Annual Report of the Chief Medical Officer 2007

ON THE STATE OF PUBLIC HEALTH: ANNUAL REPORT OF THE CHIEF MEDICAL OFFICER 2007

Contents

“On the State of Public Health

Progress Check

Under Their Skins: Tackling the health of the teenage nation

While You Were Sleeping: Making surgery safer

Jenner’s Legacy: Creating vaccines for the future

A Pathological Concern: Understanding the rise in oesophageal cancer

On Equal Terms: Achieving racial equality in medicine

The Regions: Health problems and initiatives

References

Darzi - BMA position statement on NHS Next Stage Review

BMA POSITION STATEMENT TO NEXT STAGE REVIEW (BEFORE REPORT PUBLISHED)

“Conclusion

21. The BMA will study the recommendations made in the final reports of the Next Stage Review and continue to attempt to influence the process in the interests of patients, the profession and the future of the NHS as a whole.

22. The effective engagement and buy-in of clinicians and patients will be fundamental to the success of the NHS Next Stage Review. However, the experience of BMA representatives’ involvement at the various levels of the review leads us to be sceptical that genuine engagement with the profession will be achieved across all regions and nationally without a fundamental cultural change in government, SHAs and local management. Furthermore, a recent public opinion poll commissioned by the BMA found that 7 out of 10 people are not aware of Lord Darzi’s review of the NHS and so the review does not appear to be as far reaching as has been claimed. It is essential for future success that this process is clinically led in partnership with the public.

Only by engaging on an on-going basis with clinicians and the public in a meaningful way will the NHS be able to provide the best possible care, tailored to local circumstances and make the best use of finite resources in an increasingly challenging environment. The BMA will do its part to help meet these challenges and lead the way forward.

23. We hope that publication of the final review reports will mark the beginning of a much-needed period of stability for the NHS, which will allow time for the service to get to grips with the many changes and reforms that have been introduced in recent years. Producing an NHS that is professionally led, in partnership with patients, and that truly aspires to the excellence in quality care we all wish to deliver is a prize worth chasing.”

Lord Darzi’s Report and the future of the NHS workforce

HIGH QUALITY CARE FOR ALL: NHS NEXT STAGE REVIEW FINAL REPORT

“An NHS that gives patients and the public more information and choice, works in partnership and has quality of care at its heart.

Dear Prime Minister, Chancellor of the Exchequer, and Secretary of State for Health,
This year the NHS is 60 years old. We are paying tribute to a service founded in adversity, from which were established enduring principles of equal access for all based on need and not ability to pay. We are celebrating a national institution that has made an immeasurable difference to millions of people’s lives across the country.

Quite simply, the NHS is there when we need it most. It provides round the clock, compassionate care and comfort………”

A HIGH QUALITY WORKFORCE: NHS NEXT STAGE REVIEW

“The role of the doctor

25. In his Inquiry report into Modernising Medical Careers Aspiring to Excellence, Professor Sir John Tooke highlighted the importance of reaching a consensus on therole of the doctor. This challenge has already been taken up by the medical profession itself, with the Medical Schools Council, Royal Colleges, NHS Employers and the BMA working together to address this issue. This is something that the Department of Health supports.

26. As described in High Quality Care For All, there are significant changes underway in all advanced healthcare systems. Together, these changes mean that quality is a moving target – to stand still is to fall back. It is for these reasons that expectations of the role of the doctor are changing too.

27. Recent debate within the medical profession has already identified a number of distinctive features relevant to trained doctors as expert medical practitioners. NHS patients and the public expect their doctors to:

achieve accurate and timely diagnoses

ensure the safety of patients

help patients navigate through the healthcare pathway(s)

contribute appropriately as a leader of or partner in the clinical team

contribute to healthcare research, development and innovation

train future generations of healthcare professionals

28. They recognise that doctors are vitally important because of their core skills in:

leadership

dealing with complexity and managing uncertainty

effective and efficient problem solving

working with patients to take legitimate risks and effectively managing risk by providing information alongside professional judgment to maximise patient independence and choice

grasping clinical situations intuitively based on a deep, tacit understanding of their area of practice

29. Within the medical profession, plans are already in place to take these ideas forward. This work will take account of perspectives of patients and employers as well as other healthcare professional groups. We will work with leaders of the profession to ensure that medical education and training supports the development of the identified characteristics in tomorrow’s expert medical practitioners.”

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Care and support

THE FUTURE OF CARE AND SUPPORT

“Health Secretary Alan Johnson today launched an intense six month debate about the future shape of care and support services.
A rapidly ageing population means that in 20 years’ time a quarter of the entire adult population will be over 65 and the number of people over 85 will have doubled.

The growth in the number of people with care and support needs will put tremendous pressure both on services and on the financial support that they receive through benefits and other funding streams.

