Issue
9
Putting Patients First
The Welsh Office have now released a consultation document on Quality
care and Clinical Excellence.
To set quality standards the Welsh Office will:
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Promote evidence via R&D and build on the Clinical Effectiveness Initiative for
Wales.
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Set up, with DoH, a National Institute for Clinical Excellence to promote clinical
guidelines, cost effectiveness and audit. It will advise on reducing unacceptable
variations in care and consist of professionals, academics, patients and managers.
-
Set National Service Frameworks for major diseases and programmes of care so that
patients know what to expect from the NHS, similar to the Calman/Hine reports for cancer
services.
To deliver improved quality the Welsh Office will:
-
Introduce clinical governance: a framework of accountability for clinical standards with
the Chief Executives of trusts being held accountable. They will regularly report to their
Boards on quality, just as they do at present on finance.
-
Promote life long learning to ensure quality.
-
Strengthen professional self-regulation
To monitor the delivery of quality standards the Welsh
Office will:
-
Set up, with DoH, a Commission for Health Improvement for inspection and trouble
shooting in a rolling review programme.
-
Set up a performance framework using high level indicators to be agreed.
-
Survey patients and users for views
The Welsh Assembly will be an integral part of this process. In the
mean time local programmes of action will need to be drawn up.
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Albumin for critically ill patients.
The BMJ (25 July 1998) published a paper written by the Cochrane
Injuries Group raising concerns on the administration of albumin to critically ill
patients. The authors have conducted a systematic review of randomised controlled trials
and found that the use of human albumin solutions is causing six deaths per hundred in
critically ill patients.
This kind of surveillance is obviously going to be more and more
important for our work in future.
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History of evidence-based practice
In 1836 an article by PCA Louis was hailed as a breakthrough. It was
called 'Researches into the effects of blood-letting in some inflammatory diseases and on
the influence of tartarized antimony and vesication in pneumonitis' (Am J Med Sci 1836.
18:102-111). The editor of the journal called Louis' article "the first formal
exposition of the results of the only true method of investigation in regard to the
therapeutic value of remedial agents".
At the time that this article appeared, blood-letting was the almost
universally accepted, 'proper' method of treating pneumonia. Louis gathered vast amounts
of data, which allowed him to make comparisons and systematically investigate the efficacy
of treatments.
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Controversy over donepezil (Aricept) continues
The government's Standing Medical Advisory Committee has produced
guidelines on the use of donepezil. It recommends that treatment should be initiated and
supervised only by a specialist experienced in the management of dementia and that
consultants should ensure that the characteristics of patients selected for treatment
match those of the published studies. The effects of the drug should be assessed after 12
weeks of treatment and the treatment continued only if there is evidence of benefit.
The latest Drugs and Therapeutics Bulletin disagrees. Donepezil causes
a small improvement in the clinicians overall rating of dementia but these findings have
to balanced against donepezil's unproven effects upon quality of life and day-to-day
functioning. It is not possible to predict which patients might benefit. There is also
some early evidence of psychiatric disturbances with the new drug. The Bulletin concludes
that there is no evidence for the use of donepezil in clinical practice.
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Local Health Groups and lay representation
t may seem strange for an article in a newsletter devoted to quality
and clinical effectiveness to approach the question of lay representation on the Local
Health Groups. However it is likely that a strong lay voice within commissioning will be a
powerful tool for improving the quality of care in the health service.
To date there has been no national campaign to make people aware of how
they can participate or about the changes that are going to take place in the management
of primary care services.
Commenting on Primary Care Groups (PCGS) in England, Claire Rayner,
Chair of the Patients’ Association, said: "It is worrying that the government
has not done anything yet to raise awareness about public involvement in PCGs. We now have
a unique opportunity to get patients actively involved in their local health services but
most people do not even know that the system is changing.
"For the public to ‘buy into’ the changes, the selection
process of the patient representative must be transparent. Who will be the lay members?
What are the criteria for their selection? Will they receive training? We would like to
see an open selection process that will ensure that the lay member will strongly advocate
the needs and the views of the local people".
Dr Simon Fradd, Chairman of the Doctor Patient Partnership, said:
"The NHS is everyone’s service so it makes sense that the public have their say
in how local health services are developed. Members of the public participating in the
Groups will work with GPs and other health professionals along with the health authority
and trusts in the governance of local health services and the development of health
improvement programmes. It is important that they get the support and training to ensure
they are able actively to participate.
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The supply of beds creates the demand for those beds
Roemer’s Law
Contact Dr N J Vetter, the editor of this newsletter (01222 – 744196) for an up-to
date list of projects, or to add to the list, or if you want more or less copies of The
Quince.
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