United Kingdom - Thérèse Coffey appointed Secretary of State for Health and Social Care, Sept 2022

Of course the Oxford Comma issue has no substance - but that is rather the point, there is no substance coming forward, Government has been in abeyance because of an internal leadership issue for one Party, and Parliament will have been on 'holiday' for 3 full months before it reconvenes after the upcoming Party conferences.

While it is the case that it is (sort of) custom and practice for new Ministers to brief their Department on preferred styles for the Minister's signed communications, Coffey seems to have gone beyond this, addressing the department as a whole and including the UKHSA who are the people who amongst other things deal with pandemics and when eventually given the necessary resources led the UK's COVID19 response.

Of course this may all turn out to be the irrelevance it deserves to be, but at time when the NHS is under huge stress, a new Secretary of State giving the appearance of lecturing highly capable people on minor issues of grammar as the only matter of substance isn't serving to hold a department and the NHS as a whole together. As I said above "tone deaf".

https://themarcet.com/news/therese-coffeys-be-positive-order-angers-uk-health-workers/

"The rubric has angered health workers, many of whom were on the front lines during the Covid pandemic and who now face real-terms pay cuts and added pressures as infection rates are expected to rise over the winter."

 

It's what one comes to expect from our dear Therese local Suffolk MP.... I will refrain from the obscenities I am thinking ... as I am in a refined polite forum ....which she clearly ain't..! And no political discourse is allowed here!
Over and out!

 

cbtwatch

Unreliable IAPT Gatekeeping – Questions Sent To The Health Secretary, Dr Coffey

http://www.cbtwatch.com/unreliable-...tions-sent-to-the-health-secretary-dr-coffey/

 

On the matter of the "Oxford comma", Neil Ferguson , in the Guardian, gave an interesting example allegedly taken from the Times:

Highlights of his global tour include encounters with Nelson Mandela, an 800-year-old demi-god and a dildo collector.

 

Re - the big quote in post #23...

I've never heard of Community Diagnostic Centres (CDCs) before. They sound like conveyor belt medicine. Since GPs will often just listen to one symptom per appointment I'm not clear on what these CDCs will achieve.

For example...

Patient goes to see their doctor complaining of regular headaches. That could be anything from a headache from regular wine drinking, to someone not drinking enough fluids and just needing to drink a glass of water every morning, to a life-threatening brain tumour. If the headache is all that is mentioned then an accurate diagnosis probably won't happen very often.

 

Reasonable questions. I doubt it gets any answer that isn't generic fluff. It's been 14 years and no audit, this monstrosity cannot stand any scrutiny. It will keep plowing until circumstances force change. Like how Long Covid is forcing changes in healthcare. Healthcare is resisting those changes, even though we are long past the point of absurdity. There's just no real accountability in healthcare. None. It's an honor system all throughout, and those are always terrible.

 

They ask how we know it provides value for money. Of course it does. It was introduced by an economist, after all. What further evidence could be needed?

For any who don't know, the economist was Lord Richard Layard, which takes us back to the honour system. He worked with the psychiatrist Prof David M Clark,

 

Great amount of talking and accolades fro new ICS about this. Sounds like a money saving way to offload responsibility to lay people to me.
NHS Suffolk and North East Essex ICB Board meeting, 27 September 2022
15 minutes in
Strategy section Community Diagnostic Academy and a presentation

https://www.youtube.com/watch?v=cn-COogfZuk

 

This was about Mental Health Needs as our local Foundation Trust is in disarray.....

 

Community Diagnostic Centres :

"The creation of CDCs was recommended following Professor Sir Mike Richards’ Review of NHS diagnostics capacity. The recommendation was that NHS organisations across England move to providing diagnostic services in Community Diagnostic Centres (CDCs) and all health systems are expected to include a network of CDCs as part of their health services offer.

The CDCs will allow patients to access planned diagnostic care nearer to home without the need to attend acute hospital sites. These services would be separate to urgent diagnostic scan facilities, which means shorter waiting times and a reduced risk of cancellation which can happen when more urgent cases take priority. Therefore, this would lead to improved patient experience and outcomes.

