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April 15, 2010

Health plays key part of UK's first televised election debate: leaders clash on cancer waits

The future of the NHS and service provision formed a central part of this evenings national election debate from Manchester screened live on ITV with concurrent audio on BBC Radio 4. Health care as expected did play an important role this evening. Here are a few quotes from the chief protagonists, Brown and Cameron:

Gordon Brown on the leader of the opposition, and on health care in general.

He [Cameron] couldn't give the same personal guarantees that we're giving about specialist cancer care

Fair to our National Health Service

Protect our helath service

David Cameron: rhetoric, with some serious points.

Choose hope over fear

Stop labours 'job tax' which could destroy our economy

If you work had 'll be behind you

If you're old and you become ill we will always be there for you.

Gordon Brown attacked the leader of the opposition about their plans and possible changes to the two week wait.But what is this two week wait? If you work as a doctor in the NHS, you'll already know, but for those that may not be so well informed, what does the two week wait actually mean in practice?

Essentially the 2WW (as its popular abbreviation) is the target that a patient with suspected cancer should be seen within two weeks of the referral being received. A good system? It seems so. Actually the targets go further, with the first 'definitive treatment' being delivered within the first 62 days from referral. This essentially means if you need an operation to have your cancer out, it is the responsibility of the doctors to diagnose it and treat it definitively. This means the necessary scans, biopsies pre-op checks and the like to achieve things. Lots of NHS initiatives have been criticised. The four hour wait has long been criticised by doctors (including this one) in Accident and Emergency departments, however it does seem to have driven up standards and efficiency in our hospitals. In principle, the two week wait is a good thing. So why would it be cut by the conservatives?

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The answer is complex, and not explained in the media writ large. There has been much focus on labours mailshot to potential cancer sufferers, but what politician in their right mind would cut such progress? (Guardian coverage here). The answer lies in policy and procedure, and represents why health is such a sensitive topic. ON the basis of Browns comments above, who without health insurance would not vote Labour? Unless the plans are presented clearly and simply (tonight they were not) it is difficult for those even inside healthcare to make informed voting decisions on such issues.

The conservative leader did consistently focus on the fact that Labour has had 13 years to fix things: how is Labour currently planning to fix things? By saving money, lets look at if its going to hit the workers in the health service (me) or the patients (me). Are there tough choices that have really been outlined for the NHS to date in terms of cuts?


Efficiency Savings: What is the level of 'pain' the NHS can expect?

These points come from the Department of Healths own press release hereI cant help but provide my own bottom line opinion for what it means to staff and patients.

The Department of Health and the NHS will meet this target through a range of activities including:

  • "Up to £1.5bn will be saved by driving down the costs of procurement through securing best prices for goods and services"
    • The bottom line: no pain for the workers or the patients
  • "£100m will be saved by taking a new approach to the National Programme for IT that offers greater choice to local hospitals"
    • The bottom line: no pain for the workers or the patients (unless you're in IT!)
  • "£60m will be saved by reducing the amount of energy the NHS uses, to deliver a 10 per cent cut in carbon emissions"
    • No pain for the workers or the patients, lots of energy saving light bulbs on the shopping list
  • "Up to £70m will be saved from more efficient use of NHS estates"
    • No pain for the workers or the patients, don't expect to buy the local hydrotherapy pool at a cut price
  • "Up to £555m by reducing staff sickness absence in the NHS."
    • No pain for the workers or the patients, unless you're doing things you shouldn't be.

Andy Burnham the health secretary had the following to say on the 4.5billion saved in the budget.

The NHS budget is in a strong position after a decade of record  investment. I am pleased that today’s Budget locks in that growth, guaranteeing that frontline NHS funding will rise with inflation in 2011-12 and 2012-13.  As a result of this funding, the NHS is today more resilient, has more capacity and provides better care than ever before.

Healthcare, two week waits, cancer services, provision of care for the elderly, the payment of this care, and taxation of those receiving it will continue to play a key part in the election leading up to May 2010. As you can see how these policies, and changes to current policy are presented is likely to influence the publics next choice of government.

Missed it? You can catch up on ITV here on what went on. Id be interested to hear comments from anyone and everyone on the above musings...


May 05, 2009

"Dr Death" Visits the UK: Weighing up his 'right to speak'

We often get to pass judgement on others based on short stories in the media. Consider the news today. A doctor from Australia has been lecturing today on assisted suicide in Bournemouth, England.  I thought I'd utilise my simple ABCDE approach of ethics and see where my own morals lie in the case, as presented to me by the media in various guises on the way home from work today.

Consider the reporting of Dr Paul Nitschke's arrival in the United Kingdom today. My own perspectives from the media taken from an interview on BBC radio 4 was as follows.

  • He's a doctor (but what sort?- internal medicine? anaesthetics? Doctor of music?)
  • He's here speaking in the UK on assisted suicide (which remains illegal in the United Kingdom)
  • He's an eloquent speaker
  • On the surface the arguments he puts forward seem to be rational with an explanation
  • He was detained by the UK immigration authorities and then released.
  • He apparently appraises forms of assisted suicide, and provides information on them to members of the public
  • He has been much criticised
  • He presents the activities he's undertaking in the UK as legal

I know nothing more of the man other than from this brief summary. So can I still apply the ethics? Yes, as I in common with other people will initially form an opinion  based on the available evidence

A=autonomy

B= Beneficence

C= Consent/ Confidentiality

D= Do no harm

E= Equality

Based on my assessment of the media on his arrival I asked myself two questions. In my opinion

  1. Should he be refused entry to the UK?
  2. Should he be allowed to lecture in the UK?

Autonomy

Beneficence

Consent/ Confidentiality

Do No Harm

Equality

Should he have been refused entry to the UK

No

No

No

No (Possibly)

No

Should he be allowed to lecture to the general public in the UK

Yes

No (possibly)

Yes

No (possibly)

Yes

This argument could be replayed with any number of questions. Look at the issues in bold, which I consider up for debate on the web.

Entry to the UK: I don't think this should be refused based on his opinions from the interview however this depends and is inextricably linked to my second question. This therefore becomes a bit of a 'cop out' however it reveals that this is not the central issue. This is made clear when Nitschke himself who said on the BBC:

In terms of keeping your borders closed so we can have a free and open debate thats a bit of an oxymoron

Conclusion: I think he should be allowed to enter the UK based on the evidence I've heard.

To take the second point, should he be allowed to lecture: the fact that this is such a sensitive and emotive medical, psychological and social issue, the best way forward is probably not to have an unregulated speaker who may (unintentionally) have an adverse effect on a patient or individuals decision to harm himself without due cause.

But... Will we be having the debate if he doesn't first begin to make a stand? Possibly, but not I think probably. It certainly is a topic which needs discussion, but the ethical arguments are in this instance a minefield. So on the grounds of beneficence and Do no harm, my opinion from the basis of what I have heard is that he should not be allowed to lecture to the general public in the UK.

Now the research: Searching the web this evening brings me to a number of links.

  • Sky news covering the story along with other various media outlets (The Times, The Independent to name a few).The BBC also covers the story and an audio interview can be heard online here.

I think I'll let you draw you're own conclusions, but I'd be more interested to hear people's views on these sorts of ethical issues that get discussed in a 3 minute slot on the radio. Please post comments if you

  1. disagree with the above
  2. have any thoughts on a simple one minute ethical approach like the one above
  3. have strong opinions on anything thats discussed here.

Remember this is the viewpoint on discussing a persons right to speak based on a media interview, nothing more.


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