With over £20 billion of savings to be made by 2014 it is clear that costs have to be reduced, but why is it that NHS Direct is faced with calls for it to be struck off?

Unsurprisingly Nick Chapman, NHS Direct’s Chief Executive, was immediately jumping to his organisation’s defence. His argument on the face of it seems cast iron. He quoted that more than half of all calls or visits to the website led to people treating themselves at home, 1.7 million GP consultations had been avoided, and that in 2008 the service saved the NHS £162m by reducing demand on face-to-face services.

The statistics are impressive, so why is the service having its metaphorical head placed in the budget cut guillotine?

Some may point to the fact that Pulse this week revealed figures obtained through the Freedom of Information Act that currently 40% of NHS Direct’s current call-handlers have no nurse training.  Claims have been made that this is threatening patient safety.

Others may say the £123,000,000 a year bill to fund NHS direct is just simply too big a price to pay when 25% of callers end up contacting their GP anyway.

The service might not be liked by doctors but patients appear to disagree – particularly regarding the services website. Over 5 million people log on to the site – and it is increasingly becoming a portal to obtain patient feedback, give healthy lifestyle advice and encourage healthy living. In the age of digital media, Is that something we can really afford to lose?

Perhaps it would simply be more efficient to make a noose out of the £12.7 billion price tag around the neck of the NHS’s delayed IT programme!

Obesity has been blamed for adding pressure on the NHS, causing planes to use too much fuel and for the destruction of environment, and now it’s the turn of overweight celebrities to be in the firing line.

Where it was once the media’s portrayal of skinny stars that was blamed for negative body images, healthcare professionals are now claiming that the problem swings both ways. Professor Michael McMahon of Nuffield Health recently fed the obesity debate by saying the increasing amount of larger stars on TV and film are causing obese people to become apathetic about their weight.

It wasn’t long ago that more rotund celebrities were seen as pioneers who made a refreshing change to the near skeletal models, actors and actresses who tried their best to fill our screens. There was the belief that over-weight stars such as James Corden and Eamonn Holmes gave hope to many; they showed that you don’t have to be a size zero to make it big.

So are we just looking for another excuse as to why the UK is now seen as being the second most over-weight country in the world?

A survey released last week revealed many obese people fail to recognise they have a problem at all. Researchers found some obese people refused to take any action to improve their situation, with almost one in five not contemplating doing anything to lose weight.

Professor McMahon believes the increased acceptance of obesity is alarming. In fact, if nothing changes, we could see one in six people eligible for weight-loss surgery within a generation.

While it would be unfair to think large celebrities have been in any sense entirely responsible for the obesity issue, it is clear that we all need to look at ourselves to discover what we can do to improve the health of the nation. The answer may not be hidden in Gavin & Stacey, but can it be revealed by the fact that we are all sitting on out ever expanding bottoms watching them?

Following the recent chastising of the NHS, whether it is the number of sick days staff take or a certain Tory MP calling it a ‘60 year mistake’, a review has announced that improving staff wellbeing could significantly improve efficiency and save costs.

According to the report, health services lose 10.3 million working days a year due to sickness and absence. This has been defended by UNISON, which says that working in the health sector is stressful, which, when combined with the fact that employees are surrounded by sickness on a daily basis, there are perfectly good reasons why staff are absent more often.

However, Steve Boorman, the Royal Mail’s chief medical officer, has advised that through some very simple changes, the NHS could save £555 million annually.

Organisations that performed well in health and wellbeing indicators had patient satisfaction scores that were, on average, ten per cent better than those scoring poorly.

An analysis of the four best performing trusts showed lower absence rates, agency costs, MRSA cases and standard patient mortality rates. According to the report, organisations can improve wellbeing by encouraging staff to be healthier and giving them access to occupational health services.

Dr. Boorman believes that staff wellbeing should be prioritised alongside innovation, quality and productivity. While he admits there is still a long way to go, the NHS should aim to be a role model for other sectors.

