RIGHT OR WRONG?

Antony Worral Thompson, the celebrity chef, is spearheading a campaign to overturn the ban on smoking in British pubs.

The Ready-Steady-Cook star and restaurateur is leading the Save Our Pubs & Clubs campaign calling for changes to the blanket ban which came into force in 2007.

Campaigners say the ban is "ripping the heart out" of British pubs, which are now closing at a rate of 40 a month, and want publicans to be allowed to tempt customers back by permitting smoking in some areas.

Around 250 pubs have signed up to the campaign and organisers hope thousands more will follow.

MPs from all three main parties have also leant their support.

Mr Worrall Thompson is one of 19 signatories to a letter in today's Daily Telegraph calling for the ban to be relaxed.

He said: "The smoking ban has had an extraordinarily detrimental effect on pubs and clubs and you can understand why. They used to be bastions of adult entertainment where young and old could meet and chat over a pint without the health police looking over their shoulders... The legislation as it stands is excessive and I would like to see it amended."

The campaign is aiming to secure amendments to the ban when it comes up for review in 2010. Options being put forward include allowing pubs to provide sealed smoking rooms with modern ventilation systems, repealing the ban in all pubs except those which serve food, and allowing publicans to choose whether their venues are smoking or non-smoking.

Neil Rafferty, a spokesman for the campaign, said: "This ban is absolutely ripping the heart out of the pub industry and it is hugely unpopular.

"There are tens of thousands of lifelong Labour supporters who are deeply, deeply angry about the ban and who will never vote Labour again while it still stands. It must be changed."

What do you think?

Angus

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HOT HOT HOT

90F heatwave to hit Britain as Met Office issues health alert Meteorologists have told the elderly and the vulnerable to stay out of the sun and drink lots of cold water as hot and humid temperatures soar to dangerous levels.

They issued the level two warning, two off the maximum alert, after forecasts showed there was a good chance that temperatures could top 90F (32C) during the day and remain a hot and sticky 64F (18C) at night.

The oppressive heat could, they say, put thousands of lives at risk especially those with respiratory diseases. The 2003 heatwave killed 2,000 people in Britain and tens of thousands more across Europe.

Heat stroke, heat exhaustion and dizziness could also be triggered by the hottest weather by far this summer.

Helen Chivers, meteorologist at the Met Office, said: "This is a warning to keep cool.

"Stay out of strong sun, take on extra drink and if you have elderly neighbours check on them to see that they are okay."

She said taking cold showers, avoiding tea, coffee and alcohol and keeping windows and curtains shut during the day could also help people avoid overheating.

And don’t forget the other “official” advice, paint everything white, plant trees and shrubs next to the house to provide shade, and don’t whatever you do leave your windows open because the megaphone Police will be round.


Angus

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HOW THE MDDUS (Medical and Dental Defence Union of Scotland) THINKS DOCTORS SHOULD DEAL WITH COMPLAINTS

An apology and sympathy can go a long way to resolving a grievance, explains the MDDUS's medico-legal adviser Dr Jim Rodger.

As a doctor, it is almost inevitable that you will have a complaint made about you at some point in your career. Doctors work with patients who are ill, vulnerable and who can, in some circumstances, be understandably irrational.

Doctors must know how to deal with complaints. However hard it is, try not to regard complaints as personal attacks on your competence or clinical manner.

Never be tempted to ignore a complaint, even though an expression of a patient's unhappiness may be hurtful.

Long delays in responding simply fuel the grievance and lead to more heated correspondence. Doctors have a professional obligation to respond to complaints in a timely manner; they are also obliged to do so by their terms of service.

A substantive response should be made within 10 days from a GP (or 20 days from a trust).

A sympathetic approach
Patients need a sympathetic hearing, even if this may seem difficult under the circumstances. Listening sympathetically often solves the problem.

The attitude of doctors and staff to patients is the most common complaint patients and their carers make. Recognising this will lead to better handling of the complaint.

