Health Direct » 2006 » October

NHS patient safety ‘must improve’ says Healthcare Commission

Dr Search- Principal Consultant at the Search Clinic — Tue, 31 Oct 2006 09:09:00 +0000

More needs to be done to improve standards of safety in the NHS and independent sector, a watchdog says. The Healthcare Commission said that while most patients received safe care, standards were inconsistent in England and Wales. The watchdog said there was no clear indication on the number of deaths that could be avoided. It also raised concerns about a range of other areas, including mental health care and health inequalities.

The annual State of Healthcare report draws on data from surveys, focus groups and inspections.

“It’s frustrating that in 2006 we do not have a clearer idea of how many people die or are harmed when this could have been avoided” Sir Ian Kennedy, of the Healthcare Commission. To illustrate his point, he said the National Audit Office could only estimate the number of deaths as a result of patient safety incidents ranged from 840 to 34,000.

It said attention had to be focussed on four areas: safety; designing services around patients; reducing inequalities in health; and tackling services for people with mental health problems, learning disabilities, older people and children.

Healthcare Commission Chairman Sir Ian Kennedy said: “There are real improvements to applaud and celebrate. These are having a genuine impact on people’s lives with many waiting less time for care and experiencing better treatment.”

The report revealed in the NHS, one in 10 trusts could not confirm that they fully met core standards on safety.

In the independent sector, one in 10 providers were ordered to improve the management of risks last year.

And the Healthcare Commission said 22% of the complaints it handles related to safety. Safety includes areas such as infection control and drug administration.

The report also marks the first publication of an overview of standards in the independent sector in England, which includes both private and voluntary providers.

Some 50% of providers met all 32 minimum standards, but one in 10 failed five or more – broadly in-line with NHS organisations.

Jo Webber, deputy director of policy at the NHS Confederation, said some things were improving with many trusts now actively encouraging their staff to report incidents.

“Communication to staff and patients is key here, but can often be a challenge in large and complex organisations.”

And shadow health secretary Andrew Lansley added: “It is a shame that this willingness to improve patient safety is not shared by the Department of Health.

“In December 2003, the Chief Medical Officer ordered a national audit of deaths caused by hospital-acquired infections. We are still waiting for it to be published.”

More information on this story can be found at: http://news.bbc.co.uk/1/hi/health/6098750.stm

The National Audit Office’s range of patient safety incidents estimates between 840 to 34,000 errs on the side of caution.

Health Direct warned on March 08, 2005 that 25,000 patients die from preventable VTE, when 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.

An aside from the Sir Liam Donaldson’s report last year was that July 20, 2005 Chief Medical Officer’s Annual Report was that the rate of MRSA infection is higher in this country than many other European countries and that Tuberculosis (TB) is another infectious disease that is re-emerging and work is under way to implement an action plan which he published in October 2004.

PbR Payment by Results are fundamentally flawed says coding chief

Dr Search- Principal Consultant at the Search Clinic — Mon, 30 Oct 2006 11:47:00 +0000

The current system of Payment by Results (PbR) is ‘fundamentally flawed and unacceptable’ the head of the Professional Association of Clinical Coders warned last week. Managing director Sue Eve-Jones told an HSJ conference last week that the quality of data in the NHS could compromise any chances of ensuring fairness under PbR. Her presentation was subtitled ‘doing the best we can with a fundamentally flawed and unacceptable system’.

Ms Eve-Jones said that healthcare resource groups, the standard treatment groupings used as units of currency within the health service, ‘are not designed to support payment systems and we are using them to support PbR’.

She painted a bleak picture of NHS data accuracy, blaming poor training and support for coders, Department of Health tariffs that have ‘no bearing on the real service’, and pressure to ‘upcode’ to generate more cash.

‘Some coders are asked by clinicians “which code will give me a better HRG?”, or you see directors of finance wandering around saying “we need more codes”. I am pleased to say that most coders are immune to this.’

And Ms Eve-Jones concluded that the NHS payments system ’scares me witless’. ‘It’s like going into Tesco, filling up your basket, and getting charged different prices depending on which checkout you go to.’

