The NHS was established in 1948 to provide universal healthcare free at the point of use for all British citizens. It aimed to provide medical care based on need rather than ability to pay. The NHS has undergone constant change and reorganization over the decades, moving from an administrative model to a market-based model and now emphasizing primary care and local authorities. Primary Care Trusts (PCTs) manage primary healthcare services in their local areas, including GPs, pharmacies, and walk-in centers. They are also responsible for funding hospitals and making decisions about secondary care services.
Dr rozita halina tun hussein public private intergration in malaysia past and...EyesWideOpen2008
This MOH presentation shows the extent of privatisation in Malaysian public healthcare. 1Care will completely privatise every other aspect of public healthcare. In effect, Malaysians will be living in a "no money, no health" system like America.
Chidi Izuwah Finance for Development MOOC Final ProjectChidi Izuwah
Submitted as project for World Bank FFD Project. Proposal is to expand rural health care in Nigeria by a public private collaboration that finances solar powered mobile medical units that are operated by qualified private health care operators
Taap Conference Therapeutic Jurisprudence Models In San Antonio Texas FinalGilbert Gonzales
This presentation will discuss the origin of the Therapeutic Jurisprudence from Mental Health Law and its evolution to include addiction and dual diagnosis youths and adults involved in the criminal justice system. A national movement of Drug Courts, which execute therapeutic justice strategies to motivate high recidivist populations toward treatment in lieu of incarceration, is occurring across the US.
Dr rozita halina tun hussein public private intergration in malaysia past and...EyesWideOpen2008
This MOH presentation shows the extent of privatisation in Malaysian public healthcare. 1Care will completely privatise every other aspect of public healthcare. In effect, Malaysians will be living in a "no money, no health" system like America.
Chidi Izuwah Finance for Development MOOC Final ProjectChidi Izuwah
Submitted as project for World Bank FFD Project. Proposal is to expand rural health care in Nigeria by a public private collaboration that finances solar powered mobile medical units that are operated by qualified private health care operators
Taap Conference Therapeutic Jurisprudence Models In San Antonio Texas FinalGilbert Gonzales
This presentation will discuss the origin of the Therapeutic Jurisprudence from Mental Health Law and its evolution to include addiction and dual diagnosis youths and adults involved in the criminal justice system. A national movement of Drug Courts, which execute therapeutic justice strategies to motivate high recidivist populations toward treatment in lieu of incarceration, is occurring across the US.
Information and support for patients on MKI treatmentMarika Porrey
Information and support for patients on MKI treatment - guidance for physicians and patient organizations by Dr Fabian Pitoia
Encargado de la Sección Tiroides
División Endocrinología - Hospital de Clínicas
Universidad de Buenos Aires
A Model of Integrated Primary Care: Anthroposophic Medicine ~ National Centre for Social Research
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children =
http://scribd.com/doc/239851214 ~
`
Double Food Production from your School Garden with Organic Tech =
http://scribd.com/doc/239851079 ~
`
Free School Gardening Art Posters =
http://scribd.com/doc/239851159 ~
`
Increase Food Production with Companion Planting in your School Garden =
http://scribd.com/doc/239851159 ~
`
Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
Fenin en colaboración con el departamento comercial UK Trade and Investment, de la Embajada británica en Madrid, han organizado un foro empresarial dirigido al sector de tecnología sanitaria, con el objetivo de evaluar los sistemas de compras de los sistemas sanitarios de España y Reino Unido (NHS), y conocer las oportunidades de negocio que el NHS representa para empresas españolas de tecnología sanitaria.
Regulations , Standards & Codes “CLINICAL ESTABLISHMENT ACT” I.P.H.S and UCPMP by Dr. Mira Shiva MD
National Consultation on ‘Expanding Access and Using the Law to Ensure Sexual and Reproductive Health Rights’ was held in December’ 2015. The consultation brought together experts, activists, lawyers, health workers and students from all corners in the country, in building the understanding on the issues and the emerging challenges.
Human Rights Law Network
http://hrln.org
El clàssic llibre de Pau Parassols i Pi sobre el Santíssim Misteri i el monestir de Sant Joan de les Abadesses. Escanejat del llibre original, primera edició. Història de Catalunya.
