Another nail in the coffin of NHS-funded homeopathy as Liverpool ceases funding

Another nail in the coffin of NHS-funded homeopathy as Liverpool ceases funding

Liverpool CCG has decided to decommission its homeopathic services after a public consultation found support for ending funding immediately. This is a swift about-face for the CCG after it approved spending on homeopathic services in February 2015.

The CCG opened a public consultation on homeopathy after a threat of legal challenge from The Good Thinking Society, a pro-science charity. 64% of Liverpool-based respondents indicated they wanted funding stopped, with 30% wanting the service continued. Michael Marshall, Liverpool resident and Project Director of the Good Thinking Society, welcomed the CCG’s decision: “This consultation shows overwhelmingly that the people of Liverpool believe limited NHS funds should be spent on treatments that are shown to actually work.”

The decommissioning of homeopathy in Liverpool continues the demise of homeopathy throughout the UK. Wirral CCG is the only area north of  Watford Gap currently funding homeopathy, and they are currently running a public consultation to determine whether to continue.

Homeopatic pharmacy, Varanasi Benares India
Homeopathy is a popular alternative to conventional medicine in many countries. However, there is no high-quality evidence to suggest it does what its advocates says it does.        Credit: Jorge Royan

In the South West, Bristol Homeopathic Hospital ceased funding homeopathic treatments in October 2015. The only remaining homeopathic hospital in England is in London, which receives funds from 17 CCGs. Limited information is available, but projections on what this totals range from £1.7-3m.

Elsewhere in the UK, Northern Ireland spends no NHS money on homeopathy and Wales spent £250 in 2014/15. In Scotland, 5 health boards funded homeopathy at a cost of approximately £1.9m in 2014/15, with the Glasgow Homeopathic Hospital accounting for the vast majority of this spend.

 

The letter that shows even Jeremy Hunt doesn’t believe changing junior doctors contracts will improve weekend care

Letter-from- the-Secretary-of-State-for-Health-to-the-Chair-on-seven-day NHS hospital services-page-001

Jeremy Hunt’s most recent letter in which he never mentions junior doctor contracts. An omission or an admission?

Junior doctors have been saying for months that they already work 24/7 and changing their contracts won’t improve patient care. It now seems even the Secretary of State agrees with them…

Four days ago, Jeremy Hunt wrote a letter to a fellow Conservative MP, Dr Sarah Wollaston, trying to explain the ongoing media kerfuffle about the ‘7 Day NHS’, and why it’s so important it needs to be tackled.

This is all fairly standard behaviour. Jeremy Hunt is the Secretary of State for Health. Dr Wollaston is Chair of the Health Select Committee, and the most influential M.P. on health matters outside the Government. It makes sense that they would communicate on a fairly regular basis.

He starts by explaining the 10 clinical standards that NHS England describe for 24/7 care. He explains that four standards are most important. These are:

  1. Consultant presence during initial treatment decisions
  2. Regular consultant review
  3. Access to diagnostic tests
  4. Consultant-led interventions

He then sets out his evidence for why these changes are important. He lists 15 studies that have apparently found worse health outcomes during the weekend than on weekdays. He lists a number of proposed reasons for why this might be, including the possibility of sicker patients being admitted at the weekend.

One group of people he doesn’t mention are junior doctors. Not even once. However he does mention their senior colleagues, the consultants. In fact, he mentions them a lot.

Letter-from- the-Secretary-of-State-for-Health-to-the-Chair-on-seven-day NHS hospital services-page-003
 

The importance of consultant presence at the weekend is mentioned 5 times in one page alone.

 

 

With no less than 10 mentions in what amounts to 3 sides of A4, Jeremy certainly seems to think that changes to how consultants practise their jobs are necessary to stop substandard care.

He’s also quite keen to mention improved access to diagnostic tests (4 mentions) and to suggest improvements to community and primary care services (2 mentions).


