Department of Health and Social Care
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Chief Medical Officer launches Annual Report
The Chief Medical Officer, Sir Liam Donaldson, today published his Annual Report for 2006, On the State of Public Health, in which he reviews key health problems and developments. He calls for action in five key areas:
improving levels of hand hygiene in hospitals (a key factor in infections such as MRSA) by giving patients the power to establish whether healthcare professionals have cleaned their hands and giving patients a personal supply of alcohol-based handrub tackling the present crisis in organ shortages for transplantation by introduction of an opt-out system for donors, as is done successfully in some other countries reducing the risk of radiation overdoses during cancer treatment by extending the use of monitoring devices to all radiotherapy machines in the country conducting more research to establish the reasons why 500 babies die each year despite starting the process of birth apparently healthy ('intrapartum-related deaths') taking steps to increase the number of women in the most senior positions in medicine.
The Chief Medical Officer is the UK Government's principal medical adviser. His Annual Reports have championed the need for action on key public health issues such as smoke-free enclosed public places. The Chief Medical Officer also highlights the work in each of the nine public health regions.
The report in more detail: hand hygiene
Sir Liam calls for action on the unacceptably low levels of hand hygiene in hospitals. Poor hand hygiene is strongly linked to healthcare infection and incidence of superbugs like MRSA and Clostridium difficile. Despite improvements, such as the more widespread use of alcohol-based handrubs, levels of compliance by healthcare staff with hand cleaning protocols seldom rise above 60%, and are often lower. Experience in some other countries - notably Switzerland - shows that high standards of hand hygiene cuts infection rates and saves lives. Studies show that patients are reluctant to challenge doctors and nurses even when they know that they have not cleaned their hands.
To tackle this, the Chief Medical Officer proposes that:
patients should be empowered to work with healthcare professionals and ask them if they would like to clean their hands before treating them patients will be provided with alcohol-based handrubs to offer staff
Sir Liam Donaldson said:
"Good hand hygiene should be a natural reflex for healthcare professionals, yet it no longer has the status it once had. Every time a patient is touched, several thousand bacteria can be passed between the clinician and a patient. Yet patients do not feel able to ask their doctor or nurse if they have washed their hands before touching them. I believe that by empowering patients to work with healthcare professionals on this issue we can improve hand cleaning rates amongst healthcare staff and reduce the number of infections."
The report in more detail: shortage of organs for transplantation The report also addresses the grave shortage of organs for transplantation - on average one patient a day is dying on the transplant waiting list.
The current organ donor system is based on an 'opt-in' approach whereby people enrol on the NHS Organ Donor Register to give permission for their organs to be used in the event of their death. Recent legislative changes to strengthen this wish - overriding that of their relatives - has done little to increase the number of organs for donation. The Chief Medical Officer therefore proposes an 'opt-out' system be introduced, similar to that in some other European countries which has helped improve their supply of organs. An opt-out system would mean people would register to say they specifically do not want to be donors rather than they do. Safeguards would be built in to any new system of donation.
Sir Liam added:
"There are simply not enough organs donated to meet the need for transplants, with one person dying every day while waiting for a transplant. Compounding this are issues surrounding consent, which often reduce this number further. To meet current demand for organs the number of people on the NHS Organ Donor Register would need to approximately treble. I believe we can only do this through changing the legislation to an opt-out system with proper regulation and safeguards."
The report in more detail: other topics
Launching his 2006 Annual Report On the State of Public Health, Sir Liam Donaldson also draws attention to:
Preventing harm from radiotherapy
Radiotherapy saves lives in the treatment of cancer and other conditions. Giving the wrong dose of radiation by mistake can harm and kill patients. Such errors do occur. The Chief Medical Officer recommends that the use of in-vivo dosimetry radiation checks (this is where after a first dose of radiation, it is measured to ensure it is correct) should be mandatory. He also recommends that a full analysis of all past serious incidents be carried out by the National Patient Safety Agency, working with the NHS Litigation Authority and the Royal College of Radiologists, to identify common causes and the scope for reducing risk.
Newborn baby deaths
Approximately 500 babies a year start labour apparently healthy and then die (intrapartum-related deaths), a figure that has remained unchanged since 2000. It is of concern that the current national survey on maternal and infant deaths no longer reviews the causes of intrapartum-related deaths in detail. The Chief Medical Officer calls for further review of deaths, research and education to avert these deaths.
Women in medicine
Two-thirds of new medical students are women, yet less than 30% of consultants, 11% of professors and 36% of senior lecturers are female. Studies of women doctors' attitudes and experience show that many regret entering the profession because of the barriers to career progression that they encounter. Sir Liam calls for improved flexible working patterns and increased childcare facilities for NHS staff.
Notes for Editors:
1. A copy of the Chief Medical Officer's Annual Report 2006 On the State of Public Health can be downloaded from the Department of Health website, http://www.dh.gov.uk/cmo
2. The NHS Organ Donor Register currently has approximately 13 million people on it. The actual figure or potential organs is far less, as not all people registered die in a manner that makes them suitable donors. Only 2,794 organs were actually transplanted last year, so using a simple ratio the NHS Organ Donor Register would need to recruit approximately 35 million people to meet that need.