Seven days in medicine: 3-9 January 2018BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k108 (Published 11 January 2018) Cite this as: BMJ 2018;360:k108
Hunt expands role to include social care
England’s health secretary, Jeremy Hunt, was retained in his post and given a new job title as the prime minister, Theresa May, appointed him as the secretary of state for health and social care in her cabinet reshuffle. Hunt will continue in the post he has held since succeeding Andrew Lansley in September 2012. Posting on Twitter, Sarah Wollaston, chair of the Commons health select committee, wrote, “Really encouraging to see both health and care together . . . now we need the long term planning and sustainable funding for the scale of increased demand and costs.”
Regulator will rate GP online services
The Care Quality Commission will rate services that offer medical advice and prescriptions from GPs online in the way that it rates other healthcare services—as outstanding, good, requires improvement, or inadequate—the Department of Health confirmed. England has 30 such providers currently registered with the CQC. These have been inspected, and a report on the quality and safety of online and digital healthcare is due to be published early this year.
Royal commission would examine NHS structure and funding
A royal commission on the NHS’s future should have the power to coerce witnesses to testify under oath, the Centre of Policy Studies said.123 The centre’s report, by Maurice Saatchi and Dominic Nutt, said that a commission would examine the health service’s structure, organisation, and funding—looking at such issues as the ageing population, the connection between health and social care, medical price inflation, the gap in outcomes between rich and poor people, the case for and against greater private sector involvement, potential additional funding sources, and use of patient data. Saatchi called for a royal commission last February to safeguard the NHS’s future.
Call for mandatory vaccination of NHS staff
Bruce Keogh, medical director of NHS England, proposed mandatory flu jabs for doctors and other NHS staff. A third of people with the flu virus do not know that they are carrying it, he said, and NHS staff may be putting patients, colleagues, and their own families at risk. Keogh added, “This past week’s flu figures underline why it makes sense for NHS staff who haven’t yet had the flu jab now to do so. A proper discussion for next year about mandatory jabs for doctors, nurses, and other frontline NHS staff would be sensible.” By November 2017, 59% of eligible NHS staff had received the flu vaccine.
Emergency doctors’ “disappointment” over panel exclusion
Doctors expressed surprise that NHS England’s winter pressures panel did not include representatives from the Royal College of Emergency Medicine. The panel first met on 20 December and included eight people, representing various NHS bodies and several royal colleges. The RCEM said, “We were disappointed not to be invited to be part of the National Emergency Pressures Panel, especially as many of the pressures in our emergency care systems mainly affect our members and the remarkable work they do to help maintain safety alongside nursing staff in the emergency department.” (Full story doi:10.1136/bmj.k82)
NHS hospital bans all sugary snacks
Tameside Hospital in Greater Manchester became the first NHS hospital to ban all sugary snacks from its canteen and vending machines to encourage healthy eating among its staff. The ban includes fizzy drinks, chocolates, sweets, and biscuits and will gradually be expanded to desserts and other junk food. The trust admitted that the decision had received a mixed reaction from staff but said that they should set an example to patients by eating more healthily.
Preservation techniques “should be used more widely”
Every year a few thousand women and prepubescent girls undergo medical treatment that destroys or substantially reduces their chances of having children, but only a few hundred are offered techniques to preserve their fertility, said Melanie Davies, a consultant obstetrician and gynaecologist at University College London Hospitals, at the launch of new British Fertility Society guidelines. Women undergoing cancer treatment, stem cell transplantation for sickle cell disease, or hormone therapy or surgery for gender dysphoria—or those with genetic conditions such as fragile X premutation or Turner syndrome—could all merit consideration for fertility preservation, say the guidelines. (Full story doi:10.1136/bmj.k12)
Include weekly limits on alcohol labels, says public
Only 16% of people in the UK (320 of 2000 surveyed) are aware of the weekly alcohol guidelines two years after they were announced, the Alcohol Health Alliance found. Adults are advised to drink no more than 14 units a week, while children should not try alcohol until age 15. But six in 10 people agreed that children who drink at home will “know how to handle their drink when they’re older” and that children who drink in moderation at home “are less likely to binge on their own.” Eight in 10 people wanted alcohol labels to include the weekly guidelines and a warning about the health effects of excessive drinking.
Starting long acting bronchodilators raised cardiovascular risk
Initiating treatment of chronic obstructive pulmonary disease (COPD) with a long acting β2 agonist or a long acting antimuscarinic antagonist was associated with a 50% higher risk of serious cardiovascular events in the first 30 days, including in patients with no previous cardiovascular disease, in a large case-control study from Taiwan reported in JAMA Internal Medicine. The authors recommend watching patients closely in this period. (Full story doi:10.1136/bmj.k11)
WHO prequalifies new vaccine for wide use
The first typhoid conjugate vaccine (Typbar-TCV, from Bharat Biotech) was prequalified by the World Health Organization, meaning that it can be procured by UN agencies, such as Unicef, and Gavi. TCVs are innovative products that have longer lasting immunity than older vaccines and require fewer doses. In October 2017 the Strategic Advisory Group of Experts on immunisation, which advises WHO, recommended TCV for routine use in children aged over 6 months in countries where typhoid is endemic, with prioritisation in areas with the highest burden of disease or antibiotic resistance to Salmonella Typhi, the bacterium that causes the disease.
Don’t use age test, says German doctors’ leader
Frank Ulrich Montgomery, president of the German Medical Association, condemned support for mandatory medical tests on refugees, as several politicians endorsed mandatory age tests after the death from stabbing of a 15 year old German girl by a male refugee at the end of December. Montgomery said that mandatory age tests are “complex, expensive, and burdened with huge uncertainty.” X raying bones in all young refugees “would be an invasion of their personal wellbeing,” he said, while use of x rays without medical indication would be “an intrusion of physical integrity.” He noted, however, that radiation protection guidelines do permit x ray examinations in the context of criminal court cases.