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Press releases Saturday 26 March 2005

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(1) NHS target driven culture is failing patients

(2) Improving access to healthy food has little effect on diet

(1) NHS target driven culture is failing patients

(Personal View: Will the lead clinician please stand up?)
http://bmj.com/cgi/content/full/330/7493/735

The new tick box, target driven culture of the NHS is neglecting the quality of patient care, warns a senior doctor in this week's BMJ.

Craig Gannon, a consultant in palliative medicine, describes the fragmented care of an elderly woman at his hospital whose death from kidney failure (super-imposed on a malignancy) could have been avoided.

"The hospital care was spread across three sites, delivered by six teams and by numerous members of within each team, while the information passed to her GP was patchy," he writes.

"Worryingly, it was the system ? increasingly engineered to medical technicians rather than to professionals ? that seemed to be responsible," he says. "The presiding tick box culture allowed and even fostered suboptimal assessment."

Although individual clinicians did what they were asked, they did no more than what was required. Biases towards qualitative measures (which are used to guard against litigation) can neglect the quality of care, he argues.

"We need to revitalise the role of the lead clinician," he writes. "Clearer ownership of patients should minimise oversights generated by ever expanding teams and should improve continuity of care.

Healthcare systems must minimise errors and should require an approach that is as evidence based as our approach to prescribing," he concludes.

"How many such stories lurk in the corridors of today's NHS, and what do they tell us?" asks Fiona Godlee, BMJ Editor. "If this is, as Gannon implies, a result of recent reforms, what can we expect from the next phase of the government's NHS improvement plan unveiled by Nigel Crisp last week?"

Contact:
Craig Gannon, Consultant in Palliative Medicine, Esher, Surrey, UK Email: craiggannon@pah.org.uk

(2) Improving access to healthy food has little effect on diet

(Editorial: Large scale food retail interventions and diet)
http://bmj.com/cgi/content/full/330/7493/683

Improving food shopping access for people living in deprived neighbourhoods has little effect on diet and health, says an editorial in this week's BMJ.

Ensuring communities have good access to healthy affordable food is one of the government's joined up strategies to improve public health and reduce health inequalities.

However, evidence to inform how, when, and where to reduce these inequalities is only now emerging, and uncertainty remains over whether large scale retail interventions actually work.

For instance, a recent study in Newcastle found that retail provision was not independently associated with diet. Another in Leeds found positive changes in fruit and vegetable consumption, while a similar study in Glasgow found little evidence for an overall effect.

Despite some study limitations, the authors suggest that overall, retail interventions may have either a small but important effect or no effect on diet and health.

"If new retail provision is to have an impact on diet and health, we need a multidimensional approach that also tackles food awareness, affordability, and acceptability in addition to retail change," they write.

"Changing access through improving retail provision alone may not have a substantial impact on diet and health. An approach that changes knowledge and access simultaneously may have a better chance of securing improvements in diet and health and a reduction in health inequalities," they conclude.

Contacts:
Leigh Sparks, Professor of Retail Studies, Institute for Retail Studies, University of Stirling, Scotland, UK Email: Leigh.Sparks@stir.ac.uk
or
Dr Steven Cummins, MRC Fellow, Department of Geography, Queen Mary, University of London, UK Currently in San Francisco (-8 hrs GMT) Email: s.c.j.cummins@qmul.ac.uk

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