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Press releases Saturday 31 March 2007

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(1) Still some way to go in tackling racism in mental health care

(2) Should EU patient information laws be relaxed?

(3) Supermarket surgeries ±a wake-up call for the profession±

(4) Doctor warns of growing gap in New Labour±s NHS

(1) Still some way to go in tackling racism in mental health care
(Editorial: Institutional racism in mental health care)
http://www.bmj.com/cgi/content/full/334/7595/649

Mental health services in England and Wales have been accused of being institutionally racist. In this week±s BMJ, two senior doctors say that, although services are pioneers in moving towards equity, they have some way to go before they meet the challenges of a multi-cultural society.

The ±Count me in± census, published last week by the Healthcare Commission, makes grim reading for people of African and Caribbean origin living in England and Wales, write Professors Kwame McKenzie and Kamaldeep Bhui.

The survey of 32,023 inpatients on mental health wards in 238 NHS and private healthcare hospitals reported that 21% of patients were from black and minority ethnic groups, although they represent only 7% of the population.

Rates of admission were lower than average in the white British, Indian, and Chinese groups, but three or more times higher than average in black African, black Caribbean and white and black Caribbean mixed groups.

Not only were people in these three groups more likely to be admitted to hospital, but those in hospital were more likely to be admitted involuntarily. Once in hospital, people who defined themselves as black Caribbean had the longest stay.

In a separate survey of people with learning disabilities, comprising 4,609 inpatients from 124 hospitals, only 11% were from black and minority ethnic groups. Rates of admission were lower than average in the South Asian, other Asian, white, and Chinese groups, but again they were two to three times higher than average in some ±black± groups. However, unlike inpatients with mental health problems, no ethnic differences were seen for involuntary admissions.

These results add to the increasing evidence of ethnic differences in the treatment of mental illness, say the authors. For instance, some black and minority ethnic groups are less likely to be offered psychotherapy, more likely to be offered drugs, and more likely to be treated by coercion, even after socioeconomic and diagnostic differences are taken into account.

These disparities reflect the way health services offer care according to racial group, and seem to satisfy the well established and widely known definition of institutional racism.

In response, a systems level approach called ±Delivering race equality± has been developed to improve mental health services. This could improve services but leadership is needed to ensure that it is taken up, say the authors.

But there is a danger that its impact will be undermined by other government policy, such as the proposed amendments to the Mental Heath Bill, and there are also wider questions about whether treatment is being offered and delivered effectively.

Contacts:
Kwame McKenzie, Senior Lecturer in Cultural Psychiatry, University College London, UK
Email: k.mckenzie@medsch.ucl.ac.uk

(2) Should EU patient information laws be relaxed?
(Sweetening the pill)
http://www.bmj.com/cgi/content/full/334/7594/596

In 2002 the European parliament voted resoundingly against allowing drug companies to provide information about their products directly to patients. However, five years on, this decision is set to be challenged again.

A special report in this week±s BMJ looks at the arguments.

Hard lobbying by the drug industry has convinced EU health commissioners that increasing the extent to which drug companies can provide information to patients is essential to stop Europe±s drug industry falling further behind those of the United States and Japan. Drug companies also assert that this change would benefit patients.

But health campaign groups insist that drug companies cannot provide the independent information consumers need.

The commission will set out its final position next month, but speculation is already rife that it is likely to suggest changes to legislation that would jeopardise the current ban on direct to consumer advertising for prescription drugs.

Campaigners are particularly concerned that if the commission decides it needs to relax the laws then direct to consumer advertising would be introduced almost as a side effect.

Despite assurances that blatant advertising is not the intention, Barbara Mintzes of the University of British Columbia disagrees, saying that any change in the law to allow industry to provide information could produce undesirable effects ± even if the advertising ban remains in place.

Rita Kessler of the campaign group AIM agrees. She believes that the current proposals would result in poor quality information and questions the need for more health information. She suggests that the commission should instead endorse an EU logo mark that would be awarded to high quality information sources and act as a quality stamp to help patients identify reliable, evidence based advice.

In anticipation of the commission±s final report in April, five international health associations have joined forces to step up their opposition campaign. They assert that ±relevant, comparative and appropriate information on health issues cannot be provided by drug companies,± because in a competitive marketplace, dug companies must present their own products in a more favourable light than other preventive or therapeutic options.