Health Direct has long warned that Payment by Results was doomed to be an expensive failure since April 01, 2005 Payment by Results- political pressure is undermining new PbR finance reforms

If you allow a whole load of unbundling – where you pay for little bits of the healthcare resource from up here and there – you destroy the principles, don’t achieve the benefits, and end up with locally based recovery systems, which is back to where we started with this reform.

Earlier this year the HSJ analysed the crazy conflict that Labour has created between PbR and the PFI schemes: June 10, 2006- NHS trusts feel the impact as PFI and Payment by Results collide “Imagine buying a house for a family with four children. Over the next few years you know you will need a lot of space to accommodate noisy teenagers. But in 10 years’ time your needs are not so clear cut: children may leave, elderly relatives may come to stay or you may be on your own.

Your income is also uncertain and not under your control: your boss has just refused a pay rise to reflect your high accommodation costs and says you can have the same as everyone else.”

MRSA twice as deadly as drunk drivers

Dr Search- Principal Consultant at the Search Clinic — Fri, 27 Oct 2006 14:22:00 +0000

Sir John Oldham, a GP and head of the Improvement Foundation, which advises primary care trusts, warned that one in five clinical staff failed to wash their hands, despite evidence that doing so cuts the incidence of hospital-acquired infections such as MRSA, which costs the NHS £1bn a year. Figures for 2004 show MRSA killed 1,623 patients in England and Wales. Some 580 people were killed in drink-driving incidents in Britain.

Sir John warned that “flouting of NHS hygiene was as bad as drink-driving’” and twice as deadly. Doctors and nurses who fail to wash their hands although they know it reduces hospital infections are as bad as drunk drivers, the NHS adviser warned yesterday.

The Health Direct Blog started over three years ago at the beginning of October 2004 when I became worried about the scandalous rise of MRSA in the NHS system. Which is a totally preventable and avoidable infection.

October 07, 2004 Twice as many people die of superbugs in dirty hospitals than die on British roads- The labour government seems to be surprisingly reticent in publicising the fact that twice as many people die in the UK from picking up lethal “superbugs” in dirty hospitals as die on the country’s roads.

Now three years later after the latest outbreak of a “superbug” in three hospitals in Leicester, despite NHS efforts to eradicate them, hospital- acquired infections are not going to go away.

At least 49 – possibly as many as 78 – patients were killed by the bacterium Clostridium difficile (C difficile) in Leicester and it is thought that it killed at least 20 patients at hospitals in Kent earlier this year.

Judy Potter, who chairs the Infection Control Nurses Association (Icna) said “In the last year or so we have seen a more virulent strain of C difficile that seems to cause the more severe symptoms. Antibiotics often cause the balance of friendly bacteria in the bowel to be reduced, predisposing patients to Clostridium difficile infection.”

Until now, MRSA (methicillin resistant Staphylococcus aureus) was considered the biggest superbug danger in hospitals – instances have risen by 600% in the past decade and it was cited on 1,623 death certificates in 2004 as the contributing or underlying cause of death.

However, C difficile is now thought to be a greater danger. In 1999, it was mentioned on 975 death certificates; in 2004, that had risen to 2,247, though not all these infections would have been picked up in hospital.

Experts say that hands should be thoroughly washed with soap and water, surfaces should be washed with bleach and wards steam-cleaned.

Hospitals should also find space to set up isolation wards for those affected. “There are some general measures that are recommended to protect patients against infection generally when coming into hospital,” says Potter. “They are mainly about common sense and good hygiene.”

More information on MRSA and C difficile infections can be found at:
http://www.guardian.co.uk/g2/story/0,,1887742,00.html
http://www.guardian.co.uk/uk_news/story/0,,1931589,00.html

NHS blows millions on removing 187,000 tattoos

Dr Search- Principal Consultant at the Search Clinic — Thu, 26 Oct 2006 13:03:00 +0000

The National Health Service spent tens of millions of pounds removing nearly 200,000 tattoos last year, according to figures released by the Department of Health last week. Rosie Winterton, the health minister, said in a Commons written answer that doctors had carried out the procedure, involving either skin grafts or lasers, on 187,063 tattoos.

The figure has astonished MPs and consultants who fear NHS funds are being spent on trivial surgery while patients are denied potentially life-saving drugs and staff are laid off.

