- Email: [email protected]
OUTPATIENT WAITING TIMES
54
be expected to line up on any conceivable issue in the ranks of the permissives. The politicians, in fact, or at least some of the rank-and-file ones, may be rather readier to respond to the challenge of Dr Robertson and his colleagues than the cautious counsels of the Elephant and Castle and St Andrew’s House in Edinburgh seem to have allowed. DAVID MCKIE
Notes and News OUTPATIENT WAITING TIMES "LAST time I attended, I waited for 3 hours only to be told to back in three months"..."The hospital is a world of its own where no regard is given to the patient’s other responsibilities-the "The hospital attaches no importance to other people’s time" wait could be a 2-hour of is hilarious. Surely system appointments cut down even by amateurs with no experience of this sort of thing", Such telling comments on the hospital outpatient service punctuate a booklet1 produced by the Institute of Health Service Management and the Association of Community Health Councils of England and Wales to challenge health service managers and other health care staff. A comment by a patient summarises the challenge: "I am sick of having to wait for an appointment-sometimes for hours. What is the point of making an appointment if you have to wait for hours?" Patients want less delay in referral, less waiting in clinics, and decent personal treatment and facilities (especially privacy for changing and asking questions). The booklet argues that long waits for an appointment may cause the medical condition to deteriorate and cause anxiety. Enormous variations between different areas of the country, different specialties, and different consultants suggest that long waits are not simply a result of shortage of resources. The system could be scrutinised and improved: GPs should be provided with information about waiting times and they should compare rates of referral; GPs should have access to diagnostic aids, including X-ray services and laboratory investigations, so that referral is not always necessary; consultants should question the need for routine appointments after surgery (many patients are happy to see their GPs); and repeat appointments should be questioned and arranged only when strictly and clinically necessary. The booklet points out that in 1964 it was suggested that the ratio of old to new patients should be 11to 1. In many clinics now the ratio is very much higher. come
...
Medicine and
Society
Faculty of Community Medicine Takes up WHO’s Call THE Faculty of Community Medicine* published this week its Charter for Action, aimed at making WHO’s slogan, Health for All by 2000, a reality in the United Kingdom. The charter calls for concerted action by Government, health and local authorities, employers and trade unions, and citizens. It lists those responsibilities which must be accepted by all these bodies and by all people if the aims of the WHO declaration are to be carried through in Britain. The Faculty identifies some of the challenges facing the country: Deaths from heart disease are not falling in Britain as they are in other countries. The UK has the highest death rate from this cause in the world. The expectation of further life at the age of 45 in the UK is .
among the worst in the
developed world. Infant mortality has fallen less than it has in most other countries in Europe and thefigures are still affected by regional, ethnic, and social-class differences. Deaths due to alcohol and drugs and motorcycle accidents are all rising. The death rate from cervical cancer has hardly changed over the past 15 years, although other European countries have halved theirs. Deaths from lung cancer in women are going up and rival those from breast cancer. Measles, whooping cough, and congenital rubella, which have been wiped out in other developed countries, still cause death and disability in Britain. Cigarettes cause at least 100 000 deaths a year in the UK, as well as an enormous burden of illness and disability. Alcohol is associated with approximately half of all road casualties involving pedestrians as well as nearly half of all fatal accidents experienced by motorists and cyclists. The Faculty is not arguing that change can be effected by Government and the NHS alone. Much of the required action lay outside the traditional scope of medical practice and called for "knowledgable and purposeful policies and action at many levels of society". The Government should make good health a basic human right and commit the right level of resources to maintaining the health of its citizens. Local government must maintain a safe environment; and health authorities should enter into partnership with other community organisations to make "health for all" a reality. Industry and trade unions had to care for health and safety policies and make decisions to protect the health of consumers. The charter reminds individuals in Britain that they have opportunities to shape their own lives and those of their families and the power to make choices as consumers and electors which would determine their future health. Prof Alwyn Smith, president of the Faculty, said the charter was not just a pipe dream or a list or worthy aims. It was a hard-headed look at the problems facing health professionals in Britain today and "a real attempt to discuss the responsibilities of all of us for the health of our families, friends, and communities". Each organisation receiving the document should accept that they had their own particular job top do-whether or not they were operating in the health field. The Faculty’s main argument was that public health belonged to the whole people, not just a small group of experts. *4 St Andrew’s Place, London NW1 4LB.
