Your weekly BMJ digest – 8/4/17

And we’re back for another round of Let’s-Try-and-Make-Reading-the-BMJ-fun! It’s been hard this week as this issue is predominantly concerned with the future of the NHS, which is, as we all probably know, not looking so rosy at the moment. With its cover reminiscent of Soviet propaganda posters, the articles strike a “DON’T PANIC” tone but anyone who works in the NHS knows the truth of the matter.

Cover Story:

The Future of the NHS. Ideas, Concerns and Expectations – So, the NHS is struggling. Signs that we’re now just rearranging the deckchairs on the Titanic include scrapping the 18 week target for elective surgery. It’s part of the “trade-off” suggested by NHS England’s Chief Exec, Simon Stevens, in favour of delivering a list of laudable but frankly fanciful targets for services in the 2014 NHS Five Year Forward View.

STPs also rear their head again. No, “sticky toffee puddings” aren’t the cure for the NHS’s ill health, instead STPs refer to the 44 new “sustainability and transformation plans” from our favourite document, the Five Year Forward View. Who knows if they will work but with an outcome measure being to reduce numbers of acute beds some of the motives behind STPs seem dubious. Maybe sticky toffee puddings would be a better idea after all.

All sorts of other people have investigated the NHS’s failings and are suggesting ways to resuscitate our poor old health service. The House of Lords have published a report saying that the small business structure of general practice is out of touch with the current demands and the NHS relies too much on acute medical services. Apart from more money and more everything, one solution (amongst 34 others) suggested by the report, is forming another new body to identify the “needs of a changing and ageing population and the staffing and funding the NHS will require.” Um, surely one of those committees must exist already and if not, why has it taken so long to form one?

And finally the Department of Health is looking into 5 years mandatory service in the NHS post-qualification to help keep trainees in the system. So if 50% don’t apply for training posts after 2 years hard labour, how many won’t apply after 5 years? Answers in a stamp addressed envelope to Jeremy Hunt, Health Secretary.

To Royal Commission or not to Royal Commission, that is the question – 2 bigwig members from the House of Lords argue the merits of conducting a Royal Commission (an independent investigation, usually headed by a judge) into the issues of the NHS. Maurice Saatchi says yay, now is the time, but Nigel Crisp says nay, it’s too long and clunky a process, and there are better, more flexible alternatives.

Best of the Rest:

The Unseen Multitudes; Healthcare in Prisons – Crazy figures as to numbers of deaths in custody have been released with figures from 2016 being the highest for a decade. 119 suicides (1.4/1000) occurred and this ties in with other reports of the crisis state within prisons. With prevalence of mental health problems in prisoners 10 times that of the general public, mental health should be given priority. NICE Guidelines lay special focus on this in the dual-staged health assessments prisoners are meant to have on their arrival at prison. They also advise strong community care once prisoners are released with careful collaboration amongst services.

Dodgy, dodgy I. Conflicts of interest in the NHS – With the new guidelines “Managing Conflicts of Interest in the NHS” published in February, such is the level of scrutiny about conflicts of interest, most clinicians feel guilty borrowing a pen from a drug rep these days. This BMJ editorial piece raises an excellent point – what about conflicts of interest in our esteemed Government, the people with arguably the most sway and say as to where the money goes? Where are the guidelines for them?

Dodgy dodgy II. Is Coca Cola the new tobacco industry? After donating large sums of money to fund journalism conferences at the University of Colorado, Coca Cola has been found out in their nefarious plot to ply innocent (and somewhat naïve) journalists with the message that exercise is the answer to tackling obesity and not drinking less sugary, carbonated drinks.

Doctors for doctors: Clinician Mental Health champion and all-round- good-person, Clare Gerada, is advocating a year of support for doctors, who come from abroad to work in the NHS. Having set up the Practitioner Health Program, which provides help and counselling to doctors in need, Gerada wants to provide extra support for international doctors new to the NHS. Any extra care for our caregivers is a good idea, in my opinion.

BMJ Paragraph of the Week:

Oh Jeremy! – Best chuckle in the BMJ this week comes from “The politics of the NHS’s next steps” (p44). It reads:

“Insiders who attend Hunt’s weekly meetings with national NHS leaders report that his enthusiasm for intervention with “non-performing trusts” is unabated. This enthusiasm has been joined, they say, by a wave of high concept, low practicality new ideas that must be chaperoned into the long grass as soon as possible.”