Health Direct » 2005 » July

£1 Billion PFI Paddington project debacle faces double review

Dr Search- Principal Consultant at the Search Clinic — Fri, 29 Jul 2005 22:37:00 +0000

The collapsed £1 billion Paddington health campus will be subjected to a two-pronged review in an attempt to improve the quality of future private finance initiative schemes in the NHS.

The National Audit Office this week confirmed that it would conduct its own investigation into the scheme – which spent nearly £14m of taxpayers’ money – following requests from three MPs.

The inquiry will begin after North West London strategic health authority concludes its own independent review after abandoning the project last month.

A statement released by the SHA last week states: ‘The intention of the review is to ensure that lessons are learned from the experience of planning and implementing the project, and to improve the quality of future similar PFI projects across the wider NHS.’ The review is likely to take two months.

An NAO spokesperson said it would be engaging constructively with the SHA review but would then ‘consider whether its final product addressed all the concerns adequately’.

He added: ‘We are going to see how far the review goes and do our own report to the chair of the Paddington health campus.’

The SHA ploughed on with the project to merge St Mary’s and Royal Brompton and Harefield hospitals despite reservations from government finance experts about its viability.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=2851094

Scandal of the jobless doctors

Dr Search- Principal Consultant at the Search Clinic — Thu, 28 Jul 2005 09:26:00 +0000

Doctors across the north west who are trained at a cost of millions of pounds can’t find jobs. In one shocking case, Manchester medic Ivo Dukic, 25, has been rejected from nearly 80 posts and is now looking abroad for work. He is even considering giving up medicine altogether despite seven years’ study.

The crisis is hitting recent medical graduates who have completed the first part of their training as a house officer. They need to get a senior house officer (SHO) post to become fully qualified.

This two-stage training process is designed to give young doctors experience of treating a variety of illnesses.

But, despite shortages of doctors throughout the NHS, there is an increasingly limited number of SHO jobs.

The British Medical Association said many junior medics will be left without a job when their contracts expire next Tuesday.

A survey of recent graduates – who each received around £250,000-worth of training – found many without work were now considering leaving the country, switching career, or even claiming unemployment.

More than a third of doctors who completed the first stage of their training said they had not been able to get the advanced training job they needed. Nearly 58 per cent of the 276 surveyed said they would consider going overseas to train.

Planning

The BMA has written to Health Secretary Patricia Hewitt, pointing out the problem is partly the result of increasing demand for posts and partly due to poor planning.

It says the number of places at medical schools has increased and applications from overseas medics are rising.

But at the same time the number of postgraduate training posts has not been growing at the same rate. It adds that part of the problem is down to the new training structure for young doctors.

The BMA said the government had claimed there was no reduction in the number of SHO posts. But their own research of SHO jobs advertised in BMJ Careers showed such posts halved between May 2002 and May 2005.

Simon Eccles, chairman of the BMA’s junior doctors committee, said:“We keep hearing from doctors who’ve been turned down for hundreds of jobs. It makes no sense at a time when the country is short of fully trained medical staff, we’re pushing doctors into unemployment.”

The exact number of Greater Manchester’s 2,000 medics affected is unclear, but Dr Kailash Chand, who represents the BMA in the north west, said: “There are doctors who aren’t able to finish their training. The system is fundamentally flawed.”

A Department of Health spokesman said: “There has always been healthy competition for SHO posts, particularly in popular areas and specialities.

“No jobs have been phased out as a result of the new structure. There have been a small number of SHO posts and ‘Trust grade’ posts used to pilot the new training programmes.

“There will be further changes in August 2006 with the national roll-out of the second year of the Foundation Programme, but these changes do not impact on the overall number of training posts.”

http://www.manchesteronline.co.uk/men/news/health/s/167/167520_scandal_of_the_jobless_doctors.html

Superbugs still spreading through hospital

Dr Search- Principal Consultant at the Search Clinic — Wed, 27 Jul 2005 08:40:00 +0000

An inquiry into an outbreak of a lethal ’superbug’ that infected 300 patients and caused 12 deaths at Stoke Mandeville Hospital in Buckinghamshire has been delayed because the infection is still spreading.

The independent inquiry into the outbreak of Clostridium difficile, which causes severe diarrhoea, was ordered by the Health Secretary, Patricia Hewitt, eight days after it was revealed by The Independent on 6 June. The Healthcare Commission, the Government’s NHS watchdog, announced on 14 June that it would conduct the inquiry.

More than five weeks on, the commission said it was not yet ready to go into the hospital. “The investigation will begin when it is clear the outbreak of C. difficile at Stoke Mandeville Hospital is under control.”

