Consultants fight closures

A group of 35 consultants from Cheltenham General Hospital have taken a stand against closing childrens' wards. They have sent a letter to Health secretary Dr John Reid asking him to call in proposals to move children's inpatient services to Gloucestershire Royal. They say the move is the thin end of the wedge and that it will lead to more services leaving Cheltenham and going to Gloucester.
The doctors are worried that the move will put a strain on the A &E department, reduce the skill levels of Cheltenham clinicians to deal with sick children and lead to a decline in care.
The letter has been sent just days before Battledown campaigners will confront Dr Reid when he visits Gloucester next Tuesday to open the Royal's new children's ward.
The signatures on the letter include some of the hospital's top consultants from every speciality: anaesthetists, surgical, medical, opthalmology, orthopaedics, peadiatrics and radiology.
It is an astonishing show of strength and gives the lie to the Trust's claim that the closure is in the patients' best interests.
In the letter they say: "The proposed removal of inpatient paediatric services will lead to the removal of comprehensive maternity services and affect critically our ability to deal with severely ill children.
"Sick children brought by their parents to A &E and those involved in major accidents will continue to arrive in our hospital. The necessary infrastructure and theatre equipment required for children are unlikely to be maintained when the proposed changes take effect. The loss of acute paediatrics and maternity services will inevitably affect our ability to deliver acute services to our local people."
Last month, Primary Care Trust board members agreed to move children's inpatient care to Gloucestershire Royal.
They ignored a vigorous protest, a 24,000 signature petition and objections from politicians of all parties
The letter continues: "The recent local consultation process did not mention relocation of maternity services let alone the threat to acute services in general. We implore you to call in and reconsider the proposals carefully as they will lead inexorably to major reductions in care that can be delivered to our local population."
Last week it was revealed that the Battledown ward was used to back-up Gloucestershire Royal's new children's unit 20 times in the past three months. Gloucestershire Royal's new flagship children's hospital couldn't cope because it didn't have enough nurses. Children were sent to the Battledown ward instead.
Retired surgeon and Battledown campaigner Dr Geoffrey Fox believes the letter is serious indictment of the proposals from key players at the hospital.
He said: "The consultants all agree the move could be the end of acute services at Cheltenham General. It's a commonly held opinion that the proposals are part of a bigger plan to move services from Cheltenham. Many believe the hospital will be left to deal with cancer therapy, cold surgery such as hip operations and geriatrics. Each time you take specialities away from a hospital it tends to weaken it.
"This is a powerful letter made even more significant by the people who have signed it. They see Cheltenham as being downgraded and are worried for its future. The fact that Gloucestershire Royal has struggled recently backs up their calls for the proposals to be called in."
A spokeswoman for Cotswold and Vale Primary Care Trust, which oversees children's services in the county, said: "Gloucestershire Hospitals NHS Foundation Trust is committed to a continuing future with two thriving district general hospitals.
"During the public consultations in in 2002, Trust directors stated that there were no plans for the kinds of wholescale changes to services at Cheltenham General Hospital which are suggested in this letter. The concerns about children being treated at the A &E department at Cheltenham General have been widely discussed and it's true that children will still be seen in the A &E Department.
"Currently one quarter of all A &E Department patients are children, and the vast majority of these are treated by A &E staff - this will continue.
The spokeswoman said Battledown would still be actively caring for children with an extended children's assessment unit facility operating from 9am to 10pm daily) at Cheltenham General Hospital.

http://www.thisisgloucestershire.co.uk/displayNode.jsp?nodeId=139307&command=newPage&contentPK=12010558

