A friend of mine suffers from bouts of anterior uveitis, a painful condition of the eye. She was on holiday in America recently when it flared up, and she saw a local ophthalmologist. On finding out my friend was from the UK the ophthalmologist exclaimed, “Well, you know that the world’s foremost expert on uveitis works in the UK? He is a professor of the anterior chamber of the eye. I was never ambitious enough to do all that. Me, I’m happy running my own clinic!”
During an evening locum A&E shift recently, I referred a child for an orthopaedic opinion. An FY2 doctor discharged her home, after discussion with his registrar. The child was subsequently recalled to hospital the following morning following the morning consultant review of overnight X-rays, and underwent urgent surgery a few hours later.
I tell this story not to point fingers at the on-call orthopaedic team, who acted to the best of their considerable ability, but it brought to mind the thorny issue of senior clinical decision-making “out-of-hours.”
The education and training aspect of the Health and Social Care Bill has, to some extent, been overshadowed by the much more headline-friendly changes in commissioning, the management cull and the debate surrounding competition. If you ask trainees, their overwhelming concern is the conflict of interest that will arise when training and service budgets are held by the same NHS trusts. Losing deaneries means that there will be no regional bodies to hold trusts to account when, as looks inevitable in the economic climate, training budgets gradually get chipped away by service demands.
The FDA (US Food and Drug Administration) decided to withdraw approval for Avastin as a treatment for advanced breast cancer recently. They heard evidence from individual women whose lives had been prolonged by Avastin. However, they were unswayed, pointing to the $88,000 per year cost. It is yet another example of the longstanding debate about value judgements in healthcare and the role of advocacy.