The number of infections with C. difficile have soared in hospitals across the NHS from about 1,200 in 1990 to more than 43,000 in 2004. Latest figures show there were 934 deaths in 2003, a 38 per cent rise in two years.

Stoke Mandeville was infected with a new strain of the bug, C. difficile 027, which is more virulent and harder to eradicate than existing strains, in late 2003. The number of infections peaked between January and March 2004, fell back in the summer and then peaked again last winter.

A spokesman for the hospital said yesterday: ‘We have now had a prolonged period of declining levels of infection. New cases are running at around eight to ten a month, which is about where they were before the outbreak began.’

Marcia Fry, head of operations at the Healthcare Commission, said it was for the Health Protection Agency to declare when the outbreak was under control. ‘The thinking is that it would not be helpful for us to be in there while the infection control people and the Health Protection Agency are in there getting it under control.

‘The evidence from Canada is that this has a seasonal pattern and can flare up again. If that were to happen we could find ourselves going in and then having to come out again.’

The aim of the investigation was to learn the wider lessons of the outbreak for the NHS, she said. ‘We expect them to accept us into the hospital in the early autumn. The investigation should take four to six months.’

Under terms of reference, the commission will examine all cases of infection with C. difficile from 1 November 2003 and the action taken to control and arrest the spread of the bug, as well as the role of local agencies and national policy.

A second outbreak of C. difficile struck the Royal Devon and Exeter Hospital, where 265 patients were infected in the first five months of the year and 23 died. The bug has also been identified in patients at 13 other hospitals across the nation.

Ms Fry said the commission would consider how the other hospitals were affected and how they had responded, but there were no plans to send investigators into them at this stage. ‘We want to take account of them and how they handled it and put all that in the pot.’

http://www.rednova.com/news/health/183972/superbug_still_spreading_through_hospital/

NPSA publishes first NHS patient safety data analysis

Dr Search- Principal Consultant at the Search Clinic — Tue, 26 Jul 2005 08:16:00 +0000

More than half a million patients every year suffer as a result of medical errors or incidents while in NHS hospitals. The first public analysis of patient safety data in England and Wales is published by the National Patient Safety Agency (NPSA).

This key report – the first in a series – offers a unique overview of patient safety issues in the NHS for all those working in and using the NHS with an interest in improving patient safety and the quality of care. It features:
• The latest data from the Agency’s National Reporting and Learning System (NRLS) including a breakdown of reports from different healthcare settings
• An analysis of patient safety incidents and emerging issues from the NRLS that are being flagged to the NHS via a new bulletin
• An analysis of reported deaths in the NRLS
• A description of the NPSA’s Patient Safety Observatory (PSO) and how this will support improvement in patient safety
• A comparison of the latest data from the UK with results from six other key studies of adverse incidents from across the developed world
• Case studies to illustrate how the NRLS supports the NPSA to improve patient safety

Chief Medical Officer Sir Liam Donaldson said: “Patient safety is rightly now a key priority for the NHS – and many other health services around the world. We must ensure that when patients are harmed, sources of risk are identified, solutions are implemented and lessons are learned. But we can only do this if we know what is going wrong. This first report and analysis from the NPSA helps us to understand where systems are weak and drive forward improvement.”

There were 85,342 incident reports to the National Reporting and Learning System (NRLS) between November 2003 and March 31 2005 affecting 86,142 patients. The majority of incidents – 68 per cent – resulted in no harm to patients and about one per cent led to severe harm or death.

Reporting levels are increasing rapidly. Almost 75,000 reports were sent to the NRLS in the second quarter of the year between April and June.

230 Trusts reported to the NRLS during the period covered by the PSO report. In a separate analysis within the report, information from 18 of these acute Trusts that have reported incidents consistently over a three month period was used to estimate reported incidents and deaths for the whole of England.

From this analysis we estimate that there would be approximately 572,000 incidents and 840 deaths reported to the NRLS each year from acute hospitals.

Professor Richard Thomson, NPSA’s Director of Epidemiology and Research said: “It must be remembered that the great majority of NHS care is safe and effective with over a million patients successfully treated every day. However, it is inevitable in complex healthcare systems, treating often very sick patients, that sometimes things can and do go wrong.

“When things go wrong it is usually as a result of a problem in the system within which staff work. The NPSA will improve patient safety in large part by improving the systems that support staff in providing the highest quality of care.

“Good information is the first step to understanding what needs to be done. But without action, information is meaningless. We use this information to identify issues and highlight priority areas to develop solutions.