Even conservative estimates of the cost of removing a small tattoo under anaesthetic on the NHS put the bill for 2004-05 at £37m, but some consultants suggested a figure of £300m.

Steve Webb, the Liberal Democrat health spokesman, said: “In a week when we’ve seen the NHS turning down Velcade (a cancer drug) it seems incredible that so much is being spent on tattoo removal.”

Tattoos were once seen as a rebellious statement and the preserve of criminals, bikers and sailors, but they have become increasingly mainstream adornments. According to research carried out by the Discovery Channel earlier this year, 29% of Britons aged 25-34 have tattoos.

They are popular among celebrities. David Beckham, the former England football captain, has tattoos bearing the names of his three children, while Robbie Williams, the pop singer, has a Maori pattern on his left arm, a Celtic cross on his right hip, a lion on his shoulder and his grandfather’s name on his arm.

Eight years ago there were 300 tattoo parlours in Britain; today there are more than 1,500.

Because tattoos penetrate under the skin, removing them is expensive. The tattooed area must be cut out and skin grafted over the gap. Removing tattoos with skin grafts in the private sector can cost £1,000-£2,500. Laser surgery costs from a minimum £200 to more than £2,500.

While having tattoos removed for “beautification” on the NHS is banned, surgery may be undertaken to “secure mental health wellbeing”. Earlier this year a health trust in Manchester agreed to spend £2,500 removing the tattoos of Tanya Bainbridge, a 57-year-old transsexual. The former merchant seaman, previously called Brian, claimed the large tattoos on her forearms were “not ladylike” and made her depressed.

For more information on expensive tattoos:
http://www.timesonline.co.uk/article/0,,2087-2415981.html

Coming on top of Monday’s Health Direct blog posting: Labour blamed for £2.2 bn wasted by NHS every year when the National Health Service is wasting at least £2 billion a year, more than four times the record deficit reported in 2005-06, it is no wonder that only 14% of voters think the money invested in the NHS since 1997 has been well spent, against 72% who agree that “a lot” has been used badly: Labour support at lowest level since Thatcher’s last election victory in new ICM poll October 25, 2006.

Labour support at lowest level since Thatcher’s last election victory

Dr Search- Principal Consultant at the Search Clinic — Wed, 25 Oct 2006 08:58:00 +0000

Support for Labour has dropped to its lowest level in almost 20 years with the Conservatives opening up a potentially election-winning 10-point lead, according to a Guardian/ICM poll published today. Labour has the backing of only 29% of voters, equal to its lowest-ever level of support in a Guardian/ICM poll – recorded in May 1987, a month before Margaret Thatcher won a third term.

The party’s support has fallen 3 points since last month, despite Labour’s successful annual conference in Manchester and a lack of public conflict over the succession to Tony Blair. The Conservatives have climbed three points, to 39%, with the Liberal Democrats unchanged on 22%.

Support for minor parties, growing in recent months, has dropped back 1 point to 9%. The Green party and the UK Independence party score 2% each.

The poll, carried out last weekend, follows David Cameron’s attack on NHS cuts as well as the publication last week of a party report advocating tax cuts of £21bn.

The results suggest that campaigning on the NHS offers the Tories potential gains, with an overwhelming majority of voters believing that the record sums being spent on health by the government have largely being wasted.

Only 14% of voters think the money invested since 1997 has been well spent, against 72% who agree that “a lot” has been used badly. Even 58% of Labour voters think the extra money has been misspent.

As a result only 25% of voters think that the NHS has improved since Labour came to power in 1997, against 30% who think it has got worse and 39% who think Labour has made little difference.

On the one hand the NHS remains a cherished institution that voters trust to give them the best possible treatment when they fall sick. On the other, voters think that the service has got worse, not better, during Labour’s decade in power and that much of the government’s huge extra investment in healthcare has been wasted.

Labour has more than doubled health spending since 1997 to almost £90bn a year but seems to be gaining little political credit for its efforts.

However, most people remain proud of Britain’s standard of healthcare: 55% still think that the NHS is the envy of the world. People also trust it with their lives, with 60% agreeing that they would get excellent care if they were unwell. Only 30% think they would not.

