Chief Medical Officer Sir Liam Donaldson has identified five key areas of health in need of attention in his Annual Report for 2006, On the State of Public Health.

Perhaps the most headline-grabbing of these is his suggestion for an opt-out system for organ donations to tackle the present “grave shortage” of donors. Under this system, everybody in the country would be eligible for organ donation, unless they specifically request to opt out.

This is a complete reverse of the current opt-in system under which people sign up to the National Health Service Organ Donor Register giving consent for their organs to be donated in the event of their death. Recent changes to legislation sought to give more power to a patient’s wish to donate their organs, even overriding that of their relatives, but this failed to substantially boost the number available for donation, according to the report.

Explaining the proposed move to an opt-out system, Sir Liam said: “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 move has been backed by the British Medical Association, which said that “moving to a system of presumed consent, where it is assumed that people are willing to donate their organs after death unless they opt out, combined with other reforms to the transplant infrastructure, would play an important part in improving the organ donation system so that more lives can be saved.”

Boosting hygiene

Another issue close to everyone’s hearts is that of hand hygiene, which plays a crucial role in the spread of infections such as the notorious, potentially dangerous and difficult-to-treat methicillin-resistant Staphylococcus aureus. Keeping this superbug under control has been at the top of the priority list for some time, but still levels of hand hygiene is “unacceptably low” in many hospitals, Sir Liam stressed.

To help raise the standard of hygiene, Sir Liam has proposed giving patients the power to ask healthcare professionals to wash their hands before treatment, and providing them with their own supply of alcohol-based handrub.

“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,” he explained.

The other priorities highlighted in Sir Liam’s report are: 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; and taking steps to increase the number of women in the most senior positions in medicine.