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Ethicon Media Monitoring 10/26/2018
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'Systematic' failings in mesh implants review
Oct 26, 2018 | BBC News
By Lucy Adams
A Scottish government-commissioned report into the review on mesh implants has found it suffered "systemic" failings and potential conflicts of interest. -
100,000 NHS breaches deserve 'Barlinnie', Sturgeon told
Oct 25, 2018 | HeraldScotland
By Tom Gordon
Nicola Sturgeon has admitted the legal treatment time guarantee she introduced as health secretary six years ago has now been broken more than 100,000 times. -
Matt Hancock: “We are going to make it a joy to work in the NHS”
Oct 25, 2018 | Politics Home
By Sebastian Whale
...Hancock points to the example of vaginal mesh, which was prescribed as a treatment for mild incontinence and has been linked with life-changing side effects for many women.
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'Systematic' failings in mesh implants review
Oct 26, 2018 | BBC News
By Lucy Adams
A Scottish government-commissioned report into the review on mesh implants has found it suffered "systemic" failings and potential conflicts of interest.
Prof Alison Britton has spent more than a year investigating the mesh inquiry.
She was also looking at how similar reviews should be handled in future.
Her report, seen by the BBC, says the original mesh review was "ill-conceived, thoughtlessly structured and poorly executed".
The Scottish government said it would now consider her findings.Review 'whitewash'
The original mesh review was commissioned four years ago by former health secretary Alex Neil, after dozens of women spoke in the Scottish Parliament about how transvaginal mesh implants - used mainly to treat incontinence - had ruined their lives and left them in chronic pain.
The review was expected to take six to 12 months. Ultimately it lasted almost three years and, just weeks before it was published in May last year, three members resigned and branded it a whitewash after key warnings about safety were moved to the appendices.
As a result Shona Robison, then health secretary, announced there would be an investigative review to look into how the mesh review reached its conclusions.
Prof Britton, of Glasgow Caledonian University, was tasked with carrying out that review.
She told the BBC that the perception of independence was critical to maintaining public confidence. She found a "major failing" and omission within the review was that potential conflicts of interest were not declared or even discussed.
She found some members had been paid by the pharmaceutical industry, some were suing and some were being sued.
She said the majority of members ultimately expressed strong "negative" reactions towards their involvement in the review. Some even felt traumatised.Impartiality test
The report also looked at how such inquiries should be handled in future. It makes 46 recommendations including the creation of a bespoke "dedicated" unit to support reviews, their chairpersons and members to try to avoid similar failings.
Prof Britton says that although some see such inquiries as a cynical ploy, they are clearly here to stay.
She was surprised to find that the Scottish government did not have data on how many inquiries had been held in the past few years. She says there seem to be no established procedures for such inquiries and that guidance is piecemeal.
She recommends a new "test of impartiality" - with prior involvement and interests put out in the open.
Prof Britton said the remit, budget and perceived independence of future inquiries needed to be clear right from the start of future inquiries.
In a brief statement issued on Thursday, a Scottish government spokesman said: "We received Prof Britton's Investigative Review into the Process of Establishing, Managing and Supporting Independent Reviews this morning.
"The Scottish government will publish this report tomorrow (Friday) and will give full consideration to the findings in due course."
Last month, Health Secretary Jean Freeman ordered health boards to "immediately" halt the use of transvaginal mesh implants in surgery.
The controversial implants were listed as an underlying cause of death of a woman in August, sparking calls for an inquiry and an outright ban.
Ms Freeman said NHS boards had been told to stop using mesh in cases of pelvic organ prolapse and stress urinary incontinence.
This will continue until a new "restricted use protocol" is drawn up.Cause of death
There were calls for a fresh review of protocols in Scotland after it was revealed that mesh was listed as an underlying cause of death in the case of Eileen Baxter, of Loanhead.
The 75-year-old died in hospital in Edinburgh in August. While multiple organ failure was cited as the primary cause on her death certificate, "sacrocolpopexy mesh repair" was named as an underlying factor.
This is actually a different procedure to the ones now effectively banned, but it still led to calls for action at Holyrood, with First Minister Nicola Sturgeon saying she would "give careful consideration" to a review of the use of mesh.
