NHS could charge a call out fee for doctors

According to a report issued by the NHS Confederation, the body that represents all NHS trusts, frank discussions are needed on ways to shore up NHS finances. Among the suggestions outlined in the report as means of raising funds are proposals that patients should be charged for calling out a doctor to their home (a pilot scheme has been trialled in Germany) and should pay for meals. Patients should also have to pay to watch television, an idea that some NHS trusts are already considering.

Although the Confederation said that there are no plans in place to initiate a system of charges, opponents have expressed outrage. The proposed call out charge, set at £8.50, has raised concerns about patent safety. In fact, one survey has found that if a charge was imposed 24% of patients would delay in making a call to the doctor, while some 18% would not call at all. Katherine Murphy, Chief Executive of the Patients Association, claims that such charges would amount to a tax on patients and are contrary to the NHS’s principle of “free at the point of use.” She adds that patients should not have to pay for reform of the NHS through new charges.

Chief Executive Mike Farrar, however, says that open and honest discussions are needed about why the NHS must change. He says, “We cannot risk the wheels coming off and patient care suffering.”

The report warns that the NHS may need radical proposals as it faces spiralling costs caused by an ageing population and rising levels of obesity. The NHS currently spends 1.5% of its annual £100bn budget on propping up Private Finance Initiative but this figure is expected to double in the next ten years. In 2012, for the first time an NHS trust went into administration and officials estimate that another 20 are facing a severe crisis.

Cardiac patients can access their surgeon’s performance record

At its annual meeting held in Brighton in March, the Societyfor Cardiothoracic Surgery (SCS) announced that patients about to undergo heart surgery will have access to a range of information, including details of their surgeon’s past performance and other health statistics. This information will be available via a website, Blue Book Online, which is designed to raise the transparency of the medical profession.

Due to scandals at the Bristol Royal Infirmary where 35 babies died and others suffered permanent damage due to failures in cardiac surgery and high death rates at Mid-Staffordshire Hospital, cardiac surgeons have had to become more open about their performances. SCS President James Roxburgh believes that wider availability of data and transparency might be the only way to prevent further instances of serious failures of clinical governance.

According to Professor Ben Bridgewater, a cardiac surgeon at University Hospital of South Manchester, the number of patients using the Internet to access clinical information about their care has increased exponentially. He believes that the Internet is the ideal way for up-to-date data to be made available and that greater transparency will encourage the medical profession to act more in the best interests of patients.

Until now, data relating to mortality rates following cardiac surgery and the performance of some 80% of surgeons has been published on the website of the Care Quality Commission. 

Breastfeeding could save the NHS millions

UNICEF UK has claimed that the NHS would save around £40 million a year if more women breastfed their babies.  The organization claims that breast milk boosts the immune system of babies and offers protection from more than 50 infant and adult illnesses, including respiratory illnesses, gastroenteritis and ear infections to a degree unattainable by other foodstuffs.

Unfortunately, however, although the recommended period for breastfeeding is at least six months and more than 80% of British women begin breastfeeding after giving birth, less than half continue beyond six weeks. This is one of the lowest durations for breastfeeding in the world. According to UNICEF UK, if women extended the six-week period to four months the outcome would be that nearly 10,000 fewer young children would need hospital treatment and there would be more than 50,000 fewer visits to GPs.

According to UNICEF UK Deputy Director Anita Tiessen, the vast majority of these women would prefer to have continued but give up in the face of lack of support. Ms Tiessen would like to see breastfeeding acknowledged as a major public health issue with investment and legislation introduced to improve the experience for mothers. She notes that any financial investment would reap a rapid return. 

For her part Sue Ashmore, Programme Director of the UNICEF UK Baby Friendly Initiative, would like to see breastfeeding become something that is seen around us every day. 

Professor Mike Kelly, Director of the Centre for Public Health Excellence at the National Institute for Health and Clinical Excellence, agrees that supporting breastfeeding is a simple idea that could help reduce health inequalities and save money, two of the most urgent problems facing the NHS.

NHS Lothian to take steps to reduce waiting times

To reduce its backlog in operation waiting times, NHS Lothian plans to recruit around 250 new theatre staff.

This plan was outlined in the local health board’s annual review and follows revelations earlier this year that waiting times had been manipulated by listing patients as “unavailable”. It is part of a £10 million strategy to reduce the patient backlog, which it was estimated could be up to 500 by the New Year if contingency plans were not made.

The board anticipates that some patients may have to be sent to other health boards in Scotland or, in a few cases, to Europe for surgical procedures if it is to meet new 12 week targets dictated by legislation taking effect on 1^st October. This is despite the fact that the new surgeons and extra nursing and health staff will mean that theatres can operate in the evening and at weekends.

