Hive Health

Today we tune out until January 5. It’s been a fantastic and productive year, thanks to friendships old and new. We really appreciate the support.

May your Christmas bring happiness, festive cheer and plenty of time with family and friends.

Have a great break, and we hope to see you all in the New Year.

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If you’re anything like me, you always read the Sunday magazine before the rest of the paper. Not that I don’t want to read about what’s going on the world, but most often, I only have 10 minutes to actually look at the Sunday papers!

A couple of Sundays ago, my eye was caught by the picture of Angelina Jolie on the front cover of the magazine. She’s beautiful – but more than that I thought there might be a picture of Brad Pitt inside. I was to be disappointed, but what I did find was an interesting – and disturbing – article on the “postcode lottery” pertaining to cancer treatments. I couldn’t believe this was still going on in that Primary Care Trusts (PCTs) have the authority to decide which drugs it will fund for patients in its area.

PCTs hold 80% of the total NHS budget. It is possible to challenge a PCT decision on drug funding – the patient has to demonstrate that he/she is an exceptional case, but this varies from PCT to PCT. I agree with Penny Wilson-Webb CE of the Rarer Cancers Forum that this is a “bizarre and demeaning process”. Imagine being forced to plead for your life by having to demonstrate that you are an exceptional case… what does an exceptional case look like? Is one life more valuable than another? Who decides?

It is astonishing that policies differ so much between parts of the country, and indeed, between neighbouring PCTs. But it’s not just postcodes that make this a lottery. The women featured in this article were middle class, educated; they had a voice. Who speaks for unempowered patients – those who don’t understand their choices, who have little support? A policy of one voice, one rule would solve this.

In April 2008, there was a “dramatic expansion of the patient choice initiative” in the NHS.  Patients referred to see a specialist can now choose their hospital (any that meets NHS standards). However, this doesn’t seem to cover cancer treatments. Why the lottery still?

I felt immensely for the individuals that have been affected by the decisions made by their PCTs. I also felt that doctors had in some way let down patients by not standing up to their PCTs, by not asking the difficult questions. I guess that no-one wants to put their head above the parapet and be seen to be causing a problem… or dare I say it, actually do what they believe to be right in the treatment of patients.

Recently, I had the privilege of attending a conference where William Burns, CEO of Roche was speaking.

The thing I found most fascinating was his future view: “the patient of tomorrow will be in the driving seat”.

As he says, today’s patients research via the net to talk to other patients about which trials, medicines, doctors and hospitals might be best for them. They then make informed decisions and requests based on this and will argue with multiple gatekeepers to get there.

I’m interested to know other doctors views on this….Should an informed patient be feared or encouraged?

Although many people on this side of the Atlantic feel that the US Direct to Consumer advertising has taken things too far (and I would definitely agree) I do think there is more that should be done with Direct to Patient communication.

The internet is a great leveller given that everyone can put content on it, and increasingly acts as a first stop for many patients. But it does seem bizarre that in the UK, the pharma industry, who have access to the most information on products, are prevented from joining that discussion.

A couple of stats Mr Burns gave us made me think….

• 33% of the public use the internet prior to a doctor’s appointment
• 40% of the public will do so after a doctor’s appointment

Hopefully, the current EMEA debate on DTP communication will mean industry is more able to contribute in future.

Last Friday saw me showing my mum and girlfriend around my nearly completed extension. Excitement and stupidity led me to fall (off what will be the retaining wall,) landing and cracking my ankle. Result – me, prostrate on the concrete floor and what has become a huge blue foot/ankle/leg, a pimp style limp and walking stick that has cheered my colleagues up no end.

Having left it a number of days, I finally hobbled down to St Charles Hospital’s Minor Injuries Unit for a check up and X-ray expecting the usual secondary care inner London cliché. What greeted me was an organisation that sang with efficiency and care. Each person I hobbled passed asked, ‘did I need a hand?’, and ‘whether I knew where I was going?’ Furthermore, each initiated interaction contributed hugely to my view of the NHS as a service. I couldn’t help but ask the source of this feeling. The receptionist, porter, doctor, and nurse all were consistent in their answers. They put the amazing vibe of the hospital down to it feeling autonomous, working within a clear process whilst having the freedom to use their initiative,  team and individual visibility,  defined roles, and putting the patient right at the centre. I raised this last night at a meeting with a strategy head of a large PCT, and he aired the view that Polyclinics are aiming for exactly this – smaller, autonomous, organisations, staffed with empowered carers all driving towards a better patient experience. I only hope this can be realised.