NHS PHARMACEUTICAL PRICE REGULATION SCHEME THE Secretary of State for Social Services, Mr Norman Fowler, has told Parliament where he stands in the proposed renewal of the scheme for regulating the cost of drugs to the NHS. Negotiations were complete and the Association of the British Pharmaceutical Industry was consulting its members on the outcome. A renewal of the Pharmaceutical Price Regulation Scheme was proposed for a period of six years from Oct 1,1986, with a provision for review after three years. The proposals retained the essential characteristics of the scheme, introduced in its present form in 1978, which successive Governments had used to ensure, Mr Fowler added, that NHS pharmaceutical prices were reasonable and that the United Kingdom offered a fair return for pharmaceutical innovation and investment. The changes included a more objective method, to be used from 1988-89, for keeping allowable rates of return on capital in line with changes in the average profitability of UK industry generally and for interim increases in the rates of return between renewal of the scheme and 1988-89 to reflect the rising trend in general industrial profitability. The industry would give a renewed and more explicit commitment to containment of the growth in pharmaceutical supply costs and a more explicit basis for determining the research and development allowance in NHS prices, which, in recognition of the costs and benefits of pharmaceutical innovation, the Government intended generally to maintain at not less than its present substantial level. Mr Fowler also referred to "renewed and more explicit arrangements" for consultation between Government and industry on trends in the costs of NHS medicines and on any general developments in NHS pharmaceutical services. Allowances for sales promotion, met on Out Patient Services: Time to Move. Available Portland Place, London W1N 4AN.
1. Action
(£1.25) from IHSM, 75
be expected to line up on any conceivable issue in the ranks of the permissives. The politicians, in fact, or at least some of the rank-and-file ones, may be rather readier to respond to the challenge of Dr Robertson and his colleagues than the cautious counsels of the Elephant and Castle and St Andrew’s House in Edinburgh seem to have allowed. DAVID MCKIE
Notes and News OUTPATIENT WAITING TIMES "LAST time I attended, I waited for 3 hours only to be told to back in three months"..."The hospital is a world of its own where no regard is given to the patient’s other responsibilities-the "The hospital attaches no importance to other people’s time" wait could be a 2-hour of is hilarious. Surely system appointments cut down even by amateurs with no experience of this sort of thing", Such telling comments on the hospital outpatient service punctuate a booklet1 produced by the Institute of Health Service Management and the Association of Community Health Councils of England and Wales to challenge health service managers and other health care staff. A comment by a patient summarises the challenge: "I am sick of having to wait for an appointment-sometimes for hours. What is the point of making an appointment if you have to wait for hours?" Patients want less delay in referral, less waiting in clinics, and decent personal treatment and facilities (especially privacy for changing and asking questions). The booklet argues that long waits for an appointment may cause the medical condition to deteriorate and cause anxiety. Enormous variations between different areas of the country, different specialties, and different consultants suggest that long waits are not simply a result of shortage of resources. The system could be scrutinised and improved: GPs should be provided with information about waiting times and they should compare rates of referral; GPs should have access to diagnostic aids, including X-ray services and laboratory investigations, so that referral is not always necessary; consultants should question the need for routine appointments after surgery (many patients are happy to see their GPs); and repeat appointments should be questioned and arranged only when strictly and clinically necessary. The booklet points out that in 1964 it was suggested that the ratio of old to new patients should be 11to 1. In many clinics now the ratio is very much higher. come
...
