April 16, 2015

NHS in Crisis? Perceptions of the National Health Service

Over 90% of medical professionals have concerns about the level of treatment patients receive from the National Health Service (NHS), a recent study has revealed.

According to The British Health Report, commissioned by Your Legal Friend, 26% of medical professionals believe that urgent investment into state healthcare is required to prevent standards falling further.

However, the study also revealed that 81% of patients feel that they’re in safe hands in the care of an NHS hospital, indicating a significant disparity in perceptions of the NHS between healthcare professionals and the public.

Of all medical professionals, General Practitioners (GPs) are most likely to have concerns about the state of the NHS, with almost half (45%) responding that the healthcare system is in poor health. A further 28% believe that the NHS is in very poor health and urgent investment is required in order to ensure high standards of care.

However, GPs aren’t the only professionals to voice their concerns. The report shows that 71% of surgeons, 66% of consultants and 54% of specialist doctors believe that the NHS is in poor health. A large amount (63%) of professionals are extremely concerned about the lack of bed space on wards. Over three quarters (77%) of respondents linked the lack of bed space to longer waiting times and unsurprisingly 72% said this has an impact on patient satisfaction.

Surgeons are the most likely to express unease over this issue, with 78% being extremely concerned about the lack of bed space on wards which can impact how quickly people are able to undergo operations. With medical professionals facing so much pressure to care for patients, it’s no surprise that 80% reported feeling stressed and unable to cope with the workload.

The NHS has been subject to radical changes over recent years, impacting both staff and patients alike. Two thirds of medical professionals believe that the recent NHS reforms are responsible for the health service’s demise.

With the 2015 General Election drawing close, the NHS has been thrust under the microscope again in recent months. However, despite all of the main political parties revealing policies in support of the service, the British Health Report has revealed that more than half (56%) of medical professionals in the UK don’t believe that any of the parties best represent the interests of the NHS. 20% said that Labour best represents the NHS, 15% said Conservative and 4% said Liberal Democrats.

Laura Morgan, Director of Medical Negligence at Your Legal Friend commented: “The British Health Report demonstrates that patients have genuine trust in the British healthcare system. Whilst medical professionals may feel they are in a midst of an NHS crisis, they must be commended for providing unwavering care to patients. It’s clear that the majority of the public love the NHS and admire the care it provides to those in need.

“However, the British Health Report does show there are underlying issues that could have a damaging impact on patient care. We call on the Government to listen to medical professionals working at the coal face of medical care and address standards now. Patients have the right to high quality treatment and support yet it is clear that the quality of care that medical professionals can provide is at serious risk. If this is not addressed, for some unfortunate people, it could lead to devastating consequences.”

Although patient satisfaction is currently high, if medical professionals feel unable to meet expectations and provide an acceptable standard of care, it’s just a matter of time before patients start to notice a difference too.

With support and appropriate funding, the government can help to restore healthcare professionals’ faith in the care that they offer to their patients. To read more about Your Legal Friend’s findings, take a look at this year’s British Health Report.


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April 10, 2015

Professor Giovanni Berlinguer has died at the age of 90.

Giovanni was one of the founders of the International Association for Health Policy and a great personality in the field of Italian and international public health and social medicine. Like his brother Enrico, Giovanni Berlinguer was a major figure in the Italian communist party (PCI) He was a member of the WHO Commission on Social Determinants of Health (2005-2008). In the last part of his life he was particularly interested on themes of medical ethics.

Vicente Navarro

First President of the International Association of Health Policy

 It is with an enormous sadness that I have to inform you that one of the greatest and best human beings we have had in this current and past century, Giovanni Berlinguer, has passed away. I just received a note from Giuseppe Costa communicating this news. Giuseppe had been keeping me posted for some time on the evolution on the prolonged disease and condition that determined his death.

 Very few deaths have affected me as has Giovanni’s. He was like a brother to me, with whom we have shared so many joys and also so many pains, including so many projects, and so many struggles, for so many years. I first met Giovanni immediately after Amsterdam, when we started the International Association of Health Policy. It was so long ago that I don’t even remember when. He immediately helped us to have the first international meeting of the Association in one of the buildings of the Italian labor unions, and became a founder and major force in the Association. We also travelled together to several countries in Latin America, conducting many of the Association’s meetings on that continent, in conditions of almost clandestinely. It was when that continent was governed by many nasty, ultra-right wing dictatorships—where to be  a member of the International Association of Health Policy implied a personal risk.  

 I also invited him to come to the United States, where he spent some time with us, and wrote a very entertaining and humorous book about that experience. He kindly invited me to attend political meetings of the PCI in Italy, asking me to speak at some of those inspiring meetings, with my lousy Italian, that he would always improve in the narrative and in its content. I was also very fortunate to get to know well his wife, Giuliana. Warm, kind and extremely acute and accurate in her perceptions. Giuliana and Giovanni were always so close, so loving, that it was an inspiration to all of us. They came to Barcelona frequently and he used to speak about the Catalan roots of his family.

