Reaction to the public accounts committee warning that drug manufacturers are only publishing half of completed trial results, plus the rest of the day’s news and comment.

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4:40pm Another story which has provoked strong reader comments is our lead story today on Bournemouth and Poole agreeing not to merge for a decade as part of the Competition Commission’s procedures. Here’s two of the responses:

“What an incredibly short-sighted thing to do! No change in ten years? This is the NHS, it will have been completely restructured at least twice in that period. The sooner somebody wakes up in government and realises that you can’t have an NHS which is required to make massive cost reductions at the same time as raising quality standards (and please don’t start talking about waste, Dr Fox) without restructuring or consolidating its product portfolio, the better. Complete lunacy from beginning to end.”


“What an astoundingly stupid outcome. Isn’t it time that somebody put the Competition Commission back in its box, or gave it a clue about healthcare, and the annoying fact that quality is not primarily driven by inter-provider competition?”

2:50pm Mark Newbold’s comment piece for HSJ yesterday on whole system transformation has attracted a lot of comment, much of it agreeing with the thrust of the Heart of England chief executive’s argument that the pressure on A&E services can only be alleviated by improving care in out of hospital environments. Here’s a selection of HSJ reader comments:

“… my question to secondary care is: given that you are overloaded and stressed - and so need extra support - if the total local health economy budget is effectively falling, year on year, where do you think the funding for increased/improved/better planned care out of hospital should come from?”


Mark Newbold, in response to the comment above: “We do need extra support, but the most effective way to do this would be to invest in more community capacity - alternatives to admission, home care provision to support the frail elderly through a short period of acute illness, intermediate care capacity to facilitate early discharge, and so on.

“On funding, well around half of the total NHS budget is spent in the acute sector so a good proportion will clearly have to be redistributed from there. We should learn the lessons of history though, and set up the alternative services first. If we don’t, we will simply precipitate an acute sector crisis.”


“It has been widely recognised for years that the answer to the problem is to move the activity out of acutes but no-one is brave enough to redistribute the funding allocation and as most FTs are acutes, it is like turkeys voting for Christmas, as it will affect their bottom line and viability if funding is taken off them and redistributed to other non-acute providers. Also staff working in CCGs are not experienced enough to manage what would be a major overhaul of provision, so it will be interesting to do a ‘year end reflection’ in December to see what has actually changed…”


“We also need to better inform patients and the public what care options are available to them and which to use - or not use - for which ailments. Commissioners - and ALL providers - need to embrace the concept of ‘information as service in its own right’ and commission/provide information to support patients, carers and the public to make truly informed decisions. It’s much talked about but rarely is regional, nor local resource dedicated to it.”

2:06pm The Association of the British Pharmaceutical Industry - the body representing UK pharmaceutical companies - has released a statement in response to the findings of the Commons public accounts committee featured on HSJ Live earlier today.

Bina Rawal, Research, Medical and Innovation Director at the ABPI said:

“The ABPI is a strong advocate for transparency in clinical trial data and the role it plays in improving patient care. It is misleading to suggest that thepharmaceutical industry routinely withholds clinical trial data from doctors and researchers.

“In late 2013, an ABPI commissioned study was published in a peer reviewed journal. This study highlighted a positive trend of increasing levels of disclosure for industry-sponsored clinical trials, with almost nine out of ten of all industry sponsored clinical trials disclosed by 31 January 2013.

“However we recognise that there is still work to be done and we are continuing on a journey to achieving greater clinical trial transparency. The ABPI has made available a new clinical trial disclosure toolkit to assist companies and will continue to engage with key stakeholders on this issue. ”

1:48pm The BBC reports that developing world obesity has quadrupled since 1980, according to a UK think tank.

The Overseas Development Institute said one in three people worldwide was now overweight, with the percentage of adults in this category - classed as having a body mass index greater than 25 - growing from 23 per cent to 34 per cent between 1980 and 2008.

The majority of this increase was seen in the developing world, particularly in countries where incomes were rising, such as Egypt and Mexico. The obesity increase has been attributed to changing diets - a shift from eating cereals and grains to the consumption of more fats, sugar, oils and animal produce - and larger disposable incomes.

1:10pm We’ve updated our story from yesterday on the new year’s honours list. For a full list of those given honours for their services to healthcare, the NHS, medicine or nursing click here.

12:51pm The chief executive of a troubled Berkshire trust has resigned.

Royal Berkshire Hospital chief executive Ed Donald leaves the organisation after four years at the helm. The trust is currently being investigated by Monitor after the regulator said it was concerned that underperformance against the A&E target might be symptomatic of wider governance concerns.