“The NRLS is an immensely rich source of data. However, incident reports on their own cannot tell us all we need to know about patient safety. That is why the NPSA has also set up the Patient Safety Observatory to bring together data from our reporting system with other sources of information such as confidential inquiries, litigation bodies, clinical data, industry, the public and patients. Together, these will provide a more complete picture of patient safety.”

Commenting on the study to estimate reported deaths and incidents in England, Professor Thomson said:“The number of incidents is of the same order of magnitude as previously quoted estimates of 850,000 adverse events a year but the number of deaths is considerably lower than the widely quoted figure of 40,000. Our analysis of reported deaths to the NRLS will contribute to the debate about the size of the problem, but further research is needed to arrive at a more precise figure.

“Nonetheless, every death is a tragedy for the patient, their family and, indeed, for the staff involved. We are committed to working with the NHS to prevent such tragedies.”

A new publication for the NHS is also launched by the NPSA today. Patient Safety Bulletin, a review of learning from patient safety incidents, has been developed to rapidly feed back data and safety concerns to NHS organisations and healthcare professionals.

It aims to raise awareness of specific patient safety problems, share evidence and where possible provide practical advice on how to minimise the risks. It will help to fulfil the NPSA’s commitment to feed back issues and share learning with the tens of thousands of NHS staff who take the time to report incidents and issues to the NPSA. The first issue features a number of emerging themes. They include:
• Safe medication practice with anticoagulant medication. The NRLS data included 311 incidents involving anticoagulants with two deaths. A recent study found that 6.5 per cent of hospital admissions were due to adverse drug events with problems caused by the interaction of anticoagulant medication and some painkillers featuring most commonly. Approximately 500,000 patients take anticoagulant medication at any one time.
• Missing equipment on crash call trolleys is putting critically ill patients at risk. Evidence is emerging from NRLS data of missing or unserviceable equipment on crash call trolleys. Trusts should ensure they have robust systems in place for the replenishment of trolleys.
• The management of patients with a tracheostomy. An issue has emerged over the care of tracheostomy patients, particularly when they are being cared for on general wards following time in the Intensive Care Unit. The NPSA is aware of four deaths in these circumstances. Management of these patients on general wards may be more risky than healthcare staff currently realise though this should be seen in the context of more than 10,000 tracheostomies
carried out in the NHS annually.

NPSA Joint Chief Executive Susan Williams said: “This report reflects the efforts of the tens of thousands of NHS staff who have taken the time and trouble to report errors and system failures to us so that we can identify what needs to change and make healthcare safer for patients.

“It demonstrates that having gained knowledge of issu
es, action has been taken by the NPSA and the NHS to address these issues. It is further proof that the NHS is at the forefront internationally of tackling patient safety issues head on and the NPSA has an important part to play in this,” she said.

http://www.npsa.nhs.uk/site/media/documents/1261_PSO_RepotNewsRelease.pdf

Targets are distorting patient care

Dr Search- Principal Consultant at the Search Clinic — Mon, 25 Jul 2005 08:23:00 +0000

The side-effects of targets need to be monitored to ensure they do not lead to distortions in patient care, according to Healthcare Commission chief executive Anna Walker. Speaking at the launch of the commission’s annual State of Healthcare report, Ms Walker said NHS services were improving, but mainly in areas where there were targets or a national service framework.

Those which are not so comprehensively covered by policy, like sexual health, maternity and dental services, have been left behind, according to the report, which focuses on the NHS from the patients’ perspective.

Some targets are having unintended consequences even within their own fields, said Ms Walker.

‘We need to recognise the side-effects that they [targets] could be having and adapt accordingly. We can do this by monitoring the side-effects,’ said Ms Walker. She used the example highlighted before the general election of patients being unable to make GP appointments in advance because practices feared pre-booking would restrict their ability to meet the 48-hour target.

Targets needed to be shared by the whole health economy, she added. ‘There has been less progress in areas which are not covered by targets or an NSF. The statistics on those finding it hard to sign up with a dentist are startling.’

She called for healthcare organisations to provide the commission with evidence about any unintended consequences caused by targets.

The report praises cuts in outpatient and inpatient waiting times along with improvements to cancer and heart services. It says that over 90 per cent of patients rate their care as good, very good or excellent.

However, the Healthcare Commission says that despite improvements, the NHS still has a long way to go if it is to achieve its ambition of becoming a patient-led service.

Some 58 per cent of dental practices are not taking on new NHS patients, up from 40 per cent in 2001; only 40 per cent of adults who require mental health treatment are getting it; and nearly 30 per cent of people who need sexual health services are waiting more than 48 hours for an appointment.

‘Patients are not interruptions to the NHS’

Patients are treated as if they are invisible and are not given adequate information on their care, the Patients Association has claimed.

