Government publishes ‘blueprint for trustworthy’ NHS

Today Jeremy Hunt outlined the measures that the government are going to take following the Francis Report into the Mid-Staffs scandal at Stafford Hospital. You can read about them here.

Some of them are outlined below:

• Hospitals will have to publish details of whether they have enough nurses on wards. From April, patients will be able to see the numbers on a new national safety website.

• Hospitals will have to produce quarterly reports on how they are handling complaints and clearly set out how patients can raise them.

• There should be a legal duty of candour on organisations to be open and honest about mistakes.

• A criminal offence of wilful neglect to hold staff to account.

• A “fit and proper person’s test” so managers who have failed in past will be barred from taking up posts.

• A care certificate to ensure healthcare assistants and social care workers have the right skills and training.

• Every patient should have the names of a responsible consultant and nurse listed above their bed.

However, some people do not think the government has done enough and that the legal duty of candour should include all errors – at the moment the government has only said it will apply to mistakes that cause death or severe harm although it is going to consider whether to extend that to include moderate harm. Also, the inquiry wanted the duty of candour to apply to individuals not just organisations.

The Francis Inquiry made 290 recommendations in total. The government has claimed it has accepted all but nine of them. However, of the 281 recommendations the government says have been met, one in four have not been accepted in full. For example, the inquiry called for a system of registration for healthcare assistants, but the care certificate being introduced falls short of that.

However, Robert Francis QC said he was happy that the government’s response was a “comprehensive collection of measures”.

 

Success In Medical School Interview Course

On Sunday I travelled to London for the day for a course in how to succeed at a medical interview. The Success in Medical School Interview course was held in a hotel in Paddington and I arrived at 9.30am, in time for a coffee before we started. There were several other people on the course, some graduates and undergraduates, as well as a friend of mine.

We covered key interview techniques including selling ourselves, our motivation for medicine, and the duties and qualities of a doctor. After lunch we practised communication skills and challenging interview questions, before going over some MMI style questions, such as medical ethics, law, data interpretation and hot topics. We finished around 4.30pm, after discussing the finishing touches, such as body language, dress code and confidence techniques, and were given a certificate for attending.

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I was really impressed with all the course materials we were given, and that the organisers had tailored it to specific things we’d requested before it started; eg I asked for practice with data interpretation and role play for my MMI interview. Overall I found the course very useful, and I’d recommend it especially if you live close to London, and feel you need some advice and feedback before your medical interview. Dr Ting and Mr Qiu, who organised the course, were both very professional and experienced, and I’d like to thank them both.

Funny video about multiple mini interviews (MMIs) for medical school!

When I was looking up MMIs on the internet, I found this video on youtube, which is a spoof about the medical admissions process, made for the McGill Med/Dent Talent Show in 2011. I thought it was really funny, and it helped me to put the interview in perspective and not to worry too much about it…..

Surgeon jailed for negligence & nurse found guilty of mis-conduct

Yesterday David Sellu, a consultant surgeon, was jailed for 2 and a half years for manslaughter after he failed to act quickly enough to examine and operate on a patient he had diagnosed with a rupture in his bowel. The judge said that the surgeon should have prescribed antibiotics and looked at abdominal scans earlier. Although there was a chance that the patient would die even if he had received treatment, the risks were increased by the delay in action.

Elizabeth Joslin, a lawyer for the Crown Prosecution Service, said: ‘David Sellu’s care fell far below the expected standard, with terrible consequences. Prosecution of doctors for gross negligence manslaughter is rare and the threshold for criminal prosecution is high, but this doctor’s actions were not mistakes or errors of judgment, but negligence so serious that he has now been convicted of a criminal offence.

You can read more about the case in the Guardian here

I thought it was quite interesting that also in the news this week, Janice Harry, chief nurse at Stafford Hospital between 1998 and 2006, was given a 5 year caution, but was still found fit to practice for her part in the Mid-Staffs scandal.

A Nursing and Midwifery Council panel heard that during some night shifts, a single nurse was looking after 17 patients on a ward. It said Mrs Harry should have been focused on staffing levels but she was distracted by ‘training, targets and other matters‘.

The panel told her ‘you had effectively closed your mind to your direct operational responsibilities and had limited yourself to the strategic role. You had the professional responsibility for every nurse in the Trust….you had in the past placed patients at risk of harm.

You can read more about the case here

I think that both these cases show how important it is that doctors and nurses should always put the patient first, and I think it is a good thing that there are stricter controls in place now to ensure that bad practice does not happen in the future. However, it has made me realise just how big a responsibility medicine is, and I will have to make sure that I am always focussed on the patient first and not distracted by other things like targets. I also think it shows how important it is for everyone involved in caring for a patient to work as a team, and to report anything that falls below standard.

Another Invitation for Interview!

