dentist in New Jersey, and his practice have updated their CEREC software and camera to maintain their commitment to providing the most advanced technology and procedures available. The CEREC device is designed to create custom dental restorations in one appointment so that patients can have their teeth fitted with a long-lasting solution on the same day. With statistics from the American Association of Oral and Maxillofacial Surgeons (AAOMS) reporting that 69 percent of adults ages 35 to 44 have lost at least one permanent tooth, Dr. Pollack says providing the highest quality dental restorations and the latest technology is an essential part of his commitment to patient care.
Side Effects is a cautionary tale for the British healthcare system, says pharmacologist Donald Singer
I went to this expecting a story a bit like The Constant Gardener, but translated from Africa to New York. But this absorbing thriller, set within overlapping worlds of big pharmaceutical companies, psychiatry, US private medicine and financial fraud, is much more complex than that.
At the centre of the film is Dr Jonathan Banks – a psychiatrist, played by Jude Law. He has moved from Britain to America because he believes doctors there have a more “positive” view of medicine and of mental health. As a British pharmacologist working in the NHS, I disagree. Anyway, the film implies that Banks’s move to the US was really financially motivated.
Side Effects is clear about the risks surrounding the financial interests that underpin the US healthcare system. Emily (Rooney Mara), a young woman being treated by Banks for depression, threatens to move to another doctor if Banks doesn’t give her the course of treatment she wants. As a result, Banks’s peers threaten to ostracise him for losing “business”. US pharmaceutical companies are able to influence Banks’s decisions by advertising directly to patients. Here, it’s illegal to advertise prescription-only medication to patients.
Banks starts by prescribing Emily an established antidepressant – an SSRI, which raises the level of the brain transmitter serotonin. When she can’t tolerate this, he opts for a new drug. We see a pharmacist correctly talking Emily through a list of side effects – some, like disturbed sleep, are unpleasant; others can be beneficial, like increased sex drive. But Banks then experiences what is always a major concern for any patient or prescribing doctor – she has some pretty devastating reactions.
I can’t imagine such a new drug being prescribed here so casually. We have safeguards, from the National Institute of Clinical Excellence, to a “yellow card” scheme, set up in the wake of the thalidomide scandal, that encourages doctors and patients to report concerns about side effects directly to the government’s Medicines Agency. But, as the UK moves towards a larger private health sector, this film feels like a cautionary tale.
Senior managers’ reluctance to take the blame for the deaths at Stafford hospital indicates a sickness in the system
Patients die in abject misery in Stafford hospital; another five trusts are under investigation. The Care Quality Commission warns that thousands of psychiatric patients are also receiving substandard care. Meanwhile, the Francis inquiry offers 290 recommendations that spin a thick, impenetrable managerial cocoon around an abstract notion that the culture was culpable but another culture will somehow be the cure. Since this new culture is to be built on the jelly-like foundation that nobody can be held to account, something is missing.
It is missing in the health and social care system and it manifests itself in the actions of many of the professionals, personified in the shameful refusal to resign of Sir David Nicholson, NHS chief executive, who was at the time the head of a body responsible for standards at Stafford hospital. What’s missing is an understanding of how human beings behave. What really makes the milk of human kindness flow?
Over several years, a number of inquiries have been conducted into medical training and “modernising medical careers”. One report, “Aspiring to Excellence”, quotes Sir William Osler, the father of modern medicine, who defined the medical role as “to prevent disease, to relieve suffering and to heal the sick”. What that leaves out is how human beings tick above and beyond their symptoms and, sometimes, because of them. That may come with experience, but a solid and sustained grounding during training would help.
It would also help the way managers and care staff work with each other. Why, for instance, has the desperately needed integration of health and social care proved so difficult to deliver? Is it again a question of “culture”? Or, more specifically, the unwillingness of consultants et al to become team players? Ask district nurses why they can’t deliver good preventative care in the community. Answer? Because some GPs say that’s trespassing on “their” territory, and they prefer to leave a vacant lot. Under the Labour government, “nudging”, the science of suggesting, rather than imposing, behaviour, became the vogue. Show a person the word “wrinkles” and he or she walks more slowly. The government’s behavioural insights team is still at work. A letter to individuals informing them that most people in their area had paid their tax, for instance, increased repayment by 15%. “Behavioural insights could save millions of pounds”, was the Cabinet Office’s proud headline. In early training in health and social care, it could also save lives.
The qualities required in care are well understood. “Compassion in Practice”, published in December, for example, refers to the six “cs” – care, compassion, competence, communication, courage and commitment. What’s absent is practice and a perception of what happens when you mix lists with human nature. For the most part, training for health professionals gives cursory attention to ethics, psychology and simulated patient exercises, while managerial bonding adventures are not enough to remind us that behind the targets behaviour, sometimes aberrant, also requires accounting.
