Yorkshire and Humber School of Radiology to be ran by a radiographer; a bottle of red with lunch blamed

In very specific, but very silly news, The Yorkshire and Humber School of Radiology and Health Education England have chosen a non-radiologist, supposedly Dr Anne-Marie Culpan, as its head. She has no experience of radiology and isn’t medically qualified. She is in fact, a highly capable academic radiographer who has a PhD and is a senior lecturer in breast imaging at the University of Leeds. So no slouch, but definitely not a radiologist – a fact so concerning to the Royal College of Radiologists (RCR) that they are trying to urgently meet with the school to ‘explore how the damage caused by this ill-informed and ill-conceived decision can be limited’.

Now I don’t seriously believe the interview panel didn’t know the difference between the two, but according to the RCR, there was no radiologist on the interview panel, and an experienced and qualified radiologist did apply for the job, so it’s in play. For those unaware, here’s a simple guide that works for most situations –  radiographers use the scanners to do the test; radiologists look at the images to see what’s wrong.

As Anthony points out in the comments, the line between radiography and radiology can get a bit blurry. Some radiographers give radiotherapy treatments; others report on the results of tests in the same way as radiologists. The description above is not to be conclusive.

Now for why this appointment was exceedingly dumb.

  1. Head of Schools are responsible for delivering the training set out by the Royal College of Radiologists. Anne-Marie Culpan cannot even be a full member of this college as she is not a radiologist, leaving her outside of the loop when discussing clinical training.
  2. They are responsible for pastoral and training support of all radiologists in the Yorkshire and Humber area, including those in higher specialty training. Anne-Marie Culpan has not done even foundational medical training, leaving a question open about how much understanding and empathy she will have with complicated training problems.
  3. Anne-Marie Culpan would be responsible for any concerns raised about doctors. While I generally don’t hold much of a candle to the argument that only doctors can pass judgement on other doctors, I quite like those in senior positions to understand what the juniors should and should not be doing. It’d be extremely inappropriate for a radiologist to be in charge of supervising radiographers in training, it is no different the other way around.
  4. I do not know much about Dr Culpan, but her academic and radiographic work seems to have been very focused on breast imaging.  It seems hard to visualise how someone will go from being a very specialist research and teacher in one sub-speciality of a profession, to supervising 125 trainees going through generalist and sub-specialty training in a totally different profession.

While just one appointment, it does seem to part of a trend that doctors aren’t quite necessary under the people running the NHS. To expect a radiographer to understand what its like to be a radiologist and do so well enough to train consultants in that area is a ridiculous idea. It’s the equivalent of having a doctor train nurses or pharmacists, or in the non-medical world, a mainstream school teacher trying to train special school teachers. Let’s hope Health Education England don’t try such a dumb appointment again.


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.


A Mixed Day for Gay Men’s Sexual Health

Jane Ellison, Minister for Public Health, announced yesterday that NICE will start looking at the evidence surrounding the clinical effectiveness of pre-exposure prophylaxis for HIV, or PrEP. This is in addition to £2 million being spent on cost-effectiveness studies for PrEP.

The idea behind PrEP is that someone could take medication and prevent themselves from catching the HIV virus when exposed to it, similarly to how people take malaria tablets, and was so effective in placebo controlled trials it was deemed unethical to continue giving a placebo. That same trial found that PrEP was also cost-effective.

I’ve written about PrEP before, achieving my highest accolade in journalism when Dr Christian off the telly retweeted my story. While the decision to have NICE look at effectiveness of PrEP is a positive step forward, it does illustrate the fragmentary nature of sexual health policy in this country. NHS England is looking at cost-effectiveness. NICE looks at clinical effectiveness. Local councils say they can’t afford to fund it if it ever gets approved, NHS England says they have to.

Lacking a central body to coordinate policy on PrEP, the government seems to be floundering on what is a potentially life-saving drug. This floundering will disproportionately affect gay men and other men who have sex with men (MSM).

More happily, the government has agreed to pilot a program of HPV vaccination for MSM thanks in part to the persistent efforts of Mike Freer, officially the MP for Finchley and Golders Green, and unofficially chief parliamentary rabble-rouser for gay and LGBT affairs.

