Doctors who carry out cosmetic procedures anywhere in the UK are being issued with new guidance by the General Medical Council (GMC) to make sure they provide the best possible care for patients.
Our new guidance is designed to help drive up standards in the cosmetic industry and make sure all patients, and especially those who are most vulnerable, are given the care, treatment and support they need.
The new GMC guidance comes into force from June, and covers both surgical (such as breast augmentation) and non-surgical (such as Botox) procedures.
The guidance says that doctors must:
The King’s Fund has identified three big challenges for the NHS in England:
Sustaining existing services and standards of care
Developing new and better models of care
Tackling these challenges by reforming the NHS
The Kings Fund states that the NHS faces unprecedented financial and operational challenges: deficits among NHS providers are large and growing; performance is suffering, with targets for waiting times being missed; and in all areas of the NHS staff are under pressure from rising demand alongside constrained resources.
These challenges are amplified by cuts to social care and public health and by the requirement for the NHS to deliver £22 billion of productivity improvements by 2020/21.
The Kings Fund suggests that focusing on better value offers opportunities to improve productivity. In individual organisations, better outcomes can be delivered while minimising costs by engaging clinical teams in reducing variations and changing the way care is delivered. The main focus should be on improving clinical practice, building on past experience in areas such as generic prescribing, day surgery, and reduced lengths of stay in hospitals, as well as acting on the themes identified in the Carter review.
Locally, organisations should work together in place-based systems of care to decide how to use the resources available and to break down barriers between services. Opportunities for delivering better value include providing integrated care for older people, children and people with long-term conditions and supporting people to die in the place of their choice, with health and social care budgets being pooled to deliver truly integrated care.
In the long term, as the Barker Commission has set out, we should look to moving to an integrated system for health and social care with a single local commissioner of services. The aim should be to bring public spending on health and social care up to 11–12 per cent of GDP by 2025. The Commission argued that this was both affordable and sustainable if hard choices are made about how to fund the additional resources.
There is an immediate need to ensure that workforce numbers are sufficient to meet demand. Urgent action is needed to tackle staff shortages and to make the NHS an attractive career choice.
I was recently asked to chair a round-table event for the Health Service Journal on ethnic diversity and equality in health care leadership.
Out of interest I researched the origin of the term ‘round-table’ and discovered that it came from a speech made by HRH Prince Edward, Prince of Wales, to the British Industries Fair in 1927. He urged ‘young business and professional men… to get together round the table and adopt methods that have proved sound in the past, adapt them to changing needs and wherever possible, improve them’. Setting aside the gender focus of the original use, I would like to reflect on issues that were discussed at this particular round-table event in 2016 – namely what leaders in the NHS can adopt, adapt and improve to enable black and minority ethnic (BME) staff to achieve their potential as leaders.
Participants began by sharing their personal emotional response to the topic, an important recognition of the often painful experiences of being treated differently based on ethnicity. An exploration of the existing barriers to progression for black and minority ethnic staff touched on both unconscious bias and conscious bias; there was a recognition that failure to tackle this was in itself a barrier and that talking about the conscious bias that exists in the system is a significant step towards addressing inequality.
The autism research charity Autistica has published Personal tragedies, public crisis: the urgent need for a national response to early death in autism The report examines the evidence for premature death in autism and sets out recommendations for medical research funders to increase understanding of premature mortality in autism; for the government to establish a National Autism Mortality Review and improve data collection; and for service providers to develop specific plans to prevent early death in autism.
Luyt, D. et al. Paediatrics and Child Health. Available online: 17 March 2016.
Food allergy (FA) in children is common, affecting about 6% of children in the UK, and is thought to be increasing in prevalence.
Presentation varies widely with age, causative food, type of FA (IgE-mediated or non-IgE mediated) and severity. Assessment of suspected FA includes a detailed clinical history and dietary history and appropriate confirmatory allergy testing.
The traditional management of complete dietary exclusion of the causative and related foods is evolving to one of limiting exclusion and early reintroduction. Novel treatments under investigation are mechanisms to prevent FA and oral desensitisation in selected cases in an attempt to cure FA.
This article aims to give advice to the generalist about how to assess and initiate appropriate investigation a child presenting with possible food allergy.
Loopstra, R. et al. (2016) Austerity and old-age mortality in England: a longitudinal cross-local area analysis, 2007–2013. J R Soc Med. March 2016 vol. 109 no. 3 109-116
Objective: There has been significant concern that austerity measures have negatively impacted health in the UK. We examined whether budgetary reductions in Pension Credit and social care have been associated with recent rises in mortality rates among pensioners aged 85 years and over.
