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British Medical Association launches first ever survey on assisted dying


The BMA is currently opposed to a change in the law on assisted dying, despite never having surveyed its members for their views on the issue. The Royal College of Physicians (RCP) dropped its longstanding opposition to assisted dying in favour of neutrality following a membership survey in 2019. The results of a recent poll by the Royal College of General Practitioners (RCGP) are due to be released later this month.

The BMA’s decision to survey its members for their views on assisted dying follows a debate at its Annual Representative Meeting in June 2019. Dr Jacky Davis, Chair of Healthcare Professionals for Assisted Dying, introduced the following motion, all parts of which were passed by the BMA’s Representative Body:

That this meeting notes the recent decision by the Royal College of Physicians to adopt a neutral position on assisted dying after surveying the views of its members, and:-

·         supports patient autonomy and good quality end of life care for all patients;

·         recognises that not all patient suffering can be alleviated;

·         calls on the BMA to carry out a poll of its members to ascertain their views on whether the BMA should adopt a neutral position with respect to a change in the law on assisted dying.

Dr Jacky Davis said:

“This survey is an important step for the BMA and means that members will be able to express their views on this historic issue. As demonstrated by the RCP poll last year, it is becoming clear that there is a wide spectrum of views in the medical profession towards supporting greater patient choice at the end of life, and the policy of medical organisations needs to reflect that. Politicians and patients want to know what doctors think on this issue and we need all views to be heard. Our patients have wanted this choice for decades and we should be pleased that doctors are prepared to engage in the debate.”

Sarah Wootton, Chief Executive of Dignity in Dying:

“This survey is a welcome move which shows maturity and pragmatism. For many years, the BMA’s opposition has been interpreted as most doctors being opposed to assisted dying, despite this claim never being tested against the views of its membership.

“With one Brit travelling to Switzerland for an assisted death every week, 300 terminally ill people ending their own lives in England every year, and many more suffering unbearably against their wishes, it is clear the current law is not working and this issue is not going away. It is vital that medical organisations provide an open and respectful platform for all views to be heard, but we must also ensure that the most important voices – terminally ill people and their loved ones – remain central to this debate.”



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A national ‘team science’ approach is needed to target the disease clusters of ageing


The ongoing investigation into healthy ageing by the House of Lords Science & Technology Committee has heard that targeting the diseases of ageing is the greatest future market and impact opportunity for the global medicines industry.

Targeting the disease clusters of ageing through cross-region ‘team science’ will stimulate global industry to tackle the multimorbidity challenge in the UK. With concerted national action now, the science we already have can be translated into better ageing and a better future for our bio-economy.

Multiple diseases are caused by similar underlying biology, but for historical reasons are recognised and treated differently by health providers and industry. As we age, these ‘disease clusters’, such as diabetes, cardiovascular disease and depression, cause us to be ever more medicated; initially, to treat a range of ‘single’ diseases, and then the side effects of our treatments. This approach is outdated, expensive and unscalable.

 If we are to age healthily, we must create a smaller set of medicines, targeted at the biological basis of tissue ageing. We can do this by working together, rather than using today’s jar of disease specific medicines designed – but rarely used – in isolation. Why has industry not focussed on this with vigour?

It is argued that ageing is not a recognised condition for which reimbursement or prescribing is valid; regulatory authorities ask for single disease indications and, clinical trials in ageing take years and have weak endpoints. This is no longer the case.

The UK has a global opportunity to pioneer future medicines for age related disease clusters. Using focussed national networks, it can harness regional innovation agencies across academia, Catapults, regulators and clinicians. They can work alongside its wealth of private bio-sector service providers to discover drugs that target the causes of ageing and prove their benefit in UK patients. This syndicated ‘team science’ is now possible and is advancing, with the power to radically change the way we approach medicines discovery. The Innovative Therapeutics for Ageing Consortium (iTAC) are regional leaders in public sector innovation and clinical study who have developed a ‘pharma-class’ drug discovery process to prove this approach works.

They are showing that industry quality R&D can be planned and executed across a portfolio of diseases and can use a national network of private UK skills and services. They can also leverage existing public sector investments in UK Biobank, Genomics England and NHS clinical research. As these resources are trained on the core biology of ageing and can access the funding they need, industry will be attracted to become co-developers and licensees of their products.