 Giovanni’s work has had enormous influence in all of the areas that he worked. He combined a very strong commitment to justice and democracy on the one side, with a great demand for rigor on the other, a combination that made him extremely effective. He also helped me to establish the International Journal of Health Services,that still keeps going and growing. I could have not done the international journal without his support and encouragement. He was also one of the founders of what is now called the “Social determinants of health.” It used to be called historical materialism. He was indeed very eloquent, showing that the current capitalist economic system was intrinsically pathological.

 He will continue to influence through his work, which should be read by everyone who cares about the health and well-being of populations. Giovanni will always be with us, and will always be wherever and whenever there is a fight against exploitation, whatever that form of exploitation might take. We have been enriched by his life and will always have Giovanni with us. He is part of ourselves and we should honour his life.”


Mauricio Torres-Tovar

Presidente de la Asociación Internacional de Políticas de Salud

I knew Giovanni in the 90s when his thoughts and writings were referenced by Latin American social medicine and particularly by the Latin American Association of Social Medicine – ALAMES, network he helped build and weave, like many others, including the International Association Health Policy.

But it was in the context of the dynamics of the Commission on Social Determinants of Health where I was privileged to meet and share directly with Giovanni.

What impressed him was his great simplicity and sweetness say in dealing with one, with people, despite its enormous intellectual capacity, despite the international acclaim he had. Giovanni was clear that the communist thought was combined with a huge humanist attitude, a huge ethical attitude in everyday life. A simple also on ways to treat their ideas, their approaches were understood. And despite its clear ideological and political stance, respect and appreciation of the ideas of those who dissented from his.

We were privileged to have him in Colombia at the International Congress of Public Health organized by the National School of Public Health, University of Antioquia and there besides the wonderful conference conducted by its approaches around the vision of the social determinants of health, what impressed me most was that when there was a coffee break, people host of Medellín wanted to offer him and there was a huge line to buy it and said we could advance and did not admit it, reflecting with that gesture respect for people and their deep ethical convictions carried praxis.

Physically valuable for many and many will be an integral human being, who contributed with their ideas, their positions, their convictions, their actions, their ethical examples. I thank life for having had the fortune to share with the master Giovanni Berlinguer. I deeply cherish my memories cute and ideas conveyed me to continue insisting that it is possible to build other relationships, other societies with justice and ethical values ​​as promoted Giovanni. It is his intellectual legacy, his life story, his example of commitment to continue building a deeply ethical world like the Giovanni helped build daily.

My great affection for the family of Giovanni and to the great family of social medicine in the world he helped set up.”



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April 07, 2015

Bromley by Bow Centre launches new Social Prescribing training programme for health and social care sector

‘Unlocking Social Prescribing’ is a new series of training seminars being launched by the Bromley by Bow Centre this month and running through to the end of 2015. Aimed at the health and social care sector, the seminars aim to equip attendees with the tools they need to launch innovative social prescribing projects in their local areas.

The day will include a presentation from Sir Sam Everington OBE, one of the Bromley by Bow Centre’s pioneering GPs and from other key members of the delivery team who have developed the internationally renowned holistic model over many years.

The day-long seminars will be held at the inspiring Bromley by Bow Centre in East London (easily accessible to mainline stations and the underground) which is widely recognised as one of the earliest designers of the social prescribing model. Presenters will share expertise on how to set up and run social prescribing programmes which tackle the most challenging social problems through addressing the wider determinants of ill-health.

The programme is a mix of presentations and practical workshops and will include meetings with both practitioners, as well as those responsible for developing the thinking behind the model itself. There will also be a Q&A session with an expert panel, as well as a tour of the unique site to see the integrated services in action.

For further information visit http://www.bbbc.org.uk/-social-prescribing-seminars–201

Press contacts and photo link

Dan Hopewell, director of knowledge and innovation E: dan.hopewell@bbbc.org.uk T: 07545 255 095

Janet Coan, marketing support E: janet.coan@bbbc.org.uk T: 07812 565 333


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April 03, 2015

Each death in hospital should be treated as a sentinel event

As a young hospital doctor in the 1960s it never occurred to me that patients dying in hospital was inappropriate. If I had thought about the issue at all – and I have to confess that if I did it did not leave a lasting memory – I may well have thought that far from being inappropriate dying in hospital was desirable, necessary even, to ensure that all possible efforts were made to preserve life. Of course, this was before Cicely Saunders had founded the hospice movement and long before end of life care had found its way into the NHS lexicon.

Interestingly, my direct experience of family deaths – grandparents and great aunts – was limited to death at home in all cases with close family in attendance. But this was in the 1950s and 1960s; and my mother was a nurse.

Now that I am in my mid 70s, unsurprisingly, my thinking about the circumstances of death, including its location, has taken on a very personal dimension. I want to die in my own home, in my own bed, and with family close by. I most certainly do not want to die on a dgh hospital ward. Neither do I want to die in a care home nor, dare I say it, in a hospice.

