Friday, August 14, 2009

Cameron and Hawking defend the NHS

David Cameron and Professor Stephen Hawking are among those who have defended the NHS from ludicrous and inaccurate criticisms made in America. David Cameron sent an email to supporters saying that he and his family had been grateful for the work of the NHS.

The most absurd of the attacks made by US critics of the NHS was the claim in an American newspaper that 'People such as Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.'

Professor Hawking himself, while in Washington to receive America's highest civilian honour, the Presidential Medal of Freedom, hit back at these attacks on the British health service, saying 'I wouldn't be here today if it were not for the NHS. I have received a large amount of high-quality treatment, without which I would not have survived.'

A British woman, Kate Spall, who was quoted in adverts for an American group calling themselves 'Conservatives for Patients' Rights (CPR) opposing the President's health legislation, said that she had been misrepresented and felt duped by these adverts.

She told the Times: "It has been a bit of a nightmare. It was a real test of my naivety. I am a very trusting person and for me it has been a big lesson. I feel I was duped."

No organisation should be above constructive criticism, but some of the attacks on the NHS in the USA have been disgraceful and inaccurate.

I mostly reserve party political comment for my main blog rather than this one, but I will make an exception by quoting David Cameron's email here to confirm that the Conservative Party is totally committed to the NHS: an effective National Health Service which is free at the point of delivery is one of the things we wish to conserve.

David Cameron writes:

"I've been enjoying the sun and touring my beautiful constituency of Witney today. But it goes without saying that just because I and most other politicians are not in Westminster at the moment, politics isn't somehow put on hold.

People still care about the issues they care about, and thanks to the internet they can voice their concerns whenever they want. Just look at all the support which the NHS has received on Twitter over the last couple of days. It is a reminder - if one were needed - of how proud we in Britain are of the NHS.

Millions of people are grateful for the care they have received from the NHS - including my own family. One of the wonderful things about living in this country is that the moment you're injured or fall ill - no matter who you are, where you are from, or how much money you've got - you know that the NHS will look after you.

That's why we as a Party are so committed not just to the principles behind the NHS, but to doing all we can to improve the way it works in practice. So yes, we will spend more on the NHS, but we will also improve it so that it is more efficient and responsive to patients. People working on the frontline will actually be able get on with the job they signed up for, without getting tied up in a web of targets. And we will put more power in the hands of patients by giving them better information about the care they can expect to receive.

Underlying these reforms, and our whole approach to the NHS, will be one big ambition - that future generations will be even prouder of the NHS than we are today."

Wednesday, August 05, 2009

Diagnosing Swine Flu

A survey of 251 Doctors in General Practice reported on the ITN website this morning found that 90% of them are concerned that diagnosing swine flu over the phone could lead to other diseases, like meningitis, being missed.

It's a small sample, but the overwhelming nature of the response is enough to be statistically significant and to suggest to me that the fears described by the NHS Blog Doctor and referred to in my post below "How not to deal with swine flu-or anything else" are shared by a large number of doctors.

While the levels of suspected swine flu are above what normal NHS capacity can deal with, it may be regrettably necessary to keep the current special measures such as internet and telephone diagnosis in place, but this survey reinforces my view that we should return to normal methods of diagnosis as soon as practical when infection rates trend down.

In the survey, 87 per cent of family doctors questioned, answered yes when asked: "Does diagnosing swine flu over the phone mean other diseases may be missed?"

Of the 251 polled, 10% were unsure and just 3% said no.

The associated report highlights their concerns, one stating that they had seen a case of measles misdiagnosed as swine flu. Again, this echoes the concern of the NHS blog doctor: he gives details here of a case where a teenager with life-threatening meningitis was misdiagnosed with swine flu and had to invent a false medical history to get a hospital to look at her.

Monday, August 03, 2009

West Cumberland Hospital Meeting

This post will focus on the discussion which took place in the Boardroom at West Cumberland Hospital on 24th July. I have addressed the political controversy over the meeting on my blog at or see link at right.

I have heard from several people who were there that it was a positive and constructive meeting.

Highlights included:

Out-of-hours emergency services.

The lead surgeon at the hospital, Mike Walker, said that the trust is exploring a less than 24/7 emergency surgery service for the West Cumberland Hospital, as agreed in Closer to Home.

He said it would be based on need but that no detail had yet been discussed.

Mr Walker said: “All patients will come to the West Cumberland Hospital whether it is in or out-of-hours and be assessed here.”

If a decision was made that emergency surgery was required and it was out-of-hours then, he said: “If they are unstable to travel (to the Cumberland Infirmary) then a consultant will come here (to the West Cumberland Hospital).”

Normal working hours could be, for example, 8am-9/10pm weekdays and 8am to 5pm weekends, he said.

Consultant anaesthetist, Ian Ulyett, asked if such a patient required an intensive level of care would they have to go via ambulance to Carlisle.

Mr Walker said: “It will be decided on a case by case basis, in some cases they will go there and in other cases the surgeon comes here. It will not be the case that surgeons won’t come here.” He said if someone was unstable then the surgeon would come to the patient.