More importantly, they will take these medicines to market, for the benefit of us all. Multimorbidity is already a national challenge.

Medicines R&D takes 10 years or more, so work must start now on an arsenal of smarter medicines to tackle it head on. The UK can act now to ensure global industry sees the UK as the place that is already addressing these challenges, with the world-class assets they need, and the spill-over benefits to our bioeconomy.

 

To learn more about the Medicines Discovery Catapult’s work, click HERE.



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Mind responds to CQC’s annual Mental Health Act Report


Key findings include:
• The use of the Mental Health Act continues to rise, with 49,988 new detentions recorded for 2018/19.
• Black people were four times more likely to be detained under the Act than White people, and are more likely be given Community Treatment Orders
• Mental healthcare providers are failing to protect the human rights of some people who are sectioned

Responding to the report: 

Vicki Nash, Head of Policy and Campaigns at Mind, the mental health charity, says:

“This is indisputable evidence that our mental healthcare system is on its knees. It is disgraceful that people are dying because of a lack of beds, more people are being detained under the Mental Health Act than ever before and Black people are still four times more likely to be sectioned than White people. These deep injustices are among the multitude of reasons why mental health legislation needs a complete overhaul. 

“It is equivalent to negligence that there has been a fall in the number of mental health beds without an alternative in place. The expansion of community mental health services can’t come soon enough. In the meantime providers must do whatever it takes to ensure people get the right care at the right time. 

“It is unforgivable that people’s human rights are not being respected when they are detained. Too many people are being unnecessarily segregated and enduring unjustifiable restrictions on their freedom, even after they have left hospital. Complex overlaps in different parts of the law are also leaving families confused and lacking the right protections. We must see the limitations placed on people’s freedom being regularly reviewed and the UK Government has to address the mess of mental health legislation. 

“The urgency of reforming the Mental Health Act cannot be overstated. In recent weeks the Health Secretary has asserted that he is prioritising mental health and yet we are still waiting for the Government to formally respond to the Mental Health Act Review, with its delayed White Paper fast becoming a pipe dream. The measure of this country is how it treats us when we are at our most vulnerable. We expect our Government to meet that test. Further delay is simply not an option.”



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Health Secretary faces legal challenge for failing patients with disabilities and autism


The Equality and Human Rights Commission (EHRC) has launched a legal challenge against the Secretary of State for Health and Social Care over the repeated failure to move people with learning disabilities and autism into appropriate accommodation.

The EHRC has longstanding concerns about the rights of more than 2,000 people with learning disabilities and autism being detained in secure hospitals, often far away from home and for many years. These concerns increased significantly following the BBC’s exposure of the shocking violation of patients’ human rights at Whorlton Hall, where patients suffered horrific physical and psychological abuse.

The human rights body has now sent a pre-action letter to the Secretary of State for Health and Social Care, arguing that the Department of Health and Social Care has breached the European Convention of Human Rights (ECHR) for failing to meet the targets set in the Transforming Care program and Building the Right Support program. These targets included moving patients from inappropriate inpatient care to community-based settings, and reducing the reliance on inpatient care for people with learning disabilities and autism.

Following discussions with the DHSC and NHS England, the EHRC is also not satisfied that new deadlines set in the NHS Long Term Plan and Planning Guidance, will be met. This suggests a systemic failure to protect the right to a private and family life, and right to live free from inhuman or degrading treatment or punishment.

Rebecca Hilsenrath, Chief Executive of the Equality and Human Rights Commission, said: “We cannot afford to miss more deadlines. We cannot afford any more Winterbourne Views or Whorlton Halls. We cannot afford to risk further abuse being inflicted on even a single more person at the distressing and horrific levels we have seen. We need the DHSC to act now.

“These are people who deserve our support and compassion, not abuse and brutality.  Inhumane and degrading treatment in place of adequate healthcare cannot be the hallmark of our society. One scandal should have been one too many.”

