Tuesday, 30 November 2010

Employee Benefits –Time for some fun?

This month’s Employee Benefits Magazine asked three employers what festive rewards they were offering their employees this year.

I was particularly impressed with Head of Corporate responsibility for Asos.com, Louise McCabe’s answer. She went into some detail about how the company hosted a staff party, ran best decorated office competitions and even produced a larger than life Trojan Reindeer!

There is much discussion about health and wellbeing in the workplace and in a challenging economic environment this may slip down the benefits agenda. But what about some good old fashioned fun?

Fun doesn’t have to cost a lot. A good party or some activities such as charity fund raising or festive challenges can engender a great team spirit. Throughout my career, the jobs that I remember with most fondness are those where I had fun. Come to think of it – most of my career has been spent having fun! Having fun with colleagues who shared the same work/play ethic.

I am proud to have been involved with some corporate Christmas celebrations that have taken on legendary status. There have also been low key ‘jolly japes’ (as we say in the UK). The long running joke, the affectionate nicknames and the recall of shared anecdotes all contribute to a positive workplace atmosphere.

A study published in 2005 (Journal of Leadership and Organisational Studies) noted that there were no significant differences across the public, non-profit and private sectors in their attitudes towards fun which were directly related to trust in one’s supervisors and co-workers. If you joke with someone or feel at ease sufficiently to risk making a fool of yourself with your colleagues then you are likely to trust the workplace environment. My silver medal won with three colleagues as an ABBA tribute band in a company Christmas ‘X factor’ competition is testament to that fact!

A University of Florida Study demonstrated the value of taking time to socialise with colleagues to improve productivity and boost creativity and in their book, ‘The Levity Effect’, Adrian Gostick and Scott Christopher reveal the power of fun in engaging a loyal workforce.

So think carefully if you are planning to curtail your corporate celebrations. A happy workforce is a productive workforce and we could all do with a bit of festive cheer after a tough year.

This posting is dedicated to Jean Reid who died today. A classy lady who gave her family and friends eight decades of fun.

Sunday, 28 November 2010

UK Public Health Reforms - a lesson in optimism.

Andrew Lansley, the UK secretary of state for health, says that his white paper, to be issued on Tuesday will offer ‘a radical new approach to public health, which has struggled against a tide of rising obesity rates – Britain has one of the highest in Europe – drinking, smoking and sexual health problems.’
This ‘radical approach’ could include the sales of cigarettes in plain white packaging. Indeed as politicians go, Lansley is a Goliath of optimism – if he truly believes that sales of this most lethal and addictive of legal substances in plain packaging will reduce the 80,000 deaths per year attributable to tobacco. I am unconvinced that the reason young people start smoking is due to pretty packaging considering that statements like ‘Smoking kills’ currently displayed in packets have little effect.
Another way that the government plans to ‘protect people from themselves’ is to encourage youngsters to walk to school with an incentive programme offering treats such as cinema tickets. Swipe cards to be used at check points on lampposts en route have been suggested. The cost of vandal proof card readers  strategically placed to encompass every child’s walking route must surely be prohibitive. And what about those children who have no choice but to be driven to school – either due to distance or a parent who works and needs to drop them off on their way to the office or station? So these poor young things will be deprived of this reward scheme –maybe they will seek comfort in the tuck shop?
Dear Mr Lansley – I know you mean well – but please, stay in the real world.  I am an insatiable optimist and have been likened to Pollyanna on more than one occasion. But if there is a case of serious Pollyanna complex – Mr Lansley takes the biscuit – oops – sorry – the low calorie, healthy snack.

Thursday, 25 November 2010

Forget wellbeing – how about a bit of gratitude?

David Cameron has announced that the nation’s wellbeing is to be measured for the government to ‘help the British people attain the ‘good life’

My first reaction to this is one of my favourite proverbs – ‘nobody grows by being measured’

Even assuming that the government advisers can come up with a suitable questionnaire (that’s a bit of consultancy work I would enjoy!) - I wonder what they plan to do with the findings?