According to NHS Lothian Chief Executive Tim Davison, who was appointed in July after two months as the interim Acting Chief Executive, the board is making progress in reducing waiting times for treatment but will not become complacent. The new staff will facilitate increased capacity and allow more people to be treated locally in a timely fashion.

Cabinet Secretary for Health and Well-being Alex Neill chaired the annual review meeting. He commented that NHS Lothian was undertaking the biggest operation to reduce waiting times ever mounted by a Scottish NHS Board. He believed that Tim Davison was the right man for the task.

Doctors to undergo regular performance reviews

Secretary of State for Health Jeremy Hunt has announced that beginning in 2013 doctors are to undergo annual performance appraisals and five-yearly “revalidation” checks if they wish to retain their licence to practice.

First mooted around thirty years ago, it was not until the inquiry into the high mortality rate of babies undergoing heart surgery Bristol Royal Infirmary in the late 1980s/early 1990s found that lives were put at risk because surgeons were operating beyond their competence, that the idea really took hold.

The introduction of the new scheme, a world first, follows 12 years of tough negotiations among the British Medical Association, General Medical Council and the Government and comes in the wake of a survey by the Department of Health’s Revalidation Support team in December 2011 that found that the performance of just over 4 per cent (around 6,800) of doctors in England gave cause for concern.

The majority of these (around 4,000) related to low-level concerns such as poor time management while around 1,600 were medium-level concerns such as rude behaviour towards patients. These problems will be dealt with by advice, monitoring and training. Those few doctors (around 1,400) with more serious high-level concerns such as lack of ability or alcoholism will be unable to practice while undergoing retraining or treatment.

GMC Chief Executive Niall Dickson has described the new scheme as being meaningful and robust without being overly bureaucratic but NHS Medical Director Professor Sir Bruce Keogh has warned that will have imperfections and be difficult to implement.

Overall, the scheme should help to identify those doctors who are not performing to an appropriate standard and to identify problems before they lead to major issues.

Skype could save on GP visits

Skype is a highly popular internet-based voice and video communications programme and now it has been suggested that it could be used for patient- GP consultations.

The Medical and Dental Defence Union of Scotland has recently advised doctors that Skype could be used to communicate with disabled patients or those in remote areas without the patients having to leave home. Not only will this benefit the patients but it will also reduce the number of missed appointments that GPs often contend with.

According to Dr Barry Parker, a Medical Adviser with the MDDUS, the concept of Skype consultations may have advantages in terms of convenience for both doctors and patients and may appeal to some patients. They may be better than telephone consultations as the doctor can actually see the patient and can therefore gain a better impression of the patient’s condition.

Dr Parker warned, however, that under some circumstances a video consultation would not be sufficient. Skin complaints, for example, were a case in point where face-to-face consultation and physical examination would be far superior to Skype notwithstanding the quality of the video picture.

There were also concerns with legal aspects. Dr Parker noted that Skype consultations would probably be dealt with in similar fashion to telephone consultations. Doctors would need to be aware of the limitations of video consultations and be prepared to arrange face-to-face consultations when necessary. Similarly, patients and doctors would need to be alert to confidentiality.

Secretary of State for Health Jeremy Hunt believes that ideas such as Skype could have a dramatic impact on the NHS, which is why better use of technology was a focus of the NHS mandate published on 13th November.

Hunt is Backing the Move to Skype Consultations

Would-be surgeons to train in a virtual world

Clydebank’s Golden Jubilee National Hospital has recently launched a virtual 3D surgical programme to help train future surgeons.

The first of its kind in Scotland, the interactive programme will allow medical students to learn and practice surgical techniques without the need to work on dummies or cadavers. They will be able to practice repeatedly and to proceed at their own pace. 

 

Clydebank’s Golden Jubilee National Hospital

 

Currently, the programme is being employed to teach knee anatomy and regional anaesthesia in Golden Jubilee’s Enhanced Recovery Programme.Cabinet Secretary for Health and Well-being Alex Neill attended the programme’s launch to get a first-hand view of the new system. He described it as an exciting development that demonstrated how new technology could be used for the benefit of patients in Scotland.

The man behind the project is Dr Robert Robi Zimmer. Dr Zimmer is a consultant anaesthetist with the Golden Jubilee’s orthopaedic service and is also a software development consultant. He acknowledges that the 3D training programme is in its early stages but believes that it has great potential and will benefit patients throughout Scotland.

 

Dr Zimmer hopes that the programme will help improve understanding of the anatomy and that at some stage it will move beyond the classroom and be used as a tool for helping patients to better understand their condition and treatment.

The Golden National Jubilee Hospital is already renowned for its use of computer assisted orthopaedic surgery and the development of this new virtual 3D training technique will surely enhance its already considerable reputation.

A Functional Virtual Reality Endoscopic Surgery Trainer