HPV is the sexually-transmitted virus responsible for genital warts and most cervical cancers, and since 2008, a national vaccination program has been in place for girls. HPV is also linked to an increased risk of cancers of the mouth, throat, head, neck, penis and anus, and it doesn’t take the most active imagination to realise MSM might be at higher risks for sexually-transmitted HPV.

The pilot will aim to reach 40,000 MSM in England- around 35% of those who attend sexual health clinics annually. As health is devolved to the national legislatures, Wales, Scotland and Northern Ireland are hoping to develop their own pilot schemes.

Freer has developed a highly effective niche as a  backbencher on LGBT and HIV/AIDS issues. He memorably came out to his parliamentary colleagues during a passionate speech on gay marriage.

Random sexual health story – good news comes out of Eastern Europe. Armenia has eliminated mother-to-child transmission of HIV; Moldova, who’ve done the same for syphilis; and Belarus who’ve done the double. These countries may not have made Euro 2016, but they’ve got a much better achievement to celebrate.

Private Medical Scans – My Experience of Alliance Medical

Private Medical Scans – My Experience of Alliance Medical

NHS England recently awarded a contract for cancer scans to a company called Alliance Medical. This came despite a rival bid from a group of publicly-funded NHS hospitals being £7 million cheaper.

(EDIT  FEB 2016: The contract award was made in January 2015; it has recently been doing the rounds on social media again. The message of this article still stands, however it is a mistake to describe it as ‘recently’ as I originally did. The piece is edited to reflect that.)

The fact that senior Conservative MP Malcolm Rifkind sits on the board of Alliance Medical would clearly have nothing to do with this decision.

The deal was handled by the NHS Strategic Projects team. They helped secure the deal to privatise Hinchingbrooke Hospital. This deal spectacularly collapsed last year amongst damning inspection reports.

All fairly normal for the murky world of NHS private procurement. But unusually, I can actually add something to this news story. I happen to have some personal experience of Alliance Medical and their scanning work. Here it is.

Meeting Doris

During my 2-week placement on a neurology ward, I met a lady, who I’ll call Doris for the sake of this post. Doris had come to our ward after a fall. She  happened to have lost her balance, was a bit confused, and generally seemed ‘a bit off’. This was with good reason.

A CT scan revealed, she had two substantial extradural haematomas, one on the right and one on the left. These are bleeds into the space between the layers that cover the brain and the skull. They are not good news. Quite frankly, it was a miracle Doris was doing as well as she was.


Obvious Bleeding

A couple of hours after I’d seen Doris, and after she’d been sent to surgery, I was called into an office by the professor in charge of her care. He showed me a brain scan, not the one I’d seen earlier, and asked me what was wrong with it. Like Doris’ scan, it was an extradural haematoma and, happily for me, I noticed this.

That’s the thing about massive extradural haematomas (or any massive brain bleed/injury). They are a bit obvious.

To prove this to the non-medics reading this, see if you can see what’s wrong with this scan:

A fairly obvious extradural haematoma.                                                                           Credit:MedPix

Even without the helpful arrows, I’d hope you can notice the massive white blob on the left side of the left picture. Even if you couldn’t say what it was, you’d probably say: ‘That doesn’t look like it should be there, I might tell somebody about it.’

Whoever worked for Alliance Medical and looked at the scan did not think that. They didn’t notify anyone about the massive extradural haematoma, and as a result, that patient went out into the world without being treated.

That patient was Doris. She’d had a CT scan a week before I’d seen her, for a reason I’ve now forgotten. I’m not sure it really matters. Whatever it was, doctors had not thought it serious enough to wait for the report of the CT scan.

That CT scan had been sent to Alliance Medical where three equally bad options await us.

  1. No one looked at the scan in the week leading up to me seeing Doris
  2. Someone looked at the scan and didn’t notice the massive bleed that was obvious enough for a 3rd year medical student to spot
  3. Someone looked at it, noticed what was wrong and didn’t tell either her GP, or the hospital who commissioned the scan, that their patient had a potentially fatal injury.

Actualy, we don’t have three options. It was the last one. The scan had been reported correctly, but no one at Alliance Medical thought it important to tell someone Doris was very, very ill indeed.

As a result, Doris spent a week with a bleed in her brain that could’ve killed her. She then fell and developed a second one.