Mesh implants are used by surgeons to treat conditions which some women suffer after childbirth, with the synthetic substance used to repair damaged or weakened tissue. More than 100,000 women across the UK have been given them over the past 20 years.
The use of mesh in Scotland was suspended in all but "exceptional circumstances" in 2014 after it emerged some women had suffered painful side effects - but the procedure has still been used hundreds of times since.
NHS England has also recently curbed the use of mesh on safety grounds, although it is still available as a treatment of last resort for some.
https://www.bbc.com/news/uk-scotland-45982333
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100,000 NHS breaches deserve 'Barlinnie', Sturgeon told
Oct 25, 2018 | HeraldScotland
By Tom Gordon
Nicola Sturgeon has admitted the legal treatment time guarantee she introduced as health secretary six years ago has now been broken more than 100,000 times.
However the First Minister defended it, saying it had also been met 1.6m times and the SNP Government was now investing heavily and taking steps to improve performance.
LibDem leader Willie Rennie told MSPs that if anyone else had broken the law that often they would be “in Barlinnie”, yet ministers expected the breaches to continue for years.
The sharp exchange at First Minister’s Questions followed the publication of two controversial reports on the NHS this week.
On Tuesday, Health Secretary Jeane Freeman’s Waiting Times Improvement Plan confirmed key targets would continue to be missed until 2021, including Ms Sturgeon’s 2012 guarantee that patients would be treated for inpatient or day surgery within 12 weeks.
Between April and June this year, less than three quarters of patients were treated on time.
On Thursday, the Auditor General’s report on NHS Scotland in 2017/18 also said it was “not financially sustainable in its current form” and performance was on the slide.
At FMQs, Mr Rennie said: “The law states that patients will be guaranteed NHS treatment within 12 weeks. This is the First Minister’s law, from when she was health secretary.
“It was an SNP flagship law that helped them take power in 2007... a law the government has broken over 100,000 times. But on Tuesday the government said they would keep on breaking the law for another three years.”
“If a member of the public was to break the law this many times, they would serve time in Barlinnie. Why is it when the SNP breaks the law they think they can get away Scot free?”
Ms Sturgeon replied: “It is true that the 12-week treatment time guarantee has not been adhered to more than 100,000 times, but 1.6m patients have been treated within the time.
“There are now fewer people waiting more than 12 weeks for treatment than was the case when the SNP Government came into office.”
“I do not shy away from the challenges that our health service - in common with health services across the United Kingdom and further afield - faces. We have put in place plans around both investment and reform to ensure that we meet the targets and that the quality of care is what patients expect.”
Ms Sturgeon also repeated an apology, first given last year, to women who had suffered as a result of transvaginal mesh implants.
With mesh campaigner Elaine Holmes in the public gallery, acting Scottish Tory leader Jackson Carlaw said the implants were “the greatest self-inflicted health scandal since the Thalidomide scandal in the 1960s”.
Ms Sturgeon said: “For the avoidance of any doubt and without any equivocation, I say today on behalf of the Scottish Government that I apologise unreservedly to any woman who has suffered because of mesh procedures.”
She said ministers would look at extending the blue badge scheme to mesh sufferers, and confirmed a report into a previous ‘whitewash’ review of mesh would be published soon.
Scottish Labour leader Richard Leonard said the Auditor General’s report was a “damning indictment” of SNP mismanagement.
He claimed £1.1bn had been cut from the NHS in ‘efficiency savings’ since Ms Sturgeon became First Minister almost four years ago.
He said there were “too many staff under too much pressure, too many patients waiting far too long and too many health boards having to make swingeing cuts”.
For the Auditor General to conclude the NHS was not financially sustainable after 11 years of the SNP in power was “nothing less than an abject failure of government”, he said.
Ms Sturgeon said the report did not include recent medium-term plans to raise the health budget by £3.3bn by 2023, equivalent to real terms annual growth of 2.9%.
She rejected the £1.1bn cuts figure, saying the Auditor’s report noted real terms growth in the health budget of 7.7% over the past decade.
She said: “The Fraser of Allander Institute predicts the health resource budget is likely to have to increase by around 2% per year to stand still.