Main outcome measure: Annual percentage changes in mortality rates among pensioners aged 85 years or over.
Results: Between 2007 and 2013, each 1% decline in Pension Credit spending (support for low income pensioners) per beneficiary was associated with an increase in 0.68% in old-age mortality (95% CI: 0.41 to 0.95). Each reduction in the number of beneficiaries per 1000 pensioners was associated with an increase in 0.20% (95% CI: 0.15 to 0.24). Each 1% decline in social care spending was associated with a significant rise in old-age mortality (0.08%, 95% CI: 0.0006–0.12) but not after adjusting for Pension Credit spending. Similar patterns were seen in both men and women. Weaker associations observed for those aged 75 to 84 years, and none among those 65 to 74 years. Categories of service expenditure not expected to affect old-age mortality, such as transportation, showed no association.
Conclusions: Rising mortality rates among pensioners aged 85 years and over were linked to reductions in spending on income support for poor pensioners and social care. Findings suggest austerity measures in England have affected vulnerable old-age adults.
Madeleine Bunting. The Guardian Online. Tuesday 15 March 2016.
Care is multi-faceted: it entails practical tasks such as washing and feeding, but it also requires a thoughtfulness and emotional labour. The three are inextricably interlinked.
The US sociologist Arlie Russell Hochschild first coined the term “emotional labour” to describe the work required of air stewards to satisfy customers, and it has been used widely since to describe jobs that require intense emotional engagement. It is often women who dominate such work, and its significance is routinely underestimated and underpaid.
One of the most challenging aspects of the emotional labour of care is dealing with intense vulnerability and suffering. Many interviewees stressed the importance of presence in good care; not recoiling from distress and being prepared to stop for a moment to be present with someone. This is why Suffering Alone at Home, a recent survey by Unison of social care workers, makes such painful reading, as respondents described the inner conflict between the time pressure of the job and the human needs in front of them. “Can’t even sit and talk to those who are totally alone 24 hours a day, it’s a sin,” wrote one.
“All of the service users just want to talk and we have been told we are not paid to converse,” said another. These care workers are painfully caught in the contradictions of a society that puts little value on caring.
The 2016 shortlist showcases the breadth and depth of our encounters with medicine through six exceptional works of fiction and non-fiction.
The two memoirs on the list, ‘The Outrun’ and ‘The Last Act of Love’, are both stories of devastation and recovery, one following addiction and the other a debilitating accident. ‘Neurotribes’ and ‘It’s All in Your Head’, the other two non-fiction contenders, are studies of autism and psychosomatic illness respectively, reflecting society’s interest in the human mind.
The remaining two books on the list are works of fiction. ‘Playthings’ is an immersive imagination of a schizophrenic mind, while ‘Signs for Lost Children’ recounts the pioneering work of an early female medic.
“The shortlist reflects what has moved and inspired us most about books that deal with intimate and often complex matters of the human body and human experience,” said chair of judges Joan Bakewell. “Each one has found its way not just onto the shortlist, but into our hearts.”
The winner of the Wellcome Book Prize 2016 will be announced on 25 April.
A survey study among Turkish patients with diabetes.
Eyüboğlu, E & Schulz, P.J. BMJ Open. 2016 6:e010186
Objective: This study aimed to assess the impact of health literacy and patient empowerment on diabetes self-care behaviour in patients in metropolitan Turkish diabetes centres. The conceptual background is provided by the psychological health empowerment model, which holds that health literacy without patient empowerment comes down to wasting health resources, while empowerment without health literacy can lead to dangerous or suboptimal health behaviour.
Design, setting and participants: A cross-sectional study was conducted with 167 patients over the age of 18 from one of two diabetes clinics in a major Turkish City. Self-administered questionnaires were distributed to eligible outpatients who had an appointment in one of the clinics. Health literacy was measured by a newly translated Turkish version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Chew self-report scale. Patient empowerment was measured by a 12-item scale based on Spreitzer’s conceptualisation of psychological empowerment in the workplace. Self-care behaviour was measured by the Self-care behaviours were measured by the Summary of Diabetes Self-Care Activities Measure (SDSCA). Level of diabetes knowledge was measured by Diabetes Knowledge Test.
Results: Two subscales of empowerment, impact and self-determination, predicted self-reported frequency of self-care behaviours. Neither health literacy nor diabetes knowledge had an effect on self-care behaviours.
Conclusions: Health literacy might be more effective in clinical decisions while empowerment might exert a stronger influence on habitual health behaviours.