Healthcare Campaigns- Barbara Arzymanow
Health and Social Care Bill

BARBARA

2020health blog.  20 January 2011

“...The greatest challenge has in my view always been to win the whole-hearted cooperation of doctors. We have needed to avoid taking too much time away from the frontline care of patients and to ensure that enough doctors turn out to be able, willing and keen to take on the new proposed responsibilities.

With the benefit of hindsight, the greatest mistake has probably been not consulting doctors and their professional bodies more fully prior to publishing the original White Paper. The Government’s proposals are largely based on a belief that doctors and professionals in the NHS know best. At the same time some doctors feel that the Government is not fully respecting their views. This apparent inconsistency damages morale and has implications for working in a spirit of cooperation. A bottom-up decision-making process imposed unilaterally from the top has great potential for teething problems. It is a possible recipe for disaster. The top priority of Andrew Lansley should be to make every effort to get doctors firmly back on side without compromising on the important strategies underlying the proposals...

...More work is needed to determine what tasks doctors are willing and able to carry out and with what assistance. The Government must be seen to be on the same side as NHS professionals. In an undertaking as large and complex as the NHS wise principles and strategies are to no avail without skilled and careful management implementation. If the changes are to be made to a tight timetable, even more attention to detail is vital because there is little time to correct any mistakes.”


DAVID CAMERON

6 April 2011

“...Doctors and nurses are asking what our plans will mean for them.

We hear that – and we want to work with you, not against you.

Now that the Health and Social Care Bill has passed through committee stage in the House of Commons, we’ve got a natural break before this legislation reaches its final stages in Parliament.

We’re taking this time to pause, listen, reflect on and improve our NHS modernisation plans.

Let me be clear: this is a genuine chance to make a difference.

Where there are good suggestions to improve the legislation, those changes will be made.”

Barbara Arzymanow
Campaigns begun before 2011

Examples of policies put forward by Barbara and subsequent action by others (e.g. Govenment, opinion leaders) appear below.

No  claim is made that she influenced Government policy or opinion leaders or that she was the first person to put any idea forward.

Publication

Nature of Publication

Date /Reference

Policy Proposed by Barbara

Subsequent Action by Others e.g. Government or Opinion Leaders

Health & Household Investors’ Brief

Leading  UK publication on healthcare in City of London

November  & December 1984. 

Nos. 30, 31 & 32.

Changes to planned Limited List of drugs no longer to be available on the NHS. The Government's original proposals would have led to serious patient suffering.

Following distribution of relevant editions of Health & Household Investors’  Brief to all MPs and other lobbying of the Prime Minister (Margaret Thatcher), the Secretary of State for Health (Kenneth Clarke) implemented all Barbara’s proposals. 

What Women  Want: A Manifesto for Health 2110.

Click   here  .

 

Wide-ranging publication with articles from 17 women. Compliled by 2020health.

Barbara’s article, pages 9-12.

 

1. Higher drug prices and other financial incentives for companies with R&D or manufacturing in the UK

Treasury proposals put forward in November 2010 over the  patent box and R&D tax credits. Lansley’s linkage of drug pricing with unmet healthcare needs and innovation , also in November 2010.

 

2. Encourage inv stors to invest   in biotechnology companies through tax benefits & grants

 

Treasury proposals put forward in November 2010 over the   patent box and R&D tax credits.

Comments Re:
Equity & Excellence:

 Liberating the NHS

Click   here  .

Submission to Department of Health in response to White Paper. A short summary can be viewed  here  .

September 2010

1. The main aims in NHS reform should be to provide excellent healthcare, control total costs (net of incoming revenues) and encourage R&D and exports (page 5).

The Conservative Party has a well-established track record of recognising the importance of excellent healthcare, controlling costs and aiming to encourage R&D and exports. Lansley emphasised his commitment to health research on 20 January 2011. The subsequent news over the  closure  of the  Pfizer site  in Kent is giving new impetus to the drive to strengthen the  environment for R&D  .  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. NHS to make more money from industry e.g. by sharing facilities & more cooperation over clinical trials (pages 11-12).

December 2010 Lansley said that the Academy of Medical Sciences had been asked to recommend ways of simplifying medical research regulation and governance so as to cut the time it takes for the NHS to set up clinical trials. 

3. No major changes should be made to patent/drug exclusivity or medical approval systems (page 5).

 

None have been proposed by Government during the process of formulating policy over the NHS.

