Legislation

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Breaking: Anaesthetists United take GMC to court for pushing non-doctors in doctor roles

Published by Anonymous (not verified) on Tue, 04/06/2024 - 7:19pm in

General Medical Council changed rules to allow ‘associates’ to be exempt from national standards and trusts to set own local standards

A group of anaesthetists under the name of Anaesthetists United (AU) has announced today that it has engaged leading legal firm Bindmans to take the General Medical Council (GMC) to court for allowing unqualified ‘doctors’ – so called ‘physician associates’ (PAs) and ‘anaesthetist associates’ (AAs) whose role is used to extend NHS privatisation and help private medical providers – and the Royal College of Physicians – to make bigger profits, to be confused with doctors.

The roles have also been used to avoid national standards, allowing local health boards effectively to use the roles how they wish. At least two patients, who thought they were being treated by fully-qualified doctors, have died as a result of misdiagnoses by PAs that led to no treatment being given for dangerous conditions.

The government used a backdoor ‘statutory instrument’ to push through recent changes to widen and relax the use of PAs and AAs – opposed only by independent MP Claudia Webbe. Labour then colluded with the Tories to defeat an attempt by Green and independent peers to block the legislation in the House of Lords. Actual medical professionals are horrified at the threat to patients and AU is now taking action.

The group says that the GMC is abusing the term ‘medical professionals’ to include undertrained PAs and AAs as doctors. The legal action crowdfunder explains:

The General Medical Council was given powers under the Medical Act 1983 to regulate doctors and protect the public from those falsely claiming to be qualified when they are not. But instead, we have watched with dismay as doctors are quietly being replaced by ‘Associates’. Worse still, the GMC appears to be actively encouraging this. 

We’ve listened to empty reassurances from the establishment, as the lines between the two professions have been systematically blurred.

We think patients deserve better; they should be cared for by doctors when necessary, should know who is and is not a doctor, and there should be separate regulation underpinning this.

And we’re ready to take action.

What are Physician/Anaesthesia Associates?

Physician Associates and Anaesthesia Associates are a new profession. They are not doctors, they do not have the same training as doctors, but are being permitted to take on many of the roles doctors have traditionally fulfilled. The press have reported on troubling cases. And the General Medical Council, the body legally responsible for doctors’ regulation, has now been given the responsibility of regulating Physician/Anaesthesia Associates too.

(To make it more confusing, an “Associate Specialist” is an experienced doctor.)

So how have they blurred the distinction between Doctors and Associates

Parliament originally made it clear that Associates were to be kept entirely separate from doctors. There should never have been any ambiguity as to who or what a health worker is. But instead, the GMC has made the situation vague and indistinct.

The biggest worry is that the GMC have steadfastly refused to say what an Associate can, or cannot, do to support patients. The precise term for this is their ‘scope of practice’. The GMC have even refused to hold a consultation on it, despite a statutory requirement for them to do so.

So it is left entirely down to market forces to determine scope. This favours using Physician/Anaesthesia Associates as doctor replacements. There is no good reason for this ambiguity: in comparison, the General Dental Council has strict rules on the difference between dentists, hygienists, technicians and the other professions that they regulate.

Worse still, the GMC has confusingly started to use the term ‘Medical Professionals’ to encompass both doctors and Associates. It has even issued guidance on ‘Good Medical Practice’ for both doctors and Associates to share.

We believe the GMC is simply ignoring the law on professional regulation.

You can read our legal case in more detail here.

What are we trying to achieve?

  • Clear and enforceable guidance from the GMC on the ‘privileges of members’ admitted to Associate practice, defining what they can and cannot do (their Scope of Practice) and clear rules on levels of supervision. This can be delegated to the appropriately-empowered Medical College/Faculty.
  • The current ‘Good Medical Practice’ guidance replaced by two separate sets of guidance for the two separate professions, and
  • An end to the use of the ambiguous term ‘Medical Professionals’ used to describe two separate groups misleadingly.

What have we done so far?

On 26th March we wrote to the GMC setting out our case. In their reply they answered some of our points but completely failed to address others. We feel that the only route left open to us is a legal one, and we have had expressions of interest from some top lawyers in the field.

How much money do we need?

