Tag Archives: public health

Revised Section 75 regs mire CCGs in a legal minefield

12 Mar

Further trouble not less after Government tables revised regulations on competition for providers. Who would be a Commissioner?

Ensuring Physicians’ Competence — Is Maintenance of Certification the Answer?

27 Dec

 “Pressed by their leaders, external stakeholders, and a public troubled by lapses in the quality of care and unsustainable cost increases, physicians are facing stiffer challenges in initiatives designed to link more closely the goals of learning with the delivery of better care and measures of greater accountability… ”

So begins Ensuring Physicians’ Competence — Is Maintenance of Certification the Answer? in this week’s issue of NEJM .

While the essay focuses on US system of reaccreditation, the opening remarks could apply to any (Western) healthcare system which desires its doctors to deliver best possible healthcare to citizens with greater accountability for the medical profession.

I want to know how my leaders allowed the demise of self-regulation to occur after several hundred years of autonomy.

Why does the author of the article believe there is no chance the medical profession can return to less fettered self-regulation?

Is it really in the public’s interest for politicians and healthcare payers to control medical profession ever more tightly? Is the cost for such regulation really affordable?

It is my opinion, that the majority of doctors are self-directed learners who perform better under less scrutiny rather than more. Healthcare innovation may well be stifled by the drive to tighten regulations for physician practice.

This is apparently a global phenomenon at least in the rich countries with managed healthcare systems. National medical bodies may need to work together to fight this threat to the effective care of our patients.

The increasing threats to independent practice and the profession of medicine are contrary to the human values in healthcare that is at the heart of what we do.

Samuel Shem, 34 Years After ‘The House of God’ – Atlantic Mobile

28 Nov

http://goo.gl/TZ3fx A fabulous essay celebrating humanity in healthcare which must be preserved for all our sakes

WHO | Patient safety: the rising star of clinical care

22 Oct

WHO | Patient safety: the rising star of clinical care.

Patient safety: the rising star of clinical care

Dr Margaret Chan
Director-General of the World Health Organization

Keynote address at the 29th International Conference of the International Society for Quality in Health Care
Geneva, Switzerland

22 October 2012

Distinguished delegates, colleagues in public health, ladies and gentlemen,

It is a great pleasure to address an audience committed to advancing safe, high-quality clinical care for all patients, rich and poor, now and in the future.

I thank ISQua, its officers, its programme and planning committee, and the support provided by the Canton of Geneva and the Geneva University Hospitals, for making this event possible.

The conference is timely for WHO. For many reasons, concern about the quality and safety of patient care is reaching new heights. Patient safety is on the agenda for next year’s Executive Board and World Health Assembly.

Patient safety is a complex multifaceted objective that demands a multi-pronged approach. The diversity of factors contributing to the safety and quality of care is well-reflected in the nine track programme for this conference.

Like WHO, you will be looking at top-down and bottom-up approaches. You will be looking at the role of provider education in reducing errors, and the importance of patients’ expectations, perceptions, and engagement.

Of course, hospitals are not hotels to be rated by their comfort or the quality of their food. But patient experiences yield important clues when things go wrong, and important insights into how to make things better.

You are moving beyond the hospital to consider other settings, including self-medication in homes. You are exploring innovative technologies and what they promise for the future.

Above all, you will be discussing ways to standardize and institutionalize protective and preventive measures, whether through policies, accreditation, and regulation, or practices in hospitals, doctors’ offices, pharmacies, and homes.

Patient safety is a comparatively new discipline that has rapidly risen to star status. This rise began in the late 1990s, with eye-opening reports documenting the scale of harm caused by medical errors.

These reports had media appeal, which gave them popular and political traction. And understandably so. Medical errors cause deep indignation. Health care should heal, not hurt, injure, or kill.

Documenting the costs has also helped quantify the magnitude of the problem. These are the costs of distress on the part of patients and providers, long-term if not life-time disabilities, and needlessly lost lives.

These are the economic costs of direct and indirect medical expenses, the recall of faulty equipment or contaminated medical products, and the settlement of clinical negligence claims.