Trust in the NHS is strong among voters of all parties, and especially among the people most likely to need healthcare, older and poorer voters, with 73% of over-65s confident that they will be well looked after.

True, voters are worried about catching infections such as MRSA in hospital, for instance, with only 35% sure that they will be safe from it if they have to be admitted. Most people, 51%, think they would be at risk.

But the public’s personal experience of using NHS services is none the less overwhelmingly positive: 71% of people say that their family and friends have had a good experience.

But as the government moves ahead with contentious reforms which could see closures of well-loved hospitals, the poll’s findings suggest Labour cannot take the NHS for granted as an electoral asset.

Meanwhile, most people would choose to opt out of the state system if they could afford it: 67%, say they would pay to go private if they had the money, including 61% of Labour voters.

Trust in the private sector is strong, too, when it comes to the NHS itself: 70% of all voters think that private companies should be allowed to care for NHS patients. That suggests there is backing for the government’s reform programme, which has seen private organisations invited to compete for NHS work.

Labour voters are even keener on this than the overall electorate, with 73% agreeing private firms should have a role in the NHS against only 22% who disagree.

The poll comes after other findings suggesting that Mr Cameron’s honeymoon with voters may be over. Data published in the Times on Monday from a small sample of 242 voters, gave Gordon Brown a lead among swing voters.

Even if today’s Guardian/ICM result were repeated at a general election, the Conservatives would only end up as the largest party in a hung parliament, or hold only a narrow majority, since Labour gains most from the distribution of parliamentary seats across the country.

· ICM Research interviewed a random sample of 1,019 adults aged 18+ by telephone on October 20-22. Interviews were conducted around the country and the results have been weighted to the profile of all adults. ICM is a member of the British Polling Council and abides by its rules.

The full ICM research article can be found at:
http://politics.guardian.co.uk/labour/story/0,,1930732,00.html

Health Direct has long warned against Labour’s NHS health spin eg April 11, 2005 Proof Bliar puts targets before patients when an investigation by The Telegraph laid bare how the health of hospital patients up and down the country is put at risk by direct Downing Street interference in the NHS and Labour’s obsession with targets.

Finally, it seems that voters in the real world are seeing through the lies and spin from Labour.

NHS cuts twice as likely in Tory and Lib Dem areas

Dr Search- Principal Consultant at the Search Clinic — Tue, 24 Oct 2006 09:29:00 +0000

Following Health Direct’s lead in Sept 25, 2006 NHS closures rigged in Labour voting constituencies and the Times last week: Oct 16 Hospitals in Tory seats are ‘targeted for closure’ the Sunday Telegraph has now come to the same conclusion: that hospitals in Conservative and Liberal Democrat constituencies are more than twice as likely to suffer from NHS cuts as hospitals in Labour voting seats.

Thirty-four per cent of Tory and 37 per cent of Lib Dem seats in England and Wales have been affected by cuts that have been either announced or proposed. Only 14 per cent of Labour areas are affected. The cuts range from the closure of single wards to the axing of entire hospitals.

The findings follow news that Patricia Hewitt, the Health Secretary, commissioned “heat maps” to show the potential political effects of proposed hospital closures, and figures showing that seven times as many cottage hospitals have closed or are under threat in Opposition-held areas than in Labour ones.

In response, the Government has denied that it is “playing politics” with the health service.

However, the Sunday Telegraph’s findings, calculated by analysing hospital cuts that have been publicly announced or proposed, will re-ignite the debate about the handling of the Labour Government’s much-trumpeted NHS reform plans.

Last night, Andrew Lansley, the shadow health secretary, said: “It’s bad enough that there are nationwide cuts to frontline NHS services, but it adds insult to injury that Labour are manipulating cuts to save their own political skin. Patients and healthcare professionals must come first, but Labour can no longer be trusted to do this.

Steve Webb, the Lib Dems’ health spokesman, said: “The way the dice seem to fall is very suspicious. It would be outrageous if decisions about cuts and closures were manipulated for one party’s political advantage, but this, I believe, is what’s happening.”

Michael Summers, of the Patients’ Association, said: “If political considerations are driving the changes, it is completely unacceptable.”