Cut frontline staff and collaboration splinters. My father had a dedicated consultant during years with dementia. Much of her work was reduced to tick box online diagnosis; remote control management. It may be the prevailing culture, but that’s not how you bring out the best in people. Or for people.
Regulators take step closer to placing clinically and financially troubled trust on list of NHS ‘unsustainable providers’
The hospital trust at the centre of the NHS’s biggest care scandal in years looks likely to be broken up after a health service watchdog warned that patient safety could be put at risk because of its huge financial problems.
Mid Staffordshire NHS Foundation Trust faces the prospect of other nearby hospitals taking over some of its key services as a result of an inquiry into its clinical and financial viability by experts commissioned by the regulator, Monitor.
Between 400 and 1,200 patients are believed to have died between 2005 and 2008 after receiving poor care at Stafford hospital, which the trust runs.
The results of a public inquiry, headed by Robert Francis QC, into how failings in the NHS regulatory system failed to identify and prevent the scandal are due within weeks.
While Mid Staffs trust is providing safe care at the moment, it will not be able to do so on a sustainable basis in future, according to a contingency planning team, made up of experts from Ernst & Young and McKinsey & Company, and appointed by Monitor. The trust faces many challenges, including low patient numbers, large debts and persistent difficulty in recruiting doctors and nurses, the team’s report warns.
The team says that, as one of the smallest hospital trusts in England, with relatively few patients using A&E, giving birth or receiving planned surgery at the two hospitals it runs – the other is in Cannock – Mid Staffs “will find it increasingly difficult to provide adequate professional experience for consultants and support them in the numbers recommended to maintain a high-quality service in the long term”.
Mid Staffs received £20m from the Department of Health (DH) last year to help stay afloat. It would have to make £53m of savings in the next five years in order to break even. And, even if it did so, it would still need a further £73m from the DH, the experts said.
They are now looking at whether the trust can continue to operate both hospitals, and “assessing whether some services should be moved to existing or new providers in the area”.
Monitor will submit a final report containing recommendations in March, which could lead it to make Mid Staffs the second trust, after the debt-plagued South London Healthcare Trust, to be put into the NHS’s “unsustainable providers” regime.
Lyn Hill-Tout, the Mid Staffs chief executive, said its board accepted that the trust was not clinically or financially sustainable because, despite many improvements, it was unable to break even by 2015. Its financial situation mirrored that of many smaller district general hospitals across England, she added.
A DH spokeswoman said: “Despite improvements, Mid Staffordshire is still facing serious financial challenges. This puts at risk its work on improving services for patients. It is important that valued local services will last and are able to continue providing high-quality treatment and advice for patients.”
So, the research from Virginia Commonwealth University confirms what we’ve long known: that despite spending enormous sums on their healthcare, Americans are sicker and die younger than people in other rich nations (Report, 11 January). Even more shocking is the level of ignorance within the US about just how appalling their health is compared with other nations. We could look on with pity if our own government were not introducing “reforms” that are driving us into an US-style healthcare system; this despite all the evidence that it is inefficient and bad for our health, and by a government that has no electoral mandate. If we are to have a referendum on Europe, let’s have one on the NHS “reforms”.
The US research is especially interesting because it reveals that even America’s privileged white middle class fares badly. Everybody benefits from a healthcare system into which we all pool our resources – and everyone suffers when our health is left to the mercy of profiteers. In Britain we have built a complex and successful welfare state founded on socialised healthcare, universal benefits and a comprehensive system of social security. How alarming that we are allowing it to be sold off to the locust capitalists. I don’t know how we are going to explain it to our grandchildren.
Emeritus professor Mark Doel
• I am very concerned at the government’s proposed cuts, which clearly seek to turn our NHS over to private businesses. In south-west England we can see the start of that process as 20 NHS trusts have signed up to a cartel with the express purpose of cutting the terms and conditions of health workers. This is at a time when NHS trusts are being forced to make massive cuts that will affect patients. An open meeting to discuss the NHS changes is being held tomorrow at Bristol University and there is a demonstration in Exeter on 23 March to keep the NHS free and in the public sector.
Unite the Union, Bristol
• The government has fairly successfully convinced the public that a large proportion of benefit recipients are claiming illegally. The Guardian, among other commentators that have looked more carefully at the facts, seeks to dispel this myth. However, the government is now doing its best – through its support of organisations such as Cure the NHS – to put about another myth: that NHS institutions are, at best, riddled with inefficiency and, at worst, totally uncaring.