Great Ormond St hospital cancelled operations and wards

Great Ormond Street hospital has revealed they have had to cancel operations, close beds and close wards because of a funding crisis. The famous children's hospital blamed a systemic financial crisis.
This year nearly 100,000 sick children entered for world-renowned care, hundreds more than the hospital was paid to treat - so the hospital needs to make up £1.7m.
A small sum when its budget is a hundred times that - but to balance the books by April, it has closed beds, offered nurses less money for extra shifts and cancelled some operations.
Critically ill children who can only be looked after there will not be turned away but morale is low.
Nurses have briefed a newspaper that the cuts are devastating for a hospital that has never wasted money. One parent's experiences appear to back up the claims.
The hospital is an example of the paradox at the heart of the politics of health.
The government says Great Ormond Street and the NHS has more money than ever before. The hospital gets £50m more - nearly a third of its budget - than six years ago.
This year, English hospitals and community health get an extra £5.1bn - but more than three quarters is eaten up on higher pay and new working practices.
The reduction in junior doctors' hours and indexing staff pensions all cost more. It also costs £900m on running new buildings and hospital drugs, leaving just over a billion pounds left of the extra money.
The Conservatives have hammered NHS failure this week -Michael Howard is now pushing further on what's traditionally been seen as Labour territory.
On Tuesday, he will announce plans to allow patients who do not get a rescheduled operation within four weeks to move to another hospital thereby denying the original hospital the fee it would have got for the surgery.

http://www.channel4.com/news/2005/03/week_1/06_ormond.html

£200m vaccine will be just a stopgap against flu outbreak

More than 53,000 people could die, but antiviral jab will not prevent all the deaths the Government took out a £200 million insurance policy yesterday against an epidemic of flu that could kill more than 50,000 people.
Under political pressure and on the eve of a World Health Organisation meeting in Luxembourg to discuss flu preparedness, the Department of Health rushed out a plan based on buying 14.6 million courses of the antiviral drug Tamiflu.
The plan says that more than 53,000 people could die in a pandemic in Britain unless precautions are taken. The only sure defence is a vaccine, but that cannot be made until the precise make-up of any pandemic strain is known.
Tamiflu is a stop-gap measure but should reduce the severity of the disease and prevent some deaths, said Professor Maria Zambon, head of the National Influenza Centre at the Health Protection Agency.
Yesterday’s announcement came after warnings from WHO that a strain of bird flu with the ability to spread rapidly in people could develop, turning the few cases of human infection that have occurred in Asia into a global epidemic. John Reid, the Health Secretary, said: “We are working closely with other governments and WHO to ensure the international community is as well prepared as it can be to spot and address the early signs of a pandemic. However, it makes sense to ensure that we in the UK . . . have drugs against an influenza pandemic.”
Other countries had ordered stocks of Tamiflu and the Conservatives were pressing the Government to act. Andrew Lansley, the Tory health spokesman, said: “The Government’s response is late and incomplete. We needed a stockpile of antiviral drugs to be produced months ago and action to promote vaccine production. The Labour Government once again failed to act and to give public health the priority it requires.”
For several weeks the Department of Health has been fending off questions about flu preparedness by saying the plan would be published in the spring. Paul Burstow, the Liberal Democrat spokesman, accused the Government of being slow to tackle a threat that experts believe “is not simply a question of ‘if’ but ‘when’ ”.
The quantity of the drug ordered is based on the assumption that one in four people will catch the disease. The estimated 53,700 deaths assumes a one in 300 mortality rate among those infected, as in the 1957 Asian flu pandemic.
In Asia, the death toll from bird flu has been much higher, at 75 per cent of those infected. But an avian flu virus that has developed the ability to infect people easily is expected to lose some virulence in the process, becoming much less lethal than pure bird flu which infects only those in direct contact with birds.
There are, however, many uncertainties. The 1918-19 flu virus killed 1 per cent of those it infected, and if this were reproduced in a new pandemic the death toll in Britain would reach 141,800 in the absence of effective action.
In the extreme case considered, where half the population catches flu and the mortality rate is 2 per cent, more than 700,000 people would die. But the 50,000 figure is considered much more likely.
Sir Liam Donaldson, the Chief Medical Officer, said: “Wherever in the world a flu pandemic starts, perhaps with its epicentre in the Far East, we must assume we will be unable to prevent it reaching the UK. When it does, its impact will be severe in the number of illnesses and the disruption to everyday life.”
In a typical year, between 12,000 and 18,000 people die from “seasonal” flu, mainly among high-risk groups such as the elderly. Pandemic flu occurs when the virus changes sufficiently to attack people who have acquired immunity to the regular strains.
http://www.timesonline.co.uk/article/0,,8122-1507087,00.html