The DHSC has 14 days to respond to the EHRC’s pre-action letter. Alternatively, the EHRC has offered to suspend the legal process for three months if DHSC agrees to produce a timetabled action plan detailing how it will address issues such as housing and workforce shortages at both national and regional levels. The EHRC is also calling for the immediate implementation of recommendations made by the Joint Committee on Human Rights and Rightful Lives 8 point plan.

Alongside its discussions with DHSC, CQC and NHS England, the EHRC has been calling for an enforceable right to independent living and has developed a legal model to incorporate it into domestic law. This would protect the right of disabled people to live independently and as part of the community, and it would also strengthen the law that put a presumption in favour of living in the community and the views of individuals at the heart of decision-making.



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RCEM: Emergency Departments struggling to admit the sickest patients


Commenting on the NHS performance statistics for January 2020, which show a record number of patients staying in Emergency Departments (EDs) for over 12 hours, President of the Royal College of Emergency Medicine, Dr Katherine Henderson said:

“While these figures show a slight improvement in terms of the number of patients being treated within four hours, our Emergency Departments are still struggling to admit the sickest patients to ward beds.

“The latest data shows a record number of patients staying in EDs for more than 12 hours. This must be tackled urgently; long stays put lives at risk.

“Change will take time, but we still need more staff, more beds and more social care. The Clinical Review of Standards must be an opportunity to produce measures that help drive patient flow and reduce crowding.

“Measures must also be transparent and paint a true picture; the 2,846 people who waited longer than 12 hours are just the tip of the iceberg as this figure is measured from the point a decision to admit has been made, rather than their arrival at the ED.”

Dr Henderson also urged patients to be mindful of what to do if they were worried about coronavirus: “While the risk posed by coronavirus remains relatively low, due to the considerable strain on our EDs we ask all patients who think they may have symptoms to call NHS 111 before doing anything else. NHS 111 will provide information on what to do and assess if you need to be seen urgently.”



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Hft welcome the reappointment of Matt Hancock as Secretary of State for Health


Billy Davis, Public Affairs and Policy Manager at Hft, commented: “We welcome Matt’s reappointment as Secretary of State for Health and Social Care. At a time when the sector is facing great uncertainty, continuity at the heart of government is very welcome.

“After years of government inaction, Matt will be aware of the need for proposals for reform to be brought forward as a matter of urgency. As our latest Sector Pulse Check report found, one in five social care providers in England have been forced to cut support in the last year and one in three are having to shed staff to remain financially viable.

“At a time when demand for social care is growing, this simply cannot continue. We look forward to working with Matt in delivering these much needed reforms, and delivering the sustainable future that providers, staff and the people they support, so richly deserve.”



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Two Labour MPs ditch public engagements after attending coronavirus scare bus summit


Nottingham South MP Lillian Greenwood and Leeds North West MP Alex Sobel both confirmed they were being formally tested for the condition after attending the UK Bus Summit earlier this month.

An attendee at the Westminster event later tested positive for coronavirus, the flu-like epidemic which has been designated as a public health risk by the World Health Organisation since it emerged in China’s Hubei province late last month.

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Mr Sobel’s statement read: “As has been reported, I attended the UK Bus Summit on the February 6, where there was an attendee who has tested positive for coronavirus.

“Whilst I have been informed that I am at very low risk, I have called 111 to be formally assessed.
“As a precaution, we have cancelled all engagements until next Thursday when the 14-day potential incubation period will end.

“If you think you may have been in contact with someone who has coronavirus, self-isolate and call 111 for an assessment.”

Ms Greenwood, who spoke at the summit earlier this month, meanwhile confirmed she was “cancelling my public engagements until 20th February” after receiving advice from Public Health England, which is leading the UK’s response to the virus.

While the Labour MP said she was feeling “completely well”, she shared a copy of the letter from PHE, which advises receipients to take “a precautionary approach”.

The health body said: “We are contacting you to inform you that a person with confirmed Novel Coronavirus (COVID-19) attended the UK Bus Summit at the QEII Centre London on 6th February 2020.

“One of our main priorities has been to identify any people who we think have been in close contact with confirmed cases of COVID-19 to provide public health advice, as they may be at slightly increased risk of catching the virus.”

It added: “While the degree of contact you may have had with the case at the summit is unlikely to have been significant, we are taking a precautionary approach and informing you.”

