Saturday, 24 February 2007

Dubious flawed and corrupt.............D'oh

Another night shift passes by, my eyes hurt and my breath smells of general unpleasantness. A topic of great controversy in medicine today is that of extending the roles of other non-medical so-called healthcare practitioners.

Trends seem to pass over the Atlantic almost seamlessly at times, and there appears to be little correlation between policy migration and policy quality. For one the UK has miraculously managed to export gang culture from the US of late. There are those who would utter words including privatisation, deregulation, flexible labour market and imperial capitalism. I won't go there for the moment, my fingers are too tired to embark on that journey.

In the UK the role of nurse has been extended in many ways in recent years. There are undoubtedly some new nursing roles that provide a great service very safely. However I would argue that some boundaries have been pushed back way too far, in such a way that we have pseudo-practitioners dangerously practising medicine in areas in which they have not been adequately trained. One example of this is handing the right to fully prescribe to nurses and pharmacists. Another is handing diagnostic work (which includes history taking, physical examination, ordering/interpreting investigations, initiating safe management plans and organising aftercare) to those who have not been sufficiently trained in this area.

These schemes originated in the US and have since migrated to the UK. The motives for handing more responsibility to less skilled staff are arguably linked to the pressures that drive the american healthcare system. The largely privately run US healthcare industry could be said to be trying to squeeze profit at the expense of service. It may be cheaper to replace highly trained and highly skilled workers with undertrained minions, but what of the service provided? It is certainly not unheard of for the private sector to squeeze service for the sake of profit, the term 'fat trimming' is often used to look upon this practice favourably.

Anyways I digress, back to the point, and that was meant to be extending full prescribing rights to non-doctors. In 2006 a vote was passed by a committee that handed out this power to nurses and pharmacists. Dubiously this committee was made up of a majority of non-medically trained individuals and all those who were medical voted 'NO'. The consultation process revealed that an overwhelming majority of medical bodies were opposed to the scheme. Despite this dodgy vote and flawed consultation process, surprise surprise, the government has carried on and it is now law. Someone has therefore tried to obtain a bit more juice on this from the DOH:

"Dear DOH,

I write as regards the decision to extend prescribing in non-medical practitioners in 2006.

Pulse obtained documents in 2006 that showed that not one of 16 medical bodies supported this move for pharmacists.

Also only one of fourteen medical bodies supported the move for nurses.

The moves were unsurprisingly supported by nursing and phamacists' bodies or NHS bodies, all clearly very baised sources to base any decision on.

The questions I want answered are:

1. How can this consultation process have been deemed fair and adequate when it ignored the massive majority of expert medical opinion in making a medical decision?

2. If you still claim the consultation process was adequate then did you have any scientific peer-reviewed research that suggest nurse or pharmacist prescribing is safe?

3. I do not quite understand how nurses and pharmacists can be allowed to prescribe when they have not been adequately trained to take a history, examine and diagnose; this means they cannot be safe to prescribe as these diagnostic skills are key in safe prescribing.

4. I quote Pulse: "A Department of Health spokesperson insisted the recommendations took all consultation responses into account, 'including those from doctors'."; a consultation process does not merely involve pretending to listen to the information achieved via consultation, it involves scrapping schemes where there is an abundance of expert opinion that states the scheme is not appropriate or unsafe. Why did the DOH press ahead despite the wealth of medical expert opinion against the scheme?

5. Specifically I want to who ( if the prime minister, any politicians, advisers or other senior DOH officials) had an input into making this decision to go ahead with these scheme of non-medical prescribing despite a wealth of medical expert opinion against it? I want to see any documents of discussion between officials/minister/advisers about this consultation process and decision.

6. Also there was a vote on this non-medical prescribing. I want to know how the committee that discussed and voted on the issue was decided upon. Were senior minister, politicians, government advisers, senior DOH officials involved in the decision as regards who was on this committee? I want to see documents of any discussion as to who should sit on this committee?

7. Also as regards the vote on non-medical prescribing; I would like to know the details of everyone who was on the committee and which way they voted, and if they had any conflicts of interest ( ie who they worked for and any financial interests of relevance )?

8. Finally where did this idea of giving full prescribing rights to nurses and pharmacists come from? I want to know if there were any high level discussions between the PM, politicians, advisers, senior DOH officials that reveal where this idea came from and the motives behind this idea? Were any private healthcare companies involved in lobbying politicians about this issue?

9. Specifically have any employees or representatives of any of the following companies ever discussed the issue of non-medical prescribing with any politicians, ministers, advisers, DOH officials, civil servants? The companies I am interested in are Boots, United healthcare, Capio healthcare, BMI Healthcare, MercuryHealth, Alliance Medical, Aspen Healthcare, Netcare, BUPA, InterHealth Jarvis, Patients Choice Partners.

10. I would also like to know if any of the following companies' employees or representatives ( Boots, United healthcare, Capio healthcare, BMI Healthcare, MercuryHealth, Alliance Medical, Aspen Healthcare, Netcare, BUPA, InterHealth Jarvis, Patients Choice Partners.) have lobbied or discussed any of the following subjects with politicians, civil servants, advisers, DOH officials? The subjects I am interested are the extension of nurses roles, the new role of the physicians assistant, Modernising medical careers (MMC), ISTCs and PFI schemes? If they have then I want to see evidence of any discussions/negotiations,

many thanks for the excellent service you provide,

yours, "

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