I need only mention the current meningitis outbreak, in multiple states of the USA, linked to tainted steroid drugs, with as many as 14,000 patients thought to be at risk.

Let me illustrate the consequences of medical mishaps with just a few statistics. Worldwide, unsafe injections alone are thought to cause around 1.3 million deaths, with economic losses of around $535 million in direct medical costs. That figure represents an astronomical loss of around 26 million years of life.

The prospect of reducing such costs has further increased the appeal of patient safety, especially at a time of rising public expectations, soaring medical costs, and shrinking budgets.

Such conditions place a premium on strategies that tackle waste and inefficiency. When safety becomes part of the culture of clinical care, health systems see a reduction in unnecessary, costly, and often dangerous care.

As just one measure of this appeal, patient safety Global Challenges have been the fastest growing campaigns ever launched by WHO

WHO is proud to be part of this movement. Together, we are turning clearly defined needs into concrete, practical, and highly effective tools that make the people, the patients, the winners.

Ladies and gentlemen,

Like any other young discipline, patient safety faces challenges. These include the need to change human behaviours, and the reluctance of medical professionals to acknowledge errors, on their own part or that of others.

To err is human, especially in today’s complex world of medical care with its increasingly sophisticated interventions and equipment. Errors can never be entirely eliminated, but their numbers and severity can be reduced.

Some medical mishaps are egregious and unforgiveable, like wrong-site surgery or releasing an infant to the wrong parents. These are the errors that make the headlines and blacken the image of health care. Fortunately, they are rare.

Other errors are less sensational, far more common, and greater in their cumulative impact, such as adverse drug reactions in the elderly and faulty prescribing practices that contribute to the emergence of drug-resistant pathogens.

What is disconcerting is that the same mistakes keep happening over and over again. This says much about the pressing need to make patient safety a top priority for any well-functioning health system.

This sentiment was well captured in a resolution adopted by the World Health Assembly in 2002. That resolution elevated patient safety to the level of a global priority for improving the quality of clinical care and strengthening the performance of health systems. That resolution recognized patient safety as a fundamental principle of all health systems.

As a young discipline, patient safety also needs a scientific framework rooted in multiple lines of evidence, a shared vocabulary, an accepted system of measuring and classifying adverse events, and a culture of transparent reporting.

I am pleased to note that efforts to address all these problems are being undertaken by national initiatives, international societies, like ISQua, and WHO.

But patient safety also has a number of advantages and unique opportunities, and these fuel the energy and excitement of events like this conference.

First, as I mentioned, patient safety has political appeal and popular traction, and this encourages accountability. I am thinking about the numerous chat rooms and blogs where patients share their experiences, good, bad, and sometimes horrific, holding individual facilities accountable for the quality of their services.

Second, solutions don’t need to break the bank. Measures for improving patient safety are often simple and comparatively inexpensive to introduce. For example, measures such as hand hygiene and safety checklists can be rapidly introduced. They also bring rapid results.

I can think of no other dimension of clinical care that responds so well to simple, common-sense interventions.

Approaches aimed at quality improvement leverage better results. They do so through changes in the way health care is delivered, not through a large influx of funds.

Third, solutions travel well. Many medical mishaps have common causes and common solutions that work well in rich and poor countries alike. The WHO Safe Childbirth Checklist is a good example of the kind of intervention that can make a night-and-day, life-and-death difference in clinical outcomes in the developing world.

What good does it do to offer free maternal care and have a high proportion of babies delivered in health facilities if the quality of care is substandard or even dangerous?

Fourth, patient safety resonates well with many of today’s burning issues in public health. All around the world, health is being shaped by the same powerful forces, like population ageing, rapid urbanization, and the globalization of unhealthy lifestyles.

Chronic noncommunicable diseases are on the rise everywhere, with the greatest burden now concentrated in the developing world. This means more and more people needing long-term if not life-long care. This means more and more people needing sophisticated hospital treatment for acute events.

The need for care is increasing in a world where health care is crippled by a shortage of 4 million doctors, nurses, and other health care staff, with the shortage greatest in areas most in need of care.

Taken together, these trends mean more opportunities for errors and unsafe practices to occur, everywhere. They mean increased pressure to find solutions that work well, everywhere.