Over the next six months, the government will be asking the public and stakeholders at a series of regional events for their views about care and support to create a new system that:

* Promotes independence, choice and control for everyone who uses the care and support system
* Ensures everyone can receive the high quality care and support they need, and that government support should be targeted at those most in need
* Is affordable for government, individuals and families in the long-term.
Millions of people across the country are involved with providing and using care and support services. This reform is about finding a new way to help people stay active, care for family members, retain maximum dignity and respect and have the best possible quality of life.”

CARE, SUPPORT, INDEPENDENCE

“In a civilised society, we have a moral obligation to ensure that people in need are not left without any care or support. The existing care and support system is not sustainable, because of the impact of changing demographics and expectations in our society. We need to address these challenges now, before their effects are felt on the system and impact on people’s lives.”

CARE AND SUPPORT - NEW WEBSITE

“England has a care and support system that helps people to be independent, active and healthy throughout their lives. Because we are all living longer, have different demands and greater expectations, this system needs to change.

The Government wants to hear what you have to say about how we can improve, provide and pay for care and support in the future.”

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Physician assistants

POST GRADUATE COURSES - PHYSICIAN ASSISTANT STUDIES

AIM

“To produce a new cadre of healthcare professionals to meet the needs of the NHS.

Physician Assistants will be an entirely new healthcare role in the UK, working alongside doctors in hospitals and in GP surgeries, although they are a well established profession in the United States. Physician Assistants will support doctors in the diagnosis and management of patients. They will be trained to perform a number of roles including: taking medical histories, performing examinations, diagnosing illnesses, and analysing test results under the direct supervision of a doctor. The programme is fully compliant with the national Competence and Curriculum Framework published by the Department of Health.”

BENEFITS FROM DOING THIS COURSE

“Be the one of the first people to qualify in the UK in this new and exciting career.
-Earn a starting salary of £22,500 - £32,000 at current levels
-Follow a career path that has already had proven success in the US. There are over 50,000 Physician Assistants practising in the US.
-Pursue a profession that is supported by the NHS and the Department of Health.”

NATIONAL PRACTITIONER PROGRAMME - THE COMPETENCE AND CURRICULUM FRAMEWORK FOR THE PHYSICIAN ASSISTANT

“The purpose of this document is to share analysis of the Medical Care Practitioner (MCP) Competence and Curriculum Framework public consultation document and to integrate the responses to the questions asked within that document in the form of a revised narrative and explicit recommendations.

The MCP Competence and Curriculum Framework consultation document and this final document were developed between September 2004 and August 2006 in partnership with the Royal College of Physicians (RCP) and the Royal College of General Practitioners (RCGP). Further support has been provided by Skills for Health, those higher education institutions (HEIs) expressing an interest in providing an educational programme for the role and clinical colleagues drawn from a range of backgrounds, including the armed services.

The role of the Physician Assistant seeks to build capacity in the NHS workforce, by drawing in a new cadre of recruits from sources such as life-science graduates.”

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MMC Third Report 8 May 2008

MODERNISING MEDICAL CAREERS - HEALTH COMMITTEE THIRD REPORT 8 May 2008 - HTML

“We make a number of recommendations for change and improvement in response to the shortcomings which undermined MMC. The Department of Health must address its weaknesses in project and risk management. It should strengthen and increase the independence of the MMC Programme Board and work more effectively with the medical profession on future education policy. A number of improvements to project management and to performance management of Strategic Health Authorities by the Department are also required. Employers and training providers should play a bigger role in decisions about the future of training while partnerships between the health and education sector must be revitalised.

The future structure of the training system itself must above all be made more flexible. This means allowing individual specialties to decide what length and type of training posts they offer, rather than continuing to impose one-size-fits-all solution from the centre. We therefore support the current “mixed economy” of specialty training schemes and recommend that this approach is maintained and extended. We suggest a similarly flexible approach to future recruitment processes and recommend that the Department devolve all responsibility for recruitment and selection to Postgraduate Deaneries and employers.

Devolving these detailed responsibilities to local level will allow the Department of Health to focus on more important policy questions affecting the medical workforce. Most pressing of these is how to restrict access for non-EEA doctors to UK training posts, a necessity in light of the recent expansion of UK medical schools. The Government has comprehensively failed to address this issue to date and its future policy is now reliant on a legal judgement by the House of Lords. The Department of Health and the Home Office must work together to resolve this embarrassing problem as a matter of urgency.

Finally, we recommend that the Department of Health address policy issues relating to the wider medical workforce, one of the unrealised ambitions of MMC. Reform of the SAS grades in particular is vital: the Department should aim to develop SAS posts into a genuine and valuable alternative to the formal training system, rather than the educational backwater in which they currently remain. We also propose the introduction of a hierarchy within the consultant grade. In addition, we call on the Department to resolve the key questions affecting the size and nature of the medical workforce, including whether care is to be consultant-led or consultant-delivered in future.”

