GPs’ representatives voted overwhelmingly this week for a system in which patients opt in to any sharing of medical data with third parties—rather than one in which their consent is assumed unless they opt out, the system favoured by the Department of Health. Clinical confidentiality depends on GPs being the prime data holder of their patients’ medical records, said the BMA’s annual conference of local medical committee representatives in London. It also strongly opposed using implied consent as justification for releasing information on named patients.
The hopes of people with mild Alzheimer’s disease have been dashed again by the agency that appraises treatments for use by the NHS in England and Wales, which has reaffirmed its original decision to deny them treatment with dementia drugs. The National Institute for Health and Clinical Excellence (NICE) has issued amended guidance but still asserts that the drugs would not be cost effective for the mild stages of the disease. The original guidance from NICE was challenged by Eisai, the UK licence holder for donepezil (Aricept), one of the class of acetylcholinesterase inhibitors affected. The Court of Appeal ordered NICE to hand over a fully executable form of its economic model for determining the drugs’ cost effectiveness, and Eisai and the Alzheimer’s Society made further representations that highlighted flaws in the model.
A LESBIAN couple have won the right to IVF on the NHS after a legal tussle, ahead of laws that will put same-sex patients on an equal footing with heterosexuals. The couple, who remain anonymous, had to go through a legal fight to push the NHS to fund IVF because, at the moment, individual trusts decide whether they wish to pay for treatment for lesbians. The couple were initially refused IVF by their primary care trust because they were of the same sex. One of the women had polycystic ovarian syndrome, which disrupts ovulation, and is one of the most common causes of infertility. From October, clinics will no longer be able to block lesbians by referring to a child’s “need for a father”. Instead, same-sex couples will need to demonstrate only that they can offer “supportive parenting”.
The government says it will ban all private transplants of organs from dead donors in the UK. The move comes after media reports of overseas patients paying to get onto the waiting list for organs donated by British people. An independent report said organs were scarce and no one should be able to pay for transplants, to ensure NHS patients did not miss out. Surgeons said it should reassure people organs went to those in most need.
More than 80% of NHS primary care trusts in England fail to offer the recommended three free cycles of IVF to infertile couples, an MP has claimed. The Department of Health says 30% of PCTs provide three cycles of the fertilisation treatment. But Tory MP Grant Shapps, who has contacted every PCT, says these figures are out of date. A "postcode lottery" operates, with rules on age, relationships and other children varying widely, he insists. In some cases women who would be deemed too old for treatment by one PCT would be seen as too young by another.
The 2009 Equality Bill will, if enacted, make age based discrimination in the provision of health care and social care illegal for the first time in the United Kingdom. In a speech in 2008, the then health secretary, Alan Johnson, said, "Old age is the new middle age. Health and social care services need to adapt to the changing needs of today’s older people . . . to promote health in old age and help older people to maintain independence and quality of life."
The National Institute for Health and Clinical Excellence proposes to reject a breast cancer drug despite its own rule changes on end-of-life treatments Wednesday 21 October 2009 18.11 BST A drug which can give women with advanced breast cancer extra weeks or months of life has been turned down by a government watchdog body for use in the NHS. The National Institute for Health and Clinical Excellence (Nice) says it proposes to reject Tyverb (lapatinib) in spite of changes in the rules brought in specifically to allow people at the end of their lives to have the chance of new and often expensive treatments. Tyverb is the only drug licensed for women with advanced breast cancer whose tumours test positive for a protein called HER2 and for whom Herceptin, a Nice-approved drug, is no longer working. In much of the rest of Europe, Tyverb is then given, in combination with a standard chemotherapy drug called capecitabine.
Hospital patients in England will get the legal right to be seen privately if they face NHS delays. Hospitals have to start treating patients within 18 weeks of referral - or two weeks in the case of cancer. But ministers will now give patients a legal right to private care - or treatment at another NHS centre if so desired - if this does not happen. The Tories, who would scrap waiting time targets, said it was an "unaffordable and uncosted" pledge.
