Medicopolitical Digest

UK emergency services need priorityBMA urges reduction in drink driving limitsNHS will claw back outstanding accident claimsData Protection Registrar will target GPs

BMJ 1997; 315 doi: (Published 13 December 1997) Cite this as: BMJ 1997;315:1627
  1. Linda Beecham, Medicopolitical digest is prepared by

    UK emergency services need priority

    The British government must continue to give emergency care services a high priority and make the best use of new technology.

    In a joint report on dealing with the problems of the rise in emergency admissions the Royal College of Physicians (RCP) and the NHS Confederation say that “in the final analysis people judge the NHS by how well it responds when they are in the greatest need.”

    The report comments that although emergency admissions have been increasing with sudden peaks in demand, particularly during the winter, there was now evidence that the winter pressures were extending into the rest of the year. There was a 9.9% increase in general and acute emergency admissions between 1991–2 and 1995-6—amounting to 920 new emergency admissions every day.

    The RCP and the confederation set up a working group, chaired by Professor Michael Sheppard, professor of medicine at the University of Birmingham, to look at the implications of the rise in admissions and suggest possible solutions.

    Results NHSE Should Collate

    The report welcomes the additional non-recurring £300m in 1997–8 to help in handling emergency admissions (18 October, p 971), but points out that because most health authorities will already be over budget it will be difficult to use the money to fund innovations which require an ongoing commitment. The report recommends, however, that where schemes have been put in place the NHS Executive should collate the results and share them throughout the NHS. Several initiatives are being developed to avoid admitting patients once they have attended as an emergency—for example, ensuring 24 hours' senior medical cover; establishing a medical assessment unit; providing direct entry for certain conditions to specialist wards; appointing therapists to accident and emergency departments; and involving social workers.

    The report calls for a joint agency approach, which could take an overview of the total emergency care in hospitals and the community. It says that the impact of the pressures on staff morale, recruitment, and retention must be recognised, and says that there is scope for developing more nurse specialist led services, both in hospital and the community to alleviate pressures. There should be national guidelines on a range of clinical conditions on when and how to refer or transport patients as emergencies to hospital. The team was concerned at the extent to which low dependency beds had been closed or left empty and said that before plans to close beds were approved there should be a full assessment of the impact on the hospital and the community.

    Tackling NHS emergency admissions: policy into practice. Best practice paper No 1 is available from the NHS Confederation, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ.

    BMA urges reduction in drink driving limits

    The BMA has renewed its call for a reduction in the permitted blood alcohol concentration for driving from a maximum of 80mg per 100ml to 50mg.

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    Giving evidence to the House of Lords inquiry on blood alcohol levels for drivers, Dr Vivienne Nathanson, head of health policy at the BMA, said: “We believe that a further reduction in blood alcohol concentrations will prevent deaths and reduce the number of lives ruined by drinking drivers. The introduction of the current limit, backed up by police enforcement and television and media education campaigns, led to a dramatic fall in the number of deaths on the road, but the position has been stagnant since 1993.”

    The BMA is not suggesting a zero limit because it doubts whether it would be enforceable. The association also believes that a reduction to 50mg should be accompanied by random breath testing and that renewed efforts should be made to make driving after even one drink socially unacceptable.

    NHS will claw back outstanding accident claims

    NHS hospitals can already claim from insurance companies for the costs of treating people injured in road accidents. They can charge up to £2949 for inpatient treatment and up to £295 for outpatient treatment. In addition, hospitals and GPs can collect an emergency treatment fee of £21.30 from drivers who seek immediate treatment. Hospitals will no longer collect the fee.

    The government will legislate to transfer responsibility for making claims from hospitals to the insurance companies. The Department of Social Security's compensation recovery unit will be able to collect money and transfer it to the relevant trusts.

    At the same time new guidelines require trusts to identify cases where they have treated road accident victims and where somebody else seems likely to have caused the accident; find out whether the patients are claiming compensation; find out who the insurers are; and lodge claims and pursue them vigorously.

    Data Protection Registrar will target GPs

    The Data Protection Registrar is to target GPs in a bid to raise their awareness of the registration requirements of the Data Protection Act. If patients' records are processed on computer and GPs or partnerships are not registered they are liable to prosecution.

    The registrar, Ms Elizabeth France, said: “Our initial findings show that up to 3000 GPs could be committing a criminal offence. This suggests an ignorance of data protection law which is worrying. Registration is simply a first step to understanding the duties which are placed on those who process personal data. Where sensitive data are involved it is particularly important that those duties are fully understood.”


    • A registration hotline for GPs has been set up on 01625 545 740.

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