Chief Medical Officer's Annual Report
"On the state of public health" The CMO ANNUAL REPORT 2004 by Prof Sir Liam Donaldson, the chief medical officer for England.
Since taking up the post of Chief Medical Officer, in the autumn of 1998, I have used my Annual Report to draw attention to the major challenges in health and healthcare facing our country, particularly those where I have felt that current action is not sufficient to fully address them.
I have sought also to identify smaller scale problems: for example, where an adverse trend in the occurrence of a disease is unexplained and is giving rise to concern. This very much captures the spirit of the earliest Chief Medical Officer Annual Reports – dating back to the 19th century – which fearlessly identified problems and actively championed the need for action.
This – my fourth Annual Report – comes at the end of a particularly busy year. Progress
has been made on two key public health threats which I highlighted in my 2002 Annual Report: second-hand smoke and obesity.
Since 2002, there has been widespread public discussion, ongoing media coverage and extensive consultation on these issues, as well as expert analysis and review. This culminated in the
production of a new public health White Paper. Choosing Health set out a wide range of proposed actions to improve tobacco control and curb obesity, as well as actions to address other major public health problems of today. Choosing Health puts population health and health inequalities squarely at the centre of the Government’s health policy agenda.
I have pushed very hard on the need for action to create smoke-free public places and workplaces. The proposals set out in Choosing Health represent real progress but, in my view, do not go far enough. I want this country to be alongside the best in the world in public health in protecting their populations and future generations from the scourge of tobacco.
The consultation on the proposed legislation to create smoke-free restaurants, food-led pubs/bars and workplaces offers the opportunity to strengthen the approach originally planned,
should the weight of opinion be behind this simpler and more rigorous option.
This year has also witnessed important developments in the area of infectious disease control. There has been great concern about the frequent occurrence of methicillin resistant staphylococcus aureus (MRSA) infections in NHS hospitals. MRSA is one of the so-called ‘superbugs’, a common bacterium that has become resistant to successful treatment with commonly used antibiotics.
The rate of MRSA infection is higher in this country than many other European countries.
A range of actions to improve hygiene and infection control is already being undertaken, including substantial investment in cleanliness, the recruitment of new matrons and the
establishment of infection and prevention control teams in each NHS Trust hospital.
Figures published in June 2005 indicate that these measures are beginning to work: the
total number of MRSA blood infections in England dropped by 6.1% in 2004/05 compared with 2003/04. This programme, which is being led by the Chief Nursing Officer, is vital for the safety of patients in NHS hospitals and it is essential that the current momentum is maintained.
Tuberculosis (TB) is another infectious disease that is re-emerging and work is under way to implement an action plan which I published in October 2004.
Recommendations include: quicker and more effective screening of high-risk groups, DNA fingerprinting to track the spread of the disease in communities and better co-ordination of clinical care. The rate of TB has been rising in England over the last 10 years, particularly in London and other major cities.
There are now 13 cases per 100,000 people, and every year around 350 people die from the disease. The long-term goal is not only to reduce TB infections but to all but eliminate the disease from this country.
Major planning has also been undertaken to combat the impact of an influenza pandemic. The World Health Organization (WHO) and other international organisations have recently warned that a flu pandemic is both ‘inevitable’ and ‘imminent’.
Such warnings have been largely fuelled by the persistence of a highly virulent strain of bird
(avian) flu in Asia. While these warnings aim to ensure countries are prepared for such an event, they have also caused public concern over the nature of the threat and our ability to respond to it.
The consequences of an influenza pandemic would be serious, with the numbers of people falling ill and dying being far higher than those associated with ‘ordinary’ winter flu outbreaks.
My team has worked tirelessly to bring together the best ideas and expertise, both globally and in this country, to anticipate and respond effectively to an influenza pandemic should one occur. A national plan and other supporting documents were published in March 2005, which collectively provide a proper understanding of the nature of the threat, its likely impact on the United Kingdom and the action necessary to mitigate pandemic influenza when it comes to this country.