Reinforcing the perception of an uncaring or unsympathetic attitude by responding to a complaint in a careless or dismissive way is a recipe for disaster. Even if you feel that a complaint is unfounded or even malicious, you must still treat it seriously.

Remind yourself, if necessary, of the prevailing imbalance of power and status that exists between you and your patient.

The experience of the Medical and Dental Defence Union of Scotland (MDDUS) is that it is extremely rare for a complaint to be malicious, but there may be little genuine basis for dissatisfaction.

A doctor's job is to be empathetic and, if necessary, sympathetic in clinical matters, and equally so in complaint handling. Complaints can be an opportunity, rather than a threat.

A good response
Responses should be swift, detailed and give a factual account, from the doctor's point of view, of the situation that gave rise to the complaint.

The response should be tailored to the circumstances of each specific complaint, but limited to those circumstances. A close, careful read through of the complaint and any relevant clinical records will be required.

Your medical defence organisation may assist in checking drafts of responses - the MDDUS does - but cannot help formulate this initial reply. You need ownership. It is the responsibility of you and your practice.

A good response, particularly if it includes an apology, will normally end matters. If not, a patient or carer can ask for an independent review of the way the complaint was dealt with.

In these circumstances, your defence organisation should give you all the assistance, advice and support necessary to help you deal with these investigations, which are by their nature rarer but often more complex.

Making apologies
Apologies can go a long way to assuage a patient or carer's grievance. An apology is not an admission of fault but an acceptance of what has happened.

Apologies can also be made for putting the patient in a situation that gave them cause for complaint. The MDDUS encourages their use in this way, although we would never recommend a grovelling apology if you have not done anything wrong.

So now you know.

Angus

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YOU JUST CAN’T WIN!

A few extra pounds helps you live longer Carrying a few extra pounds may actually be good for you, according to a new study which found overweight people live longer than their more slender peers.

While the obese or underweight are at greater risk of death, people marginally overweight have longer lifespans than those considered to be of "healthy" weight, researchers claim.

The findings defy the commonly held belief that staying slim is the secret to healthy and long life.
Scientists examined the relationship between body mass index and death among 11,326 adults in Canada over a 12-year period.

They discovered that underweight people were 70 per cent more likely than people of normal weight to die, and extremely obese people were 36 per cent more likely to die.

However, modestly overweight individuals were 17 per cent less likely to die, the study showed.
The relative risk for obese people was nearly the same as for people of normal weight, the report concluded.

Commenting on the findings, David Feeny from the Kaiser Permanente Center for Health Research, said: "It's not surprising that extreme underweight and extreme obesity increase the risk of dying.

"But it is surprising that carrying a little extra weight may give people a longevity advantage."
However, the researchers also warned people of normal weight not to try to put on extra pounds in the hope of improving their health.

The researches said carrying slightly more weight than normal may be beneficial in later life because it prevents people from becoming dangerously underweight when faced with health problems.

Angus

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DENTAL CARE CHANGES REPORT DUE

Just a link today BBC NEWS Health



Angus

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HAVE A HEART

Hundreds of cases of serious heart disease are being missed every year by the NHS, which is putting thousands more through needless tests which waste around £40 million a year, a leading expert has warned.

The current tests used to identify people at risk of a major heart attack - because their blood vessels are dangerously narrowed - are inadequate, costly and even risky, Prof Avijit Lahiri, of the private Wellington Hospital in London said.

Patients with chest pain are referred for initial tests and then sent for an angiogram which involves injecting dye into the veins and then taking a series of x-rays to find narrowing.

However around 40 per cent of the angiograms show nothing meaning the patient was put through the £1,000 procedure for nothing.

On top of this, an estimated one in 10 of those with chest pain perform well on the initial tests and are discharged but are in fact suffering from arteries which are up to 90 per cent blocked, Prof Lahiri claimed

.
He is now carrying out a trial of 1,000 patients who will be randomly assigned to receive either the normal NHS care or be sent to the Wellington to receive CT scans.

He said: "The use of imaging is abysmal in this country in comparison to the rest of the world.
"It is not uncommon for the NHS to turn patients away and them drop dead of a heart attack. It is the whole system. We are dinosaurs.

