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Press releases Saturday 12 August 2006
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(1) HEAT AVOIDANCE ADVICE INSUFFICIENT DURING HEAT WAVES
(2) MORE AND BETTER MANAGEMENT IS KEY TO FIXING THE NHS
(3) INTERPRETATION OF DATA PROTECTION LAW IS DAMAGING IMPORTANT RESEARCH
(1) HEAT AVOIDANCE ADVICE INSUFFICIENT DURING HEAT WAVES
(Editorial: Heat waves and
health protection)
http://bmj.com/cgi/content/full/333/7563/314
The passive dissemination of advice on heat avoidance is insufficient for health protection during a heat wave, and vulnerable people need to be actively identified and cared for, argues a public health expert in this week’s BMJ.
This summer Europe has again been affected by a major heat wave, writes Sari Kovats of the London School of Hygiene and Tropical Medicine. The UK has recently had its hottest month since records began in 1660 and England triggered its heat wave response plan for the first time. Yet little research has been carried out on the social and environmental determinants of heat-related mortality.
The elderly, the socially isolated, and those with heart conditions, diabetes or mental illness are among those at greatest risk of death during a heat wave.
Following the heat wave in 2003, public health measures implemented in Europe have centred almost exclusively on heat health warning systems that forecast high risk weather conditions to trigger public warnings. But, so far, no heat health system has been formally evaluated and the effectiveness of individual interventions is unknown, says Kovats.
The impact of heat waves also reveals important lessons about the care of the elderly and dispossessed in our society - both in the community and in social care, she writes. One of the striking things about the heat wave in France in 2003 was that the high mortality went undetected for so long. In the UK, several indicators of heat morbidity are now monitored routinely using data from GP practices and NHS Direct.
The EUROHEAT network, coordinated by World Health Organisation in Rome, and funded by the European Commission, is also developing good practice for health protection during heat waves as more countries develop heat health warning systems.
But an inter-agency approach is needed, she says. Heat wave systems also need to be better integrated within the disaster response agencies. Heat stress is also an occupational health problem, and health and safety agencies need to be prepared for the impact of hotter summers.
London’s mayor is being particularly proactive with regard to climate change, and is developing a statutory adaptation strategy to ensure that the infrastructure is appropriate for future climates.
Climate change needs to be taken into account in health protection in Europe, she argues. It would be tragic if the main response to hotter summers is to install inefficient air conditioning and to miss the opportunity to develop effective and more equitable health protection measures for extreme weather, she concludes.
Contacts:
NB. Sari Kovats is on holiday, so
please contact Paul Wilkinson, Head of Unit, Public & Environmental Health
Research Unit, London School of Hygiene & Tropical Medicine, London,
UK
Email: paul.wilkinson{at}lshtm.ac.uk
or
Dr Bettina Menne, Global Change
and Health Programme , WHO Regional Office for Europe, Rome, Italy
Email: bme{at}ecr.euro.who.int
(2) MORE AND BETTER MANAGEMENT IS KEY TO FIXING THE NHS
(Personal View: More and
better management is the key to fixing the NHS)
http://bmj.com/cgi/content/full/333/7563/358
Investing more in good managers and appropriate IT may be a far more effective way to improve the working lives of doctors and nurses than recruiting more staff, according to an article in this week’s BMJ.
Those who are against reforming the NHS blame problems on a lack of resources, bureaucracy, government interference in clinical judgement, and the “greedy” private sector. But there is evidence that better management makes more difference than more investment, writes Management Consultant, Stephen Black.
The core of the anti-reformers’ argument is that we should spend more on “frontline” staff, but this assumes that the only thing that matters is how many doctors and nurses we have. This assumption is demonstrably untrue and pernicious – distracting the NHS from simple changes in working practice that could dramatically improve patient care, he says.
He argues that changing how a hospital is organised can improve the quality, quantity and speed of patients’ care more than the most extravagant spending on doctors and nurses does. Evidence for this can be seen in two areas in particular: emergency departments and bed management.
Independent data from A&E departments show no relation at all between staffing levels and performance. Research also shows that hospitals could solve their bed problems quickly and cheaply by organising beds better.
In other words, management matters. And just increasing resources is a poor way to fix performance problems, which is why the suggestion to run the already under-managed NHS with even fewer managers is ludicrous, he says.
A well organised hospital is a better place to work than a badly organised one with twice the number of staff. Investing more in better organisation, good managers, and appropriate IT may be a far more effective way to improve the working lives of doctors and nurses than recruiting more doctors and nurses, he concludes.
Contact:
Stephen Black, Management Consultant,
PA Consulting Group, London, UK
Email: stephen.black{at}paconsulting.com
(3) INTERPRETATION OF DATA PROTECTION LAW IS DAMAGING IMPORTANT RESEARCH
(Editorial: Governance of
research using identifiable personal data)
http://bmj.com/cgi/content/full/333/7563/315
Overly strict interpretation of the data protection law is damaging important medical research in the United Kingdom, argues a senior doctor in this week's BMJ.
His warning follows a series in the BMJ, which ends this week, relating to use of personal information in medical research.
Information contained in routine medical records, disease registries, completed trials, and research programmes is an invaluable resource for research into public health. For years, the United Kingdom has been in the forefront of this research, and the NHS has been a unique source of such data.
In most medical research, doctors and investigators have direct contact with patients and can seek spoken and written consent directly. But research that re-uses previously collected data may encounter considerable difficulties with respect to both consent and anonymity, writes Robert Souhami, Emeritus Professor of Medicine at University College London.
For example, the study populations may comprise many thousands of people; some patients may have moved or died; the information may need to be linked to two or more databases; and individual identification may be necessary to prevent double counting.
Such difficulties are now damaging our population based research – an “own goal” at a time when a national system of health records would give us unequalled opportunities for research to improve health, he writes.
The problems arise from changes in the law and their interpretation by regulators, and from increasing social and political concerns about encroachment on privacy. As a result, researchers may face endless delays and demands for redesign of their proposed studies.
Research on public and patients’ views is scanty, but a recent study showed overwhelming support for personal information being used in cancer registries – a legal requirement in some countries, but which the General Medical Council does not permit.
So how should we go forward, he asks?
Regulating bodies should accept that the law permits the secondary use of data without explicit consent, provided that the likely benefit to the public is demonstrably proportionate to the risk of identification and the consequent distress caused.
The process of assessing research proposals should be simplified and there should be a single framework of guidance for researchers, regulators, and funders. There must be assured standards of data security and confidentiality, and the public should also be informed of the benefits of such research and the inherent safeguards.
These changes are all achievable, he says. The public, researchers, funders, and regulators should all take part in developing effective mechanisms of research governance using personal data. They have, after all, a shared aim in supporting research for public benefit.
With the development of the national electronic care records, the UK can become the global front runner in both research and governance, he concludes.
Contact:
Robert Souhami, Emeritus Professor
of Medicine, University College London, UK
Email: robert.souhami{at}btinternet.com
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs DivisionBMA HouseTavistock
SquareLondon WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American Association for theAdvancement of Science(http://www.eurekalert.org)
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