This is how my friend Dr Rant views the recent media reports on antidepressants:
Researchers from Hull University are claiming that antidepressants only work for patients who are severely depressed.
Whilst Dr Rant is perfectly willing to believe that placebo is just as good as antidepressants for mild to moderate depression, I think we do need to point out a glaring problem with this research. It's from Hull. I mean, have you been to Hull? ****, if I lived in Hull I'd be depressed and I don't think antidepressants would help. The 1960s didn't happen in Hull until about 1985.
Here's a suggestion: next time compare the effects on depression of taking placebo against simply moving to somewhere that isn't Hull.
Thursday, 28 February 2008
Wednesday, 27 February 2008
Spilling the beans
From The Guardian:
NHS hospitals across England are systematically rigging their waiting lists to make it look as if they are hitting key government targets, the Department of Health acknowledged yesterday.
It said GPs were right to complain that it was becoming harder to make bookings for patients to get hospital treatment.
Many NHS trusts are telling GPs that their lists are full over the next few weeks and refusing to make advance bookings for later in the year. By keeping the queues short, the hospitals hope to hit the government's target for reducing waiting times.
The main health pledge in Labour's 2005 election manifesto was to reduce the maximum wait to 18 weeks from referral by a GP to being wheeled into the operating theatre, with no extra time added for patients needing complex diagnostic tests. An inquiry by Pulse, a newspaper for GPs, found 90% of hospitals were restricting advance bookings. "The practice can mean patients are barred from going to the hospital of their choice, since popular hospitals may have no appointment slots available in the short term," it said.
Ministers told GPs it would be easier to make hospital appointments for patients using an electronic system known as Choose and Book. But the inquiry found hospitals are keeping up to a third of their appointment slots off the electronic register in an attempt to reduce demand. The British Medical Association said: "We have heard of similar reports from doctors across the country. We would be very concerned if trusts were putting targets ahead of patient care.
"It is ironic that when government has put great emphasis on patient choice, their own targets on waiting times are stopping some patients from choosing their preferred hospital for treatment."
The association said it had evidence of trusts refusing referrals from GPs to avoid breaching the 18-week target. "All additional referrals are returned to the GP and not passed to an alternative provider. Such a situation could be repeated, by various providers, and further delay the patient's treatment," the association said. In some cases, hospitals were refusing to treat patients until the GP had dealt with problems such as high blood pressure or excessive weight.
A Department of Health spokesman said: "Hospitals should not be doing this. They are required to accept all referrals if clinically appropriate, and should not be manipulating Choose and Book to help them meet other targets." He added: "It is right for patients that they now have more choice, allowing them to arrange appointments at times and at hospitals that suit them - however this should not be at the detriment of being seen quickly ...
"The department has taken direct action by putting in place a national system to ensure that where patients are told that there are no appointments available on Choose and Book for their chosen hospital, they are still referred on to the provider of their choice."
NHS hospitals across England are systematically rigging their waiting lists to make it look as if they are hitting key government targets, the Department of Health acknowledged yesterday.
It said GPs were right to complain that it was becoming harder to make bookings for patients to get hospital treatment.
Many NHS trusts are telling GPs that their lists are full over the next few weeks and refusing to make advance bookings for later in the year. By keeping the queues short, the hospitals hope to hit the government's target for reducing waiting times.
The main health pledge in Labour's 2005 election manifesto was to reduce the maximum wait to 18 weeks from referral by a GP to being wheeled into the operating theatre, with no extra time added for patients needing complex diagnostic tests. An inquiry by Pulse, a newspaper for GPs, found 90% of hospitals were restricting advance bookings. "The practice can mean patients are barred from going to the hospital of their choice, since popular hospitals may have no appointment slots available in the short term," it said.
Ministers told GPs it would be easier to make hospital appointments for patients using an electronic system known as Choose and Book. But the inquiry found hospitals are keeping up to a third of their appointment slots off the electronic register in an attempt to reduce demand. The British Medical Association said: "We have heard of similar reports from doctors across the country. We would be very concerned if trusts were putting targets ahead of patient care.
"It is ironic that when government has put great emphasis on patient choice, their own targets on waiting times are stopping some patients from choosing their preferred hospital for treatment."
The association said it had evidence of trusts refusing referrals from GPs to avoid breaching the 18-week target. "All additional referrals are returned to the GP and not passed to an alternative provider. Such a situation could be repeated, by various providers, and further delay the patient's treatment," the association said. In some cases, hospitals were refusing to treat patients until the GP had dealt with problems such as high blood pressure or excessive weight.
