Press releases Monday 21 March to Friday 25 March 2011

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's website (http://www.bmj.com).

• (1) Public satisfaction with the NHS at a record high, says expert
• (2) Health Bill spells the end of the NHS in England, warn experts
• (3) EU trade deal threatens access to life saving drugs for developing countries
• (4) Restricted working hours have had little effect in US
• (5) Patients and clinicians must share healthcare decisions, say experts
• (6) MP calls for new measures to protect children from alcohol advertising

(1) Public satisfaction with the NHS at a record high, says expert

(Data briefing: How satisfied are we with the NHS?)
http://www.bmj.com/cgi/doi/10.1136/bmj.d1836

Public satisfaction with the NHS is at a record high, says John Appleby, Chief Economist at the King's Fund, in an article published on bmj.com today.

It follows a report in the Observer newspaper accusing England's Health Secretary Andrew Lansley of "burying" similar survey results because they undermine his case for urgent radical reforms.

The latest British Social Attitudes (BSA) survey reports that 64% of the British public are either very or quite satisfied with the NHS - the highest level of satisfaction since the survey began in 1983, and part of a continuous upward trend since 2002.

The figures also show that satisfaction with GPs has now reached 80% - 3% short of its highest level in the early 1990s.

Satisfaction with inpatient services fell - by one percentage point - over the decade to 2009, despite year on year rises since 2006 following a long run decline since 1983. But the public now seems much more satisfied with outpatient and accident and emergency services than in 1999, writes Appleby.

Furthermore, analysis of respondents by political party shows that the rising satisfaction with the NHS over the last ten years or so has also been shared by Conservatives, whose satisfaction is also now the highest since the survey began.

Appleby acknowledges that interpreting responses (and their trends) to questions about satisfaction can be difficult, but says that surveys such as the BSA "provide a useful indicator of the public's general views about the NHS and its services."

He concludes: "Over the last decade the NHS must have been doing something right to earn this extra satisfaction - something even Conservative supporters have noticed, and something probably not unadjacent to the large rise in funding since 2000. Future BSA surveys will reveal how satisfied the public remain as funding for the NHS is squeezed and the government's proposed reforms take shape on the ground."

Contact:
Press Office, King's Fund, London, UK
Email: mediaoffice@kingsfund.org.uk

(2) Health Bill spells the end of the NHS in England, warn experts

(Analysis: How the secretary of state for health proposes to abolish the NHS in England)
http://www.bmj.com/cgi/doi/10.1136/bmj.d1695

The Health and Social Care Bill amounts to the abolition of the English NHS as a universal, comprehensive, publicly accountable, tax funded service, free at the point of delivery, warn experts today.

In a paper published on bmj.com, Professor Allyson Pollock and David Price examine the proposed changes and argue that the government's duty to provide a comprehensive health service in England is abolished.

They say that freedoms created under the new bill will allow corporate commissioners and investors to contract out all NHS services to a range of private providers and redefine the range of NHS services available. They will also be free to charge for some elements that are currently NHS services and to create surpluses for staff and shareholders by under-spending the patient care budget, the authors say.

International competition laws may also be used to challenge public policies that impair their profitability and freedom to operate, they warn.

In order to create a commercial market, they argue that "the government has repealed the health secretary's duty to provide or secure the provision of comprehensive care and has abolished the structures and mechanisms which follow from this duty."

However, they point out that "government belief that cost efficiency, improved quality, and greater equity flow from competition in healthcare markets is not supported by evidence, the Office of Fair Trading, the government's impact assessment, or its experience of independent treatment centres and private finance initiatives."

They call for several key amendments "to ensure continuation of NHS comprehensive healthcare throughout England."

These include restoring the duty of the secretary of state for health to provide comprehensive healthcare throughout England, imposing a duty on commissioning consortiums to provide comprehensive healthcare to all residents on the basis of need, and withdrawing the power granted to commissioners to charge for healthcare services.

Unless these amendments are made, the bill as drafted "amounts to the abolition of the English NHS as a universal, comprehensive, publicly accountable, tax funded service, free at the point of delivery," they conclude.

Contact:
Allyson Pollock, Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, London, UK
Email: allyson.pollock@gmail.com

(3) EU trade deal threatens access to life saving drugs for developing countries

(Editorial: The production of generic drugs in India)
http://www.bmj.com/cgi/doi/10.1136/bmj.d1694

A new trade agreement between India and Europe would block access to life saving drugs for billions of people living in developing countries, warns an expert on bmj.com today.