One definition of wellbeing is ‘the state of being happy, healthy and prosperous’. Therein lies the dilemma. Wellbeing to one person is purgatory to another. Some people aspire to a huge house, staff to run it and a fleet of expensive cars in the garage. Others dream of a spiritual journey to Nepal or a life working with the underprivileged. Others just want to be healthy. If you talk to people in hospices, parents with poorly children, patients facing complex surgery – their idea of happiness is to walk, breath freely, maybe even something simple like being well enough to catch a bus.

I hate travelling on the underground – it makes me grumpy and uncomfortable. But once someone very close to me who was terminally ill mentioned that he would love to be well enough for the daily commute and I need to remind myself how lucky I am to be well enough, and busy enough to need to travel in this way.

Which brings me to my point.

By all means measure our wellbeing Prime Minister, but please take note. Even if you can work out some formula for happiness and by some miracle implement policies to create this ‘good life’, unless people feel true gratitude for their lot, the mood of the nation will not change.

Somehow we need to start appreciating not only the simple, and maybe a little poetic, things of life, but also the basics that are a huge privilege for those of us lucky enough to live in the UK.

Let’s start with free healthcare, free education (up to 16 years of age) and free speech. Perhaps the government should be putting energies into protecting what we already have and helping us to appreciate it along the way.

And speaking of happiness… Wishing all my readers in the USA a very Happy Thanksgiving.

Monday, 22 November 2010

How can you tell if someone is lying to you?

Wellbeing in the workplace is about so much more that ‘being well’. A feeling of security and trust in your day to day interactions is crucial in maintaining low levels of absenteeism and high levels of satisfaction and engagement. As the administrative sections of the NHS, feeling uncannily like the SS Titanic, slowly creep towards the iceberg – self protectionist behaviours will start to emerge.

Remember, if someone is lying to you it doesn’t always mean that they are telling you a blatant untruth, it can also mean that they are trying very hard to hide their true feelings.

So how can you tell if a colleague, candidate, employee, client or even a patient, is lying to you? One of the big problems in lying is that you have to adapt automatic reflex and response. The art of lying involves storing the truth in your frontal lobe to avoid revealing it, making up an alternative version of the truth, delivering it in a way that you hope is believable, gauging the reaction of the listener and then trying to avoid further questioning or attempt to change the subject. A lot more hard work than speaking your truth! This complex mix of activity means that liars will often slip up at some stage.

There is nothing new in this list but it may serve as a useful reminder on how you can monitor and maybe improve your working environment.

In the good old stone age when life was hard but simple, man relied very strongly on his instinct. Was there a mammoth worth hunting in the near vicinity? Was that man in the cave next door about to steal your Raquel Welch lookalike? (for those of you old enough to remember the film 1 million years BC). Our relatively soft lifestyle now has dulled these instincts – but they are still there so use them. Trust your gut if there is something you are not quite sure about with an interviewee. Delve deeper if you feel a patient or colleague isn’t giving you the whole story.

There are some other very useful ‘tells’ to look out for.

Desmond Morris in his book People Watching, describes some research studying nurses who were asked to lie about some gory scenes they had seen in a surgical film. The five specific behaviours these nurses displayed can be applied to any other situation involving lies:

Abnormal gestures - A liar tries to control their body language. So when you would normally use your hands to emphasise a point, if you are lying, you tend to avoid this as it won’t feel ‘right’ So if someone is abnormally still while they are talking to you they may well be lying.

Hand to face movements - It is well known that touching your face, especially your nose (Pinocchio?) and mouth, is a sign of deception. The hand to mouth gesture is particularly telling as the subject is unconsciously trying to ‘shut themselves up’

Body movement - In the same way that children squirm, adults can shift uncomfortably, giving the message – ‘I wish I wasn’t doing this’

Use of a particular hand expression - Focussing on one action means that the liar can dampen down the other involuntary responses. Excessive use of the ‘hand shrug’ – an open handed dismissive gesture - demonstrates that the liar is absolving responsibility from their words.

Minute facial changes - That don’t seem to compliment the words being spoken.

Of course you may be faced with an accomplished liar who will try, with varying degrees of success, to mask these manifestations. But this activity may also be their undoing. For instance if someone looks you squarely in the eye the whole time they are engaging with you, this is abnormal. A normal open conversation will include a random variety of hand, facial and body gestures.