A cornerstone on the history of Sant Joan de les Abadesses and its monastery, focused on the Holy Mystery
Information and support for patients on MKI treatmentMarika Porrey
Information and support for patients on MKI treatment - guidance for physicians and patient organizations by Dr Fabian Pitoia
Encargado de la Sección Tiroides
División Endocrinología - Hospital de Clínicas
Universidad de Buenos Aires
A Model of Integrated Primary Care: Anthroposophic Medicine ~ National Centre for Social Research
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children =
http://scribd.com/doc/239851214 ~
`
Double Food Production from your School Garden with Organic Tech =
http://scribd.com/doc/239851079 ~
`
Free School Gardening Art Posters =
http://scribd.com/doc/239851159 ~
`
Increase Food Production with Companion Planting in your School Garden =
http://scribd.com/doc/239851159 ~
`
Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
Fenin en colaboración con el departamento comercial UK Trade and Investment, de la Embajada británica en Madrid, han organizado un foro empresarial dirigido al sector de tecnología sanitaria, con el objetivo de evaluar los sistemas de compras de los sistemas sanitarios de España y Reino Unido (NHS), y conocer las oportunidades de negocio que el NHS representa para empresas españolas de tecnología sanitaria.
Regulations , Standards & Codes “CLINICAL ESTABLISHMENT ACT” I.P.H.S and UCPMP by Dr. Mira Shiva MD
National Consultation on ‘Expanding Access and Using the Law to Ensure Sexual and Reproductive Health Rights’ was held in December’ 2015. The consultation brought together experts, activists, lawyers, health workers and students from all corners in the country, in building the understanding on the issues and the emerging challenges.
Human Rights Law Network
http://hrln.org
El clàssic llibre de Pau Parassols i Pi sobre el Santíssim Misteri i el monestir de Sant Joan de les Abadesses. Escanejat del llibre original, primera edició. Història de Catalunya.
A cornerstone on the history of Sant Joan de les Abadesses and its monastery, focused on the Holy Mystery
The liaison nurse at the Hospital Clinic of Barcelona. A description of the project as it was in the year 2008. The liaison nurse was dedicated to manage patients at risk as an intermediary between primary care and hospital care. Language: Catalan
Description of the quality system programme in a group of practices in Catalonia. Key words: quality, EFQM, indicators. Language: English. Please look for my article published in Quality in Primary Care
Objectives and activity indicators. Applied to a healthcare company. Might be of interest for other non-healthcare companies. Language: Catalan and English
A summary of the famous tale by Lewis Carroll, dedicated to resident doctors and young researchers. Carroll was a mathematician; in my opinion, the book is NOT a non-sense but a highly scientific sense. The history is summarized in Catalan and the most significant (for purpose) parts are copied and pasted. The most relevant sentences are highlighted in red. This is an introduction to the course of clinical reasoning
History of reasoning, that is, of Western philosophy applied to medical science. An addenda to my other presentation "history of clinical reasoning". Tools for resident doctors and medical students. Language: Catalan
History of clinical reasoning. How medical ideas evolved across centuries. A comprehensive overview of medical knowledge. Language. Catalan with notes in English and French
Designs of epidemiological studies. Fundamentals of epidemiology for resident doctors and young researchers. Types of epidemiological studies, strengths and weaknesses. Language: Catalan
We are homonyms but not relatives. Even more, I never knew him in person. But his work is of importance, indeed! A biography of this eminent radiologist. Language: Catalan
This text describes the main features of the Jamaican health system, the main issues in primary health care and the main topics of my contribution. Some pictures and leisure comments are also included. Language: Catalan
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Founding principles
Tony Delamothe, deputy editor.
BMJ 2008;336:1216-1218 (31 May)
Britain’s National Health Service (NHS) came
into existence on 5 July 1948. It was the
first health system in any Western society
to offer free medical care to the entire
population. It was, furthermore, the first
comprehensive system to be based not on
the insurance principle, with entitlement
following contributions, but on the national
provision of services available to everyone.
3. NHS Organisation
NHS Aims:
• To provide medical care free at point of use
• To rich and poor alike
• in accordance with medical need
2 beliefs:
• Those who need care will come forward
• Those who provide care know what is
required and how to provide it
4. ELS QUATRE (O MÉS?) NHS
• NHS England
• NHS Northern Ireland
• NHS Wales
• NHS Scotland
6. NHS Organisation
The New NHS
Health
Improvement
Programme
Local
Authorities
Primary Care Groups
Health Authorities NHS Trusts
DoH
NHSE
Regional Offices
Secretary of State
Type title here
7. ASPECTES DIFERENCIALS
• Els contractes (p.e. directe NHS – single-handed
GP)
• La competència
• Els tipus d’empreses proveïdores de serveis
sanitaris: persones físiques, beneficència, entitats
sense ànim de lucre, empreses privades
• El càlcul de costos
• Els sistemes d’informació
• Els indicadors en temps real
• L’assegurança, les cobertures
8. What are Primary Care Trusts (PCTs)?
Healthcare in the UK is divided into 'primary' and
'secondary' services.
Primary care services are provided by the people you
normally see first when you have a health problem. It
might be a visit to your doctor or dentist, to your
optician for an eye test, or a trip to your pharmacist.