4. For the NHS to generate more revenue from theprovision of non-medical and add-on services (pages10-11).

The required legal authority is provided under the headings 13R and 14S by sections 19 and 22 of the Bill introduced in late December 2010.

5. Drug pricing systems that involve agreeing prices of individual drugs before launch should be avoided so as not to delay the availability of valuable new medicines to patients (page 6).  

This problem can potentially be overcome by the Government’s proposal put forward in December 2010 to allow launch at a contingent price that will be adjusted later.

 

6. NICE’s role in drug rationing should end.

 

Lansley decided in November 2010 to end NICE’s role in drug rationing. More comment from Barbara    here   . However, Lansley later partly back-tracked but NICE's terms of reference and powers are being adapted.  

NATIONAL HEALTH SERVICE COMMENTS re. Liberating the 
NHS: Commissioning for Patients.

Click here   .

Submission to Department of Health in response to White Paper

October

2010

GP consortia should have the services  (not necessarily full- time) of a financial expert and a compliance officer, who would check that all rules and procedures were being followed (page 5).

The Bill published in December 2010 requires the appointment (not necessarily full-time) of an "accountable officer", who will essentially  cover regulatory aspects of both roles.

Liberating the NHS: Transparency in outcomes- a framework for the NHS

Click   here    .

Submission to Department of Health in response to White Paper

October

2010

1. Promising research in industry should be rewarded, whether or not it turns out to be successful (pages 2, 3, & 5).

The Treasury's proposals over R&D tax credits partly meet this objective but much more needs to be done if the UK is to regain its former attractions as one of the best bases for R&D. Richard Sykes has highlighted some of the issues.

 

2. Drug prices should be negotiated over a company’s total product portfolio rather than over individual products.

 

Richard Sykes has highlighted the attractions of the old PPRS drug pricing system. The challenging aspects of measuring the value of drugs are recognised even by NICE. 

Which Drugs are the Most 

Innovative?

Click  here  .

Guest blog written by Barbara for 2020health think tank 

November 2010

The most support is needed for companies  going through a barren period in R&D.

The subsequent cutbacks by Pfizer and others highlight the importance of this point.

Barbara Arzymanow
Campaigns begun in 2011

Examples of policies put forward by Barbara and subsequent action by others (e.g. Government, opinion leaders) appear below.

No claim is made that she influenced Government policy or opinion leaders or that she was the first person to put any idea forward.

Publication

Nature of Publication

Date /Reference

Policy Proposed by Barbara

Subsequent Action by Others e.g. Government or Opinion Leaders

NHS Reforms: Health and Social Care Bill 2011

Click here   .

Guest blog written by Barbara for 2020health think tank

January 2011

1. The top priority of Andrew Lansley should be to make every effort to get doctors firmly back on side.

The blog by Barbara was published on 20th January 2011. Eight  days later (28th) DAVID CAMERON wrote to doctors.

 

2. The wording in the Bill of the statutory duty to pursue equality should be changed.

Proposals to amend the wording were considered in Committee. However, my concern was eventually overcome by extending the duty in respect of research to commissioning consortia.

3. More than two doctors should be required to run a GP Consortium.

The inclusion of hospital doctors and nurses along with other safeguards covers this point.

Click here .

How to encourage pharmaceutical R&D .

Click here   .

Guest blog written by Barbara for 2020health think tank

February 2011

1. The skills needed for successful drug R&D should be covered more explicitly at university.

The importance of the right focus in developing graduates has been highlighted by Richard Sykes   and has been touched upon by the   Department for Business, Innovation and Skills .


 

2.Government should lobby internationally where the UK alone has  insufficient influence.

Octher countries (e.g   Germany ) are increasingly facing similar problems to the UK. Global innovation for the benefit of mankind could be best achieved by working together.


3. Cross party support should be encouraged in view of long time-scales in R&D.

Richard Sykes  has stress ed how the support of successive Governments for the old drug pricing scheme (PPRS) used to benefit the drug industry. Stability is important.


Response to HM Treasury Informal Consultation on the Patent Box
Click
here

Submission to HM Treasury in response to consultation document

February 2011

1. To regard profit streams from different uses of a drug separately even if they derive from the same patent.

This proposal is no longer required because of the way in which profits attributable to IP are now proposed to be calculated., as published on 6th December 2011.