 

For those of you wondering if Hunt mentions his ‘20% increase in stroke death at the weekend’ line, yes he does. He then promptly mentions that the implementation of Highly Acute Stroke Units (HASUs) has reduced this figure dramatically. In his words, ‘this clearly demonstrates the link between seven day services and reduced mortality rates.’

And in my words, ‘and it was all achievable under the current junior doctor contract, as are all your other suggestions to improve weekend care.’

Given that Mr Hunt clearly knows what needs to be done to improve weekend care (and its not junior doctor contracts), and has admitted as such, it’ll be interesting to see if he continues to peddle the nonsense that junior doctors don’t work: at all/enough/with enough ‘vocation’ (delete as appropriate) at the weekend when he pops back into the spotlight again.

Doctors of all grades and specialities want to help make all care, including weekend care, better. The implementation of HASUs shows that where problems exist, the NHS can pull together to change them.  What won’t change them is antagonising all the junior doctors to the point where half of them don’t sign up for speciality training, and quite a few of them never come back.


 

Click here to read the full text of Jeremy Hunt’s letter 

If you’re a junior doctor, medical student or anyone at all who cares about how the junior doctors who work in our NHS are treated, email jdcchair@bma.org.uk and make the subject “FAO: David Dalton & Clare Panniker”. The negotiating teams want to know your views and they want to know them ASAP!

 

 

 

 

 

 

 

 

 

 

 

 

Why Does Your GP Want Your Opinion on That Nasty Cold You Have?

This week is apparently World Antibiotic Awareness Week. If you already knew that, you’re either a microbiologist or have far too much time on your hands. In the spirit of that, I’ve had a look at what’s new in the world of antibiotics.

Last week, the Cochrane Library published a new paper looking at shared decision making and its effect on antibiotic prescribing trends.

The review analysed the results of nine randomised controlled trials, and found that if doctors and patients share the decision to prescribe antibiotics, less prescriptions are given out.

Importantly, this reduction occurred without a drop in patient satisfaction or an increase in repeat consultations for the same illness.

In other words, chatting about antibiotics means less are prescribed and there’s no significant downsides. Sounds like a win-win situation.

giphy

For those of you not convinced, and who still want antibiotics for that persistent earache, here’s a few things to bear in mind.

  1. Viruses can cause illnesses that last longer than you think, and that are worse than you think.
  2. Antibiotics will do nothing for these viral illnesses
  3. If you take antibiotics when you don’t need them, you expose yourself to unnecessary harm. Not a huge amount, but there’s no point getting a bout of nausea and heartburn when you don’t need one. To be honest, you never really need one.

While shared decision making is unlikely to be enough to reverse the rising tide of antibiotic resistance, anything which leads to a reduction of unnecessary prescriptions is good for patients, good for the NHS and good for the taxpayers who actually pay for all of this.

A Look At Homebirths

NB: I originally wrote this article three years ago for a different blog. Having now completed an obs and gynae placement I thought it would be a good time to re-release it. It’s mostly in it’s original form, though I’ve edited some bits of it.

Browsing my Twitter feed, I saw an interesting story pop up from Health Impact News. According to Judy Colhain, the American Journal of Obstetricians and Gynaecologists (AJOG) have ‘issued a warning to all doctors and midwives to refuse to attend homebirth under all circumstances. ‘ See the full text of Judy’s article here and see the full text of the AJOG statement here. I’ll be referring to them a lot so it’s probably a good idea to at least skim through them

Wow. That seems like a big step. You mean that if a woman was suffering a severe haemorrhage during labour, not one obstetrician would go to her aid? You’ll probably be unsurprised to here that this isn’t what they’ve said. They actually said that ‘We urge obstetricians, other concerned physicians, midwives, and other obstetric providers, and their professional associations to eschew rights-based reductionism in the ethics of planned home birth and replace rights-based reductionism with an ethics based on professional responsibility.’