In a passionate response to the State of Healthcare report, Patients Association policy director Simon Williams expressed dismay that ‘this country is still ranked so poorly on involving patients in decisions that affect their care’.

The Healthcare Commission report identified growing health inequalities and poor communication with patients about their treatment and aftercare as problems.

‘I find it astonishing that some of these patients report that they are spoken to as though they were invisible by too many hospital staff,’ Mr Williams said. ‘No organisation can survive if it ignores those it is here to serve. Patients are not interruptions, they are the reason for the NHS.’

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=2796544

Patient enthusiasm for private sector threatens hospitals

Dr Search- Principal Consultant at the Search Clinic — Fri, 22 Jul 2005 08:09:00 +0000

NHS hospitals across Birmingham and the Black Country strategic health authority may struggle to survive if they do not address the threat from the private sector, research has revealed. And the SHA has warned that other cities may face the same risks.

The MORI survey revealed that patients believed the private sector was superior to the NHS on 12 out of 14 factors, including cleanliness and the quality of management. Over 70 per cent of those surveyed said they would be ‘fairly’ or ‘very’ happy for their NHS care to be carried out in the private sector.

The survey asked people in each local authority within the SHA which local hospitals they would choose for an operation. HSJ has seen information published on three of the six authorities. It showed that private sector hospitals were first choice in one area and second choice in two. In two of these areas, six NHS hospitals were ‘chosen’ by less than 4 per cent of local populations.

As a result, the SHA has carried out modelling exercises which show that about £35m of annual income is in jeopardy across its seven non-specialist acute trusts.

The SHA commissioned the survey of 1,200 people in order to assess the potential impact on the NHS of choice, including the ‘extended choice network’ from next April. The sample was skewed towards those aged 45-74 to take account of those likely to access elective care. Under extended choice, patients will be given a choice of 40-50 hospitals from a menu of all foundation trusts, the private sector and local services.

The SHA stressed that it was making the findings public so that NHS services could adapt their strategies accordingly. SHA director of strategy Peter Spilsbury said: ‘We are not sure every one in the NHS has clocked that from April 2006 we are going to move much quicker to a much wider range of choice. Choice is happening now; it’s real.’

He said the rest of the NHS could learn from the SHA’s research: ‘Although the survey is based on findings from our area, they could well be replicated in many other urban areas across the country.’

Mr Spilsbury said the implications of the survey amounted to about £35m in potential lost NHS income, equating to 13 per cent of the area’s £275m income: ‘The seven trusts on our patch could lose £5m-£15m each. Choice is going to have a significant affect on everyone. It would be foolish to suggest otherwise.

‘In every local authority, between 20 and 30 per cent [of those surveyed] would consistently choose the private sector,’ added Mr Spilsbury.

MORI asked respondents what would make them more likely to use the private sector. The top reason – cited by 85 per cent of those surveyed – was if the private sector was ‘MRSA-free’.

Mr Spilsbury said the survey demonstrated how drastic the impact of patient choice could be: ‘If people do what they say they will, the independent sector could be the single biggest provider of elective surgery. Across the SHA the level of demand to use the independent sector will be 15-20 per cent of the population’.

SHA chief executive David Nicholson said the survey showed that ‘introducing choice and contestability are the right policies; people clearly have an appetite for choice and are happy for the NHS to pay for private sector care’.

HOW MUCH MORE LIKELY WOULD YOU BE TO USE THE PRIVATE SECTOR THAN YOUR LOCAL HOSPITAL IF…..

It was MRSA free:
Much more likely: 73%
A little more likely: 12%
No more likely:11%
Don’t know: 3%

Waiting times were shorter – half those for your local hospital:
Much more likely: 69%
A little more likely: 17%
No more likely:12%
Don’t know: 3%

It was recommended to you by your GP:
Much more likely: 68%
A little more likely: 18%
No more likely:11%
Don’t know: 2%

It provided free door-to-door transport for yourself:
Much more likely: 57%
A little more likely: 17%
No more likely: 24%
Don’t know: 2%

It offered flexible appointment times:
Much more likely: 55%
A little more likely: 22%
No more likely: 21%
Don’t know: 2%

It guaranteed car parking facilities:
Much more likely: 51%
A little more likely: 16%
No more likely: 31%
Don’t know: 2%

It was recommended by your friends and family
Much more likely: 49%
A little more likely: 26%
No more likely: 22%
Don’t know: 3%

It offered a private room for those that want it:
Much more likely: 48%
A little more likely: 23%
No more likely: 27%
Don’t know: 2%

Base: 1,201 residents

Hospitals failing on safety targets, says CMO

Dr Search- Principal Consultant at the Search Clinic — Thu, 21 Jul 2005 09:31:00 +0000

Hospitals are slow to introduce measures to protect patients’ lives, Prof Sir Liam Donaldson, the chief medical officer for England, said yesterday. Publishing his annual report, On the State of Public Health, Sir Liam said the NHS had “not fully embraced” the concept of patient safety.