Mr Donald survived an attempt by the trust’s former chair Colin Maclean and non executive directors to oust him two years ago. He went on “indefinite leave” in late 2011, but returned in early 2012 after winning the backing of the trust’s consultants and other local clinicians. Mr Maclean then left the trust.

12:12pm The Independent has a powerful piece from a midwife on why they are retiring after ten years in the NHS.

The anonymous midwife talks about the pressure the profession is under from staff shortages, frozen pay, and the challenge of caring for mothers with additional needs who might not have been able to conceive in the past. The author writes:

“I cannot care for each woman individually when I have so many under my care. I find it nearly impossible to give safe, high-quality care to women and their babies when I have so many others to care for. I cannot always be compassionate and kind when I am hungry and tired from not being relieved by another member of staff. This is personally devastating, as it is caring for women, giving safe and high-quality care and being compassionate that first inspired me to be a midwife.”

11:53am Also in the Mail, the paper reports that a study in Denmark has found that mothers-to-be who drank small quantities of alcohol during pregnancy went on to have better emotionally and behaviourally adjusted children than those who abstained from alcohol completely.

The Department of Health has advised that alcohol should be avoided altogether during pregnancy since 2007.

11:31am The Daily Mail reports that NHS England has sent warning notices to a number of GPs surgeries suspected of closing early without permission during the festive period.

NHS England rang round 238 surgeries in London on Christmas Eve between 3:30pm and 6:30pm and found five per cent were already closed.

10:57am The Daily Telegraph has a story that patients who suffer from shingles have an increased likelihood of experiencing a stroke or heart attack later in life, according to research.

The study was published in the journal Neurology, and also found that the link appears to be especially strong in people who had shingles between the ages of 18 and 40.

10:47am In The Times, NHS Alliance Chairman Michael Dixon has written a letter saying that patients risk destroying the health service if they are outraged at every small failure.

The GP adds in his letter that the problems in the NHS are “as much about attitude” as they are about funding.

10:33am Turning to the national papers, The Guardian has a story on a report by the Centre for Health and the Public Interest, which says that changes made to the NHS by the coalition have left Britain unprepared for a flu pandemic that could kill up to 315,000 people.

The report’s authors argue that staffing shortages, organisational restructuring, and confusion over who is responsible for what have weakened the emergency response to pandemics.They say that the response to a future flu pandemic is likely to be less effective than the response to swine flu in 2009, which claimed 457 lives and was a widely praised planning approach.

10:23am A third of GPs believe patients should be charged for some accident and emergency department visits, according to a poll for the Press Association.

The majority of those surveyed also said the changes announced by health secretary Jeremy Hunt in November regarding GP contracts would do nothing to alleviate current A&E pressures.

10:09am Here’s a story which is receiving a lot of coverage this morning - the Commons public accounts committee has warned that clinical trial results are being routinely withheld from doctors, which is undermining their ability to make informed decisions about how to treat patients.

MPs have raised “extreme concern” that manufacturers appear to only publish around 50 per cent of completed trial results and warned that the practice has “ramifications for the whole of medicine”.

Research suggests that trials giving a favourable verdict are about twice as likely to be published as trials giving unfavourable results, the committee said.

10:04am Another story from the south coast - Wessex Area Team director Debbie Fleming has left NHS England to take over at Poole Hospital Foundation Trust next April.

Ms Fleming is the third NHS England leader in the South region to have left to run an acute trust in recent years. In 2012 Ann James stood down as area team director for Devon, Cornwall and Isles of Scilly to lead Plymouth Hospitals Trust while the regional director Andrea Young left last year to run North Bristol Trust.

9:57am The leaders of Bournemouth and Poole hospitals have signed an undertaking not to attempt a merger again for the next ten years.

A planned merger by the two south coast foundation trusts was blocked by the Competition Commission last year after it concluded there was insufficient evidence patients would benefit from the plans.

9:45am King’s Fund director Chris Ham has written a comment piece for HSJ on the challenges facing the integration agenda.

Chris identifies four changes which have the potential to make integration a reality: ensuring that provider regulation does not get in the way of partnership working; ensuring that quality regulation is not overly focused on organisational performance; developing payment systems that create incentives to integrate care; and supporting commissioners to promote greater integration.

7:00am A mental health service in Kent has teamed up with police to create a street triage team that will assess suspected offenders at the point of arrest or detainment.

Kent and Medway NHS and Social Care Partnership Trust introduced the pilot project with the intention of reducing the detention of people for assessment in custody under section 136 of the Mental Health Act.

The project has been awarded a 12 month grant from the Department of Health. It involves mental health nurses accompanying police officers on callouts and assessing suspected offenders when they are arrested to see whether they could require mental health treatment.