Monday, 27 February 2012
The Chief Medical Officer (CMO) has written to Medical Directors of NHS and Primary Care Trusts, and to independent sector abortion clinics, to draw attention to the conditions under which abortions can be carried out.Those involved in the provision and commissioning treatment for termination of pregnancy need to comply with all requirements of the Abortion Act 1967. This is extremely important because if the condtions are not met then abortion remains a criminal offence under the Offences Against the Persons Act 1861.
Further information is available in the CMO’s letter which was published today. Department of Health
This guidance has been produced to help pharmacy staff with some areas of practice. The areas of practice covered are: consent; raising concerns; patient confidentiality; and maintaining clear sexual boundaries.
The government's mental health strategy set out five key issues affecting mental health, but current policy across departments is failing to address them.
A year ago the government's mental health strategy, No Health Without Mental Health, was published, with the aim of ensuring all departments and agencies worked together to reduce the annual £105bn cost to the UK of psychological ill health.
When the National Mental Health Development Unit was scrapped the month after the strategy was published, that work was given to mental health charities including Mind, Rethink and the NSUN network for mental health.
As part of attempting to design a practical implementation plan for the strategy, NSUN has assessed what progress has been made so far on delivering No Health Without Mental Health's objectives across government.
The strategy clearly identifies five main predeterminants of mental health that must be improved in order to deliver the practical objectives of the strategy: employment, housing, education, community cohesion and physical health. An assessment of the state of each of these factors reveals that ministers appear to be wrecking their own strategy.
Unemployment is now at an 18-year high and forecast to rise further while the latest Department for Work and Pensions' impact assessment on their own benefit changes found that 310,000 people are at risk of losing their homes. Investment in social housing has halved with less than 500 new social homes built last year.
Ofsted has recently been instructed to drop 'wellbeing' from the school inspection regime with schools minister Nick Gibb describing emotional and social education as "ghastly" and "peripheral", leading to entire school counseling and health programs being scrapped. Likewise schools are no longer required to encourage 'community cohesion', another prerequisite for good mental health according to the strategy.
On physical health, the first action Andrew Lansley took on taking office was to scrap the traffic light food labeling scheme and attack Jamie Oliver's attempts to improve nutrition in schools. Public health bodies are united in rejecting the government's 'responsibility agenda' involving McDonalds, Tesco, Pepsi and the Portman Group of brewers and distillers in ministerial food and drink policy commissions.
An email from health minister Earl Howe, recently published by the Guardian, revealed that he had asked the advice of tobacco manufacturer Philip Morris on how to resist imposing plain packets for cigarettes, despite the fact that people with mental health conditions smoke 40% of the tobacco in the UK.
The strategy also calls for new local public health bodies to prioritise mental health but the first and largest, the London Health Improvement Board chaired by mayor Boris Johnson, has instead opted to concentrate on childhood obesity and problem drinking.
While the DH would argue that it has invested £18m in continuing the anti-mental health stigma time to change campaign and sought to increase access to psychological therapies, these measures pale into insignificance in the wider context of worsening health and wider services.
If we in the third sector are to have a hope of delivering a practical implementation plan for No Health Without Mental Health then we need a genuine cross-government commitment to its aims particularly from the Department for Education, the DWP and the new public health bodies, to promote good mental health in schools, create good quality homes and jobs and clamp down on junk food, alcohol and cigarettes.
Edward Davie is communications and engagement office for the NSUN network for mental health
Government says it will provide free care for 40,000 women fitted with PIP implants but plans to recover costs from clinics
More than 3,500 women who attended private clinics to be given breast implants made by a scandal-hit French company have been formally referred to the NHS, government figures show.
Statistics released by the Department of Health (DoH) on Friday indicate that 3,512 women – 553 in the last week alone – have been referred to the NHS for care following the global scare surrounding Poly Implant Prothèse (PIP) silicone implants.
The DoH said that, two months after the scandal first broke in France, more than 1,400 scans had been completed and that, of those women scanned, 120 would be having their implants removed. Sixteen had already had implants removed, it added.