 

2. Eligibility for the Patent Box should require a high proportion of relevant R&D other than clinical trials to take place in the UK

This anti-avoidance measure is no longer needed because of the changed way in which the benefit from the patent box will be calculated as per the Government's announcement on 6th December 2011.

Response to HM Treasury Informal Consultation on R&D Tax Credits

Click   here

Submission to HM Treasury in response to consultation document

February 2011

The legislation and regulations should make clear how they are to be interpreted in different industries.

The Government said in June 2011 that draft guidance will be issued to clarify the meaning of production" in a number of different situations.

Dept. of Health Consultation on Drug Pricing: “A new value-based approach to the pricing of branded medicines”.

Click   here  .

Guest blog written by Barbara for 2020research think tank

March 2011

1. Satisfying unmet healthcare needs is the goal of commercial, pharmaceutical R&D. Innovation is always a part of R&D but is not an end in itself.

The Department of Health response to the first drug pricing consultation that closed in March has clearly indicated that the Government has recognised the importance of understanding this issue.

 

2. More attention needs to be paid to pricing policies over the whole commercial lives of drugs rather than just on launch.

The agreement on drug pricing reached between the Government and industry in November 2013 focused on total drug sales of all branded products 

3. The risks involved in implementing the new pricing system could be reduced by keeping more of the positive features of the old system (PPRS).

In November 2013 the Government announced that the PPRS would continue for all branded drugs.

Value-based approach to the pricing of branded medicines: a consultation .

Clic k here  .

Submission to Department of Health in response to Consultation

March 2011

The Government must recognise that EU law removes a lot of pricing freedom from the UK authorities by permitting parallel imports and exports.

The November 2013 agreement with the Government over drug pricing makes special provision to minimize the consequences of parallel importing and exporting.

The Future of Pharmaceutical R&D
Click
here 

Guest blog written by Barbara for 2020health think tank

April 2011

Drug companies should be able to raise R&D productivity by improving the management of R&D.

The failure of the R&D model that has been adopted by many large pharmaceutical companies has been widely recognised in recent months. David Cameron highlighted the matter in his   speech of 5th December 2011.


The UK Needs MoreBiotechnologyCompanies

Click here .

Guest blog written by Barbara for 2020health think tank.

May 2011

Scientists should be encouraged to acquire business skills relevant to biotechnology.

The way in which small biotechnology companies in the USA rather than big pharmaceutical giants have often been driving innovation is being increasingly accepted. The importance of small c ompanies was stressed in   David Cameron's speech of 5th December 2011   .


NHS Reforms – What the UK Government Policy changes Really Mean

Click here  .

Guest blog written by Barbara for 2020health think tank

June 2011

Competition must not be stifled but should be carefully organised so as to promote the best healthcare at the lowest cost.

Debate on this subject was intense during the passage of the Health and Social Care Bill. Unfortunately some commentators seemed to have difficulty in being objective because of ideological misconceptions. The thrust of the Government's reforms has remained intact.


The UK     Government's Latest Thinking on the Value-Based Pricing of Medicines

Click here

Guest blog written by Barbara for 2020health think tank

July 2011

The Government has learned a lot but further careful thought is needed in the light of the UK's limited flexibility in fixing drug prices and the current pressures on the drug industry. Drug pricing anomalies must also be avoided.

The issues of international pricing, pressures on the industry and unwanted anomalies are fully taken into account in the November 2013 agreement. 

Response to HM Treasury Further Consultation on the Patent Box  
Click
  here  .

Submission to HM Treasury in response to consultation document

September 2011

1. To allow companies to continue to benefit from the Patent Box even after ceasing to be involved in decision-taking over the relevant patent, providing that the company is actively working on other potentially patentable research.

The recommended change was accepted on 6th December 2011.

 

2. The proposals for splitting the profits between patents and other forms of IP should be changed. The value of IP is not closely linked to the cost of creating it

The recommended change was accepted on 6th December 2011.

What should we expect from medical and pharmaceutical R&D in the future?

Click   here .

Guest blog written by Barbara for 2020health think tank

September 2011

The choice of research projects is an area that governments should generally leave to professionals and not seek to influence.

The November 2013 agreement on drug  pricing does not attempt to influence how R&D budgets are spent.

The highest standards of medical care urgently require doctors to remain up to date through Continuing Professional Development.

Click here .