A Department of Health spokesman said: "Hospitals should not be doing this. They are required to accept all referrals if clinically appropriate, and should not be manipulating Choose and Book to help them meet other targets." He added: "It is right for patients that they now have more choice, allowing them to arrange appointments at times and at hospitals that suit them - however this should not be at the detriment of being seen quickly ...
"The department has taken direct action by putting in place a national system to ensure that where patients are told that there are no appointments available on Choose and Book for their chosen hospital, they are still referred on to the provider of their choice."
Tuesday, 26 February 2008
Freedom of Information
The Save Bedford Hospital party has been asking some questions on your behalf under the Freedom of Information Act. We will let you know the outcome : keep checking out this site, because the answers could be interesting (or painful if you are a taxpayer)
Who is telling the truth?
Gordon Brown has promised a "more personalized" NHS
Lord Darzi wants GPs to work in mega-clinics of 20 or more doctors.
Both ideas may have merit, but are they not mutually exclusive?
Lord Darzi wants GPs to work in mega-clinics of 20 or more doctors.
Both ideas may have merit, but are they not mutually exclusive?
Saturday, 23 February 2008
Jack's Eye - latest news
I reckon Jack and his wife Gay deserves a pat on the back from us all.
They were up at 0500 getting ready for the Today programme, and BBC Radio Devon, and BBC Spotlight for all of these people Gay made coffee and provided bacon and egg (sadly I had eaten before leaving for their house which proved a mistake).
They "threw me" on the the Today programme when they said that NICE were planning to issue their guidance today - I spent an hour working on a speech to deliver in case we arrive dat Downing Street to the news tat Mr Brown had seen sense.
Jack's treated eye has worsened and he almost tripped over a trailed suitcase in the busy station at Paddington - his cat like reflexes saved the day. He put on a brave face but I could see he was shocked.
We arrived at Downing Street courtesy of The Mail on Sunday (buy a copy please) and were inundated with attention.
The police have a search room and we were welcomed so warmly it felt like they were old friends. They were actually queing up to shake hands with us! I guess the coppers are in the same boat as the docs and we all admire war veterans.
We felt like filmstars with a scrum of photographers fighting to get the best shots of your cheques and Number 10 in the background.
We then swaggered up to the famous door - we were expected - and a photographer shouted out to knock.
At this point I saw it. It was huge. It was Victorian. It was cast iron. It must have weighed five pounds. I could not help myself - I reached up and banged the doorknob so hard the fillings must have been shaken from Gordons teeth (lets hope he has an NHS dentist).
A dazed car park attendant (they must get the uniforms from the same supplier) staggered from inside and asked if I was "The Doctor" Jack replied in the affirmative and said we had something for Gordon.
I was prepared to come in - afterall Gordon knows that it is impossible to get an NHS GP to make a housecall - I even had my gloves (in case he wanted to shake my hand). It was obvious that the doctor was no longer required and we were politely thanked.
We handed over the cheques and the door closed gently behind us. As we walked away I heard a distant low pitched rumble coming from the cabinet room and even Jack's ancient olfactory nerve could detect the powerful smell of flatus.
We turned to the waiting pack of reporters and gave out interviews.
The local BBC and ITV TV news were following us, Radio Devon, and the Mail on Sunday, the Express, The Herald Express, the press association - all out for a soundbite.
A few minutes of fighting talk in Whitehall (Jack was filmed with the cenotauph as a backdrop) and we were in a Taxi.
When we got on the train at Paddington my mobile did not stop ringing until the battery gave out. By this time we had a group of fascinated passengers were politely pretending to read books - the bloke in front of me must have a reading age of 8 because he did not turn a page before Reading.
When the batter packe dup a fellow passenger offered us a charger and another one her phone. We carried on interviewing. The lady with the phone texted her mum who watched the news. "mum says the doctor is going to kick down Browns's door - she says it was brilliant!!!!"...
We will see what comes up on the BBC spotlight (sky 987) and ITV Westcoutry. The crews there thought it would be on national news at 2200.
We know there will be more in the press.
The story is not over though. Now Gordon has got our cheques. And he knows that if he does not send them on to Jack the doctor will be back - which is not the sort of housecall Gordon really wanted.
They were up at 0500 getting ready for the Today programme, and BBC Radio Devon, and BBC Spotlight for all of these people Gay made coffee and provided bacon and egg (sadly I had eaten before leaving for their house which proved a mistake).
They "threw me" on the the Today programme when they said that NICE were planning to issue their guidance today - I spent an hour working on a speech to deliver in case we arrive dat Downing Street to the news tat Mr Brown had seen sense.
Jack's treated eye has worsened and he almost tripped over a trailed suitcase in the busy station at Paddington - his cat like reflexes saved the day. He put on a brave face but I could see he was shocked.