We have been quoted the sum of £15,000 to cover the initial costs of a brief and opinion. 

We are working with John Halford of Bindmans LLP, a public law solicitor with experience in the regulatory framework on protected titles, and Tom de la Mare KC of Blackstones. Both of these are highly regarded and respected in their expertise; we need to work with the best.

It is quite possible that a strongly-worded representations from top lawyers will be sufficiently forceful to push the GMC into accepting our proposals. But if not, then the next step is court action. We don’t yet know how much that will cost, although we do know that the GMC has a reputation for spending large sums of public money on defending themselves.

Who are we?

Anaesthetists United are a group of Anaesthetists of all grades. 

Anaesthetists have a reputation for getting things done. We are the group that convened the Extraordinary General Meeting of the Royal College of Anaesthetists, which led to a sea change in the way the medical profession, and the public, have looked at the whole issue of Associates. You can read more about us as a group, and details of our core members, here.

The GMC was set up so that the public could tell who was and was not a doctor. That aim is now being undermined. We urge doctors and patients to come together and fund a legal challenge to restore faith and ensure that patient safety is never compromised. 

Thank you.

If you wish to republish this post for non-commercial use, you are welcome to do so – see here for more.

US Congress passes Act to defund Defense, State Depts and NSC unless Israel gets all arms

US political insanity regarding Israel in a nutshell as politicians move to cripple their own government unless it enables foreign regime’s genocide

The US Congress has passed a bill that will de-fund the Defense Department, State Department and National Security Council if Joe Biden does not immediately agree to send Israel any and all weapons it wants, with no strings attached.

Biden had delayed some shipments of the largest and most indiscriminate bombs, in a token effort to show that he is not enabling Israel’s genocide, after polling showed many usual Democrat voters will not back him in November’s presidential election because of his support for Israel despite its slaughter of tens and tens of thousands of Palestinian civilians, mostly women and children and its deliberate creation of famine in Gaza. But it seems even that token show of resistance is intolerable to Zionist groups.

More than a dozen Democrats colluded with Republicans to pass the new Act titled “To provide for the expeditious delivery of defense articles and defense services for Israel and other matters” by 224-187 votes. The text of the Act reveals the genocidal insanity of a majority of US politicians, most of whom will have received significant funding from pro-Israel groups, or else been threatened that the same groups will fund their opponents at the next election. It mandates the defunding of the three key government departments if Biden does not submit and send Israel :

The world has not gone insane in the fact that so many western politicians – including in the UK – are prepared not just to turn a blind eye to genocide, but to actively enable it. It has long been insane, but the madness has been exposed by apartheid Israel’s nakedly genocidal ambitions.

Biden is said to be prepared to veto the legislation if the Senate does not block it.

If you wish to republish this post for non-commercial use, you are welcome to do so – see here for more.

Educational Gag Orders, etc. in the US

Published by Anonymous (not verified) on Thu, 29/02/2024 - 1:11am in

What are state legislatures across the United States doing to limit academic freedom and otherwise interfere in education?

You can see a state-by-state breakdown of existing and pending legislation on a sortable table here. The table was created by the PEN America Foundation.

It lists “educational gag orders” and other types of legislation.

If you click on the tab labeled “Other Higher Ed Bills of Concern” you’ll see a table that starts like this:

It would be good to hear from those in states in which some of these bills have been introduced or made into law about their effects on their colleges and universities, and how their administrations are responding.

 

The post Educational Gag Orders, etc. in the US first appeared on Daily Nous.

Care Without Pathology: How Trans- Health Activists Are Changing Medicine – review

Published by Anonymous (not verified) on Thu, 01/02/2024 - 11:07pm in

In Care Without Pathology: How Trans- Health Activists Are Changing Medicine, Christoph Hanssmann explores the evolution of trans therapeutics and health activism through ethnographic fieldwork conducted in New York City and Buenos Aires. Demonstrating how grassroots movements are disrupting social and biomedical power structures, the book is an essential contribution to research on depathologisation efforts in trans care, writes Robin Skyer.

Care Without Pathology: How Trans- Health Activists Are Changing Medicine. Christoph Hanssmann. University of Minnesota Press. 2023.