“We are providing resources over and above that, and I think that significantly changes the comment about financial sustainability.”
https://www.heraldscotland.com/news/17008153.100000-nhs-breaches-deserve-barlinnie-sturgeon-told/
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Matt Hancock: “We are going to make it a joy to work in the NHS”
Oct 25, 2018 | Politics Home
By Sebastian Whale
Matt Hancock was once the proud owner of a world record. In 2005, he was on a two-man expedition to the Arctic with the additional ambition (and one that secured the requisite sponsorship) of playing the most northerly game of cricket in history.
The trip was drawing to a premature close after he exposed his hands to the elements while trying to restore their ripped tent back to some semblance of use. With the rescue team mobilised, Hancock realised he didn’t have long to achieve his goal. He used ski-poles for stumps and paced out a wicket. With four of his fingers frozen solid after the previous night’s sub-40 temperatures, he was relieved to bowl his companion out for a duck.
But Hancock’s legacy – which came at the price of mild arthritis in one joint – was unceremoniously shattered by former Conservative MP Dan Byles, himself a world record holder. “You used to have a world record too,” he told Hancock. What do you mean, used to? he responded. “My mum beat it,” Byles continued.
An apparently dejected Hancock explains: “His mum had been on an icebreaker and gone on a trip to the actual North Pole. She met an icebreaker from the Indian navy at the North Pole and they got off their boats and played the most northerly game of cricket.
“That’s how I found out about it – ‘my mum broke your world record’.”
Hancock hurls me the red cricket ball that travelled with him on his trip to the Arctic. Like his dream, the inscriptions are now slightly faded. Though that coveted record has gone, he could well stake a claim to being the most energetic and enthusiastic Cabinet minister in the history of Whitehall.
He has become known for throwing himself into every situation with a self-assuredness unfathomable to those of an introverted disposition ever since becoming an MP for West Suffolk in 2010. From full-throated efforts during karaoke at Tory conferences to leaping over walls while trying out parkour as Culture Secretary, he has garnered a reputation as someone who fully commits to the task at hand.
But a move to the Department of Health could have posed a daunting endeavour. Those in charge are, often by dint of the decisions they carry out, notoriously unpopular – his predecessor being the most immediate example. Perhaps it is no surprise that Hancock wasn’t overcome with nerves about the switch.
“Lots of people have asked me whether I’ve found it daunting. The answer is that it’s a huge challenge but I’m very excited about it,” he says. Jeremy Hunt secured an extra £20bn a year for the NHS by 2023 before moving to the Foreign Office – and now Hancock’s job is to develop the plan on how to spend it (while Philip Hammond works out how to fund it).
Hancock has identified three areas of concern: workforce, tech and prevention. In his plush office in London’s Victoria, the Oxford PPE graduate (who went on to do an economics masters at Cambridge) walks me through his plans.
He has spoken of “old school management” in the NHS, where incidents of bullying and harassment are “too frequent”. “Working in the NHS should be an amazing experience. It’s a huge team effort to try to help the nation to be as healthy as possible. The vast majority of people in the NHS are driven by that mission. So, I don’t want it held back by a tiny minority who think that it’s okay to behave unreasonably, and I’m going to call it out,” he says.
Is this behaviour having a material effect on retention? “I want to see the overall morale of the workforce rise, and tackling bullying and harassment is part of the answer to that. Of course, there’s lots more to improving the morale of the NHS workforce. But that’s part of it.”
As he gazes off into the distance contemplatively, a half-eaten apple slowly oxidising in his left hand, Hancock seems invigorated by the challenge of improving the lives of NHS workers.
“We are going to make it a joy to work in the NHS,” he says, drawing eye contact. “Rather than people feeling mission driven by their job despite the system, I want them to feel the system is supporting them.”
In real terms, he would like to see leaders at a local level in the NHS instil a “collaborative, non-hierarchical structure where everyone works together”. He is in conversation with the British Medical Association about what can be changed at a national level to how clinicians work and are given professional development. He also sights “contractual issues” that need to be addressed and wants to promote greater use of e-rostering to reduce agency staff spending and bolster flexibility for NHS workers.