"I believe using CT scans can reduce the number of unnecessary angiograms – which are invasive enough tests – and make a more accurate diagnosis.

"We have got the radiation dose down to the minimum possible with our CT and at £400 a go, it is also cheaper than an angiogram."

A spokesman for the Department of Health said: "CAT scanning is an emerging technology in relation to chest pain which should be used cautiously bearing in mind the patient's exposure to radiation. New research into the place of these newer imaging techniques is always welcome and helps to inform future recommendations made by Department of Health and other organisations, such as NICE.


You pays your money, and takes your choice.


Angus



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SUFFER THE LITTLE CHILDREN

Ten thousand safety alerts over medication given to children are being issued annually in the NHS, including serious errors in the calculation of drug doses and health workers forgetting to give patients their medicine, research shows.

The first report into health service safety incidents concerning children shows that 61,000 alerts were recorded between October 2007 and September 2008 in the care of patients under 18, with 18,200 involving babies aged under 1 month.

A quarter of the cases were the result of misuse of medication, including examples where patients received ten times too much of a drug owing to a dosing miscalculation. There were more than 2,800 alerts involving wrong or unclear dose or strength and children under the age of 4 were particularly affected.

The report, by the National Patient Safety Agency (NPSA), concludes that over the period there were 33 deaths of children and 39 deaths of newborn babies that had “indicators of avoidable factors”.

Jenny Mooney, head of child health at the NPSA, said that one concern was the very small number of alerts from the primary care sector — only 4 per cent of the 61,000 total — suggesting that the figure was a substantial underestimate.

Dr Mooney said that the review showed that errors could occur when calculating and preparing drug doses for children. “It comes down to the availability in terms of drugs. You would always try to get them in liquid form, but sometimes you may not be able to. You end up having to crush up tablets . . . and it is fraught with potential problems.”

Other examples included confusion over milligrams and micrograms. Among babies, errors relating to treatment or procedure was the most common incident type (3,294 alerts), followed by medication incidents (2,881). Among children, medication incidents were the most commonly reported incident type (7,029), followed by treatment or procedure (5,416) and accidents involving the patient (4,576).

This really isn’t rocket science, but is down to the lack of proper training, for which the GMC is responsible.



Angus

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TELL US SOMETHING WE DON’T KNOW

I think that it is universally accepted that the NHS is in trouble despite the £billions poured into the dear old lady over the last ten years or so.

There is of course the £350 million wasted on “Management Consultants” the ubiquitous “Foundation Trust” farce that has only succeeded in providing outrageous salaries for the myriad of managers while there aren’t enough nurses on the wards.

The ill advised “target” policy where meeting the required numbers have become more important than patients, the total failure of the pay deal to modernise pay and conditions for a million health service workers in England which has failed to make the NHS more cost-efficient, say MPs.

Even the fall in vacancy rates that have been trumpeted as a sign of progress was more likely to be linked to post closures than a sign the contract had been effective, the MPs said.

Committee chairman Edward Leigh said he had doubts the promised savings of £1.3bn over five years - the equivalent to between 1.1% to 1.5% each year - could be achieved.

"There is no evidence of the increased productivity and other savings in the NHS that were going to be achieved."

He urged the Department of Health to issue guidance on how the NHS should manage the contract from now on and what targets they should be aiming for.

Then there is the Stafford hospital thing, the Gosport memorial hospital thing, and the fragmentation of the health service into “specialist” units, which are away from hospitals, and make patients travel twice as much as they used to, to get treatment.

GPs have to do the work that Consultants would have done a few years ago, and then are being told to cut back on referrals to consultants to save money.

The whole system is failing, because of piss poor policy; the patient is no longer at the top of the pile but is reduced to a statistic, there purely for the number crunchers benefit.

The NHS is no longer a “National Health Service” but has become a semi-privatised money maker for those at the top and the drug companies.

The sooner this powerless Government is ousted the better, but we must be very careful to pick a new administration that will protect the original ideals of the NHS of free treatment based on need and not on targets.