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The pharmacist’s role

IMPROVED ACCESS TO TREATMENT, CHECKUPS AND HEALTH ADVICE FROM PHARMACISTS

THE ALL PARTY PHARMACY GROUP REPORT INTO THE FUTURE OF PHARMACY

“We want to see accelerated progress in pharmacy service development. The time for this is right, indeed overdue. In some respects the policy climate is promising, with signs of a
growing interest in screening and diagnostic services, and a desire to address shortfalls in service provision such as in out-of-hours care. On the other hand we have serious reservations about the Department of Health’s approach to service development in community pharmacy. We do not believe that services are being developed fast enough or consistently among PCTs. We do not believe this situation will improve without changes to policy.”

MILLIONS TO BENEFIT FROM IMPROVED ACCESS TO TREATMENT, CHECK-UPS AND HEALTH ADVICE FROM PHARMACISTS.

“This extended role will see many more pharmacists being able to prescribe for and deal with minor ailments on the NHS, as well as promoting good health, supporting those with long-term conditions and preventing illnesses through additional screening and advice.

This will enable pharmacies, many of which already open out of hours - and some working as late as midnight - to provide increased access to medicines and care.

Under the new proposals, pharmacies will:

* become “healthy living” centres promoting health and helping people to take better care of themselves;

* be able to prescribe certain common medicines and be the first port of call for minor ailments - saving every GP the equivalent of around one hour per day, adding up to some 57 million GP consultations a year;

* provide support for people with long-term conditions - such as high blood pressure or asthma - 50 per cent of whom may not take their medicines as intended - especially those starting out on a new course of treatment;

* be able to screen for vascular disease and certain sexually transmitted infections, such as chlamydia;

* work much more closely with hospitals to provide safe, seamless care; and

* play a bigger role in vaccination.

Supporting this programme, the Department of Health will appoint two new pharmacist clinical directors who will champion change in hospitals and in the community.

PHARMACY IN ENGLAND:BUILDING ON STRENGTHS - DELIVERING THE FUTURE

This above site also has links to the following downloads:

REVIEW OF NHS PHARMACEUTICAL CONTRACTURAL ARRANGEMENTS

SYNOPSIS OF EVIDENCE TO THE REVIEW

IMPACT ASSESSMENTS

INTRODUCTION, GENERAL AND EQUALITY IMPACT ASSESSMENTS

PARTIAL IMPACT ASSESSMENT: PROPOSALS TO AMMEND ARRANGEMENTS FOR PHARMACIES APPLING TO PROVIDE SERVICES FOR 100 HOURS PER WEEK

INITIAL IMPACT ASSESSMENT: PERMITTING DISPENSING DOCTORS TO SELL OVER THE COUNTER MEDICINES

PARTIAL IMPACT ASSESSMENT OF PROPOSALS TO EXPAND THE PROVISION OF MINOR AILMENT SERVICES

PARTIAL IMPACT ASSESSMENT OF PROPOSALS TO EXPAND THE PROVISION OF MINOR AILMENT SERVICES

PARTIAL IMPACT ASSESSMENT OF PROPOSALS TO EXPAND THE PROVISION OF SUPPORT FOR PEOPLE NEWLY DIAGNOSED WITH LONG TERM CONDITIONS

MARKET RESEARCH REPORT

THE CONTRIBUTION OF COMMUNITY PHARMACY TO IMPROVE THE PUBLIC’S HEALTH - LITERATURE REVIEW UPDATE 2004-2007

PHARMACY WHITE PAPER
(This document is on the NHS Primary Care Contracting Site - requires registration to read.)

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Patient choice

NHS CHOICES - YOUR HEALTH, YOUR CHOICES

“From this month - April 2008 - there will be a dramatic expansion of patient choice in the NHS.

Surveys have consistently shown that patients want choice. The 2005 British Social Attitudes survey revealed that 65% of patients said they wanted choice of treatment, 63% wanted a choice of hospital and 53% welcomed a choice of appointment time.

The introduction of free choice this month means that patients referred to see a specialist will themselves be able to choose where they are treated from any hospital that meets NHS standards.

The list includes many private hospitals as well as all NHS providers. Between them offer everything from treatment to your cataracts to open-heart surgery.

Under the move to free choice, if you and your GP decide that you need to see a specialist, you’ll be able to choose the hospital that best suits your needs.

Perhaps you will want to go somewhere away from home but close to your family? Perhaps good parking facilities are vital for you? Waiting lists, cleanliness, reputation … they can all be factored into your thinking. The point is that the choice is now yours.”