A spokesman for Ms Hewitt said: “We’re shifting services to areas where the health needs are greatest, which are commonly in urban areas,” he said. “These happen to be mostly Labour seats. Decisions are driven by clinical needs. There is no political meddling.”

The full story including NHS cuts heatmaps can be found at:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/10/22/nhealth22.xml

Labour blamed for £2bn wasted by NHS a year

Dr Search- Principal Consultant at the Search Clinic — Mon, 23 Oct 2006 08:46:00 +0000

The National Health Service is wasting at least £2 billion a year, more than four times the record deficit reported in 2005-06, according to an analysis of hospital activities and finances set out by the Government today. The figures show that if the worst performing primary care trusts did as well as the best then £2.2 billion could be saved on a range of activities, including how long patients spend in hospitals, the level of “unnecessary” operations and the numbers of sick referred for hospital appointments.

The Conservatives condemned the figures as “proof of Labour’s failure”. Andrew Lansley, the shadow health minister, said: “The Government has let down the NHS and failed to provide necessary incentives for improvement. It’s time for a change and genuine reform.”

Only last week (October 17, 06) Health Direct reported that Scandal of NHS cancelled operations that £150m a year was being wasted as the National Health Service is cancelling more than 620 operations every day because of administrative blunders, it has been claimed. Mistakes, like forgetting to book operating theatres, led to about 162,500 procedures being abandoned in 2005. The numbers also appear to have gone up by a quarter over the past three years, according to newly-released figures.

Prof Sir Liam Donaldson, the chief medical officer, said earlier this year that £21 million could be saved annually by reducing the number of needless tonsil operations and hysterectomies. But today’s figures indicate that the inefficiencies are deeper and much more widespread.

The information will empower primary care trusts, which foot the bill for patients’ care and treatment, to use the figures to try to rein in the money spent by hospital trusts. Trusts in financial trouble finished the end of the last year with gross deficits totalling more than £1 billion.

The Department of Health says that £975 million could be saved by ending the different lengths of time that patients spend in hospital. An acute hospital bed costs around £225 a day.

It says that one reason for the wide variations in the length of time is that too many patients cannot be discharged when they are ready because of lack of care when they get home or absence of “step down” care.

Another £510 million could be saved if patients were not admitted too soon for their operations. This alone would have almost wiped out the £512 million net deficit.

Some trusts admit very few patients, only about 10 per cent, on the day of their operation, carrying the cost of an additional overnight stay while, in others, as many as 60 per cent of patients are admitted on the day of surgery.

The analysis also found that £348 million could be saved if the number of emergency admissions was reduced. Better care by GPs can avoid crises for people with chronic conditions like angina or asthma and some hospital doctors are more inclined to admit patients than others.

Another £278 million would be saved by reducing the cost of referrals to hospital consultants. The figures show that referral rates by GPs can be higher in affluent areas.

The department says that £73 million would be saved by reducing unnecessary surgery for grommet operations for children, tonsillectomies, hysterectomies and dilation and curettage. Some of these conditions can now be treated with drugs and others by wait and see strategies.

Finally, £16 million could be saved if more hospitals provided more day surgery.

A total of 16 “performance indicators” have been sent to all NHS trusts which compare the activities and costs in the top 25 per cent, along with the middle rank and the worst performing trusts.

The idea is to show trusts where they are going wrong and how it is possible to improve.

Andy Burnham, the health minister said the information could “unlock” £2.2 billion for reinvestment in patient care and was not about “penny pinching or cutting corners”. “Productivity is about working smarter not harder, and improved efficiency will deliver both better patient care and better value to the taxpayer,” he added.

Mr Lansley said that Gordon Brown, the Chancellor, had promised investment with reform.
“But there’s been no real reform – only money pumped in,” he added. “These indicators are condemning proof of Labour’s failure. If Labour had maintained the productivity levels they inherited from the Conservatives, they would have cleared 1.4 million patients from waiting lists. “The reality is that since 1997, NHS productivity has fallen by one per cent every year.”

Mr Lansley said the Government had set up primary care trusts four years ago but, according to the Healthcare Commission, 90 per cent were “at best adequate”.