Find this book: amazon-logo

Care without pathology_cover“The moves that would help the most transgender people the most? None of them are transgender specific”. Paisley Currah, praised political scientist and co-founder of the leading journal in trans* studies TSQ: Transgender Studies Quarterly, stated what seems to be a fairly obvious point at a seminar in 2020. Yet, considering the ways in which dominant political and media discourses speak about trans* therapeutics (the term that the author of Care Without Pathology, Christoph Hanssmann, uses to describe the wide variety of gender-affirming care), trans* health, and hence trans* lives, are still considered to be an exception.

(Following Marquis Bey, in this article I use “trans*” – with an asterisk – as a disruptive term that perturbs ontological states. Most often, in Anglophone contexts, “trans” is used as an umbrella term to describe individuals whose gender identities expand beyond, subsume, or deny a binary structure. The use of the asterisk frees “trans*-ness” from its corporeal, nominalist ties. Instead, “trans*” becomes a function or expression; one that is neither predetermined nor limited in its scope.)

Hanssmann traces the shifting definition of trans* therapeutics, from 20th century transsexual medicine to contemporary crip, trans*-feminist informed healthcare infrastructures.

In Care Without Pathology, Hanssmann traces the shifting definition of trans* therapeutics, from 20th century transsexual medicine to contemporary crip, trans*-feminist informed healthcare infrastructures. In contrast to gay and lesbian depathologisation, Hanssmann notes, trans* activists and advocates have not looked for a divorce from medicine (as the tools for therapeutic care were, and continue to be, controlled by the state), but for a transformation of biomedical care structures. This is not to say that the movement seeks assimilation with, or inclusion within, current systems, but instead asks: what would it be like to receive the care we ask for, in the way that we need?

Care without pathology […] resists the damaging effects of legal, state, bureaucratic, and financial systems upon pathologised groups

Hanssmann emphasises how issues such as medical gatekeeping and self-determination in care settings are the result of hegemonic power relations; issues that many (multiply-)marginalised groups face in their interaction with biomedical practice. Care without pathology, he argues, calls not only upon a broader change of healthcare infrastructures, but resists the damaging effects of legal, state, bureaucratic, and financial systems upon pathologised groups. As such, trans* health activism has more in common with disability and feminist movements, as they contest hierarchies of power and systemic harm within the constraints of the present.

As an ethnographic study, Care Without Pathology is founded upon eight years of research in Buenos Aires, Argentina, and New York City, USA. Hanssmann argues that by choosing locations in both the Global South and the Global North, he was able to engage in “transhemispheric discursive inquiry” (17), an approach that leans away from a standard comparative study by acknowledging the interactions and relations between research sites. Although I would contest Hanssmann’s use of this oversimplified dichotomy, his choice of locations enables us to explore different contexts in which major changes in the regulation of trans* therapeutics were taking place between 2012 and 2018.

In Argentina, 2012 saw the passing of the Gender Identity Law, which removed the requirement of a diagnosis for trans* therapeutics. In 2013, the publication of the Diagnostic and Statistical Manual (DSM-5) by the American Psychiatric Association removed “Gender Identity Disorder” from their guidelines and included a new diagnostic classification: ‘Gender Dysphoria’, which advocates saw as a positive step toward depathologisation. Hence, Care Without Pathology spans a period of significant transformation, the effects of which are continuing to unfurl. Moreover, Hanssmann draws upon ethnographic observations and interviews, ensuring that the voices of social workers, community members, activists and advocates resonate throughout the book.

Hanssmann draws upon ethnographic observations and interviews, ensuring that the voices of social workers, community members, activists and advocates resonate throughout the book.

Hanssmann describes vivid examples of grassroots activism and its volatile association with political compromise. Chapter Three, for example, focuses upon the use of epidemiological biographies by community-based researchers in Buenos Aires. This involved the combining of biographical data with statistics, creating visuals and information about the effects of violence and discrimination upon the health and lives of travesti and trans* people. Through this method, organisers were able to leverage political focus upon Argentinian state responsibilities for premature deaths, as well as institutionalised neglect and violence with regards to employment, healthcare, and housing. However, as Hanssmann highlights, this use of statistical collectivisation, and the concept of “population”, are closely associated with state power, structural violence, and trans* necropolitics.