Up to half of hospitals failed to comply or did not comply with safety improvements within the deadlines set, the report says.

“Compliance was slow and some deadlines were not met even though taking action could reduce the risk of a patient’s death. And some NHS trusts reporting compliance were found, on independent inspection, to be non-compliant.”

As a result some hospitals were stopped from delivering one type of cancer treatment until they had complied and all hospitals that provided it were being inspected again to see if they were following the safety measures.

This guidance followed the death of Wayne Jowett, aged 18, who “was killed in Nottingham” when a cancer drug was given into his spine instead of a vein. His death in 2001 followed 25 similar deaths.

Sir Liam said it was “hard to imagine a more high-profile case” than Wayne’s. Following his death, hospitals were given a year to introduce a safety checklist to avoid giving the injection wrongly in the future.

In 2002, three months after the deadline, one hospital in five was not fully complaint. In January 2003, the position had slipped back and a third were not fully compliant. By November 2004, with 12 per cent still not following all the checks, the Department of Health made the guidance more comprehensive.

In January this year all hospitals reported that they were following the new guidance. But in May a review of 19 hospitals found nine were “non- compliant on inspection despite three of these having claimed compliance prior to the inspectors’ visits”.

Another case was that of Najiyah Hussain, aged three, who died after she was mistakenly given nitrous oxide (laughing gas) instead of oxygen at Newham General Hospital, east London, in November 2000.

It then took two years for hospital trusts to report that all the resuscitation machines that delivered gas to patients had been replaced or fitted with warning systems.

The report also describes how this year, 45 per cent of trusts had failed to take action on a Safety Alert over a painkiller within a 245-day deadline.

The painkiller, wrongly given, had caused 25 deaths and 26 cases of “serious harm” over 10 years.

Sir Liam said they needed to understand why some trusts reacted so slowly. “These are not wilfully bad people down there in the hospitals. There is something about the way people respond to multiple priorities. We need to understand what is happening in an organisation,” he said.

“We have a locally-devolved NHS which is dependent on fulfilling standards which are set nationally. If the local NHS wants, rightly, to have that autonomy to meet the needs of patients and to use their budgets, then their part of the bargain is they have to meet national standards.”

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2005/07/20/nhosp20.xml

Chief Medical Officer’s Annual Report

Dr Search- Principal Consultant at the Search Clinic — Wed, 20 Jul 2005 09:18:00 +0000

“On the state of public health” The CMO ANNUAL REPORT 2004 by Prof Sir Liam Donaldson, the chief medical officer for England.

Since taking up the post of Chief Medical Officer, in the autumn of 1998, I have used my Annual Report to draw attention to the major challenges in health and healthcare facing our country, particularly those where I have felt that current action is not sufficient to fully address them.

I have sought also to identify smaller scale problems: for example, where an adverse trend in the occurrence of a disease is unexplained and is giving rise to concern. This very much captures the spirit of the earliest Chief Medical Officer Annual Reports – dating back to the 19th century – which fearlessly identified problems and actively championed the need for action.

This – my fourth Annual Report – comes at the end of a particularly busy year. Progress
has been made on two key public health threats which I highlighted in my 2002 Annual Report: second-hand smoke and obesity.

Since 2002, there has been widespread public discussion, ongoing media coverage and extensive consultation on these issues, as well as expert analysis and review. This culminated in the
production of a new public health White Paper. Choosing Health set out a wide range of proposed actions to improve tobacco control and curb obesity, as well as actions to address other major public health problems of today. Choosing Health puts population health and health inequalities squarely at the centre of the Government’s health policy agenda.

I have pushed very hard on the need for action to create smoke-free public places and workplaces. The proposals set out in Choosing Health represent real progress but, in my view, do not go far enough. I want this country to be alongside the best in the world in public health in protecting their populations and future generations from the scourge of tobacco.

The consultation on the proposed legislation to create smoke-free restaurants, food-led pubs/bars and workplaces offers the opportunity to strengthen the approach originally planned,
should the weight of opinion be behind this simpler and more rigorous option.

This year has also witnessed important developments in the area of infectious disease control. There has been great concern about the frequent occurrence of methicillin resistant staphylococcus aureus (MRSA) infections in NHS hospitals. MRSA is one of the so-called ‘superbugs’, a common bacterium that has become resistant to successful treatment with commonly used antibiotics.