The EU wants India to adopt tough new patent protection rules for drugs so that no new generic drug could be sold in India without the permission of the company that owned the brand name version of the drug, writes James Love at Knowledge Ecology International in an editorial.

Not only would this have an enormous impact on the entire developing world, it would also dramatically shrink the global market for inexpensive generic drugs, warns Love.

It will also make a mockery of promises made by EU trade officials that governments would implement intellectual property rules in such a way to "protect public health and, in particular, to promote access to medicines for all."

In 1970, India eliminated patents on drug products, which enabled it to develop a strong generic drug industry. In 2005, India modified its patent law, to conform to the World Trade Organization (WTO) rules on the protection of intellectual property. But in doing so, India provide certain safeguards to make it easier to continue to manufacture generic medicines.

Now Europe wants India to adopt strict intellectual property protection rules that go beyond its obligations at the WTO, and which will effectively remove India as a legal market for early production of generic drugs. It will also restrict other developing countries access to much-needed supplies of affordable drugs.

Furthermore, the EU is currently negotiating this agreement with India in secret, despite its potential impact on billions of people living in developing countries, writes the author.

"Political and civic leaders from Europe and around the world must appeal to the EU to avoid outcomes that make it even more difficult to manufacture and market inexpensive drugs in developing countries," argues Love. "This can begin by eliminating demands that India adopt exclusive rights on drug test data, or lower its standards for granting patents on medical inventions."

Contact:
James Love, Director, Knowledge Ecology International, Washington DC, USA
Email: james.love@keionline.org

(4) Restricted working hours have had little effect in US

(Research: Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review)
http://www.bmj.com/cgi/doi/10.1136/bmj.d1580
(Editorial: Why have working hour restrictions apparently not improved patient safety?)
http://www.bmj.com/cgi/doi/10.1136/bmj.d1200

Reducing doctors' working hours from over 80 a week does not seem to have adversely affected patient safety and has had limited impact on postgraduate training in the United States, finds a study published on bmj.com today.

Further work is now needed to assess the impact of reducing hours to 48 a week in Europe, say the authors.

There has been a progressive reduction in the working hours of doctors in training in both the US and Europe over the past 20 years. The maximum hours per week for trainees can range from 37 hours in Denmark to 80 hours in the US. The European Working Time Directive (EWTD) restricted the weekly hours for trainee doctors in Europe to 48 from August 2009.

While the aim of such legislation is to improve working conditions and safety, the medical profession has raised concern about the potentially adverse effects on postgraduate training for junior doctors and the provision of high quality care for patients.

So a team of UK-based researchers set out to evaluate the impact of a reduction in working hours on educational and clinical outcomes.

They reviewed 72 published studies from the US and UK and found that a reduction in working hours to less than 80 a week does not seem to have adversely affected patient safety and has had a limited effect on postgraduate training in the US.

However, studies on the impact of European legislation limiting working hours to 48 a week were of poor quality and had conflicting results, meaning that firm conclusions cannot be made, say the authors.

They believe that more high quality studies are urgently needed to evaluate the impact of restricting working hours on objective measures of medical training and patient safety, particularly in the European Union.

"Only then can both the public and the profession be reassured that the standard of medical training, and therefore the future care of patients, is of the highest possible quality and will be maintained or improved over time," they conclude.

Weak evidence, inadequate regulation, busier doctors, and discontinuity of care are all possible explanations for these results, says Leora Horwitz from Yale University School of Medicine in an accompanying editorial. For example, trainees are often asked to do the same amount of work in less time, while the decrease in hours worked has led to a substantial increase in discontinuity of care, handovers, and transfers.

"Without careful and continued attention to these matters, followed by adjustments to regulations and to practice as required, regulation of working hours is unlikely to have the beneficial effects for patients that regulators and the general public had hoped for," she concludes.

Contacts:
Research: Suneetha Ramani Moonesinghe, Consultant and Honorary Senior Lecturer in anaesthesia, University College Hospital, London, UK
Email: ramani.moonesinghe@uclh.nhs.uk
Editorial: Leora Horwitz, Assistant Professor, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
Email: leora.horwitz@yale.edu

(5) Patients and clinicians must share healthcare decisions, say experts

Clinicians have an ethical imperative to share important decisions with patients, and patients have a right to be equal participants in their care, say a group of experts today.