NHS walk-in centres and the NHS Direct phone
service are also part of primary care.
All of these primary care services are managed by
Primary Care Trusts (PCTs). There are about 152
Primary Care Trusts in England, each one covering
a separate local area.
9. What are Primary Care Trusts (PCTs)?
PCTs are a very important part of the NHS, and they get about
80% of the total NHS budget. PCTs decide what health
services a local community needs, and they are
responsible for providing them. They must ensure that
there are enough services for people within their local area,
and that the services are accessible. These services
include:
GPs, Dentists, Pharmacists, Opticians, NHS Direct, and
NHS walk-in centres.
PCTs make decisions about the type of services that
hospitals provide and are responsible for making sure that
the quality of service is high enough. They also control
funding for hospitals.
As PCTs are local organisations, they are in a good position to
understand the needs of their local community. They make
sure that NHS organisations work effectively with local
authorities, and other agencies that provide local health and
social care services, so that the local community's treatment
needs are met.
10. NHS walk-in centres (WiCs), which first opened
in 2000, offer convenient access to a range of NHS
services. Today WiCs are managed by primary care
trusts (PCTs).There are around 93 NHS WiCs
available in England, dealing with minor illnesses and
injuries. This includes:
• infection and rashes,
• fractures and lacerations,
• emergency contraception and advice,
• stomach upsets,
• cuts and bruises, or
• burns and strains.
NHS WiCs are predominantly nurse-led first-contact
services available to everyone without making an
appointment or requiring patients to register. Most
centres are open 365 days a year and are situated in
convenient locations that give patients access to
services even beyond regular office hours.
11. WHAT SERVICES DO GPs OFFER?
• Essential Services – All Practices
• Additional Services – Vast Majority of
Practices
– Cervical Screening (Smear Tests)
– Contraceptive Services
– Vaccinations and Immunisations
– Child Health Surveillance
– Maternity Medical Services
– Minor Surgery
• Enhanced Services – Selected Practices
12. ENHANCED SERVICES INCLUDE:
• Childhood immunisations.
• Influenza immunisations.
• Services for violent patients.
• More complex minor surgery.
• Services for alcohol and drug misusers.
• Anti-coagulation monitoring.
• Intra-uterine Contraceptive Device (IUCD) fittings.
• Specialised care of patients with depression.
• Immediate care and first response care.
• Care of the homeless.
• Intrapartum care.
• Minor Injury services.
• Specialised sexual health services.
• Specialised Multiple Sclerosis services.
13. Practice based commissioning: clinicians
in commissioning
Practice based commissioning (PBC) is
about involving GP practices and other
health and primary care professionals in
the commissioning of services.
14. Commissioning
(extract from a letter of David Colin-Thomé, National Director for
Primary Care
By engaging in the commissioning process
through PBC, GPs have the opportunity to
shape the types of care available for patients,
determine how resources are invested to best
effect and buy the services their patients need.
We have a unique and deep knowledge of our
registered patients needs and what happens to
them when they are referred on. We know that
with more influence over the whole clinical
process how much better we can make the
NHS and in the process release resources to
be used in community settings.
15. OUR VISION FOR CLINICAL COMMISSIONING
(extracte del document World Class Commissioning de
l’NHS, març 2009)
PBC recognises the central role of primary care
clinicians – through the hundreds of thousands of
treatment and referral decisions they make each
day – in using NHS resources to deliver high-quality
care for all. PBC gives local clinicians much greater
power and influence, working in partnership with
PCTs, to shape how these resources are invested
so that they deliver better health, better care and
better value for local practice populations and for
taxpayers. Especially in financially challenged
times, clinical empowerment is not a nicety but a
necessity.
16. BBC news Thursday 31 July 2008 (online)
A terminally ill woman who has been fighting
to get a kidney cancer drug has been told her
local health trust has refused to pay for it
once again.
Jean Murphy, 63, from Salford, went to court after
Salford Primary Care Trust refused to pay for the
drug Sutent.
The High Court told the trust to reconsider its
decision, but it has now refused for a third time.
Chief executive of Salford PCT, Dr Mike Burrows,
said the decision had been made after "significant
consideration".
He said in a statement: "A process review panel took
place at the request of Mrs Murphy and her legal
advisers.
17. "After significant consideration the review panel upheld the
decision of the commissioning panel not to fund the drug
Sutent for Mrs Murphy."
Jean Murphy has already taken her case to the High Court.
He added: "We realise this has been a very difficult time for
Mrs Murphy. However the PCT now believes it has examined
in depth all aspects of this case and the conclusion of all
steps of this process support the original decision."