The government has said it will provide free care for any of the estimated 40,000 women fitted with the PIP implants, which were found to contain cheap, non-medical silicone. It said it intended to recover costs from the private clinics concerned.
The women who had initially gone private but were now coming to the NHS for scans and potential implant removals had been clients of a number of clinics including the Harley Medical Group and the cosmetic surgery provider Transform, the DoH said.
Transform initially refused to pay for removals before performing a u-turn and saying that any patient who received PIP implants could have free scans and the offer of removal, although replacement could cost £2,500.
The Harley Medical Group, which fitted almost 14,000 British women with the implants, also initially refused to foot the bill. It subsequently said it would remove implants from those who underwent operations in the last 10 years, but only if they had suffered a rupture and had a scan as proof.
If implants were put in within the last six years, patients will be eligible for a replacement and, between six and 10 years, will be charged cost price to replace the implants.
According to the latest figures, an estimated 747 women are believed to have PIP implants provided by the NHS, but only 10 have received scans so far. Thirty-three have decided to have the implants removed, and four have already done so. The Guardian
The director of the Nuffield Trust explains why it is crucial that all aspects of frontline care are carefully scrutinised
Forget the bill. The biggest issue facing the NHS is the longest budget squeeze in its history, penned in to last until at least 2015. Unless the service can do more with less, the pips will squeak.
Cutting back on managers and red tape was first. Freezing pay of staff and cutting prices paid to hospitals for treatments was next. But these won't be enough. A hard look will have to be taken at all aspects of frontline care. Could costly admissions to hospital be prevented? If so, should some hospitals close? Could more services be delivered digitally? Could nurses substitute for doctors in some areas of care? Taken together, these and other such changes could deliver the savings needed.
The good news is that in a service as large as the NHS there are plenty of efficiencies to be made. And the £20bn budget challenge will prompt innovation. But the question is, can the service move fast enough to stave off more unpalatable responses to austerity?
Suggestions will come thick and fast: charge people to see their GP; give NHS patients details of how much their care has cost (debated last week in parliament); encourage people to take up private insurance; deny treatments such as IVF to women over a certain age, cosmetic surgery or bypass surgery for smokers. Letting waiting lists grow is no longer an option, as the 18-week waiting promise is enshrined in the NHS constitution.
Denying specific treatments is, in fact, a reality in every health system in the world. While the NHS offers a comprehensive service, not everyone can have everything, and priorities are already made locally up and down the land. Although relatively few services or treatments are "rationed" in this way, pressure on funds could force more, as we have seen with the new restrictions in some places on hernia operations, vasectomies and diagnostic scans.
If the bill is passed, groups of GP practices will be making these decisions. Dislike of a postcode lottery in care is strong among the public, who think what is available in Southampton should be available in Sunderland. Unsurprisingly then, professional and patient groups have started to get vocal. The prospect of setting out explicitly and nationally what is and isn't available on the NHS may become more attractive, as discussions on the ConservativeHome website have recently shown. It would be a wrong step.
Drawing up such a list on any rational basis would be impossible and unfeasible, due to a lack of information about the costs and benefits of services. Thus, applying it rigidly would be inappropriate. Those needing off-list treatments would have to pay out of their own pocket or insure themselves – hardly an equitable solution. Most countries who have flirted with this idea have backed off.
More fundamentally, should we be considering this when efficiencies can still be made? We could do better, but without such a list. The National Institute for Health and Clinical Excellence (NICE) has made a good fist of giving guidance on which drugs are cost-effective. This principle could be extended to a wider range of existing, as well as new services, building on NICE's list of "do not do" recommendations (examples include screenings of low-risk populations and the prescription of antibiotics for children with gastroenteritis). This should also be backed up by scrutiny of variations in treatment rates, which essentially go unchallenged.
This will take time. Some believe the pips will squeak loudly enough for George Osborne to write a big fat cheque for the NHS just before the next election. But even if he does, the relief is likely to be temporary. There is no option but radical change. The Guardian
More than 100,000 doctors are to be balloted on industrial action as the stand-off between the Government and the medical profession escalates. The Independent