With the final report being published in October as to how trusts are performing and recommendations on how to improve, time will tell if this is the answer to help the funding deficit over the next few years.

Paul Hodgkin, CEO of Patient Opinion, writes a guest blog for MC2
In the U.S.A, right-wing republicans are declaring that the NHS model is an antiquated system and a British cancer specialist is even quoted as saying that patients “lose control over their own destiny in a public health system.

The argument is causing ripples of discontent in Britain too. Some are jumping to the NHS’ defence, others are looking for us to undertake an American style reform. So, as a nation should we all start wearing an “I ♥ NHS” badge - or should we follow the States down a path where private healthcare sits hand in hand with a publicly funded provision?

Patient Opinion has published over 10,000 comments from patients since our website was established. We ask patients to tell us about their experience of the NHS, warts and all, and then pass these comments on to hospitals.

As over 50% of the comments show, the NHS is, at heart, a great institution. Many people simply use Patient Opinion to show publicly their appreciation for the help and support they received.  Furthermore, through our taxes, we all help and support anyone who needs healthcare. This in its own quiet way, is astonishing, and is the reason I am proud to be a GP.

But that does not mean that all is well. I think we will all admit that changes could and should be made to the NHS.

22% of comments to Patient Opinion report poor or very poor care. What is interesting is that these people rarely call for an overhaul of the whole system. The issue is that while more people than ever value the NHS, sometimes they don’t feel valued by the system when they are in it.

At a high level, NHS reporting is still dominated by topics such as MRSA rates and waiting times. These are vitally important – but such targets shouldn’t be the be-all-and-end-all. Feeling looked after and safe is just as important.

Things are changing. What’s more, the power to cause change increasingly lies in our hands. In the age of Foundation Trusts and websites such as Patient Opinion, everyone in the UK can play a role in shaping the future of their local hospital. The age of ‘doctor knows best’ is long past and now, for the first time, you can help prescribe the improvements you want for your NHS.

The future of our healthcare system does not and should not depend on what happens in America, and I take issue with the cancer specialist who says that you lose control of your healthcare in a public health system.  Currently, we have more chance that we have ever had to determine how local NHS services are shaped.  The question is, will we take it?

It was always going to happen.  Gone are the headlines of soaring mortality rates and warnings of global doom; the media storm surrounding swine flu has instead turned on the general public, who are apparently deceiving their bosses, and the NHS and its perceived incompetence.

The People blasts: “Nine in 10 swine flu cases are colds”, while the Sun claims: “Sick Britain: Swine Flu skivers”. Even the Independent scolded: “Tens of thousands have faked swine flu symptoms to persuade the NHS to issue them with antiviral drugs”.

The paper goes on to claim that unless the government has seriously underestimated the scale of the epidemic, many of those prescribed Tamiflu are stockpiling it to be sure of having access to the powerful drug if and when they or their family contract the disease.

But before we start chastising the alleged thousands stashing Tamiflu in their mattresses, maybe it is worth asking ourselves why people are putting on their best sick voice to phone the NHS helpline, or shelling £50 to buy the drug on the internet.

Could it be the apocalyptic headlines that these papers have been brandishing in the last few months?

As the Mirror pointed out, swine flu is the “biggest challenge for the NHS in a generation”. Undoubtedly, the pandemic (a word that in itself has caused people to stockpile tins of spam) is one of the biggest logistical challenges to face NHS managers, but so far it seems to be less dangerous to health than the headlines suggest.

This raises two issues.  If the media hype has led to people stockpiling Tamiflu, then it is the hype that has caused the inefficient use of NHS resources. And if the pandemic does take a more deadly turn, will anyone who has experienced the media rollercoaster of the past four months take any of the subsequent health messages seriously?

The papers are reporting that couples seeking IVF treatment are being discriminated against in some parts of the country. Most are taking a sympathetic view to the plight of people who desperately want to become parents, but others are asking: is it really the taxpayer’s responsibility to pay for others’ desire to have a baby?

