I’ve got a pile of irony to do tonight – from Scottish independence to NHS reform

On my train journey from Edinburgh this morning, I listened to a BBC Radio Scotland phone-in about the implications of Scottish independence.  The intricacies of a possible de-coupling from the UK are fascinating – from the economy to people’s pensions, to the NHS.

I’ve yet to read an article written specifically about the pros and cons from a medical research or science point of view.  But this is a good overview of the economic issues as recently appeared in the Financial Times.  In terms of the day-to-day, though, I wonder just how much more of a difference formal ‘independence’ will make in some areas.

For the irony is that, for a good few years, the forums I am involved in have become well-versed in encompassing the devolved administrations and their points of view as if they are wholly independent.  The discussion and negotiations are not always easy.  Sometimes – well, quite often actually – colleagues look jealously upon the enlighted approach they are taking.  But the upshot is that broad agreement is reached sooner or later and the various partners left to their own devices to how it is implemented.  So the real issue is not about de-coupling.  Rather it is how to ensure these different approaches remain linked to everyone’s benefit.

While away, I have intermittently followed the latest blows being traded over NHS reform. Mike Birtwhistle from MHP has blogged insightfully about the various politics behind the stance, or should I say different stances, of the medical professions.

How ironic it is that the Royal College of Physicians – who brought the BMA to heel to create the NHS in 1944 – is now being pressued by the BMA to ‘save the NHS.’  Or so the BMA would have us believe.  The relationship between the two has never been an easy one.  My sense is that the survival instincts of the Colleges – which are even greater than that of our own political parties – will come out on top.  They will want to stay at the negotiating table come what may.

Meanwhile, the irony is that life with the NHS reforms goes on.  Chris Ham, Chief Executive at the King’s Fund, wrote a blog last week which was much quoted for only one aspect, his comments about what the aforementioned medical professions and their latest salvos.

His other main observation was that, while the politics rev up again, the reforms continue apace in other ways, regardless of and without little need of legislation. And many, including Royal Colleges, position themselves rightly and astutely to ensure the reforms benefit their respective constituency – note this from the Royal College of Paediatrics and Child Health (RCPCH) about the new Children’s Forum. 

In other sectors – medical research for instance – the debate during the parliamentary stages has been highly relevant, important and constructive.  Much has been gained and much is still on the table.  Its cross-party support can only be helpful as we reach the final stages of the legislative process.  The potential impact on how the NHS supports research in the future is significant.  So, for some, I am sure, it would be ironic if this gain were to fall along with the Bill.  At the very least it would supposedly leave things in a bit of a pickle.  But I doubt very much that will be the outcome, one way or the other.

If you wish to get up to speed with the latter debate ahead of the Report Stage of the Bill in the House of Lords have a look at the ever-comprehensive analysis on Becky’s Policy Pages.

 

Doctors' hours and research: the space-time continuum

Yesterday I spoke at a meeting of the Royal College of Paediatrics and Child Health (RCPCH).  There was an outstanding presentation before mine by Kate Baker, a young academic paediatrician, about what inspired her to go into research.  She talked about the importance of charismatic role models in attracting young doctors to science.  But also highlighted the importance of doctors being given time and money (and not necesarily a lot!) to pursue research.   And it is not just at the beginning of their career but further along too, I learnt.

Today the normally mild-mannered Royal College of Physicians took a potshot with its blunberbuss at the increasing pressures on the NHS that would be caused by the growing demand for its services and the lack of a strong consultant workforce to help cope with this challenge. 

But more pertinent still was the BMA statement also today about pressurised NHS organisations squeezing the amount of support they give to doctors to pursue what are known as professional activities not directly related to clinical care (what they call SPA time) including research. 

The BMA has produced an excellent booklet called ‘Quality Time’ which gives a host of examples of how doctors have used this time to improve services, for research, and to improve the knowledge and understanding of colleagues and patients.  I particularly liked this quote:

‘One of the problems with decreasing consultants’ SPA time is that they won’t have time to innovate.’

Nudge nudge, wink wink

‘Medics’ will be gathering in Scotland this week for a 5-day meeting at the Royal College of Physicians of Edinburgh to discuss the medical breakthroughs that have done most to shape and indeed saved lives over the past fifty years. 

Scotland on Sunday have a report today previewing the meeting.  The article includes a list of the top 20 advances as voted by over 600 ‘docs.’  Antibiotics came top and Scotland has a link to 8 of the top 20; interesting also to see things appear in the list such as randmized clinical trials.

But Office for National Statistics data published earlier in the weekend shows that Scotland still has mountains to climb in combatting the biggest killers in society – cancer, heart disease and stroke. (Note the very important health warning on the stats though given by the British Health Foundation).

The challenge is that it will require not just new medical breakthroughs such as stem cell treatments or stratified medicine but also changes in people’s behaviour as well if we are to truly win the battle against them,  And that is what will probably mark the next 50 years out from the previous 50 in many respects.

So, I have been following with interest the House of Lords Science and Technology Sub-Committee Inquiry into behaviour change that is underway. The committe have already taken evidence from members of No 10’s so-called ‘nudge unit’ and Government departments and I think witnesses from MRC and other science organisations are up before the committee on 30th November.

This committee may be going quietlyand efficently about its business outside of the glare of media attention but sometimes a ‘nudge nudge, wink wink’ can speak volumes.

A fillip for rare diseases

It has been one of those weeks!

But I got a bit of a fillip with the Chief Medical Officer (CMO), Sir Liam Donaldson’s, annual report on Tuesday.

Apart from being a good read, the CMO’s annual address on the state of the nation’s health can give voice and momentum to an issue within the Department of Health and Government.

I well remember when at the Royal College of Physicians, how Sir Liam’s words and support  ensured the campaign to ban smoking in public places had a strong tailwind within Whitehall.  The rest is history.

So it was significant that this year, among other things, he should choose to focus on rare disorders.  You’ll recall that many of AMRC’s members represent and fund research into rare disorders and there is growing concern about the lack of attention given to their agenda (See my post in September 2009).

Sir Liam puts forward an action plan for the future including a National Clinical Director, he training of more specialists to improve service provision, greater public awareness, and measures to strengthen research. 

I couldn’t see a response posted on Rare Diseases UK’s website but it sounds like an agenda we can all rally behind.