The CDCs will help achieve the following ambitions:

• To improve population health outcomes by diagnosing health conditions earlier, faster and more accurately
• To increase capacity in the diagnostic service by investing in new facilities, equipment and training new staff, contributing to recovery from COVID-19 and reducing pressure on acute hospital sites
• To improve productivity and efficiency by streamlining the way we provide acute and elective (planned) diagnostic services where it makes sense to do so; redesigning clinical pathways to reduce unnecessary steps, tests or duplication
• To contribute to reducing health inequalities by ensuring everyone has the same access to care and the same health outcomes
• To deliver a better diagnostic service and more personalised experience by providing a single point of access to a range of services in the community
• To support more joined-up care across primary, community and secondary care"

This actually looks sensible.

 

Sensible in theory. There is no such thing, though, as a single point of access. There are just new points of access which fail to communicate effectively with the legacy ones, and then work differently in every trust or geography.

 

Is that not a clinic? If not, what's the difference? They're clearly describing clinics here.

 

UK primary care - mainly GP run health centres, don't routinely have diagnostic tech onsite, so the GPs refer a patient on to what are usually hospital based technician run services, prior to (where diagnostics indicate) further referral to a hospital based Specialist Consultant led team. Because the hospital based services are often shared with emergency medicine, and elective treatments where pre and post treatments require emergency testing, outpatient appointments can be delayed or cancelled on the day because of inpatient demands. What is proposed is not a clinic with a Primary Care doctor making the first assessment, but a dedicated diagnostic service dealing with GP requests for further investigation, specifically:

The purpose of the CDC is to provide the following diagnostic tests:

• Imaging: CT, MRI, Ultrasound, Plain X-Ray and Mammography
• Physiological measurement: Echocardiography (ECHO), Electrocardiogram (ECG), including 24 hour and longer tape recordings of heart rhythm monitoring, ambulatory blood pressure monitoring, oximetry spirometry including reversibility testing for inhaled bronchodilators, Fractional exhaled nitric oxide (FeNO), full lung function tests, blood gas analysis via Point of Care Testing (POCT) and simple field tests (e.g. six min walk test)
• Pathology: phlebotomy, Point of Care Testing, simple biopsies, NT-Pro BNP, urine testing and D-dimer testing
• Large CDCs must provide endoscopy services including: Gastroscopy, Colonoscopy, Flexi sigmoidoscopy

As Shadrach says above, the probability is that while this is good at management theory level, it may well fail in practice. For patients there may be downsides even where it works because services such phlebotomy which are currently available in some GP run clinics may actually be removed to the CDCs, meaning longer journeys for patients. A driver of the CDC model may well be Government preference for outsourcing to the private sector, which if run in competition with GP led services, would lead to a reduction in the overall number of GP led services available in a given locality, meaning some patients having greatly reduced access to the services that are specific to their needs.

 

This concept seems pretty similar to what we have in the US. Dedicated centers for doing testing on outpatients are common here. They're sometimes affiliated with local hospitals, but not always. Sometimes testing is done there, sometimes it's done at a hospital. For example, the last time I needed bloodwork, I headed to a lab at a hospital. But the time before that, I visited a lab that was in a building full of clinics. They were affiliated with a local hospital, and in fact, only a few blocks away from it.

 

Its been a while since anything came out of the DHSC, beginning to get concerned things have been sidelined.

 

This is almost "can we inject bleach" level of dangerousness in a politician:

 

While I agree that some prescribed medicines (sleeping tablets, painkillers) could possibly be available OTC antibiotics are definitely ones that should not. Overuse of them is causing a big drop in their efficacy.

 

I wonder if she has heard of pseudomembranous colitis and multiple resistance staph aureus?
People regularly die from using antibiotics.
Others die from bacteria no longer susceptible, as a result of overuse.

If antibiotics are available off prescription their use is likely to rise tenfold. That will mean tens of thousands of unnecessary deaths.

 

The proposition seems so improbable that a cynic might say that it is simply a "dead cat" story diverting attention from elsewhere. Even if that is the case it is still highly problematic to have the area of government that should be the least contentious, being used in this way.

The concern I think is that this hyper charged stuff coming from the top - nurses pay, mad policies on medications etc, creates an atmosphere where any of the progress we would hope to see becomes impossible because the whole system is either jammed by argumentative politics or by workforce battles. I'm perhaps afflicted by old bloke catastrophising but I really don't recall both the practical challenges AND the politics being this bad at any time in the last 50 years.