A mere 44 per cent of patients could recall being offered a choice of hospital for their first outpatient appointment in May – down from 48 per cent in March – with provisional results for July showing a further decline to 43 per cent.

An even smaller proportion of patients were aware before visiting their GP that they had the right to be offered a choice of at least four hospitals. Just 38 per cent were aware of this right, although that figure for May is one percentage point up on March.

However, of those who were aware of their right to choose, only 63 per cent remember being offered a choice, a drop from 63 per cent on the March figure.

The Healthcare Commission, the NHS inspectorate, said this week that choice was the national NHS target that was being missed the most, with 2 per cent of primary care trusts in March achieving the indicators on which the effectiveness of patient choice is measured.

From:
http://www.ft.com/cms/s/0/6ce095c6-7ea9-11dc-8fac-0000779fd2ac.html

Nearly two years ago Health Direct posted, January 02, 2006 Choose and Book- your new right for NHS treatment

Most patients in England gain a historic new right this week – to be treated in a private hospital at National Health Service expense. The arrival of “patient choice” – the right to choose, initially from at least four hospitals, and by 2008 from any hospital prepared to meet NHS standards and prices – is a symbolic moment in the Labour government’s endeavour to use market forces to drive up health service performance.

Though quite how this policy will actually work in practise- with the introduction of the Choose and Book IT disaster- which it is currently hoped that it will be delivered 12 months late in December 2006, is anyone’s guess.

Experts on aspects of thrombosis attacked guidelines issued by the National Institute for Clinical Excellence (Nice) for lack of consultation and inappropriate use of evidence.

Dr Beverley Hunt, medical director of Lifeblood, the thrombosis charity, told the Commons health committee: “The Nice process doesn’t use experts well.”

She said specialists in the field were often excluded for fear of conflicts of interest, but those drafting drugs guidance lacked understanding of the scientific data they were reviewing.

Dr Hunt argued that suitably qualified experts should be more closely involved, and that conflicts of interest could be tackled through disclosure and excluding only those who derived more than 10 per cent of their salary from products linked to their advice.

Conflicts could be further minimised by allowing experts to act as advisers rather than formally being among the drafters of guidance, she said.

Dr Hunt’s criticisms were shared by Prof Roger Atkins from the British Orthopaedic Association, who expressed frustration that his colleagues “who have dedicated 20 to 30 years of their lives [to the subject] were simply not involved” in drafting relevant guidance.

Prof Atkins said some guidance issued last year had “very significant flaws”, and it had proved difficult to discuss and propose amendments with the Nice committee concerned.

Richard Barker, director-general of the Association of the British Pharmaceutical Industry, the trade body, endorsed the calls, but stressed that drug companies were keen to consult leading specialists when designing clinical trials.

Nancy Devlin and John Appleby from the King’s Fund, the health think-tank, called for the creation of an independent review mechanism separate from Nice to assess its cost-effectiveness threshold – similar to the Bank of England’s monetary policy committee.

http://www.ft.com/cms/s/0/5c2160b4-7e98-11dc-8fac-0000779fd2ac.html

Drugs watchdog faces legal review- NICE’s approach is irrational and flawed
http://www.healthdirect.co.uk/2006/11/drugs-watchdog-faces-legal-review.html

Health Direct notes that even the experts are questioning the deliberations of the National Institute for Curbing Expenditure.

On Fri 17 Nov 06 Health Direct posted- Drugs watchdog faces legal review- NICE’s approach is irrational and flawed

A decision by the Labour government’s drugs watchdog to restrict the use by the NHS of Alzheimer’s medication is to be challenged in court.

Two drug companies plan to apply for a judicial review of the way the National Institute for Health and Clinical Excellence reached its conclusion. NICE ruled NHS patients with newly diagnosed, mild Alzheimer’s disease should not be prescribed the drugs.

Neil Hunt, chief executive of the Alzheimer’s Society, said: “It’s great news that NICE will be challenged in court. NICE holds the fate of thousands of people’s lives in its hands and it is only right that it is brought to account.”