Angus

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Fifteen million patients cannot see a GP when they need to

From the Telegraph (July 2008) Fifteen million patients cannot book appointments with their GPs when they need them, according to the healthcare watchdog.

Ten million adults in England cannot book an appointment more than three days in advance, despite pledges from Tony Blair to fix the problem over three years ago.

Five million people cannot see a GP within the target of two working days and 55 per cent of people - more than 22m across England - say they have problems getting through to their surgery on the phone, according to a survey of patients.

A quarter of patients surveyed - equivalent to more than 10m people - said they had been put off going to their GP or health centre because of inconvenient opening hours.

The Healthcare Commission also found serious problems with access to NHS dentistry with 16m adults reporting that they would like to be treated on the NHS but can't find a dentist.

Access to primary healthcare varies significantly around the country with access to NHS dentists better in the north of England and worst in the south and more patients complaining of inconvenient GP opening hours around London and the South East.

Overall trust in GPs is high but there is huge variation from less than six in ten patients reporting they had trust and confidence in their family doctor in some areas compared to almost nine in ten in others.

Patients should be able to book an appointment with a GP within two working days of asking for one under targets set out in the NHS Plan published in 2000, which were to be met by 2004.
But this target was found to encourage GPs to keep appointments open for booking the same day and caused a rush of phone calls to surgeries early in the mornings.

In 2005, during the election campaign, Tony Blair was confronted on Newsnight by Diana Church, a patient who said her surgery was refusing to allow her to book an appointment more than three days in advance.

Mr Blair conceded that the Government should set fewer targets and later that year, then health minister Lord Warner announced that patients would be 'guaranteed' advance booking so they could choose to have an appointment more than three days ahead in order to fit better with their daily lives. But no target date has been set.


Times haven’t changed: it is still difficult to get an appointment, maybe another reason why men don’t go to their doctors.


Angus

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Millions unaware of red meat cancer risk

A poll found that less than a third of people in Britain were aware of the cancer risk of eating large amounts of red and processed meat.

Previous research has found evidence of a link between bowel cancer and heavy concentrations of certain types of meat in the diet.

One study, which followed 500,000 from across Europe over a decade, suggested that eating a lot of meat could increase the risk by up to a third.

The European Prospective Investigation into Cancer and Nutrition (EPIC) reported in 2005 that people who ate two portions of red or processed meat a day were as much as a third more likely to develop bowel cancer than those who had only one a week or less.

The World Cancer Research Fund (WCRF) advocates a maximum of no more than 17.6 oz of cooked red meat a week per person.

Marilyn Gentry, chief executive of the WCRF, told the Daily Express: "It is a concern if two thirds of people are not aware of the link because the evidence is strong.

"That is why experts' advice is the best amount of processed meat to eat is none at all.

"But if people don't know about the link between bowel cancer and processed meat they are not in a position to make informed choices.

" There's still a lot of work to be done to spread the message about how people can reduce the risk."

Angus

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WHY MEN DON’T GO TO THE DOCTOR

Being of the male gender, I think I have a bit of an insight to this.

The latest research shows that the reluctance of men to adopt a healthy lifestyle and visit the doctor may be fuelling a gender gap in cancer cases and deaths, experts say.

Among cancers which affect both sexes, men are 60% more likely to develop the disease and 70% more likely to die from it, Cancer Research UK said.

There is no known biological reason for this but it may be because women take better care of themselves, they said.

Experts said men needed to be made aware of the risks they faced.

It is thought half of all cancers can be prevented through lifestyle changes.

Ok that’s the “Official” version, the real reasons are:

GP surgeries are geared to women and children.

It is difficult to actually get an appointment, “urgent” is within 48 hours, “normal” is within about a week and “routine” is within a month.

There is no guarantee that you will see the doctor you want to, unless you are willing to wait.

It is annoying to have to keep ringing back to “grab” an appointment.

Most men don’t know their Doctors.

Most men don’t have the time to keep farting about trying to get an appointment.