The 2004 NICE guidance states that the NHS should fund three cycles of IVF for women under 40. However, research suggests that eight out of ten primary care trusts are still failing to follow government recommendations. Regional disparities mean that the same woman can be too old for treatment in one part of the country and too young in another.

While this caused a public outcry from many this week, Ed West, a journalist at The Telegraph, took a less sympathetic approach, saying that the NHS is not made of money. He said: “When this incredible organisation was conceived (so to speak), it was intended to help the sick, not to provide liposuction for people who could easily lose weight themselves, sex-change operations and reverse sex-change operations, pills for men who can’t get erections, boob jobs and fertility treatment, not to mention a staggering 180,000 abortions a year, each costing around £500.”

With an increasing number of women choosing to have children later on in life, is IVF not a viable option if they experience fertility problems?

One blogger states in response to Mr West’s article: “Some women decide to earn a living and pay taxes for a decade before attempting to have children. One in four women suffers infertility. So taxes on four career incomes over a decade would easily pay for IVF treatment for the one in four women who chose to establish careers so that they can support the children they end up bringing into the world.”

Regardless of whether you are opposed to or in favour of the NHS providing IVF, it seems to be in a difficult position when deciding how to approach the issue. Whereas it must be heartbreaking for couples to know that where they live could make all the difference to whether they can have a baby or not, a one-size-fits-all approach to the system would surely not be the answer considering the consequences of IVF treatment.

As Melanie Phillips put it: “It’s the National Health Service, not the National Happiness Service”. 

In the first move of its kind in the UK, the management of a struggling NHS hospital could be transferred to a private company after the Government threw its weight behind controversial franchise plans.

NHS East of England SHA has been given the green light from the Department of Health to look for a new partner to run Hinchingbrooke Hospital in Huntingdon, which has an accumulated deficit of almost £40m.

Many are fiercely against the part privatisation believing it is the thin end of the wedge, with UNISON claiming: “A locally-based management system is needed if it is to be run efficiently, and not an arms-length, subordinate franchise.”

But is it not a valid option to turn to independent companies who can provide expertise where the trust has failed?

Mark Miller, chief executive of the Hinchingbrooke Hospital, said the aim was to secure a sustainable future while delivering best value for patients.

However, with the move attracting wide criticism, unions are particularly worried about the effect such an approach could have on staff and working conditions. Fears have also been voiced over the future of the assets and how the performance of the chosen organisation will be monitored in the long-term.

One possible option would be for another Foundation Trust to become the hospital’s partner and indeed the franchise has been offered to local FTs. However, they would need to be prepared to take on the substantial debt. It could also impact services with some being cut and run from just one hospital involving increased travel for treatment.

An independent provider with a strong management team that can make a profit to inject back into services and for itself could be the answer. A successful prototype has been running in Glasgow, with the local authority using a private company to provide management services while the manpower and service provision is still the responsibility of the council.

Time will tell if this is a successful proposal. But with more than 20 health trusts being warned they are not going to make Foundation Trust standard, and others in financial difficulty, Hinchingbrooke may be the first but possibly not the last to be part privatised.

It has been a week since World Health Organisation (WHO) adviser, Professor Michael Kramer, questioned whether the benefits of breast-feeding had been greatly exaggerated.

This has led to many health practitioners and mothers to angrily cry out: “Professor Kramer - WHO do you think you are?” 

On one level, the answer is simple. Professor Kramer is a man who has spent 20 years of his life studying the benefits of breast milk. During this time he has undertaken one of the largest trials ever conducted into human lactation and found that “there is little evidence that [breast feeding] … reduces the risk of leukemia, lymphoma, bowel and heart disease and high blood pressure.”

His research would appear to go against information material produced by the NHS and the views of The Royal College of Midwives – who all claim that breast milk is a “superfood” that can reduce the possibility of a raft of serious medical conditions.