Another tell tale sign is Throat clearing. Even politicians who are so well schooled in the art of body language cannot hide this one.

It is no coincidence that in delivering his spending review speech a few weeks ago, George Osborne, the UK chancellor of the exchequer struggled throughout with a bad throat, constantly clearing it and breaking up his sentences with little choking coughs. I am not suggesting that he was lying but I have no doubt that he was uncomfortable in delivering many of the words.

And finally – men – there are some lies that are essential. Women prefer to hear these answers at all times…

‘No it doesn’t’…
‘Of course I do’ … and

Sunday, 21 November 2010

Doctor, doctor – can you hear me calling, calling?

The UK Daily Mail’s headline story on Friday outlined the government’s draft plans for axing GP receptionists in a bid to automate doctor’s appointments.

The (scaremongering?) article suggests that patients will be ‘forced to ring national call centres to make an appointment’. It goes on to say that ‘receptionists may be sacked while appointments are handled by operators hundreds of miles away’

A few blogs ago, I discussed the patient journey and it is generally accepted that the way  a patient journey starts can have a dramatic effect on the outcome of that journey. For most patients in the UK, this starts with a call to their GP.

Although sometimes referred to as ‘Rottweilers’, a good GP reception team will not only be the gatekeeper for the practice, but also the vital first point of contact for patients. It is no coincidence that in two of my recent primary care service improvement projects I have included practice managers in the communication strategy. It is not just the elderly who need sympathetic response to their calls to a GP practice. The new mother, the family member caring for a terminally ill patient, and the anxious but busy businessman all have equal right to reasonable and timely access to their local surgery.

I have cast my mind back to primary care utopia - my childhood in rural England. Our family GP was based in a town a few miles away and to see him, you called the surgery and after a quick chat with the receptionist, were given an appropriate time slot to attend that day if needed. You turned up during surgery hours and took your place in the waiting room where there was a strict rotation of chairs and you sat on the next free chair in line. There was only one green chair, at the end of the line and the rest of the chairs were various colours. Each time the bell rang (it was like the bells that used to ring in servant’s quarters in stately homes), then the person in the green chair would go in to see the doctor and everyone shifted up a chair.

This sounds quite comical, but it actually worked and I don’t remember having to wait very long for an appointment. Our doctor was a real ‘old school’ GP who held some very strong views. He didn't believe in 'molly coddling' and believed that housewives who kept their houses too clean were dampening their children’s immune system (interestingly a theory that has gained credibility over the past few decades). He used to say – ‘a bit of dirt never did anyone any harm’. But he was a wonderful caring doctor.

I wonder what he would have thought of the proposal for call centres to replace direct telephone contact with patients. Never one to mince his words, I suspect a few expletives would have been involved with a suggestion that he would rather answer the phone himself than hand over the control to a remote call centre.

But then of course, back in 1965, a GP didn’t have a consortium to run or his share of a £80 billion budget to control…..

Thursday, 18 November 2010

Medicines advertising in the US – patient power gone mad?

Originally trained as a pharmacist, I have always kept an eye on the pharmaceutical industry and drug information for patients in general. For a while I worked on drug development for a major pharmaceutical company so I have a clear understanding of the costs involved in bringing a new drug to market. However during my recent visit to the US, I was, as always, bemused by the level of drug advertising on television.

In the UK, we only see TV adverts for over the counter medicines, and promotion of prescription-only medicines is confined to medical journals and specialist conferences.

There seems to be a push on diabetes in the US at the moment. Not surprising, considering there are 20 million diabetics there. This is also a growing problem in the UK, with approximately 5% of the population suffering from the condition as unhealthy lifestyles are bordering on pandemic.

I found it bizarre to hear the voice-over on the TV advert asking (in effect) – ‘could your diabetes be controlled better with insulin? Check with your doctor and discuss insulin treatment with him’

This unsettles me on so many levels. With my limited knowledge of diabetes, my understanding is that Type 1 is treated with insulin and type 2 is normally controlled by diet and tablets, with insulin therapy an option if the first line of treatment fails. Does this advertising suggest that a) patients are not being offered insulin when they should or b) physicians are being pressurised into prescribing a mallet to crack a nut? The thought that a patient would go to their doctor’s surgery and suggest that they be treated with a medication that may well be unnecessary and is normally avoided if possible seems extreme. And yet clearly this advertising works as I find it hard to believe that the drug company would invest in prime time slots to no avail.