Most men are of the opinion that if you can stand up, drive, eat, go to work and not throw up there isn’t much wrong.

Most men are intimidated by Doctors surgeries, the receptionists, the “touch screen” the fact that it is full of ill people, the waiting around, and then when you finally get into the consulting room the endless bloody nagging about “healthy life styles” giving up smoking, eating “five a day” drink less, get more exercise-WE KNOW about all these things.

Biologically men are not there to last 100 years we are built for procreation and supplying, not for the long haul.

Most men do not want to tell a woman doctor about the “droop”, or the runs or other symptoms, we really don’t want to know that there is a chance of something like cancer, we do not relish the thought of someone shoving what feels like a broom stick up their arse to “check the prostate” or eight feet of hosepipe up the same orifice for something called a “colonoscopy”.
Male Doctors have a different outlook, as they should being medics, they can consult with another male Doctor at any time, they are always first in the queue to have the test, they don’t have to wait all day in a hospital full of sick people without food or water because their name begins with Z.

Female Doctors have this mindset that says men are children: they need a good talking to, and should do what we say, because it is good for them.

Men don’t really care what is good for them; they want what they want, and they want it now, it doesn’t matter that it might give them a disease in thirty or forty years, our minds don’t work that way. We like our fags and beer, we like hamburgers and crisps, pork pies and chips; we expect to get a bit overweight as we get older.

We get enough nagging at home, we do not listen to reason, and trying to persuade us that if we change now we will still be here in sixty years, men don’t really want to grow old, we have all seen the “old farts” that smell of urine and drive like David Blunkett, and staggering down the road with their sticks really doesn’t fill us with joy.

Men in the main are not able to appreciate that living a healthy lifestyle will result in a healthy “old age”, we have all heard the urban myths about athletes dying of heart attacks aged forty, or the bloke that never smoked and died of lung cancer aged forty five.

So we think “what’s the point?” and carry on, another male concept is that if they have been smoking for fifty years giving up now will be a waste of time because the “damage is already done” and look at old bill, he smoked all his life, gave up when he was sixty and was dead a year later, case proven.

Most men know that the Doctors are right, that their wives are right, and that we should eat rabbit food, give up everything enjoyable and live a long and miserable life, looking like a beanpole and munching on raw carrots and limp lettuce leaves for our sustenance.

But we just don’t work that way.





Angus

The Angus Dei politico is back up and running this blog is also on the “all and sundry” blog because it is important for us men to get our message across.

Time and Tide

See http://angusdeionallandsundry.blogspot.com/2009/06/time-and-tide.html


Angus

DARZI’S IMPROVEMENTS FOR THE MENTALLY ILL

All the promises, all the money, all the spin which we have heard over the last few years, and the result is Catastrophic shortage of psychiatrists on NHS - Telegraph

There is a "catastrophic" shortage of psychiatrists in the NHS, leading to a reliance on foreign staff who may have difficulties with communication and the UK culture, a senior doctor said.

Prof Robert Howard, dean of the Royal College of Psychiatrists (RCP), said the number of UK doctors was far too few to fill hundreds of training posts.

He pointed to an over-reliance on overseas doctors, saying some were brilliant but cultural awareness was an essential part of being a good psychiatrist.

He said: "Catastrophic is the word I would use for the shortage we are now facing.
"We have always struggled to recruit significant numbers but this year is particularly acute.
"It has got to the point where you can count the number of UK doctors coming into it in tens, when we have hundreds of training posts to fill.

"The doctors who are coming in from overseas to work in the UK: some are brilliant, and our president (Dinesh Bhugra) is a shining example. This is not being racist or unpleasant.

"But many of them have difficulties with communication and the nuances of the UK's culture.
"And if there is a speciality where it is essential to know the culture, it is psychiatry. There needs to be a balance.

"Overall, because of the lack of competition, we are giving jobs to some people who are 'appointable' but certainly not people who it fills our spirits to have given jobs to.

"The fact that we have to make a decision about the minimum standard cut-off point for potential 'appointability', and that we feel relieved when we find sufficient people who just scrape over this is damning enough."