The rate of MRSA infection is higher in this country than many other European countries.

A range of actions to improve hygiene and infection control is already being undertaken, including substantial investment in cleanliness, the recruitment of new matrons and the
establishment of infection and prevention control teams in each NHS Trust hospital.

Figures published in June 2005 indicate that these measures are beginning to work: the
total number of MRSA blood infections in England dropped by 6.1% in 2004/05 compared with 2003/04. This programme, which is being led by the Chief Nursing Officer, is vital for the safety of patients in NHS hospitals and it is essential that the current momentum is maintained.

Tuberculosis (TB) is another infectious disease that is re-emerging and work is under way to implement an action plan which I published in October 2004.

Recommendations include: quicker and more effective screening of high-risk groups, DNA fingerprinting to track the spread of the disease in communities and better co-ordination of clinical care. The rate of TB has been rising in England over the last 10 years, particularly in London and other major cities.

There are now 13 cases per 100,000 people, and every year around 350 people die from the disease. The long-term goal is not only to reduce TB infections but to all but eliminate the disease from this country.

Major planning has also been undertaken to combat the impact of an influenza pandemic. The World Health Organization (WHO) and other international organisations have recently warned that a flu pandemic is both ‘inevitable’ and ‘imminent’.

Such warnings have been largely fuelled by the persistence of a highly virulent strain of bird
(avian) flu in Asia. While these warnings aim to ensure countries are prepared for such an event, they have also caused public concern over the nature of the threat and our ability to respond to it.

The consequences of an influenza pandemic would be serious, with the numbers of people falling ill and dying being far higher than those associated with ‘ordinary’ winter flu outbreaks.

My team has worked tirelessly to bring together the best ideas and expertise, both globally and in this country, to anticipate and respond effectively to an influenza pandemic should one occur. A national plan and other supporting documents were published in March 2005, which collectively provide a proper understanding of the nature of the threat, its likely impact on the United Kingdom and the action necessary to mitigate pandemic influenza when it comes to this country.

From August 2005, the two-year Modernising Medical Careers Foundation Programme begins. All junior doctors starting their pre-registration house officer year in August will benefit from this innovative development in postgraduate medical training. Under the new curriculum,
junior doctors will need to demonstrate their competence in a number of areas not previously addressed in medical training, including: communication and consultation skills, pat ient safety, clinical governance and team-working. Trainee doctors will need to show they have learned a range of skills, including the undertaking and use of research, time management and use of
evidence and data.

The development of the Foundation Programme curriculum for the first two years of postgraduate medical education will help ensure that trainees’ acute clinical and professional skills are secure and robust. It is a curriculum focused on quality of care and ensures that, at the end of their two years’ training, doctors are both confident and competent and so patients will benefit.

The issue of how best to quality assure medical practice came to the fore in the Shipman Inquiry’s fifth report produced by Dame Janet Smith. I have been asked by the Secretary of State for Health to consider the implications of this report and recommend further measures to strengthen procedures aimed at
ensuring the safety of patients in situations where a doctor’s performance or conduct poses a risk to patient safety or the effective functioning of services.

The proposals will also seek to ensure the operation of an effective system of revalidation (the five-yearly review of a doctor’s licence to practise) and will examine the role, structure and functions of the General Medical Council. At present, this work is at the consultation stage and I have appointed an expert advisory panel to assist me with this task.

The United Kingdom has the Presidency of the European Union (EU) in 2005. For the health element of the Presidency, two areas have been chosen that are of great importance in improving health outcomes in all EU countries: tackling health inequalities and improving patient safety.

There will be over 20 meetings and summits scheduled between July and December 2005. With the enlargement of the European Union there will not be another Presidency for the United Kingdom until 2017, when it will be shared with two other member states.

Our Presidency in 2005 therefore represents a vital opportunity for the United Kingdom to
make a significant contribution to the EU agenda, and from the health perspective we want to play our full part.

I have selected five new topics for attention in this year’s Report. Firstly, I have reviewed the extent to which the movement of cigarettes across international borders, either through smuggling or duty-free imports, is seriously undermining the traditional effectiveness of price increases to reduce tobacco consumption.

It is estimated that up to 25% of all cigarettes and hand-rolled tobacco in this country is not being taxed, leading to concerns about long-term health implications and the need for greater awareness are issued by the Department of Health and its agencies.

Awareness of the problem of patient safety has grown greatly over the last few years and, as illustrated in last year’s Annual Report, it is a worldwide problem.