Mrs Murphy's husband Michael, who has Crohn's disease, a
heart condition and diabetes, has now said he will stop
taking his own life-saving medication.
18. His wife is his sole carer, and they believe the drug
Sutent could prolong her life.
The drug is available on the NHS to patients in Cheshire
and Merseyside, but not Greater Manchester as it has
not been approved by the National Institute of Clinical
Excellence (NICE).
People in Greater Manchester can only receive it
through clinical trials - and Mrs Murphy does not fit the
criteria.
When she was first told the trust would not pay for the
drug, Mrs Murphy said: "There's no other thing for me
to have and I'm frightened of dying - really frightened
of dying."
19. She has undergone several unsuccessful treatments to
slow the cancer's progress and her consultant said
she would be an ideal candidate for Sutent.
Mr Murphy said he now has "no option" but to refuse his
own treatment.
"I love and care for my wife, and I'll do anything for her,"
he said.
"I've helped her through the years, and we've been
married 25 years, and for them not to help, well I don't
want any help from them."
The couple's daughter, Cathy Ostasz, said the PCT
were sending her mother to an early grave.
"This family will fall apart without my mum," she said.
"This is all because of Salford PCT and I think they're
disgraceful. They are sending my mother to a
premature death."
20. Cancer patient wins drug battle
Amanda Crook
October 22, 2008 - Manchester Evening News (online)
A TERMINALLY ill grandmother has won a landmark
battle to force health chiefs to pay for a life extending
cancer drug - by proving it works.
An anonymous donor stepped in giving Jean Murphy,
62, £10,000 to pay for pioneering drug Sutent to tackle
her kidney cancer after Salford primary care trust
refused to fund it four times.
Mrs Murphy says she felt better within days of taking the
drug and now scans have confirmed she has
responded 'exceptionally' well to the treatment -
prompting PCT bosses to change their minds.
21. Mrs Murphy was told she had 18 months to live in April but
since starting treatment says she has stopped using a
wheelchair, oxygen supply and stair-lift. Before taking the
drug she was virtually housebound but now she is shopping
for the family and socialising again.
She hopes her six month battle, which took her to the High
Court, will pave the way for other patients to be offered a two-
month 'taster' of the drug on the NHS to see if it works for
them. She said: "I am overwhelmed, I cannot believe it, even
though I have had it in writing I have to keep looking at it
again and again because we have had such a long fight and
they refused me for so long.
22. "I really hope that what I have been through will change things
for other people, so that no one else has to go through what my
family has done. I think everyone who doctors think would
benefit from Sutent should get to try it for two months - anyone
can accept not having a drug that doesn't work for them.
"I knew straight away that the drug was working, I am a different
person now, but it was great to have my doctor confirm it, saying
my tumours have shrunk dramatically.
"We want to thank everyone at the hospital, my solicitor and all
the people who have contacted us, supporting us and most of all
the donor who has made this possible."
Benefit
23. On average Sutent patients can expect to live an extra six
months. The government's health watchdog issued draft
guidelines a few months ago saying Sutent is effective but
too expensive to be provided on the NHS. Mrs Murphy and
doctors at The Christie hospital in Withington have written
asking them to reconsider before publishing their final
decision.
Salford PCT chief executive Dr Mike Burrows said the PCT
had agreed to fund Mrs Murphy's treatment because she
was one of a 'minority' for whom it was effective. He said:
"We hope the treatment continues to be effective for Mrs
Murphy in line with the initial indications.
24. "NICE guidance states that patients currently receiving
Sutent should have the option to continue therapy until the
patient and their clinician consider it appropriate to stop.
"The funding of new high cost drugs, particularly for cancer
treatments, will continue to be an emotive and challenging
issue for PCTs to manage, given our responsibility as the
local leader for health, and the need to work within the
financial resources available to us.
"The PCT has to act in a way that ensures we have high
quality, convenient and timely health services and
treatments available to everyone in Salford."
Funding
25. Prof Robert Hawkins, Mrs Murphy's consultant at the
Christie said: "I am delighted Jean is doing so well and has
responded so positively to Sutent. I'm also delighted that
she be able to have her treatment funded on the NHS as
this will take away a lot of anxiety for her and her family.
We are so grateful to the anonymous donor who has made
this all possible."
He says around half of patients respond well to Sutent but
around 10 per cent - including Mrs Murphy - have an
exceptional response to it.
26. Last summer broadcaster Tony Wilson, who
later died of a heart attack, had to rely on
showbiz friends to pay for the drug because
health bosses wouldn't approve the treatment.
Mrs Murphy's solicitor Mark McGhee said:
"Obviously Jean is grateful that the PCT has
finally done the right thing. We now hope this
sets a precedent for all kidney cancer patient
sufferers in Salford."