Nine patients in the UK have so far tested positive for the coronavirus. Public Health England is currently advising anyone who has travelled to the UK from mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau in the last 14 days who experiences flu-like symptoms to stay indoors and contact NHS 111.

The Government has already declared the virus an “imminent threat” to public health, and new powers allocated to ministers this week mean authorities can place new restrictions on any individual considered by health professionals to be at risk of spreading it.

Health Secretary Matt Hancock told the Commons on Tuesday: “Dealing with this disease is a marathon, not a sprint. The situation will get worse before it gets better. We will be guided by the science. Be in no doubt: we will do everything that is effective to tackle this virus and keep people safe.”

The virus was first identified in the Chinese city of Wuhan, capital of the Hubei province.



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The Royal Osteoporosis Society responds to the Government’s plan to scrap visas for low-skilled workers


Restricting the number of visas for overseas social care workers amid claims of the Government’s major immigration shake-up could lead to even more people not being able to remain independent and in their own homes following a fracture.

Alison Doyle, Head of Operations and Clinical Practice at The Royal Osteoporosis Society, says, “Limiting the number of low-skilled care workers who offer significant value to those who need the care will severely affect the ability of people who have recently suffered a fracture, often caused by osteoporosis, to stay in their own homes and live well.”

It is estimated that in the UK, there are more than 500,000 fragility fractures every year – that’s one every minute or 1,400 a day.

“The effect that a shortage of social care workers could have is further illustrated by the fact that just 22% of people with osteoporosis think the NHS gives the condition the attention it deserves, and one in three people in long-term pain from fractures describe it as severe or unbearable,” says Ms Doyle.

“In addition, figures show that one in three people who have fractured have difficulty with domestic chores, highlighting the importance of assistance received from social care workers even more.”

The Royal Osteoporosis Society calls on the government to reconsider its aim of ending visas for low-skilled workers as it will most certainly affect critical social care provision.

The Royal Osteoporosis Society is the only UK-wide charity dedicated to improving the prevention, diagnosis and treatment of osteoporosis. The charity works to raise awareness of and prevent osteoporosis by encouraging people to take positive steps to build their bone health.



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Baroness Finlay: We must utilise the skills of refugee doctors


This week’s news of 900,000 refugees fleeing war-torn Syria threw into focus the terrible plight of the innocent. Amongst many fleeing are health care workers, displaced and unable to practice at all, their experience wisdom and skills gradually dwindle in the cycle of despair that is the fate of so many. By contrast here in the UK, we bemoan our shortage of healthcare staff, yet efforts to support healthcare professionals coming here as refugees or asylum seekers seem paltry and uncoordinated. Often, they have fled with nothing – no papers to show they are qualified, no-one to vouch for them and no way to access their university records to prove their qualifications. Some of these are Christian or other minority religious groups, fleeing the double jeopardy of religious persecution as well as civil wars.

These healthcare professionals are desperate to work, desperate to support their families and above all desperate to live in peace and contribute to doing all they can for the most vulnerable humans they encounter.

These doctors, dentists, pharmacists, nurses, physiotherapists and related professionals are refugees from many countries, not only Syria. According to the UNHCR lists, there are currently 1,182 Iraqi doctors in camps in Jordan alone. Many have been trained in English; some have undertaken postgraduate training in the UK at some time before 2016. Yet they are not allowed to work in Jordan.

Proven good English language is essential to being registered in the UK to work as a healthcare professional. Some doctors pass the IELTS (International English Language Testing System), others take the newer Occupational English Language test. But sitting these exams costs money. And passing them is the first of many hurdles, including verification of their professional qualifications to obtain professional registration, developing familiarity with the application process, and securing a post in an approved practice setting with a designated body for revalidation of the professional registration.

Often, they have fled with nothing – with no papers to show they are qualified”

The General Medical Council supports refugee doctors by allowing them two free attempts at Professional and Linguistic Assessment Board (PLAB) part 1 knowledge exam and then two attempts at the part 2 exam at 50% of the normal fee, with a flexible approach to paying professional registration fees once registered. The GMC also fund the verification of primary medical qualifications through the US Educational Commission for Foreign Medical Graduates, a compulsory requirement for all doctors who have qualified outside the EEA. Other registration bodies should follow their example.