25,000 die from preventable VTE

Each year over 25,000 people in England die from venous thromboembolism (VTE) contracted in hospital. This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents, and more than twenty-five times the number who die from MRSA. The figures are alarmingly high.
Even more alarming is the fact that many of these deaths are preventable. There is a safe, efficacious and cost effective method of preventing venous thrombosis which is not being as widely administered as it should be.
There are various reasons for this situation. Witnesses told us that many physicians and surgeons were not aware of the extent of VTE. A substantial number of patients who develop VTE first show signs that they have the disease after they have been discharged from hospital. As a result the original physician or surgeon who treated the patient in hospital is often not informed that their patient suffered from the condition after leaving their care.
Moreover, there are no national guidelines which would ensure that doctors consider the risk of VTE and the availability of prophylaxis.
The Department of Health has now commissioned the National Institute of Clinical Excellence to produce a set of guidelines for the administration of preventative measures which are expected to be published in May 2007. This is a remarkably tardy response to a serious situation and, moreover, the scope of the guidelines commissioned by the Department is limited to a subset of surgical patients, while the majority of sufferers are non-surgical patients. In contrast, in the United States the American College of Chest Physicians has recently published the 7th revision of their guidelines which were first produced in 1986.
Based upon the effectiveness of the intervention and the cost effectiveness of applying that intervention, routine thromboprophylaxis for appropriate potential groups in hospital was ranked the number one most important safety practice in that country by the US Health Agency for Research and Quality.
We recommend that the NICE VTE guidelines be extended in scope to cover the majority of hospital patients. We further recommend that on admission to hospital all patients, both medical and surgical, be counselled about the risks of VTE and undergo a risk assessment to determine if prophylaxis, to help prevent the onset of venous thrombosis, should be administered. To raise awareness among medical practitioners of the extent of the problem we recommend that all physicians and surgeons are informed if their patients contract VTE after they have been discharged from hospital.
During the inquiry we heard serious doubts as to the extent to which the guidelines will be implemented when they finally become available. This is a recurring problem which the Committee has come across in several inquiries. Accordingly, our report makes recommendations to ensure their effective implementation. The Department, NICE and the Royal Colleges should work together to raise awareness of the extent of VTE and to audit the use of the guidelines. Our most important recommendation is that thrombosis committees and thrombosis teams should be established in each hospital to promote best practice now, using accepted guidelines adapted for local practice, and to be a source of education and training for all staff dealing with patients at risk of VTE. When NICE guidelines are published the committees and teams will be in place to ensure adherence.
They should be modelled on the effective teams and committees dedicated to improving the use of blood transfusion. Finally we recommend that the Healthcare Commission audit the availability and use of venous thrombosis prophylaxis in hospitals.

http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/99/99.pdf

NHS needs foreign Doctors

The NHS is so short of doctors that it would stop running if it didn't bring in doctors from abroad. The British Medical Association said last year that 70% of accident and emergency departments across the country were short of doctors.
Many left A&E departments to become General Practitioners - where there's also a shortfall.
Some 14,736 new doctors appeared on the medical register last year, according to the General Medical Council (GMC). Of these, 10,005 came from other countries.
Bringing in skills from abroad is proving cheaper than training new doctors, as each one costs an estimated £200,000.
And with fewer than 8,000 new medical students in Britain last year, more are needed to fill the gaps.
According to the GMC's figures, the majority of new doctors registering in Britain came from India - a total of 3,644.
Pakistan accounted for nearly 1,000 new doctors.
But there are also large numbers from other European countries, for example, 771 came from Germany.

http://www.sky.com/skynews/article/0,,30000-13305447,00.html