Ours is one of the leading countries working to improve patient safety. It is important, however, that when serious risks to patients are identified, action is taken rapidly to reduce those risks. This action needs to be taken not just on an incident-by-incident basis but as part of a long-term strategy to be implemented throughout the NHS. It is clear that the culture of some NHS organisations needs to change. It is not enough to be aware of the problem of
improving patient safety nor to report adverse events when they occur. When alerts are issued, there needs to be commitment from the very top of the organisation to initiate immediate action to address the identified risk, to ensure that all staff are properly and consistently informed,
and to establish new procedures and processes of care to sustain the reduction of the risk in question.

In compiling this report, I am grateful for the help of a number of colleagues in the Department of Health. I am also indebted to a number of colleagues outside Whitehall in particular Elizabeth Draper, Angela Towers and Sean O’Kelly.

I should like to make clear, however, that the conclusions and opinions expressed in the Report are my own.

I hope you enjoy reading this Report. Every one of us has a role to play in addressing the issues raised. The progress, described in this Report, on issues highlighted in my previous Annual Reports, shows that public discussion as well as individual and collective action does make a
difference in improving health and the quality of healthcare in this country.

Sir Liam Donaldson
Chief Medical Officer

On the state of public CMO ANNUAL REPORT 2004 blic health 5

http://www.dh.gov.uk/assetRoot/04/11/57/83/04115783.pdf

NHS still has a long way to go to achieve a ‘patient-led’ service, says the Healthcare Commission

Dr Search- Principal Consultant at the Search Clinic — Tue, 19 Jul 2005 09:16:00 +0000

Despite improvements the NHS still falls short on putting patients first, says a watchdog. The NHS still has a long way to go to achieve a ‘patient-led’ service, says the Healthcare Commission.

The independent Commission is publishing its flagship annual report to Parliament on the state of healthcare in England and Wales, focusing for the first time on the experience of patients.

The Commission strongly praises the improvements that have taken place in some services, such as cancer and heart services. But other services have been left behind, such as sexual health, mental health, maternity and dental services.

The Chairman of the Healthcare Commission, Sir Ian Kennedy, said:

“There are many achievements to celebrate in the provision of healthcare. Services subject to targets and the requirements of national frameworks have produced significantly better outcomes, particularly for people with cancer and heart disease. People are not waiting as long for care in hospital. New ways of providing services, such as NHS Direct and walk-in centres, are helping to make services easier to obtain.

“The Government has set itself the aim of a ‘patient-led NHS’. But our health services still have a long way to go before we can say that they are really putting patients first. Being an NHS patient is too often a frustrating experience. Services can seem fragmented and seem to be designed more to suit the needs of those providing them than those using them. People want better access to services, and they also want to understand what doctors tell them and to be treated and spoken to in a caring manner. They need more comprehensive information about their health and appropriate involvement in the decisions about their care and advice on how to look after themselves when they leave hospital.”

The picture in Wales is harder to judge because the information is more limited. However it is clear that access to care in Wales is improving. The number of people waiting longer than 18 months for an outpatient appointment is down from 6,270 in December 2004 to 28 in March 2005.

The report asks three questions: do people receive effective healthcare services, do they have enough control over the care that they receive, and do some get a better deal from healthcare services than others.

The report pulls together the most available existing evidence on the experience of patients, including the Healthcare Commission’s own surveys of patients. The emerging findings were also checked with a series of patients groups.

In relation to the effectiveness of care, while overall patients’ satisfaction is high for most NHS services, there are a number of areas highlighted as concerns:

* Many people across the country have difficulty making an appointment with an NHS dentist. Nearly 60% of NHS dental practices are not taking on new patients, an increase from 40% in 2001. In some areas, no dentists are taking on new NHS patients.
* There are long waiting times for sexual health services, with 28% of people who need to be seen urgently having to wait more than 48 hours and 29% of people who have symptoms waiting more than two weeks. Only half of sexual health clinics in the UK are open more than 21 hours a week.
* Many maternity services do not meet the needs of women. Three independent investigations into maternity services over the past two years have highlighted a range of problems including: inadequate support and information for women who do not speak English; over-crowding; poor standards of cleanliness, and a lack of support and advice on issues such as feeding and bathing.
* Although services have improved for some people who need for mental health care, many mental health services still fall short of what people need. For example: fewer than half the people needing crisis care report being able gain access to it; half of people with depression are not receiving treatment; 23% of those on mental health wards and learning disability wards report having to share rooms with the opposite sex; and many people detained under the Mental Health Act say that their rights have not been explained to them.