[The] use of statistical collectivisation, and the concept of “population”, are closely associated with state power, structural violence, and trans* necropolitics

This is particularly salient for travesti, for whom the subsuming of their livelihoods, identities, and culture under a wider trans* umbrella is colonial oppression. (I urge readers to review the work of Malú Machuca Rose, who writes about travesti and resistance to colonial usage of the word; as well as the works of Giuseppe Campuzano and Miguel A. López.) It is through the discussion of these conflicting ideas that Care Without Pathology deftly illustrates the complexity of struggles for change.

Another example is outlined in Chapter Four, where Hanssmann describes the “narrow passageways of action” (149) used to contest Medicaid exclusion. Activists and advocates pressed for access to trans* therapeutics by using the language of state authorities that spoke predominantly of economic risk. They highlighted the negative effects of austerity measures and reframed the narrative around trans* therapeutics as a public good. Nevertheless, as Hanssmann explains, by utilising a method that draws upon human capital and the politics of investment, one may ask whether more harm may be caused (or left to fester), through an adherence to these neoliberal conceptions. It seems antithetical to use economic value as a measure for the “worthiness” of lives, when coalitional social change is what you are striving for.

What happens when trans* people seek to distance themselves from biomedical and state institutions, and find self-supporting solutions?

Hanssmann acknowledges that there has been a narrative shift from trans* health to trans* wellness, a change that reflects depathologisation efforts. He also mentions the work of scholars such as Cameron Awkward-Rich, Hil Malatino, and Andrea Long Chu, who highlight the constitutive pain and negativity of trans*-ness as a counter to “curative” discourse surrounding trans* therapeutics. Yet what could expand upon Hanssmann’s work is an exploration of self-procurement and therapeutic experimentation. What happens when trans* people seek to distance themselves from biomedical and state institutions, and find self-supporting solutions? Consequently, we may ask whether the term “trans* therapeutics” is appropriate to describe trans* care practices. It is in this area that my own PhD research is situated. My current research approaches the topic of trans* care through qualitative, participatory techniques and looks to complement Hanssmann’s analysis.

Where Care Without Pathology succeeds is through the presentation of trans* activisms that have acknowledged the epistemological ties between groups and individuals that are labelled as “an exception”. By demonstrating how the politics of difference creates harm through biomedical structures and other systems of power, Hanssmann highlights the need for coalitional activism in the struggle for social change, and as resistance to neocolonialism. It is an excellent addition to the reading lists of scholars, activists, and indeed, anyone interested in social movements, queer studies and the sociology of care.

This post gives the views of the author, and not the position of the LSE Review of Books blog, or of the London School of Economics and Political Science. The LSE RB blog may receive a small commission if you choose to make a purchase through the above Amazon affiliate link. This is entirely independent of the coverage of the book on LSE Review of Books.

Image Credit: Ross Burgess on Wikimedia Commons.

Activists labelling Israeli supermarket items as ‘apartheid’ and ‘apartheid Starmer’

Hum(our)ous and deadly serious

Activists have begun labelling Israeli items in supermarkets as ‘apartheid’ products, in a campaign to raise public awareness of Israel’s crimes against Palestinians and promote the peaceful ‘BDS’ (boycott, divestment and sanctions) movement to pressure Israel into ending its apartheid and war crimes – with different versions laid out to match (at least) Sainsburys and Tesco label layouts:

And Keir Starmer has also made himself a target of the campaign for his unstinting support of Israel’s flagrant breaches of international law, after at least one group took the original labels and edited them to reflect his ties to and funding from right-wing and pro-Israel groups and figures, before applying them liberally to supermarket shelves:

The global BDS campaign’s effectiveness can be seen in the fact that Israel created a whole ‘Ministry of Strategic Affairs’ to combat it and the way that Israel’s supporters constantly attack it. The UK government is in the process of passing probably-unlawful legislation to ban local authorities from applying BDS against goods and services from illegally-occupied territories.

The campaign has also been deployed against global brands such as Starbucks and McDonalds, with reportedly substantial impact on their profits.

Israel’s genocidal campaign in Gaza has so far killed at least 33,000 civilians, mostly women and children, and wounded more than twice that number of people – often with life-changing injuries. The country is facing a genocide case brought against it before the International Court of Justice by South Africa.

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