Guest blog written by Barbara for 2020health think tank

 

October 2011

The General Medical Council should place great emphasis on making sure that doctors remain up to date with new drugs and diagnostic tests.

Steps ate being taken, for example through NICE, to increase awareness of treatment options.

Parallel importing and exporting of pharmaceuticals severely limits the options in designing an effective UK drug pricing scheme.

Click   here .

Guest blog written by Barbara for 2020health think tank

 

November 2011

A pure value-based pricing system that excludes the transfer of revenue between products, outlaws patient access schemes and disallows the negotiation of direct arrangements with pharmaceutical companies is not the way forward.

          The November 2013 agreement keeps patient access schemes allows transfer of revenues between products and permits direct arrangements with companies.

 

 

 

 

 

 

 

Barbara Arzymanow
Campaigns begun in 2012

Examples of policies put forward by Barbara and subsequent action by others (e.g. Government, opinion leaders) appear below.

No claim is made that she influenced Government policy or opinion leaders or that she was the first person to put any idea forward.

Publication    

Nature of Publication

Date/ Reference

Policy Proposed by Barbara

Subsequent Action by Others e.g. Government or Opinion Leaders

Misleading, Biased Reporting on the Health and Social Care Bill in the Media.

 

Click   here .

Guest blog written by Barbara for 2020health think tank

 

January 2012

Journalists should take special care to ensure that their reporting on the Health and Social Care Bill is fair and accurate.

The dire claims of many uninformed journalists in 2012 can be seen in 2014 to have been false.

The Health and Social Care Bill: Final Stages in Parliament

 

Click   here .

Guest blog written by Barbara for 2020health think tank

February 2012

When the Bill becomes law, the NHS will suffer if medical professionals and others fail to co-operate.

Fortunately by 2014 co-operation between the professionals and others involved appears to have improved.

Pharmaceutical   R & D – the value of radical innovation versus incremental progress

 

 

Click  here .

Guest blog written by Barbara for 2020health think tank

March 2012

R&D should be directed towards trying to improve the treatment of patients as much as possible irrespective of the degree of innovation involved.

The November 2013 pricing agreement rewards innovation without passing judgement on R&D goals.

The NHS needs outstanding management as well as a legal framework, for example, to unlock the potential of the property portfolio.

 

 

Click   here .

Guest blog written by Barbara for 2020health think tank

April 2012

The vast potential of the NHS property portfolio is great enough to justify having some of the very best managers or advisers on the case.

The NHS is increasingly seeking ways of being more commercial whilst still putting patients first.

A wrong decision on UK drug pricing could seriously undermine all the good work that HM Treasury and the Department for Business, Innovation and Skills have done to encourage the UK pharmaceutical industry.

Click  here .

Guest blog written by Barbara for 2020health think tank

May 2012

The Treasury, the Department for Business, Innovation & Skills and the Department of Health should work closely together. They should be asked to advise ministers on whether value-based drug pricing is an unacceptable risk.

The November 2913 pricing agreement is so different from the original Dept. Of Health proposals that an input from other departments seems likely.

Management Priorities in the NHS under the Health and Social Care Act

Click  here

Guest blog written by Barbara for 2020health think tank.

June 2012

Medical professionals, politicians and patients must work together to take tough decisions.

The misleading criticisms of the Health and Social Care Act are by 2014 fading into history.

Response to HM Treasury Consultation    on an 'above the line' credit for Research and Development (R&D)              

Click  here

Submission to HM Treasury in response to consultation document.

June 2012

All companies should receive the full ATL credit immediately.

My recommendation was essentially accepted by the Government in December 2012.

The Pharmaceutical Industry – Friend or Foe?

Click  here

Guest blog written by Barbara for 2020health think tank.

July 2012

The pharmaceutical industry is one of the major drivers behind the progress of mankind. We must not allow the shame of wrongdoing in the industry to distract us from seeing the big picture.

The pricing agreement in November 2013 demonstrates the ability of the industry and Government to work together with mutual respect.

Do private patients in the UK help or harm the NHS?

 

Click  here

Guest blog written by Barbara for 2020health think tank.

September 2012

Most decisions should be taken on their merits with a minimum of political preconceptions .

No serious proposals have been put foreword to limit the freedom of patients to choose private treatment if insured or able to pay.

Think carefully about value-based drug pricing in the UK and let common sense prevail.

Click  here

Guest blog written by Barbara for 2020health think tank.