Thanks a lot Ara Darzi.



Angus

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GMC LICENSE SCHEME-DOCTORS ARE HALF HEARTED

I "borrowed" the pictue from Web Wombat hope the mention makes up for it.

Times Online More than half of the 200,000 doctors in Britain have not yet signed up for a new licence that they need to continue working next year, The Times can reveal.

All doctors will, by November, be required by law to have a new licence to practise medicine as part of the biggest overhaul of medical regulation for 150 years.

The licences, to be issued by the General Medical Council (GMC), are the first practical step towards major reforms in which doctors will face mandatory annual appraisals to ensure they are fit to practise and are maintaining their clinical skills.

However, about 110,000 doctors - 55 per cent of the total - have yet to sign up to the system and the GMC is urging them to do so by the deadline of the end of September.

The wider system of revalidation, prompted by a series of medical scandals such as the Harold Shipman affair, is due to be phased in from 2011 but the announcement of the start date comes amid signs of disquiet among the medical profession, with some doctors saying that the reforms will force them to leave medicine.

A poll carried out for The Times of more than a thousand hospital consultants and GPs found last week that one in six doctors was considering a change in career due to the new regulations, while one in 12 might stop practising medicine altogether.

The GMC says it expects the vast majority of doctors who wish to continue practising to have a new electronic licence by November, but the watchdog is commencing a “reminder” campaign at the end of this month in an attempt make sure anyone currently on the medical register who wishes to be included in the system is not left out.

All those who apply will have to renew their licences every five years, subject to the results of the annual appraisals, which will involve “multi-source feedback” — including the views of colleagues and patients.

However unpopular this scheme is the GMC have doctors by the painful bits, it has been I the pipelne for quite a while now and doctors have sat back and let it happen, if they are not happy they only have themselves to blame.

This is not a pop at doctors but, if you want to change something you actually have to get off your arse and do something about it.




Angus


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THEY THINK THEY ARE CONFUSED!

The use of jargon is a blight on the NHS and could end up harming patient care, doctors and campaigners say.

The British Medical Association and Plain English Campaign have criticised the use of words such as service users and clients to describe patients.

They said gobbledygook phrases were causing confusion for staff and patients alike.
The government agreed jargon was a problem and said it was working with NHS trusts to improve communication.

The issue will be debated at the annual meeting of the BMA consultants group on Wednesday.

West Yorkshire consultant anaesthetist Peter Bamber, who proposed the motion, said: "We see all sorts of phrases creeping into the NHS.

"Some of it is an attempt to destigmatise conditions, but I do not think there is anything wrong with the use of 'patient'.

"Using something else suggests the condition may be something the person should just snap out of and that is damaging in itself."

Other phrases highlighted included "disinvestments" instead of "cuts", "proof of concept" instead of "pilot" and "let's take this discussion off-line" in place of "let's talk about this afterwards".

And a document about a new pay deal for nurses and NHS support staff was also highlighted.

It included the passage: "Where the combined value of the above payments before actual assimilation remains greater than the combined value of the payments after assimilation, the former level of pay will be protected."

Dr Paul Hobday, a GP in Kent who has complained to his local trust about the use of jargon, said: "I got guidance recently asking me to record the ethnicity of patients. It was five pages long and full of management speak when it only needed to be a few sentences.

"The problem with this is that either the doctor does not bother reading it or spends too much time doing so which takes them away from patients."

Well, doctors, don’t sit there complaining about it DO SOMETHING!


“I’m not confused, I’m just well mixed.”-Robert Frost "quoted in Wall Street Journal (New York)", August 5, 1969


Angus

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OVER THE COUTER MEDICINES-OR FRIUT?

Joanna Moorhead has an interesting article in the Guardian today.

Sales in over-the-counter remedies are mushrooming. But would we be better off buying fruit, asks Joanna Moorhead.

Have a read, it is very interesting and may save you some money.

“The only way to treat the common cold is with contempt.”-William Osler


Angus

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