I’m really happy because I just heard today that I’ve been invited for an interview at one of my other medical school choices. It’s at the end of this month, so not too far away. This one is more of a traditional interview with a panel of 2 interviewers and will last about 20 minutes, while the first one is MMI (multiple mini interviews) with 6 stations each lasting 6 minutes. I hope I hear from my other choices soon too.

Yesterday I had a mock interview at school, with three of my teachers. It was really good practice and I got some good feedback. They gave me some role play questions, some ethical dilemmas and some traditional questions. I was quite nervous and my mouth went dry really quickly, so I’ll make sure that I take a bottle of water with me for the real thing! I didn’t realise how long 6 minutes is until I had to pretend I’d hit the interviewer’s car and had to role play what I’d do. Some of the answers I gave were too long though, so I’ll have to try to time them better.

image from http://img.allvoices.com/thumbs/image/609/609/93594083-medical-ethics.jpg

The Student room have posted information about what to expect at interviews at all the different medical schools. You can see what to expect here.

Here are some good interview questions that I found on the web. They have all been asked at medical school interviews recently.

Interview with Dr Robert Newman, MD, MPH, Director of the Global Malaria Programme, World Health Organisation

Recently I asked Dr. Robert Newman, MD, MPH, Director of the Global Malaria Programme at the World Health Organisation, a few questions about malaria.

This is what he said:

Me: Drug and insecticide resistance, lack of global funding, and poor testing and treatment facilities in many infected areas are some of the obstacles to eradicating malaria, but which one gives you most cause for concern?

Robert Newman: While all of these issues are concerning, the greatest threat to continued success in the control and elimination of malaria is financial rather than biological. While there has been a massive increase in international funding for malaria, from less than 200 million USD annually to nearly 2 billion USD today, that total still falls far short of the more 5 billion USD annually that are required to scale up life-saving malaria interventions.

That said, parasite resistance to antimalarial medicines, and mosquito resistance to insecticides are also major threats to success. In the past, the spread of resistance to chloroquine in Africa was responsible for major increases in child mortality on the continent. We now have resistance to artemisinins that has emerged in the greater Mekong Subregion. For the time being, this is restricted to four countries (Cambodia, Myanmar, Thailand, and Viet Nam) but given population movements in Asia and the world, the geographic scope of the problem could widen quickly.

Insecticide resistance has been detected in 64 of the 99 countries with ongoing malaria transmission. This affects all classes of insecticides that are used in malaria vector control, and has had the worst impact on the pyrethroids, which are the only class used on insecticide-treated nets. While vector control tools remain effective in most settings, this issue needs to be addressed urgently to prevent a global resurgence of the disease.

WHO has released global plans on the management of these two biological threats (The Global Plan for Artemisinin Resistance Containment and the Global Plan for Insecticide Resistance Management). If adequate funding were available, both challenges could be fully addressed.

Me: I read recently that the UK has pledged £1 billion over the next 3 years for the Global Fund, which is really good news for the fight against malaria. What do you think is the most positive news in the fight against malaria today?

Robert Newman: The most positive news today is the steady decline in malaria cases and deaths that have occurred over the past decade. The unprecedented scale up of life-saving malaria interventions, including long-lasting insecticidal nets, indoor residual spraying, diagnostic testing, and effective antimalarial treatment (especially with artemisinin-based combination therapies or ACTs as they are known) has resulted in an estimated 26% decline in malaria mortality rates globally, and a 33% decline in the WHO African region.

Malaria interventions saved an estimated 1.1 million lives over the past decade; this is a tremendous achievement. But the gains are fragile, and history shows us just how quickly malaria can resurge if funding is decreased or stopped. A decade of progress can be undone in one or two malaria transmission seasons.

Me: Do you think you will see a world without malaria in your lifetime?

Robert Newman: I do believe that I will see a world without malaria in my lifetime, but this requires a few assumptions to be met:

a) that I have a long life (as I think global malaria eradication is probably 40 years away)

b) that political and financial commitment to control, eliminate, and ultimately eradicate malaria continues

c) that innovative tools continue to be developed that allow us to stay ahead of the mosquito and the parasite, and

d) that overall development continues, especially in Africa.

I am optimistic that these assumptions will be met, and I believe that human beings are capable of amazing things when we dedicate ourselves to solving a challenge and then work together to get there.

I’d like to thank Dr Newman for his generous time in answering these questions for me. I first met Dr. Newman when I went to the APPMG at Westminster to give a presentation about malaria for World Malaria Day in April. This is what he said afterwards: ‘I very much enjoyed meeting you… during the All-Party Parliamentary Malaria Group meeting earlier this year, and I was so impressed with what you said, and the way you delivered it.’

You can read my presentation on the APPMG website here, and read what the other speakers said here.