September 2012

No VBP system   can possibly take into account all the relevant facts affecting the likely benefit of a drug to every patient because individual circumstances differ too much.  Some patients are bound to be the victims of decisions that appear unfair.

VBP was finally abandoned by the Government in November 2013 some three years after my campaign began.

The NHS Constitution- the turning point?

Click  here

Guest blog written by Barbara for 2020health think tank.

November 2012

Real hope exists that public support for the Government’s handling of the NHS has turned the corner. 

Looking back in 2014 Jeremy Hunt appears to have understood the public mood on a number of key issues e.g. dementia.

Health and Social Care Act 2012:Response to Attacks on the Act

Click  here

Article published on this website.

November 2012

The Act creates an opportunity for greater alignment of the interests of patients, doctors, managers, taxpayers and other interested parties.

Viewed from 2014 relationships appear to have improved.


Barbara Arzymanow
Campaigns begun in 2013

Examples of policies put forward by Barbara and subsequent action by others (e.g. Government, opinion leaders) appear below.

No   claim is made that she influenced Government policy or opinion leaders or that she was the first person to put any idea forward.


Publication    

Nature of Publication

Date/ Reference

Policy Proposed by Barbara

Subsequent Action by Others e.g. Government or Opinion Leaders

Prevention is better than cure.

 

Click  here

Guest blog written by Barbara for 2020health think tank.

January 2013

Awareness of healthy diet and lifestyles should be increased by education.

Increased attention is being paid to certain causes of ill health e.g., excessive sugar.


Response to Department of Health Consultation on NHS Constitution

Click  here

Submission to Department of Health in response to consultation document.

January 2013

The main points in the new draft constitution deserve strong support.

The new constitution was one of Jeremy Hint’s first moves as Health Secretary and was well received.


Waiting for Decisions on UK Pharmaceutical Pricing

Click  here

Guest blog written by Barbara for 2020health think tank.

April 2013

Hopefully the slow pace of progress reflects a radical rethink of unworkable proposals.


The unworkable proposals were dropped in November 2013.

Value-based pricing: the wrong medicine for the nation?

Click here

Report from 2020health think tank with Barbara as main author.

May 2013

Value-based pricing is not in the best interests of patients.

Value-based pricing was at last dropped in November 2013.

Pharmaceutical Industry- Innovation is the only way forward.

Click  here

Guest blog written by Barbara for 2020health think tank.

August 2013

Innovation must continue to be strongly encouraged.

Innovation remains at the heart of Conservative Party thinking.

Pharmaceutical companies must be free to determine their own research priorities: Lessons from Alzheimer’s Disease.

Clic k here .

Guest blog written by Barbara for 2020health think tank.

October 2013

Drug companies are in the best position to decide what to research.

Governments should resist any temptation to influence how R&D spending is split between projects within companies.


Negotiations with the UK Government over pharmaceutical pricing have achieved a good result for patients, the NHS and the industry.

  Click here .


Guest blog written by Barbara for 2020health think tank.

December 2013

Value-based pricing has at last and rightly been dropped.

A good result for all concerned. Political opposition has been minimal.


Barbara Arzymanow
Campaigns begun in 2014

Examples of policies put forward by Barbara and subsequent action by others (e.g. Government, opinion leaders) appear below.

No claim is made that she influenced Government policy or opinion leaders or that she was the first person to put any idea forward.

Publication

Nature of Publication

Date /Reference

Policy Proposed by Barbara

Subsequent Action by Others e.g. Government or Opinion Leaders

Medical advisory body “NICE” should not spend too much time valuing drugs.

 

 

 

Click  here     .

Guest blog written by Barbara for 2020health think tank

April 2014

1. NICE is in danger of putting too much effort into assessing the financial value of drugs. The only benefit from NICE finding a drug too expensive is to protect other drug companies from paying a rebate.

On 18 September 2014 the Chief Executive of NICE said, “We’ve been looking in detail at how to change the way we appraise medicines and other technologies on behalf of the NHS. Following an extensive consultation, it’s clear that just changing NICE’s methods will not overcome concerns about how the NHS accesses new treatments.”

2. Rebates received by the Government under the 2014 PPRS should be reflected in the budgets of Clinical Commissioning Groups so that they do not restrict the availability of drugs unnecessarily.

Action has not yet been taken on this front as at 12 December 2014.