THE HISTORY OF CHOICE

“When the NHS was first founded, choices were limited, but in recent years, choice has become a key feature in the provision of health care services. Here we chart the evolution of patient choice and look at the milestones and policies that have firmly placed it at the heart of the healthcare today… “

DEPARTMENT OF HEALTH POLICY AND GUIDANCE ON PATIENT CHOICE

“Policy and guidance on improving patient choice including how, when and where they receive treatment and giving the public a bigger hand in shaping local care systems.”

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MMC House of Commons Select Committee - Written Evidence

MODERNISING MEDICAL CAREERS - SELECT COMMITTEE - WRITTEN EVIDENCE (HTML)

MODERNISING MEDICAL CAREERS - SELECT COMMITTEE - WRITTEN EVIDENCE (PDF)

“EXECUTIVE SUMMARY

Modernising Medical Careers is a collection of policies to improve the way in which junior doctors are trained and to modernise the Senior House Officer grade. The original principles as set out in Unfinished Business and Modernising Medical Careers aim to do just that and are still valid.

In the main, the implementation of MMC was in line with the original principles. However, the introduction of run-through training, thought by many stakeholders to be a good thing, limited the flexibility inherent in the original principles. The Department is re-introducing flexibility for 2008 and beyond. “

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MMC House of Commons Select Committee - Oral Evidence

THE WITCH DOCTOR’S OFFERING - MMC

MMC - UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 15 NOVEMBER 2007

Sir Liam Donaldson KB, Professor Martin Marshall, Ms Clare Chapman, and Mr Nic Greenfield.

“Sir Liam Donaldson: I know that some of this is caught up in language and terminology, but might I just clarify that to begin with. The original programme was not called Modernising Medical Carers. It was, as you rightly say, a reform of the senior house officer grade, which was, in my view, an educational scandal in this country and needed to be remedied. I produced a report, advised by members of an expert committee, which suggested reforms to the SHO grade. The Modernising Medical Careers programme then was a broadening out of that.

MMC - UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 6TH DECEMBER 2007

Professor Sir John Tooke and Sir Jonathen Michael

Dr Richard Marks, Mr Matthew Jameson Evans and Professor Steve O’Rahilly

“Professor Sir John Tooke: The Committee will be aware that the distress caused by the selection system known as MTAS in the spring generated a good deal of anxiety within the profession. That ultimately precipitated the then Secretary of State for Health having a telephone conversation with me and inviting me to consider chairing an independent panel to look into the circumstances surrounding that perceived failure.”

MMC - UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 13TH DECEMBER 2007

Professor Alan Crockard and Professor Shelley Heard

Dr Jo Hilborne, Dr Ian Wilson and Dr Ramesh Mehta

Mr Mark Johnston

“Professor Crockard: I think the final stage was total frustration, feeling that our views as medical people, and as people with an interest and background in education, was being neglected. I felt that the whole principles of MMC, which I thought were very important, were being subsumed into an attempt to get the workforce running. We saw the situation unfold from fairly well back; I had tried very hard to make this known to the SRO to whom I was accountable in terms of MMC, and to the DCMO.”

MMC - UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 17th JANUARY 2008

Professor Dame Carol Black, Mr Bernard Ribeiro and Dr Bill Reith

Professor Elisabeth Paice, Professor David Sowen and Professor Sarah Thomas

“Mr Bernard Ribeiro: Therefore, we supported the initial principles of MMC in Unfinished Business but not what happened subsequently; it was imposed. Many of the comments that our college made were ignored in this situation.”

MMC - UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 24th JANUARY 2008

Professor Peter Rubin, Professor Neil Douglas and Professor Sir Nick Wright

Ms Anne Rainsberry, Dr Moira Livingston and Ms Sian Thomas

“Professor Rubin: The timing was largely coincidence. I should qualify that by saying that I was not involved in the establishment of PMETB. I came on the scene somewhat later than the establishment process, which was earlier on. Inquiries and reviews going back to 1970 recommended that postgraduate medical education should be regulated, as undergraduate medical education has been since 1858. The most recent of those reviews was the Bristol heart inquiry and in that review Ian Kennedy very clearly recommended that postgraduate education should be regulated and PMETB was a consequence. MMC was developing in parallel with all that. One of the issues that has been all too apparent to us is that, because the MMC came on the scene at much the same time, there has been a lot of confusion about what the two organisations do.”

MMC - UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 18th FEBRUARY 2008

Ms Lorraine Rogerson and Ms Judith MacGregor

Rt Hon Alan Johnson MP, Mr Hugh Taylor, Sir Liam Donaldson and Ms Clare Chapman

“Ms Rogerson: The Department of Health first approached the Home Office in 2005 about using the Immigration Rules to limit further competition for training posts from international medical graduates.”

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