Sobbing teenagers, angry staff and threats: my week in NHS payroll

Monday

I arrive at my desk just as our manager approaches a colleague suffering from back pain and asks how she’s doing. She replies that she is in a lot of pain. Our manager responds: “I’m not interested; I’m asking if you’re going to meet your deadline. If you don’t complete your work by 10am you can explain to 5,000 people that they haven’t been paid due to your failure to do your job properly.”

I am personally responsible for the distribution of millions of pounds of public money: I pay domestic, portering, maintenance, clerical, nursing and medical staff, senior managers, chief executives and apprentices. My in-tray is brimming with timesheets, expenses claims and new starters to set up.

Among the 43 emails that have arrived over the weekend, there are queries about sickness entitlements, reports of unpaid enhanced hours, and a request for a salary advance “because I’ve spent all my money”.

Tuesday

A team member announces her pregnancy. We are happy for her but it means extra work for the rest of us. Any absences for maternity, paternity, sickness, career breaks and in many cases leavers, are dealt with by sharing out the workload among those of us still present.

I check reports, set up new starters and calm a sobbing teenager who thought she’d be paid the living wage rather than apprentice rate. I have four overpayments to calculate, all due to failure by departmental managers to inform us of two leavers, a reduction in someone’s contract hours and a member of staff suspended. I have to produce a report for each to pass to NHS fraud investigators. The managers apologise to me for the extra work, but leave me to deal with their upset and angry staff.

Wednesday

I plough through a huge report detailing changes to employee records made by HR and departmental managers. To do this thoroughly would take several days but I have an hour so a perfunctory scan and crossed fingers will have to suffice.

I receive a beautiful handmade thank you card from a grateful payee I arranged an urgent payment for after her manager forgot to send us her timesheet for a whole month of night shifts. It is the second one I have received in over 20 years in the job and it will be treasured. I am happy all day.

Thursday

An angry man calls and tells me his expenses payment is wrong again; he insists his claim detailed an overnight stay in a hotel and several hundred business miles. I fax him a copy which displays 22 miles and a 60p parking ticket. He tells me his sister-in-law works in HR at our trust and will have me fired.

Not speaking my mind when my managers and people are rude to me is difficult. Senior managers tell us we are there to support them, middle managers focus on their next promotion and the line managers carry their workload. Their frustration is not reported due to a culture of fear and blame, and is instead directed at us.

A colleague has the flu but is afraid to stay off as it will trigger a sickness review: three short absences in a year, or just one long-term can lead to job loss. I make her hot drinks and cover her work for her.

Friday

An electrical fault has affected our telephone line and for once it is quiet. The peace is short-lived. When the line is repaired, people accuse me of switching off my phone to stop them getting through. I calm each one down and deal with their problems and queries. I notice it is 6.30pm and I have been working for free for the last hour – again.

Some details have been changed

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Sobbing teenagers, angry staff and threats: my week in NHS payroll

Poorer countries fail to act on smoking due to big tobacco threats, says WHO

Many low- and middle-income countries are too scared by the threats and misinformation of big tobacco to raise the price of cigarettes, even though it would hugely benefit both health and the economy, according to a major new report.

The most effective measure to help people stop smoking is to impose high taxes on cigarettes, says the report by the World Health Organisation and the US National Cancer Institute. But even though smoking costs the world economy $ 3trn (£2.5trn) a year, poorer countries are afraid to tackle it in the most effective ways, it says.

“They are scared because of the issues raised by the tobacco industry,” said Jeremiah Paul of the WHO’s tobacco control economics unit. The industry warns of an increase in smuggling and illicit trade in tobacco, for instance, which the WHO and the US National Cancer Institute, the co-producers of the report, say does not happen.

“They are afraid of being taken to court if they increase tobacco taxes,” said Paul. “They [the industry] will scare you that tobacco taxes are anti-poor, that government revenue will go down.” But there is no evidence to support any of these claims, he said.

Six million people die every year as a result of smoking tobacco and although smoking rates are slowly going down, the numbers are increasing as the population of the world grows. There are also fears of a big expansion in Africa and the Middle East as big tobacco targets poorer countries now that hardline control measures such as bans on smoking in public places have taken effect in wealthier ones.

There are 1.1 billion smokers globally over the age of 15 and already 80% are in low- and middle-income countries. Many are already poor – an estimated 226 million smokers live in poverty. Those are the people who would benefit most from stopping, because they are least likely to get good healthcare and most likely to suffer from the disabling and economic effects of tobacco, such as losing their job.