Unneccessary Harm

Happily, Doris left hospital alive and well. However, it could’ve finished quite differently. She was exposed to a week of serious harm completely unnecessary.

She could’ve easily died if she hadn’t had the ‘luck’ to fall and be ill enough to require a second CT scan.

In this incident Alliance Medical, which  through incompetent management or lack of clinical judegemnt, failed Doris. They failed the NHS, which was required to pick up the pieces of the failure of private healthcare. They failed the British taxpayer who pay them handsomely to look at non-urgent scans so stretched NHS doctors don’t have to.

I imagine my experience is a one-off. I hope it is for the sake of patients like Doris and the NHS as a whole. Otherwise, it seems very unlikely that Alliance Medical will be able to provide a service that’s worth paying an extra £7 million for.


Labour granted emergency debate in Parliament over junior doctor crisis

Labour Shadow Health Secretary Heidi Alexander has been granted an urgent debate on junior doctor contracts in the House of Commons. The debate will take place at 3:30pm on Monday 8th.

The debate comes just two days before junior doctors across England are due to go on strike over proposed new contracts.

Despite several series of negotiations, the British Medical Association and the Department of Health have not reached agreement.

The BMA and the government are clashing over issues such as Saturday pay rates, automatic pay progression and payment for doctors who work on-call shifts from home.

This is the second time Labour has called an urgent debate  on junior doctor contracts. The previous one, on November 20th 2015, attracted some controversy after Jeremy Hunt failed to turn up to respond to Labour MPs.

UPDATE: According to Heidi Alexander, Jeremy Hunt will not be responding to the urgent debate today.


Junior doctors to go ahead with industrial action

Junior doctors will be going on strike after the British Medical Association (BMA) and the Department of Health failed to reach an agreement over new contracts.

Junior doctors protesting in London on 17th October 2015. Credit: Rohin Francis
Junior doctors protesting in London on 17th October 2015. Credit: Rohin Francis
For 24 hours beginning at 0800 on Wednesday 10th February, junior doctors in England will offer emergency care only. Junior doctors in Scotland, Wales and Northern Ireland will not be striking.

Johann Malawana, head of the BMA Junior Doctor Committee, said: “We made some good progress. But the Government has made clear, yet again, that they are not prepared to address issues our members have made clear are critical to them.”

The strike on 10 February was originally planned to be a 12-hour walkout from all care – including A&E and other emergency care. Malawana said about the change: “We believe that this balances the need to demonstrate our determination to the Government whilst minimising disruption to patients.”

Junior doctors are concerned about the removal of safeguards to prevent them being overworked; the removal of year-on-year pay progression and the Government’s plan to make Saturday a normal working day.

However some junior doctors online expressed frustration with their trade union. Andreas Leonidou described the move from ‘full walkout’ to ’emergency care only’ as: “A bad move by the BMA. Again.” Debar Rasoul called it: “Nothing less than ridiculous.”

The Department of Health or NHS Employers have yet to comment at the time of writing.


Subedited by Kip Dudden.

Previously written for and published on WestminsterWorld.com

WHO to discuss action over Zika virus pandemic

The aedes mosquito - the main carrier of the Zika virus
The aedes mosquito – the main carrier of the Zika virus.   Credit: James Gathany

The World Health Organisation (WHO) is having an emergency meeting today to discuss the continuing Zika virus outbreak in the Americas.  The mosquito-borne virus has spread to 22 countries within North and South America.

Zika virus has been linked to microcephaly, a serious developmental disorder where babies are born with small heads. In Brazil, there have been over 4,000 case of microcephaly since October 2015. Normally, Brazil would see approximately 150 cases a year.

The WHO can recommend placing travel restrictions to and from infected countries, among a wide range of infection control measures. With London as a major business and travel hub, any future restrictions would likely have some impact on the capital.

Those who are pregnant or are planning to get pregnant should seek advice from a medical professional before travelling to countries affected by the Zika virus (click here to find a list.)

Those with chronic medical conditions, or who have a weakened immune system, are also advised to talk to a medical professional. Pregnant women who have recently travelled to any of the countries on the above list are advised to inform their obstetrician or midwife.


Subedited by Kip Dudden

Original written for and published on WestminsterWorld.com