Thousands of “health tourists” are going as far as India, Malaysia and South Africa for major operations – such is their despair over the quality of health services.

The first survey of Britons opting for treatment overseas shows that fears of hospital infections and frustration with NHS waiting lists are fuelling the increasing trend.

More than 70,000 Britons will have treatment abroad this year – a figure that is forecast to rise to almost 200,000 by the end of the decade.

Patients needing major heart surgery, hip operations and cataracts are using the internet to book operations to be carried out thousands of miles away.

India is the most popular destination for surgery, followed by Hungary, Turkey, Germany, Malaysia, Poland and Spain. But dozens more countries are attracting custom.

Research by the Treatment Abroad website shows that Britons have travelled to 112 foreign hospitals, based in 48 countries, to find safe, affordable treatment.

Almost all of those who had received treatment abroad said they would do the same again, with patients pointing out that some hospitals in India had screening policies for the superbug MRSA that have yet to be introduced in this country.

Andrew Lansley, the shadow health secretary, said the figures were a “terrible indictment” of labour government policies that were undermining the efforts of NHS staff to provide quality services.

The findings come amid further revelations about the Government’s mishandling of NHS policies, and ahead of official statistics that will embarrass ministers:

• On Wednesday, figures are expected to show rising numbers of hospital infections. Cases of the superbug Clostridium difficile, which have risen five-fold in the past decade, are expected to increase beyond the 55,000 cases reported last year.

• On the same day, statistics will show that vast sums have been spent on pay, with GPs’ earnings rising by more than 50 per cent in three years to an average of more than £110,000.

• New research shows that growing NHS bureaucracy has left nurses with little time to see patients – most spending long periods dealing with paperwork.

Katherine Murphy, of the Patients’ Association, said the health tourism figures reflected shrinking public faith in the Government’s handling of the NHS.

“The confidence that the public has in NHS hospitals has been shattered by the growth of hospital infections and this Government’s failure to make a real commitment to tackling it,” she said.

“People are simply frightened of going to NHS hospitals, so I am not surprised the numbers going abroad are increasing so rapidly. My fear is that most people can’t afford to have private treatment – whether in this country or abroad.”

Some foreign hospitals touting for business on the internet offer consultations in hotels in Britain. But other patients are happy to rely on email to discuss their treatment with doctors thousands of miles away.

Low prices in India, where flights, hotels and a heart bypass cost less than half the price charged by British private hospitals, explain its top ranking in the survey by Treatment Abroad, a British website providing information on hospitals overseas.

Hungary’s popularity rests on a boom in dentistry, thanks to a shortage of NHS dentists in Britain.

Mr Lansley said: “Healthcare is an area where Britain could be a world beater because we have some of the best research and best clinicians. If people don’t trust the health service, then that is a terrible indictment of this Government, which has turned the NHS into a nationalised bureaucracy, instead of something able to focus on what patients want.”

The British Medical Association advised people to be careful when considering treatment abroad, highlighting the dangers of flying soon after surgery, which can cause complications.

A spokesman said: “Travelling can place a great deal of stress on the body. Patients travelling abroad for surgery should consider their fitness to fly and get an understanding of an appropriate convalescence period before attempting to return home.”

A Department of Health official said the number of patients seeking treatment abroad was a tiny fraction of the 13 million treated on the NHS each year.

Waiting times had fallen. Almost half of patients were treated within 18 weeks of seeing a GP. Most people who had hospital care did not contract infections.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/10/28/nhealth128.xml

Health Direct is incredulous. The complacency of Department of Health officials and ministers is breathtaking. For someone to say “most people who had hospital care did not contract infections” is disgraceful. Why should ANYONE be treated in dirty hospitals?!

Andrew Lansley, opposition health spokesman, accused the government of taking too long to address the problem and said something had “gone wrong” within the Department of Health.

In a report published earlier this month, the Healthcare Commission, the National Health Service inspectorate, found that a “litany” of errors led to at least 1,170 patients being infected in outbreaks of C. difficile at the Maidstone and Tunbridge Wells NHS Trust over two years.