The family of a man left severely brain damaged by a hospital trust's failure to diagnose meningitis promptly have been awarded £3.2m for his future care. Mark Thomas, of Walsall, in the West Midlands, developed an ear infection, which led to the meningitis in 2002. His parents took him for blood tests at Walsall Manor Hospital but the results were not reviewed for five days. Without the delay, Mr Thomas, 20, would not have been left brain damaged, Birmingham High Court was told earlier.
A powerful arthritis drug, judged too expensive for patients in England and Wales, has been approved in Scotland. The National Institute of Clinical Excellence (Nice) provisionally ruled that Tocilizumab was too costly for NHS patients south of the border. However, the body's Scottish equivalent has recommended patients in Scotland be treated with the drug.
The doctors' union claims that England's medical records database is being pushed through too fast, with details sometimes being uploaded without patients' knowledge. But those behind the new system say many patients are astonished that hospital doctors still do not have access to basic information, and the process to opt out is very straightforward. What are the issues?
Doctors leaders have called for a halt in the development of a medical records database for patients in England. The British Medical Association says the computer-based Summary Care Records are being set up at "break-neck speed", sometimes without patients' knowledge. Ministers have expressed surprise at fears of fast change after previous criticism that it was moving slowly. The NHS IT upgrade will link more than 30,000 GPs to nearly 300 hospitals through an online appointments system. It will also feature a centralised medical records system for 50 million patients, e-prescriptions and faster computer network links.
At least 100,000 non-medical staff in NHS trusts have access to confidential patient records, claim campaigners. Big Brother Watch, who based the figure on 151 responses from trusts, said it demonstrated "slack security". The group says hospital domestics, porters, and IT staff are among those with access to records in some trusts. The Department of Health says the report muddles paper files and the newer electronic systems for which access will be strictly controlled. Big Brother Watch asked every NHS Trust in the UK for the number of their non-medical staff who had access to confidential patient records.
Checklists that spell out exactly how to care for patients with common conditions have dramatically reduced hospital deaths, say doctors. The British Medical Journal reported a 15% fall in the number of people who had died at one north London hospital trust using so-called care bundles. These are checklists covering dozens of conditions including strokes, heart failure and MRSA infections. The researchers said death rates could be "halved" using the system.
This article examines the implications for patient care, and for the future of rationing within the NHS, of the recent decision to permit NHS patients to supplement their care by paying for medicines — mainly expensive new cancer drugs — which are not available within the NHS. The starting point is the recommendations of the Richards' Report and their implementation through new guidance issued by the DoH and NICE. Practical challenges arise from the insistence upon the 'separate' delivery of self-funded medicines, and more flexible cost-effectiveness thresholds for end of life medicines may have repercussions for other patients. While undoubtedly part of the trend towards explicit rationing, top-up fees might also represent a significant step towards regarding the NHS as a core, basic service. Finally, the issue of top-up fees is located within the broader context of current cancer research priorities and persisting health inequalities.
GPs are considering whether to abandon their involvement in a scheme to put medical records on a computer database. BBC News understands that talks are continuing to try to make it easier for patients to opt out of the system. Thirty million people in England have already been formally contacted about the computer record. Health ministers from the coalition government insist the rollout will continue.
Although the number of patients seeking treatment elsewhere in the European Union is small,3 this could easily change, especially if people are faced with growing waiting lists or other forms of rationing as the new groups seek to control their budgets. British residents have had the right to obtain treatment in another EU country since 1971.4 Initially, the opportunities were limited mainly to people who fell ill when abroad or, less often, when the NHS agreed that there were good reasons for patients being treated abroad (for example, a citizen of another country resident here returning home to give birth
Patients in England will be able to inspect and correct their NHS and social care records online from 2015 if the coalition government’s vision for the use of IT in the NHS becomes reality.
National efforts to improve care at the end of life should be speeded up to maintain the progress made in some parts of England, it has been claimed. The health policy think tank the King’s Fund has warned against a loss of momentum on England’s end of life care programme in a new report published this week and has questioned the government’s intention to leave a review of this area until 2013. Around 500 000 people die each year in England. More than half (55%) of deaths occur in hospital and only 20% at home. The government has said that several surveys have shown that most people’s preference is to die at home.