From August 2005, the two-year Modernising Medical Careers Foundation Programme begins. All junior doctors starting their pre-registration house officer year in August will benefit from this innovative development in postgraduate medical training. Under the new curriculum,
junior doctors will need to demonstrate their competence in a number of areas not previously addressed in medical training, including: communication and consultation skills, pat ient safety, clinical governance and team-working. Trainee doctors will need to show they have learned a range of skills, including the undertaking and use of research, time management and use of
evidence and data.
The development of the Foundation Programme curriculum for the first two years of postgraduate medical education will help ensure that trainees’ acute clinical and professional skills are secure and robust. It is a curriculum focused on quality of care and ensures that, at the end of their two years’ training, doctors are both confident and competent and so patients will benefit.
The issue of how best to quality assure medical practice came to the fore in the Shipman Inquiry’s fifth report produced by Dame Janet Smith. I have been asked by the Secretary of State for Health to consider the implications of this report and recommend further measures to strengthen procedures aimed at ensuring the safety of patients in situations where a doctor’s performance or conduct poses a risk to patient safety or the effective functioning of services.
The proposals will also seek to ensure the operation of an effective system of revalidation (the five-yearly review of a doctor’s licence to practise) and will examine the role, structure and functions of the General Medical Council. At present, this work is at the consultation stage and I have appointed an expert advisory panel to assist me with this task.
The United Kingdom has the Presidency of the European Union (EU) in 2005. For the health element of the Presidency, two areas have been chosen that are of great importance in improving health outcomes in all EU countries: tackling health inequalities and improving patient safety.
There will be over 20 meetings and summits scheduled between July and December 2005. With the enlargement of the European Union there will not be another Presidency for the United Kingdom until 2017, when it will be shared with two other member states.
Our Presidency in 2005 therefore represents a vital opportunity for the United Kingdom to
make a significant contribution to the EU agenda, and from the health perspective we want to play our full part.
I have selected five new topics for attention in this year’s Report. Firstly, I have reviewed the extent to which the movement of cigarettes across international borders, either through smuggling or duty-free imports, is seriously undermining the traditional effectiveness of price increases to reduce tobacco consumption.
It is estimated that up to 25% of all cigarettes and hand-rolled tobacco in this country is not being taxed, leading to concerns about long-term health implications and the need for greater awareness are issued by the Department of Health and its agencies.
Awareness of the problem of patient safety has grown greatly over the last few years and, as illustrated in last year’s Annual Report, it is a worldwide problem.
Ours is one of the leading countries working to improve patient safety. It is important, however, that when serious risks to patients are identified, action is taken rapidly to reduce those risks. This action needs to be taken not just on an incident-by-incident basis but as part of a long-term strategy to be implemented throughout the NHS. It is clear that the culture of some NHS organisations needs to change. It is not enough to be aware of the problem of
improving patient safety nor to report adverse events when they occur. When alerts are issued, there needs to be commitment from the very top of the organisation to initiate immediate action to address the identified risk, to ensure that all staff are properly and consistently informed,
and to establish new procedures and processes of care to sustain the reduction of the risk in question.
In compiling this report, I am grateful for the help of a number of colleagues in the Department of Health. I am also indebted to a number of colleagues outside Whitehall in particular Elizabeth Draper, Angela Towers and Sean O’Kelly.
I should like to make clear, however, that the conclusions and opinions expressed in the Report are my own.
I hope you enjoy reading this Report. Every one of us has a role to play in addressing the issues raised. The progress, described in this Report, on issues highlighted in my previous Annual Reports, shows that public discussion as well as individual and collective action does make a
difference in improving health and the quality of healthcare in this country.