“The average length of hospital stay fell at least twice as fast pre-1997, as after. There are now over 100,000 more administrators in the NHS than in 1997 and nine out of ten PCTs are not using money efficiently.”

Examples of the differences in performance across the country include the Norfolk and Norwich University Hospital NHS Trust which could potentially save £6.1 million if it reduced lengths of stay.

The Hull and East Yorkshire Hospitals NHS Trust could save £11 million by the same method.

Using 100 as the level expected, Newham Primary Care Trust, in east London, had an out-patient appointment rate of 73.9 compared with Richmond and Twickenham, in south-west London, with a rate of 140.61.

In Milton Keynes, Bucks, the out-patient admission rate was 61.13 compared with Windsor, Ascot and Maidenhead, Berks, with a rate of 152.72.

The cost of statins, the drugs given to reduce cholesterol, varies from around £2 a day to £30 a day.

In North East Derbyshire PCT 84.35 per cent of statins prescribed were “low cost” compared with Bradford City Teaching PCT where the proportion of low cost statins prescribed was 36.11 per cent.

More information can be found at:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/10/23/nhs23.xml

Eighty cottage hospitals face cuts

Dr Search- Principal Consultant at the Search Clinic — Fri, 20 Oct 2006 08:32:00 +0000

As many as 80 cottage and community hospitals in England are threatened with cuts or closures in direct contradiction to Government policy, which calls for more health services near people’s homes. Campaigners said yesterday that 10 community hospitals closed within the first six months of this year and that since 1999 as many as 2,000 local beds had been lost.

The cuts are being forced by financial deficits and many of the affected hospitals are in Conservative constituencies.

In Surrey, which has to save £100 million across the county, MPs are already concerned over the possible downgrading or amalgamation of large district hospitals and have organised a meeting to consider joint action about the funding of the NHS in the county.

Residents have launched a Surrey-wide petition as well as a separate campaign to “save” the Royal Surrey County Hospital in Guildford, where local people fear services will be downgraded and the accident department may be lost.

Plans are awaited from Surrey Primary Care Trust but a rally is being held in Guildford on Saturday.

Anne Milton, MP for Guildford, said she did not expect to see plans until November or December. “I am appalled at the delays in the process because of the effects on staff. Morale is at rock bottom,” she said.

She said Surrey did not attract extra funding given to deprived areas. But it had a high proportion of elderly residents, who were the highest users of health services.

“There are deficits but I contend that we need to get our fair share in the first place. A significant proportion of tax revenue comes from Surrey. We get a lot of pain for that, it feels like very rough justice,” she said.

In Oxfordshire there is a well established campaign to maintain full children’s and childbirth services and emergency surgery out of hours at the Horton General Hospital in Banbury.

In Ludow, Shropshire, the fight is on to save two wards of the local hospital. Another battle has begun in Skegness, Lincs, to save two wards at a hospital which also deals with the effects of thousands of summer visitors. The campaigners fear that running down services will lead to later closures.

Yesterday Lord Warner, the health minister, launched 30 pilot projects in the drive towards an “NHS closer to home” which would see surgically trained GPs doing operations and out-patient clinics in local centres.

Ministers believe that half of the 45 million out patient appointments could be dealt with locally.

A spokesman for the Department of Health said: “We agree that losing successful community hospitals solely to solve short-term financial problems is not acceptable. Options for changing NHS services must be developed with local people and not for them.”

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/10/17/nhospital17.xml

Health Direct is pleased that there is recognition at the Dept of Health of the role that community hospitals can play in improving patients’ service and cutting costs, but since May 11, 06 in A record 6 NHS hospitals closures announced in one day in one county we have been questionning the lack of “joined up thinking” when massive cuts to health services across Gloucestershire saw 500 NHS job losses- many compulsory, community hospitals closed and maternity services moved to help balance a £38 million deficit.

NHS does not know how many jobs lost

Dr Search- Principal Consultant at the Search Clinic — Thu, 19 Oct 2006 09:04:00 +0000

The newly appointed chief executive of the National Health Service admitted on Tuesday that he did not know how many jobs would be lost this year as a result of budget cuts and reorganisation. David Nicholson was challenged on the impact on jobs of English NHS trusts plunging £523 million into the red at a press conference called by the Prime Minister to highlight health service reforms.