On whether people have enough control over the care they receive, the Commission found:

* Many people are not getting enough information about healthcare, particularly about diagnostic tests and medication. Some say they do not have enough time to discuss their health with doctors and other professionals, and 70% of general practices did not have information available in a form suitable for people with learning disabilities. It is particularly worrying that more than a third of patients were not given information on the side effects of medicines, and 22% of patients with heart disease were not being told of alternatives to coronary artery bypass surgery and 49% were not given advice about necessary changes to make in their diet before being discharged.
* Many people have been given more control and choice over where they go for treatment. In areas where people were able to choose quicker treatment when they had waited six months, between 50% and 70% took up the offer. In England, 24,300 people have taken the option of faster treatment. In Wales almost 11,500 people took up the option for faster treatment in an alternative hospital.
* The Expert Patient Programme is an initiative that shows real potential and benefits, in terms of patients taking more control over the services they receive and the provision of help and support. In England, 17,000 people with long term conditions have attended courses to help them manage their own condition and become more involved in influencing how care is provided in their community. It has led to less use of A&E; and greater confidence in patients in managing their pain, tiredness and depression.

On whether some people get a better deal than others, the Commission found:

* There are wide variations in service and treatment, depending on which hospital patients go to and where they live. These are again highlighted as a national problem. For example, rates of immunisation and the take-up of screening programmes, as well as stop smoking services, showed lower levels of take up in poorer areas. The experience of ‘seldom heard’ groups, such as people with learning disabilities, homeless people and travelers, can be significantly worse than that of others using the health service.
* Last year, the Commission revealed that primary care trusts (PCTs) serving more deprived populations tended to fare worse than others. This year, the Commission has found that extra funding is now going to PCTs in deprived areas in England, and distribution is now more in line with levels of deprivation. Progress has also been made in Wales, where £41 million has been redistributed and the five areas that were most below their target allocations in 2003/2004 are now getting closer to these allocations.

The report also highlights a number of lessons for healthcare organisations and regulatory bodies, such as the Healthcare Commission. In particular, it emphasises the need to:

* ensure services are assessed on a broad enough basis
* improve information for patients at all stages of their care
* involve patients and the public in the design of services
* spread good practice and take action on wider inequalities in health

http://www.healthcarecommission.org.uk/NewsAndEvents/PressReleases/PressReleaseDetail/fs/en?CONTENT_ID=4018541&chk;=KvG1sX

Prostate cancer ‘priority’ call

Dr Search- Principal Consultant at the Search Clinic — Mon, 18 Jul 2005 09:11:00 +0000

Over 30,000 men are diagnosed with prostate cancer in the UK each year. Prostate cancer patients are demanding the disease is given a higher priority by the government and the NHS.

Prostate Research Campaign UK surveyed over 1,000 people who had the disease or were close to someone who did.

They found 96% felt there should be more investment in research and therapies for a disease which is the UK’s commonest form of male cancer.

Experts said advances in treatment were being made, but were not always available to all patients.

“Although, we are making significant steps in treating prostate cancer, such advances don’t always reach patients.” Professor Roger Kirby, Prostate Research Campaign UK

The survey also found 90% felt the negative impact of prostate cancer was under-estimated by the general public.

The survey follows a report from the National Audit Office published in February this year, which found prostate cancer patients were dissatisfied with the information they received about side effects and treatment outcomes, as well as waiting times to be seen by a specialist.

Each year, around 30,100 men are diagnosed with prostate cancer, and 10,000 die from the disease.

Drug review

Professor Roger Kirby, Visiting Professor in Urology at St Georges’s Hospital, London and chairman of Prostate Research Campaign UK said: “The findings of our survey should help us understand the needs of those directly affected by prostate disease and ensure that we direct resource where it will be most valued.

“Although, we are making significant steps in treating prostate cancer, such advances don’t always reach patients.”

Studies have shown the drug Taxotere (docetaxel), currently used to treat breast cancer, can help men with advanced prostate cancer.

It has been licensed for treating men with prostate cancer, but is not yet widely available, pending a review by the drugs watchdog, the National Institute for Clinical Excellence.

Professor Kirby said: “Men living with prostate cancer should be given the opportunity to make an informed choice about and have access to new treatments which provide prolonged survival and better quality of life.”

A second organisation, the Prostate Cancer Charity is beginning its own national survey of patients’ experiences of their diagnosis and treatment for the disease.

John Neate, the Charity’s Chief Executive says: “Our job is to drive hard to secure the very best NHS services for men affected by prostate cancer.”

A spokeswoman for NICE said: “People should not be denied any drug simply because it is under review by us.”

She said it would its conclusions would be published next summer.

http://news.bbc.co.uk/1/hi/health/4682299.stm