The British Medical Association has brought together UK volunteers who have organised small refugee support schemes. Wales, Scotland, Lincolnshire, the North West and the North East of England have been supporting refugee doctors into NHS employment. Nine years’ worth of data published from London’s multiagency collaboration (the Building Bridges Programme) showed high rates of success overall with professionals settling in their own or in related healthcare professional positions in the NHS.

The UK’s healthcare professionals’ regulatory bodies should follow the GMC’s example. A lead agency is needed to ensure that wherever in the UK a refugee health care professional finds him or herself, support is available.

We have a staffing crisis in the NHS. It will take years for our own new graduates to come through. It is unethical to drain doctors, nurses and others from countries whose staff shortages are worse than ours. But shouldn’t we let highly skilled refugees have a chance to contribute, rather than leave them forgotten, in camps?

 

Baroness Finlay of Llandaff’s Oral Question on the case for accepting refugee doctors to the UK is scheduled for Monday 24 February



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Baroness Finlay: We must utilise the skills of refugee doctors


This week’s news of 900,000 refugees fleeing war-torn Syria threw into focus the terrible plight of the innocent. Amongst many fleeing are health care workers, displaced and unable to practice at all, their experience wisdom and skills gradually dwindle in the cycle of despair that is the fate of so many. By contrast here in the UK, we bemoan our shortage of healthcare staff, yet efforts to support healthcare professionals coming here as refugees or asylum seekers seem paltry and uncoordinated. Often, they have fled with nothing – no papers to show they are qualified, no-one to vouch for them and no way to access their university records to prove their qualifications. Some of these are Christian or other minority religious groups, fleeing the double jeopardy of religious persecution as well as civil wars.

These healthcare professionals are desperate to work, desperate to support their families and above all desperate to live in peace and contribute to doing all they can for the most vulnerable humans they encounter.

These doctors, dentists, pharmacists, nurses, physiotherapists and related professionals are refugees from many countries, not only Syria. According to the UNHCR lists, there are currently 1,182 Iraqi doctors in camps in Jordan alone. Many have been trained in English; some have undertaken postgraduate training in the UK at some time before 2016. Yet they are not allowed to work in Jordan.

Proven good English language is essential to being registered in the UK to work as a healthcare professional. Some doctors pass the IELTS (International English Language Testing System), others take the newer Occupational English Language test. But sitting these exams costs money. And passing them is the first of many hurdles, including verification of their professional qualifications to obtain professional registration, developing familiarity with the application process, and securing a post in an approved practice setting with a designated body for revalidation of the professional registration.

Often, they have fled with nothing – with no papers to show they are qualified”

The General Medical Council supports refugee doctors by allowing them two free attempts at Professional and Linguistic Assessment Board (PLAB) part 1 knowledge exam and then two attempts at the part 2 exam at 50% of the normal fee, with a flexible approach to paying professional registration fees once registered. The GMC also fund the verification of primary medical qualifications through the US Educational Commission for Foreign Medical Graduates, a compulsory requirement for all doctors who have qualified outside the EEA. Other registration bodies should follow their example.

The British Medical Association has brought together UK volunteers who have organised small refugee support schemes. Wales, Scotland, Lincolnshire, the North West and the North East of England have been supporting refugee doctors into NHS employment. Nine years’ worth of data published from London’s multiagency collaboration (the Building Bridges Programme) showed high rates of success overall with professionals settling in their own or in related healthcare professional positions in the NHS.

The UK’s healthcare professionals’ regulatory bodies should follow the GMC’s example. A lead agency is needed to ensure that wherever in the UK a refugee health care professional finds him or herself, support is available.

We have a staffing crisis in the NHS. It will take years for our own new graduates to come through. It is unethical to drain doctors, nurses and others from countries whose staff shortages are worse than ours. But shouldn’t we let highly skilled refugees have a chance to contribute, rather than leave them forgotten, in camps?

 

Baroness Finlay of Llandaff’s Oral Question on the case for accepting refugee doctors to the UK is scheduled for Monday 24 February



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