I have been a patient more than once at the much reviled Stafford hospital. The treatment I received was pretty good, though perhaps not always perfect. Any organisation – particularly a large one – will get things wrong from time to time and, obviously, every effort must be made to keep this to a minimum. Stafford, it would appear, got things wrong more often than most hospitals; but most of the time, I think, they got it right and we should not lose sight of that fact. I would not discourage anyone from having treatment there.
I hope that those who are seeking to nail the benefits myth will have enough energy to dispel the NHS myth as well. Maybe everyone who has had a good experience of the NHS should write to both the provider of that service and to the media to tell them about it.
SUNNYVALE, CA–(Marketwire – Dec 18, 2012) – Objectivity, Inc. announced today that KING ICT has joined the Objectivity Global Partner program to bring InfiniteGraph, the only distributed graph database to healthcare organizations across Europe. As the growing challenge of real-time healthcare data and patient records management rises, organizations are turning to the power of the graph to bring just in time analysis and data management to discover the connections between patients, treatment and data. King ICT, the leading systems integrator in Eastern Europe, has joined Objectivity to help foster new graph applications to the market.
Why online businesses must be patient in pursuit of profit
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Category : Stocks
Department of Health study finds £100m yearly cost of new system of revalidation would pay for itself in 10 years
Giving all doctors annual assessments and detailed checks every five years will result in better care for patients and reduce compensation claims, but may see an exodus of experienced medics from the NHS who are reluctant to be tested, a government study has warned.
The announcement last month that doctors would undergo “fit to practise” checks for the first time surprised the medical world after a decade of seemingly fruitless negotiation. The system, called revalidation, will begin in December.
In new evidence, the government argues that the cost of the checks – about £100m annually – will be outweighed by benefits to patients and the profession. Better care and fewer court cases against medics will save nearly £1bn over 10 years, so revalidation would almost pay for itself, the government says.
The study, released on Tuesday, shows that about one in hundred patients who would have died or suffered harm in the course of being treated would “be avoided” because of revalidation. Even more striking is the drop the cost of litigation in cases where doctors are taken to court over mishaps resulting from their care.
The Department of Health (DoH) says payouts for medical mistakes has spiralled from £400m in 2003 to £860m in 2011. “The prevention of deaths and incidents of harm, as well as the introduction of a stronger culture of accountability, is expected to result in fewer incidents that would lead to litigation payouts. The data showed that a 3% reduction in future payouts as a result of revalidation can be anticipated,” said the report.
However, the DoH says the new tests may see an exodus of experienced staff from the NHS. “One possible consequence of revalidation … is that some doctors may choose to leave the system rather than undergo appraisal and revalidation processes that would be new to them. This may particularly be the case for older doctors, who would take with them many years of experience and expertise.”
Health minister Dan Poulter, who still works a session a week as a hospital doctor, said the UK will be the first country in the world to regularly review its doctors, batting away criticisms that the scheme is too expensive and would divert money from frontline services.
“Revalidation will cost an estimated £100m each year, or less than 0.1% of the NHS’ total budget. The evidence published today shows that this cost is outweighed by the enormous benefits that regular fitness to practise reviews will bring – increased trust in doctors, safer care, fewer claims for clinical negligence and positive cultural change in the profession,” he writes in an article for the Guardian.
“As a doctor myself, I welcome this support for my own clinical practice. It will make medicine safer by eliminating poor practice through supporting those doctors who need to improve some of their clinical skills, and by tackling the tiny minority of doctors who are not fit for their roles.”
Poulter says that even the “best, most qualified doctors can be let down by poor communication. Regular appraisals will target the quality of their bedside manner and include genuine patient feedback, so that all doctors … are supported to improve their relationship with patients and to build up that essential trust”.
The report also pointed out that doctors working outside of the NHS would also face regular check-ups. The DoH says that only one in 20 of the 157,000 practising doctors in England work solely in the private sector. “The … data showed that there are considerably lower appraisal rates in the independent sector”.
However, the government acknowledges that there will be an extra cost to private health. “These are costs which might be expected to be passed on to the consumer, who would in turn experience the resulting benefits.”
The General Medical Council will be responsible for revalidation, which will be on the basis of a dossier of evidence of a doctor’s competence compiled over five years. This will include annual assessments and patient questionnaires.
Negotiations with doctors’ leaders at the British Medical Association over how revalidation would be carried out has caused some of the long delays. The BMA has traditionally been wary, while saying that it supports the principle.
Plans were under way at the time of the Shipman inquiry in 2005, but Dame Janet Smith, who chaired it, was strongly critical, saying the proposals would not ensure that failing and bad doctors were picked up, so they had to be reworked.