- Email: [email protected]
Recipe for NHS reform
Correspondence
William Jeffcoate (July 8, p 98)1 provides a compelling critique of the mismanagement of the UK’s National Health Service (NHS) as a prelude to its privatisation, and issues a cri de coeur for the retention of an integrated NHS run on humanitarian rather than business lines. The functioning of the NHS as a firstclass service has been handicapped by long-standing estate underfunding, lack of administrative support, inefficient working practices, and inadequate information systems. The UK government is understandably frustrated that its substantial and unprecedented funding has not been matched with greater productivity. But it seems to have despaired of the existing NHS matching the efficiency of the private sector and opted to extend further the role of the independent sector in the provision of NHS care. However, in Scotland and England, substantial improvements have been achieved in reducing waiting times for cancer treatment within the NHS. Supported by modernisation agencies, cancer professionals have been brought together to redesign the “patient pathway” to speed up the time from the first referral from primary care. Much of this success has been due to detailed analysis of working practice. From the experience of 26 demonstration sites in England, lessons learned in reducing waiting include having demand management systems, referral protocols for all tumour sites, single referral pathways, pooling of referrals, defined patient pathways, and robust booking and scheduling systems.2 Retention of the goodwill of healthcare professionals, speedy introduction of well designed information systems, professionally led redesign of services, and sustained investment in estate, equipment, and staff are the prerequisites for best care for patients and for keeping us at the forefront of biomedical research. www.thelancet.com Vol 368 August 19, 2006
I declare that I have no conflict of interest.
2
Ian Kunkler
3
[email protected] University Department of Clinical Oncology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK 1
2
Jeffcoate W. Mismanagement as a prelude to privatisation of the UK NHS. Lancet 2006; 367: 98–100. Cancer Services Collaborative ‘Improvement Partnership’. Applying high impact changes to cancer care. London: Cancer Services Collaborative ‘Improvement Partnership’, 2005. http://www.cancerimprovement.nhs.uk/ documents/CSC_High_Impact.pdf (accessed Aug 1, 2006).
Ethnic inequalities in health: socioeconomy, tobacco use, and obesity Tony Blakely and colleagues’ view on ethnic inequalities in health (July 1, p 44)1 is reasonable and probably right: differences in socioeconomic position and tobacco use are major contributors to inequalities. We would like to raise another factor as a critical contributor to inequalities in health: obesity. Obesity is increasing worldwide,2 and its prevalence and associated morbidities are greatly influenced by ethnic background.3 Furthermore, obesity often coexists with smoking, especially among lower socioeconomic groups.4 Therefore, these three factors—ie, socioeconomic position, smoking, and obesity— should be the major target of research and of strategies to redress ethnic inequalities in health. We declare that we have no conflict of interest.
*Takeharu Koga, Atsushi Kawaguchi, Hisamichi Aizawa [email protected] Department of Medicine, Division of Respirology and Neurology (TK, HA) and Center for Biostatistics (AK), Kurume University School of Medicine, Kurume 830-0011, Japan 1
Blakely T, Fawcett J, Hunt D, Wilson N. What is the contribution of smoking and socioeconomic position to ethnic inequalities in mortality in New Zealand? Lancet 2006; 368: 44–52.
4
The Lancet. Curbing the obesity epidemic. Lancet 2006; 367: 1549. McTigue K, Larson JC, Valoski A, et al. Mortality and cardiac and vascular outcomes in extremely obese women. JAMA 2006; 296: 79–86. Healton CG, Vallone D, McCausland KL, Xiao H, Green MP. Smoking, obesity, and their cooccurrence in the United States: cross sectional analysis. BMJ 2006; 333: 25–26.
Medicines for children Following your Editorial on the new European Directive on Drugs for Children (June 17, p 1953),1 we thought it would be worth alerting readers to the UK’s approach to this issue. In 2004, the Department of Health announced the establishment of a national Medicines for Children Research Network and, after a competitive tender, appointed a consortium including the University of Liverpool, Imperial College London, the National Perinatal Epidemiology Unit, Royal Liverpool Children’s Hospital, Liverpool Women’s Hospital, and the National Children’s Bureau to establish and coordinate this network. Six local research networks have now been established and staff are being appointed within them. By the end of 2006, we expect to have a fully functional research network that will provide the infrastructure within the National Health Service, in collaboration with academia, industry and other partners, to do high quality research into medicines for children. We fully agree with the Editorial’s view that children deserve the highest standards of research and ethical protection, and the Medicines for Children Research Network is committed to providing this, and to creating the environment needed for significant progress in this previously neglected but very important area of health care.
We do not have the rights to reproduce this image on the web. Science Photo Library
Recipe for NHS reform
For Medicines for Children Research Network see http://mcrn.org.uk/
The authors are Director and Associate Director of the Medicines for Children Research Network.