A change of culture is also in his sights. In an interview with The House in June, Health minister Jackie Doyle-Price said that women often feel “patronised” and “diminished” by doctors and, as a result, are forced to “suffer in silence”.
Hancock points to the example of vaginal mesh, which was prescribed as a treatment for mild incontinence and has been linked with life-changing side effects for many women. A leading consultant who fought against the use of mesh, he continues, told some “extraordinary stories” about how her efforts were “belittled”. “So, right across the board there’s a culture change that’s needed to be open-minded to everything,” he adds.
Hancock’s second target area is around prevention. The public health agenda does ostensibly seem anathema to Conservative ideals – it is based around the government intervening in matters of life choices. But it is one the party has embraced in recent years, with two iterations of a childhood obesity plan as evidence. Hancock says the government can now be “much more targeted” with its campaigns, such as encouraging pregnant women to stop smoking. “So, you don’t necessarily have to have blanket policies,” he adds.
Hancock took part in a jog with pupils from a primary school in London as part of a new ‘active mile’ scheme. Is he still doing his daily run? “I try to do a mile,” he replies with some ambiguity. Does he get his five a day? Turning his head to what’s left of his apple, he lets out a laugh. “I’m definitely five a day.”
The challenge with health policy is that increasing life expectancy could then put pressures on to other areas such as social care (which Hancock announced £240m earlier this month to stave off yet another winter crisis. The government’s green paper is expected before the end of the year).
But Hancock argues that keeping open community hospitals to alleviate pressure from acute services – which is “where the majority of costs go now” – and taking a lead on public health, saves money overall.
“Life expectancy increasing does shift the burden of disease from some of the acute killers of late middle age if you like – stroke, heart disease, cancer, which have been falling rapidly over the last generation – onto the diseases of old age like dementia and Alzheimer’s. But that’s a good thing – that’s because people have survived longer to the point where you’re more likely to suffer from dementia.
“We need to treat those diseases too and they’re treated in different ways. But overall, preventing ill-health saves money. That’s one of the reasons it’s a big focus of mine.”
He adds: “You want people only to go to use their GP or hospital when they need to, but on the other hand, when they do need to, we need them to go. It’s part of the prevention agenda because they can pick up problems earlier if you get it right.
“We have one of the best systems for treating cancer once it’s discovered in the UK. But, our cancer survival rates aren’t nearly as good as comparative countries because we don’t pick it up early enough. So, the system doesn’t spot the signs and individuals don’t present with the very early signs, you need to have the primary care and community care out there in the community preventing these problems getting worse.”
Hancock, familiar with the topic from his days in DCMS, has taken a tough stance on social media companies as he seeks to cut down on mental ill health among children and young people. What is behind the recent rise? “It’s a combination of prevalence and being more willing to talk about it. I definitely think social media has got a part to play. If you look at the figures, there’s an increase in self-harm amongst teenage girls but not amongst teenage boys. And that implies that something happened in the last decade to increase the pressure on teenage girls,” he replies.
“Now, thankfully that hasn’t yet been reflected in a material change in suicide rates, which is the ultimate failure of somebody’s mental health – suicide rates are currently at a seven-year low. But that implies that there is a problem in terms of the pressures being put on teenage girls and the consequences for their mental health.”
Hancock, who has young children, does not allow them to use social media (phones are allowed as “sometimes you do need to talk to them”). In early October, he asked the Chief Medical Officer, Dame Sally Davies, to draw up guidelines on social media use by children.
“The terms and conditions of the main social media sites are that you shouldn’t use it under the age of 13, but the companies do absolutely nothing to enforce against that. And they should, I think that should be a requirement,” he says.
“You shouldn’t be on WhatsApp, according to their own terms and conditions, before you’re 16. And yet, the pressures that people feel under when they’re on a WhatsApp group to wake up in the middle of the night to get back to messages – this is teenagers or young kids who aren’t even teenagers yet.
“So, if the company say that you shouldn’t be on it till 16, they should do something about that and they should empower parents to allow it to happen.”
Is the general rise in reported mental health problems due to an increased willingness to talk or because of challenges unique to today?