The monograph says that global tobacco excise taxes generated nearly $ 269bn (£221bn) in government revenues in 2013-2014 – yet less than $ 1bn was invested in tobacco control.

High tobacco taxes raise money for governments while deterring smokers. The monograph says annual excise revenues from cigarettes globally could increase by 47%, or $ 140bn, if all countries raised excise taxes by about 80 cents per pack. This tax increase would raise cigarette retail prices on average by 42%, leading to a 9% decline in smoking rates and up to 66 million fewer adult smokers.

Controlling tobacco does not harm economies, the report says. The number of jobs dependent on tobacco has been falling in most countries, and when smokers quit they spend their money on other sectors of the economy instead. Tobacco farmers, who mostly do not earn a good living, can be helped to diversify into other crops.

“Tobacco use remains one of the world’s leading causes of preventable death, and increasingly, the health and economic burden is borne by the poorest countries and people,” said the WHO’s global ambassador for noncommunicable diseases, Michael R Bloomberg, whose philanthropic foundation has invested nearly $ 1bn into tobacco control. “By accelerating the adoption of the many cost-effective tobacco control policies available today, we can save millions of lives,” he said.

José Luis Castro, chief executive of the global health organisation Vital Strategies, warned that the death toll from tobacco will rise if tougher controls are not brought in. “While governments are committed to reduce tobacco deaths, the lack of effective tobacco control laws in many countries means that tobacco will kill one-third more smokers and non-smokers by 2030: 8 million deaths every year,” he said.

“This is avoidable. We urge governments to implement strong tobacco control policies, particularly high tobacco taxes that have the greatest, fastest impact on consumption, while also potentially funding better access to healthcare.”

Poorer countries fail to act on smoking due to big tobacco threats, says WHO

Merck Makes use of Legal Threats To Stifle Negative Suggestions About Zetia And Vytorin In Italy

In response to repeated legal threats, a public health physician in Italy has withdrawn tips to curtail use of a controversial drug. The drug, ezetimibe, is a important ingredient in Zetia and Vytorin, which is produced by Merck Merck. The cholesterol-reducing drug has been the subject of fierce controversy due to the fact it has never ever been shown to improve clinical outcomes. Regardless of the controversy, in 2013 the medicines had mixed revenue of a lot more than $ two.six billion.

MSD Italy, the Italian arm of the company, sent two “cease and desist” letters to Alberto Donzelli, who is “the head of education, appropriateness, and evidence based mostly medication at the public health authority of Milan (Milan Healthcare),” according to The  BMJ, which published a information report of the affair. The letter was also sent to Milan Healthcare’s director standard and to Roberto Carlo Rossi, the president of the physicians’ regulatory organization in Milan.

As reported in The BMJ, right after the very first letter Rossi replied that the medical commission had concluded “that there was no purpose to object on ethical grounds to Donzelli’s behaviour. Donzelli also replied to every single level raised in the letter. ‘I exercised my right to inform the general practitioners what emerged from our in-depth analyses of the published literature, on a peer to peer basis.’”

In a second letter MSD Italy “reaffirmed its intention to go to court except if Donzelli stopped his ‘seriously damaging action, [that was] tarnishing the company’s and the drug’s picture and status.’” MSD’s medical director, Patrizia Nardini, advised The BMJ: “We are in favour of balanced info, and we decided to write individuals letters simply because we didn’t see a willingness to assess all the data in a balanced way.”

Last month Donzelli capitulated and removed the contentious material from his internet site “until the problem is more clarified within the scientific neighborhood,” The BMJ reports.

In a published statement, quoted by The BMJ, the editors of 5 Italian publications expressed assistance for Donzelli: “In the educational and informational process, the disagreement should be expressed on the pages of scientific journals as a debate between peers, such as the readers who will be ready to determine freely what is the most proper option for individuals.”

Donzelli is hardly alone in criticizing the continued use of ezetimibe in spite of the absence of evidence for clinical benefit. Just recently, ACP Internist, an inner medicine website, raised the query: “Why are we even now prescribing what appears to be a ineffective drug?” The continued use of ezetimibe in clinical practice was also the topic of a information feature in JAMA.

Merck Makes use of Legal Threats To Stifle Negative Suggestions About Zetia And Vytorin In Italy