In non-medical speech, this means ‘We ask every health professional involved in pregnancy and birth to act based on what is best for the patient, not based on what the patient thinks they should have.’

Just because a woman wants a homebirth it does not automatically make it an obstetrician’s responsibility to let her have one. It is his/her professional duty to tell the woman what is the best course of action based on the collective published evidence and to act upon this. If the obstetrician feels a homebirth is appropriate and safe, then here in Blighty at least, the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) approves them. I happen to agree with them, and think wider use of midwifery led care in appropriate cases would help ease the considerable pressure maternity units are under. The AJOG disagrees with on this issue, and that is their prerogative, though I think they are probably a bit over zealous,

Continuing through her article, Mrs Colhain quotes the AJOG as recommending ‘that all obstetricians and other concerned physicians, midwives and other obstetric providers, and their professional associations not support planned home birth… refuse to participate in planned home birth.. and recommend strongly against planned home birth’. Note the ellipses that Mrs Colhain has correctly used. For the non-grammatical amongst you, an ellipsis is used to indicate where someone has omitted words from a quote. Or in this case, taken a quote out of its context to make it support her own position. The above quotes actually comes from a sixteen line paragraph. Mrs Colhain has also changed the order of these quotes and changed the wording of them. Hopefully, I’ll clarify the picture for you.

This is what the first part of the above quote should say –

We call on obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations not to support planned home birth when there are safe and compassionate hospital-based alternatives and to advocate for a safe home-birth-like experience in the hospital.’

The AJOG are recommending that health professionals support a safer yet still compassionate alternative to homebirths, and that even in hospital, the experiences should be ‘home-birth-like’. Having seen a labour in a hospital birthing pool, I can attest that it was a very relaxing experience. The scented oils, classical music and copious amounts of tea made me very comfortable. Can’t speak for the lady giving birth.

The second part of the quote comes from earlier in the paragraph and put in context says:

 ‘refuse to participate in planned home birth; but still provide excellent and compassionate emergency obstetric care to women transported from planned home birth’.

Yes, the AJOG are recommending that health professionals don’t participate in homebirths as they are generally less safe and often, women who choose homebirth end up being transported to hospital due to complications. For example, the lady I saw in a hospital birthing pool ended up transferring for an emergency C-section. I’d say it was a good job she was in hospital, rather than in her living room.

As we can see from above, doctors will still give care to these women, somewhat ruining the ‘people-in-hospitals-are-monsters’ angle that the article is seemingly going for. This also explains why the Royal College of Obstetricians and Midwifes here in Britain thinks home births are OK. Generally in Britain, you are very close to an obstetrics unit if something goes wrong, as Britain is a minuscule island. In the US, there are large stretches of the country without easy access to an obstetrics unit so home-based difficulties are much likely to cause morbidity or mortality.

The third part of the quote is mysterious. Certainly, the words Mrs Colhain quotes never seem to appear in the article, I can’t find them anywhere and neither can the search function of Microsoft Word (other word processors are available). Strangely what I think Mrs Colhain is quoting appears earlier in the article, and she appears to put this quote last solely for a dramatic finish. I’m going to be extremely generous and suggest that the changes in words and order were not deliberate obfuscations but she was merely paraphrasing for ease of reading. Let’s compare what should have been written and what was actually written next to each other.

QUOTED: and recommend strongly against planned home birth

ACTUAL: respond to expressions of interest in planned home birth by women with evidence-based recommendations against it

As I have highlighted above, Mrs Colhain neglects to mention a small thing. What’s that? Oh, just the small fact that the evidence goes against her position. Which, when you’re trying to be persuasive, is not the best of things.

Next, Judy Colhain talks about the ‘splendorous diversity of human conditions’ after a long list of reasons that may cause a woman to choose a homebirth. This doesn’t alter the fact if something goes wrong, which it can often do, then the hospital is a much safer place to be. Yes, it would nice if every woman could give birth at home surrounded by family in comfortable conditions. But the cold hard truth is that this would probably result in more mothers dying in childbirth. Something to think about.