Rosalind L Smyth, *A David Edwards [email protected] 645
William Jeffcoate (July 8, p 98)1 provides a compelling critique of the mismanagement of the UK’s National Health Service (NHS) as a prelude to its privatisation, and issues a cri de coeur for the retention of an integrated NHS run on humanitarian rather than business lines. The functioning of the NHS as a firstclass service has been handicapped by long-standing estate underfunding, lack of administrative support, inefficient working practices, and inadequate information systems. The UK government is understandably frustrated that its substantial and unprecedented funding has not been matched with greater productivity. But it seems to have despaired of the existing NHS matching the efficiency of the private sector and opted to extend further the role of the independent sector in the provision of NHS care. However, in Scotland and England, substantial improvements have been achieved in reducing waiting times for cancer treatment within the NHS. Supported by modernisation agencies, cancer professionals have been brought together to redesign the “patient pathway” to speed up the time from the first referral from primary care. Much of this success has been due to detailed analysis of working practice. From the experience of 26 demonstration sites in England, lessons learned in reducing waiting include having demand management systems, referral protocols for all tumour sites, single referral pathways, pooling of referrals, defined patient pathways, and robust booking and scheduling systems.2 Retention of the goodwill of healthcare professionals, speedy introduction of well designed information systems, professionally led redesign of services, and sustained investment in estate, equipment, and staff are the prerequisites for best care for patients and for keeping us at the forefront of biomedical research. www.thelancet.com Vol 368 August 19, 2006
I declare that I have no conflict of interest.
2
Ian Kunkler
3
[email protected] University Department of Clinical Oncology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK 1
2
Jeffcoate W. Mismanagement as a prelude to privatisation of the UK NHS. Lancet 2006; 367: 98–100. Cancer Services Collaborative ‘Improvement Partnership’. Applying high impact changes to cancer care. London: Cancer Services Collaborative ‘Improvement Partnership’, 2005. http://www.cancerimprovement.nhs.uk/ documents/CSC_High_Impact.pdf (accessed Aug 1, 2006).
Ethnic inequalities in health: socioeconomy, tobacco use, and obesity Tony Blakely and colleagues’ view on ethnic inequalities in health (July 1, p 44)1 is reasonable and probably right: differences in socioeconomic position and tobacco use are major contributors to inequalities. We would like to raise another factor as a critical contributor to inequalities in health: obesity. Obesity is increasing worldwide,2 and its prevalence and associated morbidities are greatly influenced by ethnic background.3 Furthermore, obesity often coexists with smoking, especially among lower socioeconomic groups.4 Therefore, these three factors—ie, socioeconomic position, smoking, and obesity— should be the major target of research and of strategies to redress ethnic inequalities in health. We declare that we have no conflict of interest.
*Takeharu Koga, Atsushi Kawaguchi, Hisamichi Aizawa [email protected] Department of Medicine, Division of Respirology and Neurology (TK, HA) and Center for Biostatistics (AK), Kurume University School of Medicine, Kurume 830-0011, Japan 1
Blakely T, Fawcett J, Hunt D, Wilson N. What is the contribution of smoking and socioeconomic position to ethnic inequalities in mortality in New Zealand? Lancet 2006; 368: 44–52.
4
The Lancet. Curbing the obesity epidemic. Lancet 2006; 367: 1549. McTigue K, Larson JC, Valoski A, et al. Mortality and cardiac and vascular outcomes in extremely obese women. JAMA 2006; 296: 79–86. Healton CG, Vallone D, McCausland KL, Xiao H, Green MP. Smoking, obesity, and their cooccurrence in the United States: cross sectional analysis. BMJ 2006; 333: 25–26.
Medicines for children Following your Editorial on the new European Directive on Drugs for Children (June 17, p 1953),1 we thought it would be worth alerting readers to the UK’s approach to this issue. In 2004, the Department of Health announced the establishment of a national Medicines for Children Research Network and, after a competitive tender, appointed a consortium including the University of Liverpool, Imperial College London, the National Perinatal Epidemiology Unit, Royal Liverpool Children’s Hospital, Liverpool Women’s Hospital, and the National Children’s Bureau to establish and coordinate this network. Six local research networks have now been established and staff are being appointed within them. By the end of 2006, we expect to have a fully functional research network that will provide the infrastructure within the National Health Service, in collaboration with academia, industry and other partners, to do high quality research into medicines for children. We fully agree with the Editorial’s view that children deserve the highest standards of research and ethical protection, and the Medicines for Children Research Network is committed to providing this, and to creating the environment needed for significant progress in this previously neglected but very important area of health care.
We do not have the rights to reproduce this image on the web. Science Photo Library
Recipe for NHS reform
For Medicines for Children Research Network see http://mcrn.org.uk/
The authors are Director and Associate Director of the Medicines for Children Research Network.
Rosalind L Smyth, *A David Edwards [email protected] 645