However, the quick turnaround of MEPs means that few of the original objectors from 2002 remain in office ± and that could mean a completely different outcome when patient information laws are debated again.

Contacts:
Hannah Brown, Freelance Journalist, London, UK
Email: Hannah@two-cultures.com

Barbara Mintzes, Research Associate, Center for Health Services and Policy Research, University of British Columbia, Vancouver, Canada Email: bmintzes@chspr.ubc.ca

(3) Supermarket surgeries ±a wake-up call for the profession±
(Open all hours)
http://www.bmj.com/cgi/content/full/334/7595/668

Last week, the government announced plans to let supermarkets and retail pharmacies provide GP services, particularly in under doctored areas. Boots the Chemist welcomed this as ±good news± but doctors raised concerns that this may be ±a back door way of privatising the NHS.±

A report in this week±s BMJ asks is ±24-7 healthcare± really likely and how real is the threat of backdoor privatisation?

It±s understandable that general practitioners might fear this new face of primary care as a threat to their business, writes author and freelance journalist, Lynn Eaton. But so far no company has voiced any intention of being direct providers of primary care. If anything, they want to steer clear of it, insisting they are merely renting out empty space to others.

However, GPs cannot afford to be complacent, warns Michael Dixon, chair of the NHS Alliance. ±It±s a wake-up call for the profession,± he says. ±If supermarkets are going to open surgeries with longer hours, it±s going to put pressure on GPs to open longer too.±

The national clinical director for primary care, David Colin-Thome, believes that shifting GP surgeries into supermarkets is, potentially, a good idea, but stresses the need to keep the principles of good general practice.

The threat of backdoor privatisation of primary care is real enough, if you look at what has happened in social care in the last decade, writes Eaton. Voluntary sector organisations now sit alongside multinationals, while care homes are run by anyone from big companies like BUPA through to local entrepreneurs. What±s to say primary care won±t go the same way?

One flaw in the ±backdoor privatisation± argument is that GP practices are already independent businesses, so maybe the real question is not whether primary care services will be privatised, but whether we might now see the corporate heavyweights ± the chains and multinationals that grace our shopping centres ± muscling in on the primary care act.

The supermarket model is a step too far for most doctors, but Michael Dixon does see change ahead, as primary care trusts try to provide patients with the longer opening hours and Saturday morning surgeries.

He warns: ±There is pressure on GP practices to shape up. The government has tried the command and control method, but they can±t do that because GPs are independent practitioners. The next thing was to bribe us ± which was the new GP contract. The last thing is to create the big bad wolf of open competition, which is what we are beginning to see now.±

Contact:
Lynn Eaton, Freelance Journalist, London, UK
Email: lynn@lynneaton.co.uk

(4) Doctor warns of growing gap in New Labour±s NHS
(The growing gap)
http://www.bmj.com/cgi/content/full/334/7595/670

It is time to close the gap between public discussion and political practice in New Labour±s NHS, says a doctor in this week±s BMJ.

Public discussion is directed towards improving services for patients. Yet, on the far side of the gap, we have the accelerating privatisation of healthcare provision, and a medical profession that is being simultaneously coerced and demoralised for political ends, argues general practitioner, Iona Heath.

A weakened medical profession may be more politically compliant and less able to resist the distortion of the health service for commercial ends, but it cannot serve patients well, she says.

Consider the chaos surrounding the new systems for recruiting young doctors into specialist training. The whole process contributes to the political objective of enforcing conformity and marginalising dissent, which in turn damages patient care.

How is medicine to continue to attract high calibre applicants if this sort of career path awaits them, she asks?

Only if doctors have the freedom to explore and explain options can patients be free to make their own decisions, she writes. If doctors are encouraged to offer standardised care, as they are under their new contracts, drug consumption rises and patient choices become constrained.

Here again we find the growing gap. Public discussion promotes self determination and free choice for patients, but political practice dictates that only those choices that concur with the interests of the politically and economically powerful are actively supported.

Society needs the most able young people to want to study medicine and then to use their knowledge and skills, independently of political and economic power, for the benefit of all, she says. Has this suddenly become an impossible aspiration? It is time to close the gap.

Contact:
Iona Heath, General Practitioner, Caversham Group Practice, London, UK
Email: iona.heath@dsl.pipex.com

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