We arrived at Downing Street courtesy of The Mail on Sunday (buy a copy please) and were inundated with attention.
The police have a search room and we were welcomed so warmly it felt like they were old friends. They were actually queing up to shake hands with us! I guess the coppers are in the same boat as the docs and we all admire war veterans.
We felt like filmstars with a scrum of photographers fighting to get the best shots of your cheques and Number 10 in the background.
We then swaggered up to the famous door - we were expected - and a photographer shouted out to knock.
At this point I saw it. It was huge. It was Victorian. It was cast iron. It must have weighed five pounds. I could not help myself - I reached up and banged the doorknob so hard the fillings must have been shaken from Gordons teeth (lets hope he has an NHS dentist).
A dazed car park attendant (they must get the uniforms from the same supplier) staggered from inside and asked if I was "The Doctor" Jack replied in the affirmative and said we had something for Gordon.
I was prepared to come in - afterall Gordon knows that it is impossible to get an NHS GP to make a housecall - I even had my gloves (in case he wanted to shake my hand). It was obvious that the doctor was no longer required and we were politely thanked.
We handed over the cheques and the door closed gently behind us. As we walked away I heard a distant low pitched rumble coming from the cabinet room and even Jack's ancient olfactory nerve could detect the powerful smell of flatus.
We turned to the waiting pack of reporters and gave out interviews.
The local BBC and ITV TV news were following us, Radio Devon, and the Mail on Sunday, the Express, The Herald Express, the press association - all out for a soundbite.
A few minutes of fighting talk in Whitehall (Jack was filmed with the cenotauph as a backdrop) and we were in a Taxi.
When we got on the train at Paddington my mobile did not stop ringing until the battery gave out. By this time we had a group of fascinated passengers were politely pretending to read books - the bloke in front of me must have a reading age of 8 because he did not turn a page before Reading.
When the batter packe dup a fellow passenger offered us a charger and another one her phone. We carried on interviewing. The lady with the phone texted her mum who watched the news. "mum says the doctor is going to kick down Browns's door - she says it was brilliant!!!!"...
We will see what comes up on the BBC spotlight (sky 987) and ITV Westcoutry. The crews there thought it would be on national news at 2200.
We know there will be more in the press.
The story is not over though. Now Gordon has got our cheques. And he knows that if he does not send them on to Jack the doctor will be back - which is not the sort of housecall Gordon really wanted.
Open all hours
MPs' working hours
Sir - I recently wrote to my MP about the Government's plans for GPs' extended hours. I was dissatisfied with her response.
I contacted her secretary to make an appointment and was told that her next available surgery appointment was six weeks away. I was even more surprised to learn that she does not offer appointments in the evening or at weekends. I was told she sees constituents between 3pm and 4.30pm on a Friday once a month, take it or leave it.
I had heard that MPs had abandoned evening and weekend parliamentary sittings for more family-friendly hours. However, I was taken aback by how unfriendly their hours are to working constituents. It would appear that the Government does not practise what it preaches.
Dr Steven Nimmo, Plymstock, Devon
Sir - I recently wrote to my MP about the Government's plans for GPs' extended hours. I was dissatisfied with her response.
I contacted her secretary to make an appointment and was told that her next available surgery appointment was six weeks away. I was even more surprised to learn that she does not offer appointments in the evening or at weekends. I was told she sees constituents between 3pm and 4.30pm on a Friday once a month, take it or leave it.
I had heard that MPs had abandoned evening and weekend parliamentary sittings for more family-friendly hours. However, I was taken aback by how unfriendly their hours are to working constituents. It would appear that the Government does not practise what it preaches.
Dr Steven Nimmo, Plymstock, Devon
Wednesday, 20 February 2008
No wonder
No wonder so much public money is wasted:
A report has revealed that not one single Permanent Secretary (the senior civil servants in charge of Whitehall departments) has a professional finance qualification and so, according to the National Audit Office, government departments lack the financial expertise to manage their multi-billion pound budgets efficiently.
Government spending will reach £678 billion by 2010-11, yet six government departments don't even have a qualified finance director in their senior management team, despite a Treasury requirement to do so.
I wonder what this tells us about how our money is being spent?
A report has revealed that not one single Permanent Secretary (the senior civil servants in charge of Whitehall departments) has a professional finance qualification and so, according to the National Audit Office, government departments lack the financial expertise to manage their multi-billion pound budgets efficiently.
Government spending will reach £678 billion by 2010-11, yet six government departments don't even have a qualified finance director in their senior management team, despite a Treasury requirement to do so.
I wonder what this tells us about how our money is being spent?
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