It is interesting to note that the annual drug spend per person in the US in 2008 was £507 compared to £200 per person in the UK. (http://www.abpi.org.uk/)  Are drugs more expensive in the US than the UK? I don’t think so. Does excessive prescribing lead to increased costs in the US? Maybe.

Of course patients should question their doctors on any aspect of their treatment and of course they should be free to suggest options for drug regimes. I can also see the merit in the popular press in informing patients of innovative treatments as they become available. But who should be the driving force in planning treatment regimes?

We don’t have the luxury (or is it a curse?) of TV and popular press advertising for prescription only medicines here in the UK just yet. And I hope it will be a long time before we do.

Tuesday, 16 November 2010

William and Kate – wellbeing ambassadors?

William and Kate – wellbeing ambassadors?

As a UK based blogger with over 50% of my readership outside these shores, I felt that I really should mention the royal engagement. But as this is a healthcare blog, I must stay true to the brief so will shamelessly link today’s news to wellbeing.

David Cameron has recently launched an inquiry into the Nation’s wellbeing at the Google Zeitgeist Europe Conference (the what??)

(Thank you to Paul Roberts www.enlighten.co.uk for the link)

Cameron stated ‘Wellbeing can’t be measured by money or traded in markets. It’s about the beauty of our surroundings, the quality of our culture and above all the strength of our relationships’. Pretty words – but how can you measure these ethereal parameters?

I am sure that David Cameron is very pleased that there is some ‘feel good’ news hitting the UK headlines right now – it’s a lot more positive than job cuts, double dip recession and student unrest.  But what does wellbeing really mean? I believe that wellbeing in the workplace is about a feeling of ownership, about honesty and trust. About a fair day’s wage for a fair day’s work. About not being bullied (I have a ream of blogs to write about that). It’s not just about nutrition and health screening – although these do of course have their value. It’s about feeling good about who you are and where you work (or live). It’s about someone actually listening to your views and where possible acting on them. Caring and valuing your colleagues and having a real team spirit.

So back to William and Kate. The nation is rejoicing at two young people who appear to be genuinely in love. We know it will be a great party (In London we really are supreme at organising weddings and funerals) and there will most likely be a universal feeling of wellbeing on the day.

Maybe David Cameron should really investigate what makes us happy? As a Manchester United supporter (I hope that doesn’t mean I lose half my readership), being part of a crowd of 75,000 celebrating an injury-time home goal takes some beating. The fact that I’m fit enough to climb to the top tier of the stadium to my season ticket seats enhances my feeling of wellbeing but that doesn’t equal the buzz of being part of a stadium full of people all on the same side.

So while you ponder what real happiness and wellbeing means, let us also not forget the value of humour. As you can imagine, the UK news is completely dominated by the royal engagement. On the BBC – a hapless reporter was charged with interviewing a senior army officer, currently serving in Afghanistan, to ascertain the troops’ reaction to William’s good news. This wonderful, brave, cool soldier, when asked if he had any marriage advice for William answered – ‘Always keep a separate bank account’


NHS/US Healthcare – If you are going to fall off your horse….

….may I suggest you do it in the UK?

I have just returned from another great trip to the US, this time, New York. The trip was mainly business but I always find time for pleasure in the city that never sleeps.

Since starting this blog my brain is now finely tuned to looking out for healthcare stories and I didn’t have to look far while I was away. One of my friends from New Jersey was telling me about her nasty riding accident a few weeks ago. The horse reared and after throwing her then landed on her. The accident sounded horrific and as she lay stunned on the ground, her husband was frantically organising the emergency services and potentially an air ambulance.