3. All QALY methodologies deprive patients and doctors of the freedom to make their own decisions about quality of life.

NICE announced a major rethink on 18thSeptember 2014.

Are pharmaceutical mega-mergers in the public interest?

 

Click   here

 

Guest blog written by Barbara for 2020health think tank.

May 2014

In order to justify mergers, pharmaceutical R&D needs to be arranged more like it was in the 1980’s. Pfizer must speak for itself about its future R&D intentions but its actions over the Sandwich site and its recent R&D strategy give grounds for concern over how well placed it is to serve as guardian to a large slice of the UK’s pharmaceutical R&D.

Pfizer admitted defeat on 26/5/2014.

Threats to Mankind from Drug Resistant Bacteria and Viruses

 

Click  here

 

Guest blog written by Barbara for 2020health think tank.

August 2014

1.  Governments can help in the discovery of antibiotics and antivirals by funding academic research and courses relating to bacteria, viruses and microbiology.

The UK Government continues to give high priority to ways of responding to bacterial and viral resistance.

 

2.  Detailed, high-level expert guidance is required on the best prescribing practice for patients with the least development of resistance.

In November 20!4 for the first time, the Royal Pharmaceutical Society, the Royal Colleges of General Practitioners,  Nursing, Physicians and the Faculty of Public Health, in collaboration with Public Health England and the Department of Health, came together to o help shape the delivery of the Government’s five-year antimicrobial resistance strategy.



 

3.  Improved, very quick, accurate tests to determine which drugs will be effective in a patient would slow the development of resistance. A major drive to develop such tests is appropriate. The arrangements could be self-financing because of the reduced use of ineffective, expensive products and shorter stays in hospital.

Many companies, academics and hospitals are working towards this goal with rising funding.

 

4.  Every case of suspected poor hospital hygiene should be independently investigated and recommendations made.

Hospital inspections by he CQC are rightly putting high emphasis on this area and imposing high standards.   

 

 

 

 

 

                                                         

 

 

 

5.  Sufferers from new deadly viruses need to be put into isolation quickly. Doctors must record details relevant to learning about the virus and send them to a national monitoring and coordinating centre. Scientists should start immediate work to see whether there is the potential to develop a useful vaccine rapidly.

Emergency plans have been made to isolate Ebola victims although much more would need to be done if infection levels were to rise sharply in the UK. The effort put into work on potential Ebola vaccines has been encouraging.  

Hospital inspections: lessons to be learnt

Click here

 

 

Guest blog written by Barbara for 2020health think tank.

 

December 2014

 

The inspectors should consider whether terms such as “inadequate” could be taken out of context and frighten patients when used to describe leading internationally renowned hospitals.

My advice has been given recently.








T

Barbara Arzymanow
Campaigns begun in 2015

Examples of policies put forward by Barbara and subsequent action by others (e.g. Government, opinion leaders) appear below.

No  claim is made that she influenced Government policy or opinion leaders or that she was the first person to put any idea forward.

Publication

Nature of Publication

Date /Reference

Policy Proposed by Barbara

Subsequent Action by Others e.g. Government or Opinion Leaders

How can A&E units improve their performance?

Click here

 

Guest blog written by Barbara for 2020health think tank.

January 2015

1.            1. Patients whose medical circumstances do not justify a visit to A&E should not be allowed to utilise excessive resources.

There is not time for radical action to be taken before the General Election on 7th May 2015.

 

2.  A&E departments should have a single, strong leader with experience of A&E.

There is not time for radical action to be taken before the General Election on 7th May 2015.

3. The NHS could have a small central team available to help A&E units on request with their statistical analysis and to provide appropriate software so that bottlenecks can be kept to a minimum.

There is not time for radical action to be taken before the General Election on 7th May 2015.

4.  The biggest obstacle standing in the way of major improvements in A&E departments is not money but rather real difficulty in recruiting and retaining doctors and staff. This issue must be addressed.

There is not time for radical action to be taken before the General Election on 7th May 2015.

5. There are strong arguments for fewer, larger A&E departments.

There is not time for radical action to be taken before the General Election on 7th May 2015.

6. Additional steps should be taken to educate the public about when to attend A&E, when to call an ambulance and what alternatives exist.

There is not time for radical action to be taken before the General Election on 7th May 2015.



 

      THIS PAGE WAS LAST UPDATED ON 3RD MAY 2015.  

Barbara Arzymanow