In December 2010, 58 people from 18 countries attended a Salzburg Global Seminar to consider the role patients can and should play in healthcare decisions. Today, they publish a statement urging patients and clinicians "to work together to be co-producers of health."

It comes as the government in England finalises plans to give people more say and more choice over their care than ever before.

The experts argue that much of the care patients receive is based on the ability and readiness of individual clinicians to provide it, rather than on widely agreed standards of best practice or patients' preferences for treatment.

Results from the 2010 Cancer Patient Experience Survey seem to support this view. It found significant variations in the choice and information patients are given, and their involvement in decisions about treatment.

The experts also say that clinicians are often slow to recognise the extent to which patients' wish to be involved in understanding their health problems, in knowing the options available to them, and in making decisions that take account of their personal preferences.

As such they call on clinicians to stimulate a two-way flow of information with patients, to provide accurate information about treatment, to tailor information to individual patient needs and allow them sufficient time to consider their options. In turn, they urge patients to ask questions and speak up about their concerns, to recognise that they have a right to be equal participants in their care, and to seek and use high-quality health information.

They also call on policymakers to adopt policies that encourage shared decision making and to support the development of skills and tools for shared decision making.

One of the signatories, Professor Glyn Elwyn from Cardiff University, says that despite considerable interest in shared decision making, and clear evidence of benefit, implementation within the NHS "has proved difficult and slow."

Angela Coulter from the Foundation for Informed Medical Decision Making agrees and points to recent evidence showing that most patients want choice, but that many clinicians remain ambivalent or antagonistic to the idea. She believes the government's new commitment to shared decision making presents a challenge to entrenched attitudes and the need for big change in practice styles.

The BMJ is hosting an expert roundtable event to discuss shared decision making at 3pm on Thursday 24 March 2011. Following the roundtable, at 5.30pm Muir Gray and Gerd Gigerenzer will be launching their book: "Better doctors, better patients, better decisions: Envisioning health care 2020."

Any journalists wishing to attend these events, please contact Emma Dickinson on +44 (0)20 7383 6529, Email: edickinson@bmjgroup.com

(6) MP calls for new measures to protect children from alcohol advertising

(Editorial: Alcohol marketing to children)
http://www.bmj.com/cgi/doi/10.1136/bmj.d1767

Next week, Sarah Wollaston MP will put forward a private member's bill urging the government to adopt a new approach to protect UK children from alcohol advertising.

In an editorial published on bmj.com today, Professor Gerard Hastings and Dr Nick Sheron set out why we urgently need to tackle the excessive drinking of our young people and their massive exposure to alcohol advertising.

The bill will call on the government to adapt French legislation that allows alcohol advertising in media aimed at adults but not children, and ensures that promotional messages are factual and verifiable.

The measure (called the "loi evin") was applied in France in 1991 to protect their children from alcohol marketing and has been a key plank in France's effort to reduce its alcohol problems. Alcohol consumption in France has been falling consistently since 1960.

In contrast, the UK has "clumsily imposed self regulatory codes" and now has one of the highest levels binge drinking and drunkenness among schoolchildren in Europe, say the authors.

In 2008, there were more than 600 alcohol-related deaths - almost two a day - among 15-24 year-olds in England and Wales and significantly more than the combined toll from cancer, heart disease, and respiratory disease in this age group.

Added to this are problems of anti-social behaviour, unwanted pregnancies and sexually transmitted diseases.

Meanwhile, the UK drinks industry spends £800m a year promoting alcohol compared with a budget of just £2.6m for the UK's biggest alcohol education initiative in 2010. "For every £1 spent advising young people about the downsides of drinking, several hundred pounds are spent encouraging them to drink more," say the authors.

In the long term the bill will change drinking behaviour in young people, they write. Evidence clearly shows that alcohol promotion encourages children to drink at an earlier age and in greater quantities than they otherwise would. A recent study found that 96% of UK 13 year olds were aware of alcohol advertising.

"Removing this profoundly unhealthy influence is, unsurprisingly, recognised as a key public health priority," they conclude. "So, along with their café culture, the "loi evin" is a French innovation that the UK needs."

Contact:
Gerard Hastings, Director, Institute for Social Marketing, University of Stirling, Scotland, UK
Email: gerard.hastings@stir.ac.uk

Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bma.org.uk

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