Patients, in rich and poor countries alike, need and expect quality clinical care. Don’t disappoint them.

Finally, patient safety has passionate and articulate champions. I am pleased to share this podium with Sir Liam Donaldson. I am pleased that platforms established by WHO have given a voice to more than 250 patients groups and other champions in more than 50 countries.

As I said, I am proud that WHO is part of this movement.

Ladies and gentlemen,

In clinical care, things will go wrong. To err is human. Some medical errors are unforgiveable. Others are more understandable. All can be addressed.

Health care will never be risk-free. But we can make these risks extremely rare rather that so disconcertingly common.

The best way to make progress is to learn from each other, with our eyes clearly on the patients as the ultimate winners. We want to heal, not harm.

I warmly welcome this conference, and wish you a most successful meeting.

Thank you.


Doctors’ letter to David Cameron, how to sign it

4 Feb

Calling all physicians and surgeons in UK, join the protest and get your name down here please

My main problems with the NHS Bill

30 Jan

More opprobium poured on the Health and Social Care Bill

Ian Greener's Academic Blog

Without wanting to create scare stories, I think it sensible to try and explain the reasons why I think it will lead to problems later on. I’m not alone in foreseeing problems – several other commentators have written about this as well. What I can do is explain my perspective on this, and to try and justify my fears.

I’ve organised the following under three headings: problems about the market; problems about provider failure; and problems about responsibility for the system. I can then end by explaining briefly a different way of thinking about the problem of NHS reform than is in the Bill.

Problems about the proposed market

We seem completely in thrall to the idea that there must be some kind of market for healthcare reform to work. However, I’m not convinced about this at all. I’m very much of the view that the problems of putting in…

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Social Care Faces Looming Cash Crisis, Say MPs On Health Committee

24 Jan

Keeping up the pressure on our politicians!

Dr Alf's Blog

This is an interesting but rather sad article. Check it out!

Social Care Faces Looming Cash Crisis, Say MPs On Health Committee.

As I get ready to travel overseas, reading articles like this will no doubt make me want to stay away longer.

I can remember when I first started working in the early seventies, I was working away from home in Darlington in the North East of the UK. I was unfortunately admitted to Darlington Memorial Hospital for a week with food poisoning.

My memories of the NHS Darlington Memorial Hospital are still vivid forty years later. What I especially remember is the cleanliness, the excellent nurses in their immaculate starched uniforms and the discipline and routine of hospital life. No doubt with years of statistics under Labour and cost cutting under the Coalition Government, I would probably be appalled if I went back.

It’s quite…

View original post 180 more words

Health and Social Care Bill Must Be Rejected

22 Jan

Red Lines for House of Lords

All UK citizens should fear the future of the NHS and their own healthcare unless the Health and Social Care Bill is thrown out, even at this late hour.

The link offers a legal framework for the challenge.  Everyone is encouraged to make their  loca Peer aware of the concerns.

All UK doctors are urged to contact their College to make their concerns known too.

The following is from http://callonyourcollege.blogspot.com/



Urgent – Lobby Your College

This website has been set up to allow doctors to lobby their Medical Royal Colleges about the Health and Social Care Bill currently in the House of Lords.
In only a few weeks time this Health Bill could become law. Your input is urgently needed.

The Bill 
   – poses an enormous risk to the future of a viable equitable NHS. 
   – allows the elected Secretary of State to abdicate his or her ultimate responsibility for the NHS. 
   – allows local hospitals to use up to 49% of their beds for private patients meaning NHS patients will wait longer for their care.
   – will tranform a cost effective public service into a healthcare market.
   – has no democratic mandate. We were promised ‘no top down re-organisation of the NHS’ prior to the election yet we now see this enormously damaging NHS upheaval before us which is already proving a huge distraction to all NHS workers.

Continuing with the implementation of the Bill carries far more risk than stopping it now and withdrawing it.

The Bill is now opposed by the British Medical Association, the NHS Consultants Association, theRoyal College of Nursing,  Royal College of MidwivesUnison and Unite.