Sir Liam Donaldson
Chief Medical Officer
On the state of public CMO ANNUAL REPORT 2004 blic health 5
http://www.dh.gov.uk/assetRoot/04/11/57/83/04115783.pdf
Since taking up the post of Chief Medical Officer, in the autumn of 1998, I have used my Annual Report to draw attention to the major challenges in health and healthcare facing our country, particularly those where I have felt that current action is not sufficient to fully address them.
I have sought also to identify smaller scale problems: for example, where an adverse trend in the occurrence of a disease is unexplained and is giving rise to concern. This very much captures the spirit of the earliest Chief Medical Officer Annual Reports – dating back to the 19th century – which fearlessly identified problems and actively championed the need for action.
This – my fourth Annual Report – comes at the end of a particularly busy year. Progress
has been made on two key public health threats which I highlighted in my 2002 Annual Report: second-hand smoke and obesity.
Since 2002, there has been widespread public discussion, ongoing media coverage and extensive consultation on these issues, as well as expert analysis and review. This culminated in the
production of a new public health White Paper. Choosing Health set out a wide range of proposed actions to improve tobacco control and curb obesity, as well as actions to address other major public health problems of today. Choosing Health puts population health and health inequalities squarely at the centre of the Government’s health policy agenda.
I have pushed very hard on the need for action to create smoke-free public places and workplaces. The proposals set out in Choosing Health represent real progress but, in my view, do not go far enough. I want this country to be alongside the best in the world in public health in protecting their populations and future generations from the scourge of tobacco.
The consultation on the proposed legislation to create smoke-free restaurants, food-led pubs/bars and workplaces offers the opportunity to strengthen the approach originally planned,
should the weight of opinion be behind this simpler and more rigorous option.
This year has also witnessed important developments in the area of infectious disease control. There has been great concern about the frequent occurrence of methicillin resistant staphylococcus aureus (MRSA) infections in NHS hospitals. MRSA is one of the so-called ‘superbugs’, a common bacterium that has become resistant to successful treatment with commonly used antibiotics.
The rate of MRSA infection is higher in this country than many other European countries.
A range of actions to improve hygiene and infection control is already being undertaken, including substantial investment in cleanliness, the recruitment of new matrons and the
establishment of infection and prevention control teams in each NHS Trust hospital.
Figures published in June 2005 indicate that these measures are beginning to work: the
total number of MRSA blood infections in England dropped by 6.1% in 2004/05 compared with 2003/04. This programme, which is being led by the Chief Nursing Officer, is vital for the safety of patients in NHS hospitals and it is essential that the current momentum is maintained.
Tuberculosis (TB) is another infectious disease that is re-emerging and work is under way to implement an action plan which I published in October 2004.
Recommendations include: quicker and more effective screening of high-risk groups, DNA fingerprinting to track the spread of the disease in communities and better co-ordination of clinical care. The rate of TB has been rising in England over the last 10 years, particularly in London and other major cities.
There are now 13 cases per 100,000 people, and every year around 350 people die from the disease. The long-term goal is not only to reduce TB infections but to all but eliminate the disease from this country.
Major planning has also been undertaken to combat the impact of an influenza pandemic. The World Health Organization (WHO) and other international organisations have recently warned that a flu pandemic is both ‘inevitable’ and ‘imminent’.
Such warnings have been largely fuelled by the persistence of a highly virulent strain of bird
(avian) flu in Asia. While these warnings aim to ensure countries are prepared for such an event, they have also caused public concern over the nature of the threat and our ability to respond to it.
The consequences of an influenza pandemic would be serious, with the numbers of people falling ill and dying being far higher than those associated with ‘ordinary’ winter flu outbreaks.
My team has worked tirelessly to bring together the best ideas and expertise, both globally and in this country, to anticipate and respond effectively to an influenza pandemic should one occur. A national plan and other supporting documents were published in March 2005, which collectively provide a proper understanding of the nature of the threat, its likely impact on the United Kingdom and the action necessary to mitigate pandemic influenza when it comes to this country.