I have no doubt that the hospice movement was a desirable development that has put end of life care, at least for those with cancer requiring symptom control, on the map. In my mid career as a health service planning and policy functionary, I actively promoted the establishment of hospices. Indeed, for a while I was a patron of one of them. But my knowledge at that stage was all theoretical involving strangers, not members of my own family. It was the death of my father in a hospice that made me appreciate that, though better than dying in a hospital ward, it was not much better. My father had cancer of the prostate with bony secondaries which caused him great pain. So pain relief was necessary and I have no doubt that he received this at the level required to make him at least comfortable. But the ambience was all wrong – far too professional and institutional with always the sense that the staff were waiting for his bed to become available for another patient. And his pain relief could, I am sure, have been provided in a home setting without too much difficulty.

My current view is that the role of the hospice is not to provide the final stanza of end of life care but to provide respite care, to serve as the base for domiciliary symptom control teams working in support of community nursing and care staff, and, where necessary, to assess patients’ symptom control needs.


To drive the change in NHS culture that is required to make death at home the norm a sustained educational programme for all nhs staff is required. In addition, a strong stick is needed such as would be provided by adopting the proportion of inpatients dying in hospital as a sentinel statistic requiring formal explanation where it is above an agreed level. Of course there will always be patients like those in intensive care units and requiring highly technical or constant medical/healthcare support who will inevitably die in hospital so the proportion of inpatients dying in hospital will never be zero.

However, there is more to making dying at home the norm than changing the culture and habits of health service staff. For many people to die at home requires social care support as well as symptom relief and nursing care. So it was with interest that I noticed a recent BMJ piece entitled, “ Make social care free at end of life to help more people die at home.” (BMJ 2015;350:h1457) This reported that a cross party House of Commons Health Committee, set up to look at how end of life care had progressed since the review of the Liverpool care pathway chaired by Julia Neuberger, has recommended that means testing for social care should be phased out for people who have been recognised as being in the last days, weeks or months of their life.

The chair of the Committee, Dr Sarah Wollaston, pointed out that 53% of deaths still occur in hospital whereas between 63% and 72% of people have indicated in surveys that they would prefer to die at home. Currently only 21% of deaths happen at home. It is clear, she said, that wrangling over how social care is funded kept many people in hospital in their last days when what they wanted was to die at home.

Of course the integration of health and social care, so long talked about but still not achieved except in a few experimental schemes, could overcome the social care funding issue. Short of this I do not believe that anything as sensible and simple as removing means testing on social care is achievable..

But, more important than a specific change in NHS culture relating to end of life care, a global change is needed which considers the patient’s subjective wellbeing in parallel with treatment and care options. If patient subjective wellbeing had been put centre stage in the NHS there would be no need for sentinel statistics measuring the proportion of deaths occurring in hospitals.


Paul Walker, April 2015.


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March 26, 2015


A large pilot study of a new bowel cancer screening test has demonstrated a major increase in participation rates across population groups.

This new data is being presented by Bowel Cancer Screening Hubs and Queen Mary University of London at Cancer Research UK’s early diagnosis conference in London today (Friday).

The new test is called a Faecal Immunochemical Test or FIT for short.

In addition to being able to detect many more cancers and pre-cancers, the pilot of FIT in 40,000 people in the northwest, midlands and the south of England showed almost double the uptake with FIT than with the current test (guaiac faecal occult blood test or gFOBt) for those who had previously chosen not to participate (14.5 per cent climbed to 25.6 per cent).

Marked improvement in uptake was also observed in 60 year olds invited for the first time – an increase from 54.4 per cent to 63.9 per cent. For men of all ages there was an uplift from 57 per cent to 65.5 per cent participation.

The authors also showed improvement in uptake across the socioeconomic spectrum with as great an overall increase amongst the ‘hard to reach’ deprived population as among the least deprived.

The new test only requires one stool sample while three are required for the current gFOBt. FIT uses a simple and cleaner sampling technique and comes in an easy-return postal package.

The new screening test eliminates potential dietary interference and can measure very low concentrations of stool blood from bleeding colon cancers and pre-cancers.

Scotland have recently committed to the adoption of FIT and it is also recommended in the European Guideline for colorectal cancer screening.

Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “These results provide real encouragement that FIT can further improve our ability to increase screening uptake and detect bowel cancer early.  Cancer Research UK recommends that each nation’s bowel screening programme should combine Bowel Scope Screening – also known as flexible sigmoidoscopy – with FIT. We know that Scotland has already committed to upgrading their screening programme, and we urge the other UK nations to do the same without delay.”

Deborah Alsina, chief executive, Bowel Cancer UK: “Currently only around half of those invited take part in the NHS bowel cancer screening programme, meaning opportunities to detect cancer early are being lost. These exciting results clearly show that introducing the FIT test as part of the screening programme could help address that. Both by increasing participation and detecting more bowel cancers.  We therefore urge England, Wales and Northern Ireland to follow Scotland’s lead and rapidly commit to implementation.  It will save lives and help us stop bowel cancer.”


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