The Bill has now received a damning report from the Health Select Committee

We now ask for the help of all doctors who are members of a Royal College to lobby your own College about the Health Bill, advise them that you are opposed to the Health Bill and ask them to speak out on your behalf.

We ask you to cut and paste the template email below and then click on the link for your own College which should allow you to send the email easily. Of course feel free to design your own email.

It would be helpful to know how many of you have contacted your College so please add your name to the ‘comment’ section below (or initials if you prefer to remain anonymous).

Dear College President,

I am writing to you as a member of our College. I have major concerns over the Health Bill currently in the House of Lords and ask that you speak out and oppose this damaging policy. 

The Bill lacks a democratic mandate and carries enormous threats to the structure and function of the NHS.  It threatens quality, training and standards, all of which fall within the remit of our College. The risks of continuing with this legislation are now felt to be greater than the risks of stopping it.

Our medical leaders need to lobby against the legislation. Please join the BMA, RCN and RCM in publicly opposing the Bill and calling for its withdrawal.

Yours sincerely,


List of Royal Colleges and their email addresses you can click after you have copied and pasted

Royal College of Physicians         infocentre@rcplondon.ac.uk
Royal College of Surgeons           president@rcseng.ac.uk
Royal College of GPs                  president@rcgp.org.uk
Royal College of Radiologists       president@rcr.ac.uk
Royal College of O&G                 president@rcog.org.uk
Royal College of Psychiatrists     reception@rcpsych.ac.uk
Royal College of Paediatrics        president@rcpch.ac.uk
Royal College of Pathologists      president@rcpath.org
Royal College of Anaesthetists    president@rcoa.ac.uk 
Faculty of Public Health              president@fph.org.uk
College of Emergency Medicine  mc.prescem@gmail.com  – Mr Mike Clancy

Chair of Academy of Medical Royal Colleges – Professor Sir Neil Douglas



8 Sep

Via Scoop.itOf human kindness

To address the global public health concern, the AF AWARE campaign convened a group of international experts to develop the AFIP tool, which helps bring primary care physician (PCP) practice closer to AF management …
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Long-term Outcomes Following Positive Fecal Occult Blood Test Results in Older Adults

8 Sep

Via Scoop.itOf human kindness
Background In the United States, older adults have low rates of follow-up colonoscopy after a positive fecal occult blood test (FOBT) result. The long-term outcomes of these real world practices and their associated benefits and burdens are unknown. Methods Longitudinal cohort study of 212 patients 70 years or older with a positive FOBT result at 4 Veteran Affairs (VA) facilities in 2001 and followed up through 2008. We determined the frequency of downstream outcomes during the 7 years of follow-up, including procedures, colonoscopic findings, outcomes of treatment, complications, and mortality based on chart review and national VA and Medicare data. Net burden or benefit from screening and follow-up was determined according to each patient’s life expectancy. Life expectancy was classified into 3 categories: best (age, 70-79 years and Charlson-Deyo comorbidity index [CCI], 0), average, and worst (age, 70-84 years and CCI, 4 or age, 85 years and CCI, 1). Results Fifty-six percent of patients received follow-up colonoscopy (118 of 212), which found 34 significant adenomas and 6 cancers. Ten percent experienced complications from colonoscopy or cancer treatment (12 of 118). Forty-six percent of those without follow-up colonoscopy died of other causes within 5 years of FOBT (43 of 94), while 3 died of colorectal cancer within 5 years. Eighty-seven percent of patients with worst life expectancy experienced a net burden from screening (26 of 30) as did 70% with average life expectancy (92 of 131) and 65% with best life expectancy (35 of 51) (P = .048 for trend). Conclusions Over a 7-year period, older adults with best life expectancy were less likely to experience a net burden from current screening and follow-up practices than are those with worst life expectancy. The net burden could be decreased by better targeting FOBT screening and follow-up to healthy older adults.   Archives of Internal Medicine (Online first)
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Illusions of Autonomy

Where medical ethics and human behaviour meet, by Dr Philip Berry

Enjoying every second

Cada lugar, cada rincón, cada momento compartido arreglando el mundo entre imprescindibles

The Commonplace Book

blogs on public health, science, books, theology and more