I asked my friend what was going through her mind at that time as she was contemplating the possibility of a serious spinal injury. ‘Well – I could wiggle my toes and move my hands, so my first thought was to tell my husband to cancel the air ambulance as I could imagine what a pain that would be, negotiating with my health insurance company’

For someone who can bathe in the comfort of free healthcare, this is really quite a shocking story. In the UK, I suspect that for most of us, our first thought following accident, illness or injury, is ‘where shall I go for care and how will I get there?’ Invariably that will be a trip to the emergency room or a referral to an NHS hospital. Either way – ‘how can I pay and will I get the urgent care I need?’ tends not to be an issue.

Whatever anyone may say to criticise the NHS, if you are unconscious, bleeding badly, are suffering a suspected heart attack or acute neurological disorder, in the UK, you know that urgent care is there for you. No need for discussions with your insurance agent, lawyer, third party provider. No financial questions asked in that ambulance.

There are many of us in the UK who follow the journalist Melanie Reid’s inspirational weekly column in The Saturday Times Magazine. Earlier this year, Melanie was air-lifted to a specialist spinal unit after suffering  serious spinal injuries in a riding accident and in her column, she documents her weekly struggle as she progresses to regain strength and mobility.

I am glad that for patients like Melanie, as they work so hard with their rehabilitation, at least one thing they don’t have to worry about is ‘can I afford this care?’

Wednesday, 10 November 2010

A month in cyberspace – the story so far

Six weeks ago I attended a conference in LA (see blogs 1 and 2) and during one of the social events I was enjoying a glass of wine with an extremely handsome man who encouraged me to start a blog.

My original plan was to write a one-off article for a trade magazine, but after several more glasses and the exchange of many business cards I was persuaded that maybe it was worth a go.

A couple of weeks later, Finchers Consulting Blog was launched.

Then another very handsome man (I lead a charmed life) suggested that I should join Twitter to promote my blog. I felt that tweeting really was a bridge too far for someone who had a major aversion to Facebook! But some quick research demonstrated that I had been given good advice and should start tweeting. (@Finchershealth)  Just for the record, I am not one of those ‘I’ve just had breakfast’ tweeters.

So here I am, immersed in cyberspace and loving every minute.

I have been amazed at the response. Over 500 people from 13 countries have now read my postings and the global reach of a few personal ramblings is incredibly powerful. I must confess that this blogging malarkey is pretty addictive. I take my blogs very seriously and although writing the posts isn’t too time consuming, I do try to research my facts carefully beforehand. As a passionate follower of all things to do with health and wellbeing, it has been easy to find things to write about.

I have become a slave to the stats I am thrilled every time a new country is listed among my readers. It is very exciting to think that people I have never met from as far afield as Singapore, Australia, Israel and Serbia are reading my postings and I am particularly pleased to note that a third of my followers are in the US.

Paperwork, phone calls to friends and the minutiae of life are slipping to a poor also-ran as blogging takes over. This blog feels like a living entity, newly populating my day to day existence. It is at the same time a beast that demands feeding and an infant that needs nurturing.

Thank you to all those of you who have been reading these pages. And thank you for the feedback, although most of this has been by email so far, so please do post some comments. And please pass the link in to others who may find the blog of interest. Making a small dent in cyberspace has been remarkably easy, but world domination (the healthcare world at least) may take a little longer……

I’m just off to my favourite city in the World, New York, for a few days but will be blogging again early next week.

Tuesday, 9 November 2010

NHS - The patient journey

One of the strings to my bow is training and facilitating process mapping and this is widely used to assist with service improvement initiatives and resource planning. I have run several events recently on behalf of the NHS with the aim to map and subsequently improve patient journeys.

But how do you define the patient journey? Who is responsible for the care of the patient from ‘cradle to grave’ ?

Andrew Lansley is boldly stating that he will give 80% of the healthcare budget to GPS. No doubt his motives are pure, believing that effective healthcare starts with primary care. The government’s plans to inject an additional £2 billion into social care are also laudable. But what about ‘joined up care’?

I have observed excellent care at every stage of ‘the patient journey’ within the NHS. But I have also observed patients ‘falling through the cracks’.  A brilliant GP may not communicate with a fantastic secondary care team. A cancer patient may have life saving surgery and chemotherapy in a hospital trust but the practice nurse in the community may not have all the information she needs for follow up care. An elderly lady who survives a stroke due to the highly effective acute stroke pathway may forget to attend the clinic to monitor her anticoagulation therapy when she gets back home.