“It’s a combination of the two. My reading of the evidence is that it’s undoubtedly easier to talk about mental health issues than it was a generation ago. That is unambiguously a good thing,” he says, praising MPs such as Charles Walker who have spoken publicly of their own experiences.
“There are also signs of an increased prevalence of mental illness that needs to be addressed and there’s certainly more pressures,” he continues, once more referencing social media.
“And in a way, society as a whole – and work in particular – has moved from relying on your brawn and physical capability a generation or two ago to relying on your straight-line, cognitive thinking maybe a few years ago, to increasingly relying on your emotional intelligence.
“The health system needs to make the same journey from focussing on the nuts and bolts of people’s bodies to concentrating increasingly on ensuring the whole person’s physical and mental health is supported.”
He adds: “The best doctors have always understood all of that. The training increasingly includes the human and emotional side. For instance, doctors are actively trained now how to impart difficult messages to patients. But the overall system needs to clearly move in that direction.”
Hancock looks taken aback as I ask, is politics good for your mental health?
“Politics is a highly stressed occupation, but it’s also one where you have a sense of mission and a sense of duty and is very gregarious. Those three things are definitely good for your mental health, but some of the stresses and strains are a challenge,” he says after mulling it over.
His final strand is on tech and one in which Hancock (who has an app named after himself for his constituents) has carved out his niche in recent years. Was he surprised by the standards and use of technology in the NHS? “No, I knew that it left a lot to be desired,” he says laughing. “Having driven tech transformation across other parts of government, it’s something that I can bring to the table.”
He believes that patients’ health can be improved through developments in genomics and artificial intelligence. More refined IT systems could make life easier for clinicians and patients, he continues, to allow greater flexibility in booking appointments and managing them, as well as overseeing ongoing health conditions.
“So, all the way from the basic logistical improvements that will cut waste, through to using cutting-edge technology to treat cancers and rare diseases, there are massive opportunities,” he says.
The issue of most immediate concern to some in the health service is Brexit. What can Hancock say to assuage the majority of medical professionals who, according to a recent YouGov poll, think the NHS will deteriorate after leaving the EU?
“I don’t think it needs to be detrimental to the NHS. Of course, we’ve got to prepare for a no deal scenario, but I don’t think that’s the most likely outcome. We’ve got to make sure that we continue to attract the brightest and best from around the world. Other than that, there’s no reason that Brexit shouldn’t be anything other than a positive experience for the whole country, so long as we ensure that we are future-focused, outward-looking and international,” he says.
It is not only on Brexit where Hancock’s views differ from his former boss, George Osborne (he served as Osborne’s chief of staff from 2005 after working at the Bank of England. Both voted Remain, but Osborne has taken a tougher pro-EU line). He has called for calm throughout the tumult of the past 18 months and pledged loyalty to Theresa May. What is his message to his warring party?
“Everyone should get behind the Prime Minister, who’s in the best position to deliver a good Brexit for the country. And we should be united in serving the country that we love and ensuring that biggest catastrophe that could befall the politics of this country is avoided and Jeremy Corbyn is always kept out of power,” he says.
Over the weekend, some of Hancock’s colleagues give incendiary briefings to the Sunday newspapers about the Prime Minister. “People in public life have got to be very careful with their language. Being an MP, being in public life is a great privilege. But it comes with responsibilities. We’ve got to remember the people who we serve in all this,” he says. “My attitude is to be a forward-facing, future-facing Conservative who wants to solve problems for my constituents. And it’s frustrating when the mass focus, and the language of politics, is all focussed around one subject and can be quite negative.”
The mother of a former Conservative colleague erased Hancock’s name from the world record books. But what would he like his legacy to be at the Department of Health?
“I’d like a better relationship between the system and the workforce who comprise the service. I’d like better prevention and, crucially, link up to the local authority-provided services including social care and public health. And I’d like the NHS to use the best available technology and be one of the most technologically advanced in the world,” he says.
“I picked three priorities because if you have more than that, you end up having none at all.”
https://www.politicshome.com/news/uk/health-and-care/nhs/house/house-magazine/99336/matt-hancock-%E2%80%9Cwe-are-going-make-it-joy-work
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