The National Audit Office Report 2011 - The healthcare perspective

The latest version of the NAO report out last week highlights deficiencies across the board with the government sector, as is the remit of the individuals trusted with its collation and publication. What is of concern to those of us with a vested interest in the health sector and the formulation of health policy and its actuation, are certain grave and fundamental shortcomings within this same sector. The aim of this short note is not to dwell in depth on each point but to emphasize the importance and relevance of the basic facts elucidated by this report.

The NAO report 2011 review of the Ministry for Health and the Elderly can be easily subdivided into the following criticisms:

I) The lack of control on employee attendance and the brazen refusal of doctors' and dentists' unions to accept such a basic tenet of employment. 

II) The fact that tendering procedures for medicines and surgical materials and also non-surgical equipment are routinely circumvented by direct orders, and the limits and approvals required for the latter are disregarded at will.

III) The storage of medicines and surgical materials is not centralized and one of the depots does not provide satisfactory storage conditions under the regulations laid out by the MA. This suggests that sub-standard medicinal and supplies are being passed onto the local treatment chain.

IV) The discrepancy in stocks held was said to be less than Eur 2,000 on a total figure of over Eur 18 million. This range of accuracy is not credible to the trained observer, as it implies no human error in stock transfers and no inventory pilferage. For some reason this did not seem odd to the auditors.

The implications of the NAO report are many and will be discussed in detail in a future note. What these brief points do immediately emphasize is that the Maltese healthcare system is not suffering from a lack of funding, but rather from a very inefficient utilization of the funds available to it. With points of failure at every main cost sector: wages, stocks and purchasing and stock control are all major weaknesses. This implies that major gains are to be had by simply getting the basics done right. Deeper analysis is required to quantify the magnitude of the savings to be had, but the report leaves no doubt that the material impact on the level of local health outcomes would be dramatic, given the gross wastage of resources identified.

John

Its not about the bike

The title of this post was also the title of Lance Armstrong's autobiographical narrative of his fight against almost certain death from testicular cancer and his subsequent return to professional cycling and to the pinnacle of his chosen sport. Recent events have borne Armstrong out to be a liar and a cheat of the highest calibre, however our revulsion at his cowardly acts must be restricted to his sporting achievements. 

The Livestrong Foundation, set up by himself, has raised close to $500 million and provided hope and solace to countless individuals who have battled cancer. As much as all observers and involved persons alike would prefer to black out all reference to Armstrong and damn him to the darkest abyss, such instincts must be curbed for the greater good. Livestrong must be allowed and supported in its good work, and one hopes that Armstrong will have the good grace to disassociate himself from the foundation and allow it to create its own legacy, free from his own tainted and deeply flawed journey.

Another year begins!

A quick word to wish good luck to all pharmacy students on the start of the new academic year, especially to the new entrants!

Lets hope we all get settled pretty quickly and manage to juggle the twin feats of having a good time and getting some productive learning time under our belts.

See you!

John

Why education and business must mix for the greater good

Business interests and the aims of tertiary education are not initially similar or even remotely , related at an initial and cursory first glance. However, upon further evaluation one will come to the conclusion that the two are mutually connected and the possibilities for gain for both parties can lead to a situation where cooperation is the only way forward in the near future.

The current situation in the Maltese Islands is such that various university departments suffer from a chronic lack of funding due the limited resources available and the fact that the University of Malta has little sources of income, save for tuition fees charges to overseas(non-EU) students and certain evening and part-time courses.

Without going into the politics of it all, we are currently punching above our weight, taking into consideration the small pool of students and lecturers at hand, and the quality of graduands has improved greatly.

The next step must involve external funding, on a level to that similar in the United States. Various industry and business leaders often complain of a chronic shortage of quality and specialised graduands. One manner in which this might be solved could be by having  companies sponsor courses in fields where we have little or no current expertise, and then allow  these same companies to offer job opportunities to the students prior to the course completion, even have the students undergo work placements at these companies as part of the course curriculum. Alternatively, companies might be allowed to sponsor a chair in a particular area, and be given the opportunity to promote themselves to students in a regulated environment.

Opponents to this might state that education must never be subservient to financial interests and pressures, and they may be right. However, such an arrangement, or a derivative of the above idea, might be the only way in which our minute country can continue to punch above its weight in the field of tertiary education.

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John Vella B.Pharm. (Hons.) M.Sc.(Pharmacoeconomics)

8, Islets Promenade, Bugibba, SPB2502, Malta

+356-21571649, +356-27571649, +356-99497510

http://www.stsimonpharmacy.com

Breaking News! Statins are safe again!

Up to recently, a majority of studies had  shown no obvious gain  in administering statins to patients who had not experienced a previous cardiac event or were at an elevated risk of cardiac pathology.  These studies had not been widely publicised by the pharmaceutical industry for obvious reasons. 

A preview of the results of a meta-analysis of 27 large studies (175,000 subjects in total) to be published in the Lancet in late 2013 suggests otherwise. According to authors quoted from the University of Oxford, anyone over the age of 50 would benefit from statin therapy. The authors insist that the extra cost of therapy would be outweighed by the savings made by a reduction in cardiac events and subsequent hospitalisation and rehabilitation costs.

The link to the full article is here: http://www.bbc.co.uk/news/health-18091708

Why I refuse to lie down and shut up!

Why I refuse to lie down and shut up!

It is easy enough to go along with the rest of the world and accept what is the present state of affairs as the norm. This is all well and good if one's conscience is at peace and the majority of society is well served. In this case, however, both the former and the latter are not satisfied.

I argue that the formulators of public policy are not being given the right amount of information and professional direction to enable decisions to be taken in their best interest. I argue that public health would be better served if those taking macro health decisions placed the well-being of Maltese citizens ahead of personal, political or corporate gain. I argue that the time has come to take a stand and put forward the case for wholesale reform of the manner in which we apply ourselves to healthcare and its delivery.

I will not rest my case.


John

Does money or patient welfare drive our profession?

An extremely well-written and thought provoking book is The Truth About The Drug Companies: How They Deceive Us And What To Do About It, by Marcia Angell. Dr. Angell is a former editor of the New England Jounrnal of Medicine and a respected authority in the field of medical and pharmaceutical matters. Her book tackles what she has termed the takeover of the pharmaceutical field by 'big pharma'

Dr. Angell opines that the massive profits generated by the leading pharmaceutical companies are no longer morally justified and sustainable. She argues that truly innovative and socially profitable drugs are now few and far between, and that the current system of patent protection and profit taking is being manipulated by pharmaceutical companies, to the detriment of the general public. Her arguments are well reasoned and backed up by fact and lead one to give a certain credence to her thesis.

In this light, an introspective view at the manner in which we conduct our profession is warranted. Do we, as Dr. Angell so well describes in her writing, take every word and advertised fact proposed by drug companies as being incontrovertibly right? Do we question research we are quoted and probe the efficacy of newer and more costly medicinal products? Do we consider the financial implications that pharmaceuticals have on the daily well-being of our patients? Are we placing our own motives for profit, financial or otherwise, before those of the public we are obliged to treat impartially?

The above questions are not easily answered, and as in most situations in life, the pragmatic response is a grey line somewhere down the moral middle. Considering them and applying the consequent thoughts to our daily professional practice can only lead to better application and patient benefit. The above mentioned book is also worth a read as it portrays the pharmaceutical industry in a manner few have had the courage to.