If I had just one wish from the genie as I rubbed the magic lamp – it would be to improve communication at every stage along the patient journey. If we could find a common language for all healthcare professionals, if we could find a way to ensure that ‘shared goals’ is reality, not fantasy, if we could overcome professional brinkmanship and somehow overcome budgeting boundaries. Then the patient journey would be safer and more effective and outcomes (not targets) would improve

Monday, 8 November 2010

NHS reform – the fear factor

As the consultation process regarding the White Paper outlining NHS reforms drags on, the fear factor continues to increase.

I’m not sure that I agree with the mantra ‘Feel the fear and do it anyway’ from Susan Jeffers’ book. Let go of fear – yes; feel the fear – no. Fear serves only a few useful purposes. The fight or flight response can be very useful if escaping from a dangerous situation or finding previously undiscovered strength to face a physical or emotional crisis. But generally fear in the workplace is a negative and unhelpful emotion.

I wrote a few days ago about the ‘rabbit in the headlights’ response to the threat of withdrawal of funding and potential job cuts. As the public sector in the UK braces itself for the projected loss of nearly half a million jobs, those employed in administrative functions in the NHS feel that they are right at the front of the firing line.

Workers in the public sector took an average of just under ten days off sick in the past year – three more than employees in private firms, according to the Chartered Institute of Personnel and Development (CIPD). This costs the NHS an estimated £1 billion annually and is set to rise as the fear factor increases.

Trades Union Congress (TUC) general secretary Brendan Barber said: ‘Many public service jobs are stressful at the best of times but now, with everyone across the public sector fearful for their jobs and the extra pressure of having to do more for less, it’s hardly surprising that the health of many workers is under threat.’ A spokesman for the PCS union, which represents civil servants, added: ‘There have been tens of thousands of jobs already lost in the public sector in recent years. It’s not surprising that stress levels are high given that civil servants are being asked to do more work with fewer resources and staff.’

One could argue that the NHS and other public sector workers are facing what those in the private sector have borne for many years – there is no such thing as job security. But as the consultation process prolongs the agony, there are some very afraid workers.

The impact on individuals really struck me when I visited a Primary Care Trust headquarters recently. In the canteen there is a notice board where staff are invited to place their thoughts, suggestions, and questions regarding the NHS reform and restructure. Among all the clever quips and insightful comments, on a pink post-it note, in very small writing, someone had written:

 ‘I’m worried that I’ll lose my job and I’m scared that I won’t find another one’.

The reality of reform is beginning to hit home….

Friday, 5 November 2010

Ask me no questions and I’ll tell you no lies...

The American author Padgett Powell has just published a book that consists of sentences that are entirely questions. A strange concept, but it got me thinking how blogging is a perfect opportunity to ask questions that may never be answered.

So – in the light of the US and UK healthcare reforms, here are my questions for Barack Obama and Andrew Lansley (UK Secretary of State for Health)

Questions for Barack Obama:

·         Do you sometimes wish you hadn’t said ‘Yes we can?’
·         Do you think that the Republicans can block your health care reform plans now?
·         Considering that the Healthcare Reform Act is unpopular with half the population of the USA, do you wish that the Act have never been passed?
·         Have you considered how businesses can pay for the mandatory increased commitment to healthcare and the inflationary effect it will have on goods and services?
·         Do you really believe that such a thing as an Adult Child? (the act makes it mandatory for cover to be offered to children up to 26 years of age)
·         The world health organisation ranked the US at 37th for quality of healthcare – do you think your reforms will address the quality issue?
·         What about cost of healthcare – you promised that the cost of healthcare wouldn’t rise yet it is now projected that by 2019 the cost per family per year will have increased by $1000. Is this another case of ‘No we can’t?
·         Time to ‘repeal and replace’?