It would mean that West Cumberland Hospital would still provide a 24-hour consultant-led emergency medicine care but not 24-hour surgery. “The frequency to transfer patients for out-of-hours operations will be very small.”

He said only a very small number of patients are ever operated on out-of-hours, that the aim for any hospital is always to operate in-hours.

The Reverend John Bannister, the Save Our Services spokesman, asked about the reasons for this. Mr Walker explained that it was to ensure there was a clinically safe service and robust out-of-hours rota for vascular and emergency surgery. He said there would be eight surgeons on the rota for out-of-hours surgery (with two on at any one time) that will cover the whole of North Cumbria. He said the hospital would still have a resident operating team available 24/7.

Charles Brett, A&E consultant, said there has never been any suggestion the A&E service would be reduced, that it is consultant-led and would remain so. “We are signed up to deliver the services outlined in Closer to Home and look forward to being an integral part of that.”

The subject of emergency out-of-hours surgery would be discussed at length and a plan agreed with consultants, said Mr Walker, before being tested on, for example, a nine month basis.

Microbiology and Pathology

It was confirmed that some microbiology services are being centralised in Carlisle which means that certain tests would be transported there to be analysed on behalf of patients at West Cumberland Hospital instead of being done on site. A ‘hot lab’ facility however would remain to ensure that emergency specimens could still be done there and then on site.

Consultant orthopaedic surgeon, Mahesh Dhebar, said: “I think we should retain this service.” And a hospital physician said he did not want to have to telephone around for test results for a suspected acute meningitis patient as he would require them within 30 minutes. “We are very stretched on the floor with regard to juniors and seniors and if juniors are required to ring Carlisle for results then that is not an efficient service.”

Mike Walker said that would be sorted out to make sure the service remained efficient.

Regarding pathology, Mr Clarkson said: “It is not a loss of service. There will be a quicker turnaround time for people in West Cumbria and for cancer work.”

Nick West, said he thought there was a drip drip of centralisation of services regarding histopathology and microbiology. “It’s a loss to this hospital and this community. Each one is a little drip drip which demoralises staff and doesn’t help recruitment.”

Mike Walker said services needed to be safe and that occasionally it would mean that services have to be delivered from another site.

What is planned for the new and refurbished hospital

Gerard Richardson, of the Save Our Services group, asked “Is the hospital we are planning now any different to the hospital we were promised?"

Carole Heatly, Trust chief executive, said: “No. We are committed to everything in Closer to Home.” She said the only changes there would be is if they were for clinical safety reasons, and such a decision would be made by the clinicians themselves."

David Hounslea, project director for the £100million hospital redevelopment, said visible work would be evident by the end of the financial year.

He said there would be an improved environment on wards, efficiency changes so that services were grouped together properly and that views from the hospital would be maximised on wards.

The need for support

Concern was expressed about the impact on morale, recruitment and retention of the perception that services are gradually slipping away to Carlisle.

Soonu Verghese, consultant ophthalmologist at West Cumberland, said: “All the drip drip has been towards Carlisle. Why can’t management think about services coming this way? It has to be a two-way process. People should be made aware of the fact that they will have to travel. A lot of my patients are elderly.”

Liz Twist, Unison regional representative, added: “There is a real concern over here about the drip drip of services. People fear that even with a great building that the hospital may not provide all the services. So it would be good to open early dialogue with staff and address issues.”

Kevin Clarkson said: “People are not applying to Cumbrian posts. We are not down-grading the service, we are trying to build it up and make things sustainable for the workforce. We are continually advertising.”

Carole Heatly said: “There are national shortages of histopathologists. We also cannot get anaesthetists and it is a major worry. We are really trying to promote the area and get doctors to come and work here.” She said the Trust had even made a DVD to send out promoting its hospitals and the area.

Mahesh Dhebar said: “Unless you guarantee the future of this place (West Cumberland Hospital) you will not recruit. Unless you have a hospital that will be there 40 years from now, you will not recruit. Also, there are problems recruiting to a split site (ie two separate hospitals).

Rev Bannister said there were underlying and historic reasons why hospital staff and the community were often concerned about hospital services. “For the 10 years I have been here there’s been fear over this hospital. I am not sure we will actually be able to alleviate that until the day the (redeveloped) hospital opens its doors.

“We have a responsibility not to hijack this process with issues that do not warrant public concern. But,"
he added: “The Trust needs to look at its communication policies.”

Trust chairman, Mike Little, said: “Our Trust Board is committed entirely to this hospital here at West Cumberland and all its services. There is £100 million coming to this hospital.

“We need support for moving this hospital forward. We have got a contractor, we are making a start. But as we go through the next few years there’s going to be far more problems than we are discussing here,”
he warned. “There are always financial issues, we have to live with them. Our board has turned around this Trust.”

Carole Heatly added that nationally there was going to be a significant reduction in the amounts of government money coming into the NHS so it would mean that things would have to change.

“We can do this together and we can make this a success. If we don’t, it will be a disaster,” she added.

The main source of information for this post was the Whitehaven News report which can be read in full here.