Women consultants lag behind in merit awardsBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6936.1106 (Published 23 April 1994) Cite this as: BMJ 1994;308:1106
The Advisory Committee on Distinction Awards is concerned about the lower percentage of awards given to women consultants compared with their male colleagues. About 20% of women consultants hold awards compared with about 37% of male consultants. In 1993 the women received only 12.7% of the available awards, although they formed 17% of the consultant body.
About one third of all consultants hold awards, of which there were 7103 at the end of 1993, costing pounds sterling 104m.
In the committee's first annual report its chairman, Professor Sir Gordon Robson, says that the imbalance is partly because most female consultants enter five specialties-psychiatry, anaesthetics, paediatrics, radiology, and public health medicine. Last year new consultant entrants to these specialties comprised 64% of women and only 36% of men. The younger age pattern of women consultants is another factor.
In addition, there are wide regional variations. The South Western region with 39 awards available selected only one woman and in Wessex, where 16% of consultants are women, they received only two recommendations for C awards. By contrast, the Thames regions all recommended that 20% or more of their awards should go to women.
Sir Gordon casts doubt on the age limit for merit awards, which was intended to prevent awards being granted close to retirement so as to boost pensions. He says that the number of awards granted to consultants aged between 60 and 65 does not support the contention that they are retirement presents. He believes that the practical effects of the age limits are a loss of incentive and early resignations and that this has been to the detriment of the NHS.
Under the new five year review all awards given in 1989 were reviewed. None was withdrawn or downgraded, although several cases were reviewed “in considerable detail” by the regional committees and brought to the committee's attention. This year's awards round will be completed in October, enabling authorities to be notified of awards in November instead of February.
The committee welcomes the government's current review of the awards scheme, which is taking account of the NHS reforms. The report of a working party, which is chaired by the Scottish chief medical officer, is now being considered by the Department of Health, with its decisions expected to be announced in June.
Junior doctors want more action on hours
The chairman of the BMA's Junior Doctors Committee, Dr Edwin Borman, has called on the government to take a much stronger line with hospital managers to ensure that there are changes in the way that junior hospital doctors work. He said in a press statement that the recent report of the death of a young doctor, Dr Alan Massie, highlighted the kind of pressure that junior doctors were under when they worked for long periods or had no rest. He would raise the matter with the minister for health, Dr Brian Mawhinney.
Dr Borman said that the national confidential inquiries into perioperative deaths and inquests into the deaths of patients after clinical mistakes by junior doctors showed the consequences to patients of doctors working long hours with poor supervision. His committee would like to see the number of consultants increased from the present 19 000 to 25 000 over the next four years. This could be achieved readily by upgrading senior registrar posts and would produce a safer and more efficient service. “Consultants,” he said “need to be able to devote a greater proportion of their time and workload to supervising juniors.” Hospital managers should recognise the reduction in juniors' hours as a safety and quality of care issue.
There should be an informed campaign on confidentiality, says BMA
The BMA wants an informed and focused campaign on confidentiality before the whole of the NHS is computer networked. The proposal came from the medical ethics committee, which believes that the NHS's information strategy is being driven more by the perceived needs of managers than the need to facilitate patient care. The committee is worried that insufficient funds are being put into security measures to prevent unauthorised access to confidential information.
The BMA has called for the reconvening of the Inter-Professional Working Group. This produced a code of confidentiality for health service employees, which was never published because the Department of Health held the copyright. The group has been asked to update the code, take into account the draft European Union directive on data protection, and publish the code before the BMA's annual meeting.
The BMA is to ask the government to establish a watchdog body to monitor the protection of personal health information in areas not covered by the disciplinary powers of the GMC or the Data Protection Registrar.
The association would like to see specific legislation on confidentiality, which would be binding on all health service employees. It wants consideration given to setting up a monitoring body for screening and genetic information and to the possible role of a privacy commissioner for health, along the lines of the Australian model.
Public health trainees face career problems
Each health authority will have to advertise for one public health consultant each year for the next five years if all the trainees in public health medicine are to find a post. This was the bleak message that the chairman of the Committee for Public Health Medicine and Community Health gave the committee last week. Dr Stephen Watkins, director of public health in Stockport, said that merging of more and more health authorities had caused the manpower crisis.
In the current discussions on the functions and manpower review questions were being asked about the role of doctors in public health, but Dr Watkins believes that few other people were capable of doing the work of public health physicians. There had to be medical involvement in needs assessment and in giving public health advice to defined populations. There was no question, however, of attempting to drive a wedge between doctors in public health and general practitioners or other people with public health qualifications who were not doctors. But if general practitioners were to take on more responsibility for commissioning the CPMCH chairman believed that they would need advice from doctors not social scientists or managers. The specialty had 500 doctors in training ready to take on the challenge of purchasing and commissioning.
Patients like hospital food, audit shows
Patients' satisfaction with hospital food in England varies substantially among hospitals, according to a survey conducted by the National Audit Office (NAO). The survey found that 85% of patients overall thought that the food was either good or excellent, with 15% regarding it as poor or very poor. But in some hospitals as many as a quarter of the patients were dissatisfied with the catering.
The NAO surveyed around 1500 patients in 24 randomly selected hospitals, in 12 of which between 90% and 100% of the patients questioned were satisfied. But in five of the hospitals less than 75% of the patients were satisfied. Younger patients were found to be less satisfied in general with the food: among the under 35s more than a quarter rated it as either poor or very poor.
As far as cost was concerned, the survey found that some hospitals were managing to feed patients for less than pounds sterling 2 a head a day while others were spending up to pounds sterling 15.
The survey also looked at the nutritional content of hospital food. Patients' concerns included high fibre dinners being served when their doctor had told them to avoid fibre and lamb chops and chips being described on one menu as “low fat.” The report acknowledges the importance of nutrition in feeding long stay patients and those who arrive at hospital malnourished. But it says that such cases are addressed by doctors and dietitians rather than catering managers.