I WAS tremendously impressed by John A. Elliott’s comprehensive analysis of the causes of NHS meltdown (Letters, January 9).
His conclusion that a cross-party commission is urgently needed implies there is a need to “depoliticise” medicine, or at least to stop using the NHS as a political football. The idea of politicians “sorting” the NHS has always struck me as rather odd. Of course, the NHS was a political creation.
The idea of a publicly funded health service, free at the point of delivery, is profoundly political and although conspiracy theorists see the NHS, particularly south of the Border, being dismantled by stealth, every significant political party in the UK supports the fundamental principles of the NHS. The overriding political consideration regarding the NHS is the extent to which it needs to be funded.
But the decision as to how the funding is used should not be political; it should be medical. The NHS is the sum of all of the millions of individual medical consultations (and treatments arising) that take place every day. The medical consultation seeks to preserve and protect patient autonomy, beneficence, non-maleficence, and justice. These concepts are embedded in patient “management” (yes, doctors are managers) and their application is unique to each consultation. There is no reason on earth why a politician should have any input into medical interventions into pathophysiological processes.
Therefore health-care professionals need to tell politicians and the public at large how to organise and run the NHS. But we don’t have a good track record in leadership. We are too tribal; we operate in silos; the speciality with the biggest “mana”, or power, gets the biggest slice of the cake.
Since health is devolved, Dr Elliott’s cross-party commission needs to be the Academy of Medical Royal Colleges and Faculties in Scotland. The politicians should hand the responsibility for “sorting” the NHS to the academy, and it should take it on.
Dr Hamish Maclaren,
1 Grays Loan, Thornhill, Stirling.
THERE has been increased reporting on influenza as we experience a sharp rise in the number of reported cases in Scotland. Many reports have contained clinical inaccuracies. Given the importance of vaccination as a response to influenza, it is important to clarify some of these misconceptions.
Each year, the World Health Organisation reviews evidence from previous years and determines the most likely flu viruses that should be covered by vaccine programmes in the northern and southern hemispheres for the next influenza season. Manufacturers of vaccines adopt these recommendations and these products are incorporated in countries’ vaccine programmes.
At present, the vaccine is a good match for the predominant strain in Scotland, a variety of influenza A (H3N2). There has been discussion between the Scottish Government and public health experts about the experience of southern hemisphere countries such as Australia. The predominant strain in Scotland is not the same strain that was predominant in Australia. There are differences even across the UK with which influenza strain is predominant and this may fluctuate and change in a flu season. Remaining vigilant about patterns of influenza activity is important.
A small rise in all-cause mortality in the final weeks of 2017 has been reported as being a rise in “flu-related deaths”. It is not possible to infer this from the data and it is too simplistic to say this was due to flu, particularly as flu detections were at a low level until part of the final week of this reporting period and other serious, complex clinical presentations were being seen by services.
When epidemiologists talk about “excess deaths”, this is a statistical term reflecting a greater number of deaths than normally expected. Vaccination offers the best defence against flu and I would encourage those who are eligible but who have not received it to do so.
Gregor Smith,
Deputy Chief Medical Officer for Scotland,
St Andrew’s House, Edinburgh.
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