Questions for Andrew Lansley (UK Secretary of State for Health)

·         Do you think that the general public understand that with your plans for NHS reform you will be, in effect, passing 80% of the NHS budget to private contractors (GPs)?
·         Do you understand that ‘local’ is not always best?
·         Could you explain the difference between ‘targets’ and ‘outcomes’?
·         Do you appreciate the fantastic outcomes already achieved in hospital trusts and the value and knowledge of the specialist clinical teams working in hospitals?
·         What does consultation (regarding the government white paper) mean and who has the final decision on the changes laid out in the White Paper?
·         Do you accept that as this period of uncertainty and lack of clarity continues – we may lose some of the best leaders and strategic thinkers currently working in the NHS and how do you plan to address this?
·         You have stated that clinical teams will have more time to concentrate on patients and that data collection should be left to administrators. Yet you are planning to shave off £20 billion in administrative costs. Could you expand on how this will work please?
·         Consortia – who decides what, when, where and how?
·         Is the fact that your ex wife is a GP significant in your decision to hand £80 billion of the healthcare budget to GPs?

Well – there’s no harm in asking…….

Wednesday, 3 November 2010

US Healthcare Reform – crocodile tears?

I can’t pretend to be a political commentator or any sort of expert on US elections but I can confess to a continuing fascination with all things to do with the US Healthcare Reform Act.

Here in the UK, Obama’s defeat in the mid terms and the changing political landscape in Washington is big news. As Mark Mardell form the BBC states ‘Mr Obama’s fall from grace has been hard and fast. He has been pulled to earth by an electorate that is deeply divided, by a politics that has become tidal’

Most commentators here echo the view held by everyone I have spoken to in the US – that it is unlikely that the Republicans, even with their control in Congress, will be unable to bring about their previously stated aim of toppling the ‘Obamacare’ bill. But it is widely believed that they won’t make things easy for the President as he tries to push through reform.

As President Obama faces months of compromise deals, The Healthcare Reform Act, which was a masterful piece of legislative victory for him just a few short months ago, will now hang like a heavy burden on already leaden shoulders.

Obama lost a lot of friends, including me, when his disproportionate response to the ‘British Petroleum’ (or BP to everyone else in the world) incident offended many Brits and I suspect annoyed a few US citizens as he tried to divert attention from his struggling economic policies. But I do have just the tiniest sympathy as he faces narrower hoops and higher hurdles to bring his dream to reality.

Tuesday, 2 November 2010

NHS Reform – not so NICE for GPs?

Yesterday the UK Department of Health announced that NICE (National Institute for Health and Clinical Excellence) is to lose its power to reject the funding of new medicines for use on the NHS. It will continue to give advice and guidance on the efficacy of drugs, but will not decide whether patients should be given the treatments their doctor recommends.

It will now be GPs who decide if a drug should be funded and there will be a new system of ‘value based’ pricing.

Andrew Dillon, the Chief Executive of NICE commented ‘We support the moves to extend access to new treatments at prices which reflect the additional value to patients. NICE is the global leader in evaluating the benefits of new drugs and we anticipate being at the heart of the new arrangements’

I am relieved that NICE will still be involved as an independent review body, assessing the value of new drugs and existing drugs for new indications. But how are GPs going to make ‘value based decisions’ on medicines? They will either need to dedicate more time to this complex task or employ people who know how to do this – i.e. the existing procurement and medicines management teams currently employed by the Primary Care Trusts.

So is this really same old same old? Same jobs but different titles and where is the saving in that?

Dr Laurence Buckman, Chairman of the BMA's General Practitioners Committee voiced his concerns stating ‘The thing I find worrying is this suggestion that you go to your GP and your GP decides whether or not you cab have that particular drug or not This is going to make GPs rationers of healthcare and many will feel very nervous about that’

So let me summarise…

As a result of the NHS reforms GPs will…
Ø        Create and operate Consortia to control spending
Ø        Hold power and responsibility for £80 billion of healthcare budget
Ø        Make purchasing and commissioning decisions on primary, secondary and tertiary care
Ø        Be measured on ‘outcomes’ not ‘targets’
Ø        Make decisions on the availability and funding of medicines
Ø        Be required to keep records of their own performance, and produce reports on mortality rates.

Ø        And one more important function…

Let me think – what is that important function?

Ah yes – I remember now…...

Ø        Look after patients.