Medicine and
Society
Faculty of Community Medicine Takes up WHO’s Call THE Faculty of Community Medicine* published this week its Charter for Action, aimed at making WHO’s slogan, Health for All by 2000, a reality in the United Kingdom. The charter calls for concerted action by Government, health and local authorities, employers and trade unions, and citizens. It lists those responsibilities which must be accepted by all these bodies and by all people if the aims of the WHO declaration are to be carried through in Britain. The Faculty identifies some of the challenges facing the country: Deaths from heart disease are not falling in Britain as they are in other countries. The UK has the highest death rate from this cause in the world. The expectation of further life at the age of 45 in the UK is .
among the worst in the
developed world. Infant mortality has fallen less than it has in most other countries in Europe and thefigures are still affected by regional, ethnic, and social-class differences. Deaths due to alcohol and drugs and motorcycle accidents are all rising. The death rate from cervical cancer has hardly changed over the past 15 years, although other European countries have halved theirs. Deaths from lung cancer in women are going up and rival those from breast cancer. Measles, whooping cough, and congenital rubella, which have been wiped out in other developed countries, still cause death and disability in Britain. Cigarettes cause at least 100 000 deaths a year in the UK, as well as an enormous burden of illness and disability. Alcohol is associated with approximately half of all road casualties involving pedestrians as well as nearly half of all fatal accidents experienced by motorists and cyclists. The Faculty is not arguing that change can be effected by Government and the NHS alone. Much of the required action lay outside the traditional scope of medical practice and called for "knowledgable and purposeful policies and action at many levels of society". The Government should make good health a basic human right and commit the right level of resources to maintaining the health of its citizens. Local government must maintain a safe environment; and health authorities should enter into partnership with other community organisations to make "health for all" a reality. Industry and trade unions had to care for health and safety policies and make decisions to protect the health of consumers. The charter reminds individuals in Britain that they have opportunities to shape their own lives and those of their families and the power to make choices as consumers and electors which would determine their future health. Prof Alwyn Smith, president of the Faculty, said the charter was not just a pipe dream or a list or worthy aims. It was a hard-headed look at the problems facing health professionals in Britain today and "a real attempt to discuss the responsibilities of all of us for the health of our families, friends, and communities". Each organisation receiving the document should accept that they had their own particular job top do-whether or not they were operating in the health field. The Faculty’s main argument was that public health belonged to the whole people, not just a small group of experts. *4 St Andrew’s Place, London NW1 4LB.
NHS PHARMACEUTICAL PRICE REGULATION SCHEME THE Secretary of State for Social Services, Mr Norman Fowler, has told Parliament where he stands in the proposed renewal of the scheme for regulating the cost of drugs to the NHS. Negotiations were complete and the Association of the British Pharmaceutical Industry was consulting its members on the outcome. A renewal of the Pharmaceutical Price Regulation Scheme was proposed for a period of six years from Oct 1,1986, with a provision for review after three years. The proposals retained the essential characteristics of the scheme, introduced in its present form in 1978, which successive Governments had used to ensure, Mr Fowler added, that NHS pharmaceutical prices were reasonable and that the United Kingdom offered a fair return for pharmaceutical innovation and investment. The changes included a more objective method, to be used from 1988-89, for keeping allowable rates of return on capital in line with changes in the average profitability of UK industry generally and for interim increases in the rates of return between renewal of the scheme and 1988-89 to reflect the rising trend in general industrial profitability. The industry would give a renewed and more explicit commitment to containment of the growth in pharmaceutical supply costs and a more explicit basis for determining the research and development allowance in NHS prices, which, in recognition of the costs and benefits of pharmaceutical innovation, the Government intended generally to maintain at not less than its present substantial level. Mr Fowler also referred to "renewed and more explicit arrangements" for consultation between Government and industry on trends in the costs of NHS medicines and on any general developments in NHS pharmaceutical services. Allowances for sales promotion, met on Out Patient Services: Time to Move. Available Portland Place, London W1N 4AN.
1. Action
(£1.25) from IHSM, 75