David Cameron, the Conservative leader, claims the financial crisis in the health service is costing 20,000 jobs – a figure which NHS Employers, representing health service managers, has said “may turn out to not be too far off the total reduction in workforce numbers this year”.

Health Direct’s current running total stands at 19,088 jobs lost.

Mr Nicholson admitted that the 20,000 figure was the only estimate that had been produced so far, but argued that the true number of jobs lost would be “significantly less”.

When challenged to give his own estimate, he admitted that he did not know what the final figure would be.

An increasingly impatient Tony Blair intervened to say that, according to documents he had seen, most staffing reductions would involve posts remaining unfilled or people being moved to new positions. He believed that compulsory redundancies would number only “a few hundred”.

A survey by NHS Employers suggested that the total head count reduction might reach 20,000, though the organisation stressed last week that this figure related to cuts in numbers of posts and not to individuals losing their jobs.

For more information please see:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/10/18/nhealth218.xml

Health Direct also reports that the claim by bliar that compulsory redundancies would number only “a few hundred” was described by Dave Prentice the head of the Unison union as showing how out of touch with the real world the prime minister has become.

Elderly home care ‘needs change’

Dr Search- Principal Consultant at the Search Clinic — Wed, 18 Oct 2006 09:53:00 +0000

Inspectors have criticised the standard of home care for hundreds of thousands of elderly people in England. The Commission for Social Care Inspection report said many people found their carers too rushed and there was little time to build trust. Commission chair Dame Denise Platt said the report Time to Care? painted a “mixed picture” of the quality of care. The government admitted that “issues of poor quality and reliability” remained.

The report concluded that the services were vital for thousands, but councils should rethink them and offer people more choice.

Dame Denise said: “It is critical that those who commission and provide home care services listen to what people say they want and value.

“Failure to listen to what people really need, and respond to this, results in missed opportunities to promote independence and to help people live full and rewarding lives. At worst, it can also result in services that do not respect people’s rights and dignity.”

She said as the numbers of older people grew, councils must reshape services to give people living at home “more personalised care”.

The CSCI also found that councils concentrated services on people with the most severe needs, meaning others who would benefit missed out.

The report said the number of people receiving council-funded home care fell from more than 500,000 homes in 1992 to 354,500 in 2005, despite a rise in the older population.

Inspectors also found the home care services were often beset with serious problems in recruiting, training and retaining quality staff.

Younger people were given little incentive to work in the care industry, with many finding better-paid jobs in their local supermarkets, the report said.

CSCI’s Chief Inspector Paul Snell said since it started regulating the sector three years ago, home care services had improved, but “fundamental change” was still needed.

“What we found in this report is that when we talk to older people about their experiences almost universally they are pleased with the care provided by their direct carer, but that the systems for delivering the care don’t always match up to the quality people want to see.”

He said carers could be rushed and could be numerous, citing one case where a woman had had five different carers in 10 days.

“There are problems of recruiting, retaining and training good quality staff,” he said.

Age Concern’s director general, Gordon Lishman, said care at home was often what older people wanted, but local authorities must “provide the levels of services needed”.

“At a time when the government is emphasising care services that enable older people to stay in their own homes, too many frail and vulnerable older people are being let down by under-pressure staff and over-stretched councils who are not providing the care they need,” he said.

He added that less intensive and preventative services that helped keep older people healthy and independent for longer were being withdrawn.

The full story can be found at:
http://news.bbc.co.uk/1/hi/uk/6061130.stm

Health Direct warned that the lack of real money on Feb 03, 2006 in Labour’s NHS pledge ‘needs more money’ if it will work when health campaigners and doctors insisted more money was needed if the Government was to succeed in meeting its ambitious pledges to improve NHS services in the community.

Health Direct also questioned the seriousness of the Minister wants Dignity debate for caring for the elderly (June 22, 2006) when the new care services minister Ivan Lewis has said he wanted to make dignity of older people one of his top priorities. Speaking at a session on the out of hospitals white paper, he said: ‘I want to make dignity an important theme in my time as a minister. ‘This is not a gimmick; just another initiative. It should be at the heart of what we are doing.

However that heart didn’t include a single new Pound of funding.