So the question has to be asked: have we been sold a breast-feeding dummy? Is bottled milk really the right formula?

Despite what the headlines imply, the results of Kramer’s research actually “provide strong evidence that prolonged and exclusive breast-feeding improves children’s cognitive development.” He is hardly unsupportive of breast feeding.

Kramer’s real argument is that the battlefield between the formula milk industry and the breast-feeding lobby is fuelling a breast milk debate that has moved away from scientific conclusion. Research and evidence is being jumped upon and distorted to further arguments and agendas, meaning the clarity of scientific conclusion is being lost.
 
As such, our understanding of breast-feeding is “outdated” as it is shaped by the ideas and concepts of previous centuries, rather than the scientific evidence of the current age.

As the many varied headlines that followed the release of his research highlight, Kramer has a point. Lobbyists, midwives, companies and mums have all been waving their metaphysical placards claiming “Breast is Best” or “Bottle for Babies”, using something from Kramer’s research to support their cause.

So is Kramer actually only nourishing an argument he was trying to clarify and reason with? Could it be that the best thing that everyone can do is to let each mother make a decision based on her own judgement without the cloud of debate hanging over her?

By way of example, a study by the University of Leicester in 2007 found “the manner in which current breastfeeding promotion strategies are communicated may contribute to feelings of guilt and fears of inadequacy by mothers suffering from depression who are unable to breast feed their child”.

I am not sure whether leaving each mother to come to her own conclusion is the best thing, but I am sure someone will commission some more research and start some more debate to find out!

With the departure of Health Minister Lord Darzi on Tuesday, cynics and supporters alike were shocked as another of Gordon’s ministers resigned in a rather chaotic manner.

Having been enrolled into Gordon Brown’s spectacularly titled, Government Of All The Talents (GOAT), in 2007 following his NHS London review, Lord Darzi attracted some genuine buy-in as a practicing clinician who could credibly have conversations about clinical quality. Equally for the public, having a doctor in charge of health policy began to rebuild confidence in the government’s ability to run the NHS. His next-stage review, an ambitiously and maybe improbably named ‘High-quality care for all’ remains a commendably determined document.

While it is still too early to quantify any real changes, as a health policy, many healthcare professionals believe it has driven improvements in care. Quality, safety and the patient experience have been exposed to scrutiny as never before. GP opening hours are being extended, many hospitals now pride themselves on the effectiveness of their infection control, and there are numerous local examples of managers and clinicians who have been inspired to provide better services.

The official party line is that Lord Darzi has resigned to spend more time concentrating on his clinical work even though he is his least busy now in his political role having completed his one year review last month. While many saw his role in government a victory for the NHS, having one of their own on the inside able to make a change, others saw it as losing him to the dark side. Let’s just hope that the force is still with him.

Following news reports that the first sperm have been created artificially in a laboratory in Newcastle, debate has once again been raging from both medics and the public around the ethics of scientists playing God when it comes to reproduction.

While scientists are claiming this could lead to major advances in finding the causes of male infertility, others are questioning the ethics of destroying healthy human embryos in the name of research.

Professor Karim Nayernia, who led the trials, says: “This is an important development as it will allow researchers to study in detail how sperm forms and lead to a better understanding of infertility in men. This understanding could help us develop new ways to help couples suffering infertility so they can have a child which is genetically their own.”

However, the trials have sparked criticism from ethical groups who claim they are “immoral madness”. Josephine Quintavalle from Comment on Reproductive Ethics said: “Perfectly viable human embryos have been destroyed in order to create sperm over which there will be huge questions of their healthiness and viability.”

Like most initial findings, scientists admit more investigation is needed before a definite breakthrough is found. The million-dollar question is funding. Without a change in the law allowing such in-vitro derived (IVD) sperm for reproduction, will pharmaceutical companies shy away from opening their…wallets to fund further research?

One thing is clear though: men of the world can breath a sigh of relief that they are still at least useful for one thing…map reading.