Mrs Colhain states that ladies that have embolisms may die in hospital anyway, the mortality rate in hospitals being 27%. To me that shows the three quarters of ladies would survive. Now I don’t know about you but I think suffering an embolism in a homebirth scenario might have a slightly worse survival rate than 73%. I’d also like to point out that the statistics she gives are for amniotic fluid embolisms, and not the much more common thromboembolism. Why does she assume a lady with an embolism would have an amnoitic fluid one? I’ve absolutely no idea.

I’ve split this article into two parts – I’ll post the link to part two here when it’s published

A Survival Guide for the Sheffield Central General Election (Part 3)

Welcome to the third, and final, part of my Sheffield Central election preview. Having already looked at the not-going-to-be-winners and the probably-not-going to be winners, this week I’m looking at the man who is likely walking off with the top prize.

If you haven’t read the first two parts, click here and here.

The Probable Winner

Paul Blomfield is the incumbent MP, and Labour candidate. He holds one of his parties’ thinnest majorities at 154 and presided over a 23.1% loss of majority in his first general election. Seems like a possible lost Labour seat right? Let’s go through his challengers to see who might beat him:

  • Communist, Pirate and Above and Beyond – don’t think even the candidates themselves think they will win
  • Conservative – given the unpopularity of the Tories nationwide and the demographic of the seat (students, working class people and more students), Stephanie Roe will be doing well if she can match the 10% share the Tories usually get here.
  • Liberal Democrats – in the 2014 council elections, the Lib Dems got an average of 11.7%. That is just over one quarter of what they got in the 2010 general election. Given that students can’t be arsed to get out of bed for the local elections, that isn’t even lost student votes, that is just lost votes. I think I may have been too optimistic giving Joe Otten a possible in this election
  • Greens – Probably the most likely challenger to Paul Blomfield, the Greens were the clear second party in the local elections (30.52% to 42.12%), and the only party other than Labour to win council seats in the 5 constituency wards that make up Sheffield Central. However, they still have to gain 37% form their 2010 general election performance. If they pulled it off, it would be the single biggest increase ever in a general election.

For those still paying attention, Paul Blomfield in all likelihood is going to sleepwalk into his seat. According to electoralcalculus.com, he’s predicted to get 46.3% of the vote. Though I’m not sure how much I trust them as they have UKIP gaining 12% of the vote, and they aren’t even running a candidate in this constituency.

They are still probably correct though. The Lib Dems will lose votes this time around, the Tories haven’t got much of a look in, and the Greens could improve by 1000% percent and still possibly not get in . Even without looking at the advantages Mr Blomfield has, the disadvantages of every other party will probably gift him the seat.

Speaking of advantages, what does Mr Blomfield have? Well he has had 5 years to raise his profile, and has, so far, avoided any huge political cock-ups. Thanks to theyworkforyou.com, we can see that his voting record is pretty appealing to his left-leaning constituency (for an elected Lords, against tuition fees, against the bedroom tax etc.). His one major challenger last time around was basically kneecapped by the tuition fee saga, and his up-and-coming challenger needs to gain 15,582 votes cast to catch up with him.

Now those votes do exist. 28,000 people didn’t vote in Sheffield Central in 2010, easily enough to catch up with Labour. Fortunately for Labour, that was also the biggest turnout in 60-odd years and they still didn’t lose.

Another positive indication for Paul Blomfield, he’s just won a national award for higher education which was awarded through a popular vote. In other words, he’s just had a load of students vote for him and come out on top. Which is more or less what he needs to happen on May 7th.

Realistically, Paul Blomfield is highly likely to win; both the bookies and pollsters think so. The Greens simply have to jump through too many hoops to win, and any small pothole could send the whole campaign bus spinning for them.