From August 2005, the two-year Modernising Medical Careers Foundation Programme begins. All junior doctors starting their pre-registration house officer year in August will benefit from this innovative development in postgraduate medical training. Under the new curriculum,
junior doctors will need to demonstrate their competence in a number of areas not previously addressed in medical training, including: communication and consultation skills, pat ient safety, clinical governance and team-working. Trainee doctors will need to show they have learned a range of skills, including the undertaking and use of research, time management and use of
evidence and data.
The development of the Foundation Programme curriculum for the first two years of postgraduate medical education will help ensure that trainees’ acute clinical and professional skills are secure and robust. It is a curriculum focused on quality of care and ensures that, at the end of their two years’ training, doctors are both confident and competent and so patients will benefit.
The issue of how best to quality assure medical practice came to the fore in the Shipman Inquiry’s fifth report produced by Dame Janet Smith. I have been asked by the Secretary of State for Health to consider the implications of this report and recommend further measures to strengthen procedures aimed at ensuring the safety of patients in situations where a doctor’s performance or conduct poses a risk to patient safety or the effective functioning of services.
The proposals will also seek to ensure the operation of an effective system of revalidation (the five-yearly review of a doctor’s licence to practise) and will examine the role, structure and functions of the General Medical Council. At present, this work is at the consultation stage and I have appointed an expert advisory panel to assist me with this task.
The United Kingdom has the Presidency of the European Union (EU) in 2005. For the health element of the Presidency, two areas have been chosen that are of great importance in improving health outcomes in all EU countries: tackling health inequalities and improving patient safety.
There will be over 20 meetings and summits scheduled between July and December 2005. With the enlargement of the European Union there will not be another Presidency for the United Kingdom until 2017, when it will be shared with two other member states.
Our Presidency in 2005 therefore represents a vital opportunity for the United Kingdom to
make a significant contribution to the EU agenda, and from the health perspective we want to play our full part.
I have selected five new topics for attention in this year’s Report. Firstly, I have reviewed the extent to which the movement of cigarettes across international borders, either through smuggling or duty-free imports, is seriously undermining the traditional effectiveness of price increases to reduce tobacco consumption.
It is estimated that up to 25% of all cigarettes and hand-rolled tobacco in this country is not being taxed, leading to concerns about long-term health implications and the need for greater awareness are issued by the Department of Health and its agencies.
Awareness of the problem of patient safety has grown greatly over the last few years and, as illustrated in last year’s Annual Report, it is a worldwide problem.
Ours is one of the leading countries working to improve patient safety. It is important, however, that when serious risks to patients are identified, action is taken rapidly to reduce those risks. This action needs to be taken not just on an incident-by-incident basis but as part of a long-term strategy to be implemented throughout the NHS. It is clear that the culture of some NHS organisations needs to change. It is not enough to be aware of the problem of
improving patient safety nor to report adverse events when they occur. When alerts are issued, there needs to be commitment from the very top of the organisation to initiate immediate action to address the identified risk, to ensure that all staff are properly and consistently informed,
and to establish new procedures and processes of care to sustain the reduction of the risk in question.
In compiling this report, I am grateful for the help of a number of colleagues in the Department of Health. I am also indebted to a number of colleagues outside Whitehall in particular Elizabeth Draper, Angela Towers and Sean O’Kelly.
I should like to make clear, however, that the conclusions and opinions expressed in the Report are my own.
I hope you enjoy reading this Report. Every one of us has a role to play in addressing the issues raised. The progress, described in this Report, on issues highlighted in my previous Annual Reports, shows that public discussion as well as individual and collective action does make a
difference in improving health and the quality of healthcare in this country.
Sir Liam Donaldson
Chief Medical Officer
On the state of public CMO ANNUAL REPORT 2004 blic health 5
http://www.dh.gov.uk/assetRoot/04/11/57/83/04115783.pdf
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