Alan Johnson, health secretary, told parliament he had received the report on October 9. But the Conservatives alleged that the health department had received an initial draft report on May 3 and a further draft on September 12.

Mr Lansley said: “As health secretary, Alan Johnson has the power to suspend NHS board members, so why wasn’t this exercised until after patients and the media learnt the contents of the report?”

The DoH said: “The report received on May 3 was an early outline of the final report, and did not contain either recommendations or conclusions for ministers.”

From:
http://www.ft.com/cms/s/0/0d6e1010-8038-11dc-b075-0000779fd2ac.html?nclick_check=1

Coming only days after Health Direct learnt that labour’s own MRSA report was buried as it carried bad news, this new report compounds the culpability of labour health ministers.

As 40 to 50 people every week die from MRSA, Clostridium Difficile and other superbugs in UK hospitals, it’s the equivalent of a plane crash every month.

Every week that labour ministers and health officials bury their heads in the sand and ignore warnings there will be a growing and huge outcry when the general public wake up to their negligence.

The National Treatment Agency (NTA), which runs the £500m-a-year scheme, admits the practice is “unethical”.

Its own survey of almost 200 clinics in England found users were being offered extra methadone, a heroin substitute, or anti-depressants for good behavior.

A third of clinics in the survey said users who produced a drug-free urine sample may be offered increased doses of heroin substitute as a reward – known as “contingency management”.

A quarter admit that clients can choose the type of substitute drugs they want.

The survey also found clinicians offering anti-depressants, cash vouchers or access to detox as a reward.

The NTA said offering drugs for anything other than clinical need was wrong and it wanted certain practices “squeezed out of the system”.

The agency’s chief executive Paul Hayes told the BBC: “One of the things that’s important before we start rewarding people through things like contingency management is to make sure that we’re doing it according to the best principles for drug treatment.

He said the NTA was set up to not only expand the provision of drug treatment, but also to improve its quality.

He added: “It is entirely appropriate to prescribe other drugs alongside prescription drugs that are to deal with withdrawal. Not as a reward, which is why we wouldn’t advocate it.

“What we would say is the dose people get ought to be determined by the individual’s needs, not by whether or not they’re co-operating with the regime.

“That’s why the contingency management programme that we’re thinking of introducing, based on American research, is going to be very different to the ad hoc rewards that operate in not very well managed services in this country at the moment.”

Martin Barnes, chief executive of drug information charity DrugScope, said it was “appalling” to offer drugs as a reward.

“The idea of bribing the patient to achieve a result which wasn’t actually something they felt important is quite abhorrent” said Dr Michael Ross who was a drug service clinical director in Bradford

“It is a complete distortion of the principles of ‘contingency management’,” he said. “The practice is unethical, contrary to official guidance and creates potentially serious risks for the drug user.”

Matthew Taylor, of the Royal Society of Arts, a think tank looking at how best to get addicts off drugs, said an overhaul of current policies was needed.

“I think the reality is that our drug strategy just isn’t working,” he told BBC One’s Breakfast.

“Only a very small proportion of those people who are put through drug detoxification successfully complete the programme, and even when people do successfully complete the programme they revert to drug use very quickly.

“So we need a different approach, and the fact that some people feel that they need to incentivise drug users with other drugs in order to keep them off illegal drugs is, I think, part of that general problem.”

The drugs treatment project is the centrepiece of labour government strategy. Only about 6% of users on the programme leave free of drugs each year.

However, there is evidence that giving addicts access to services can reduce crime and improve health even if they continue to take drugs.

From:
http://news.bbc.co.uk/1/hi/uk/7049934.stm

Drug addicts problmes are compounded by labour’s failed financial fudges. On August 01, 2007
Health Direct posted: Hypocrite Stalinist Brown cuts £50m from drugs rehab budget

The flagship labour government scheme for treating drug addicts faces swingeing budget cuts of £50 million.

Plans to slash total funding by more than 12 per cent, outlined in an email leaked to The Sunday Telegraph Health Direct has learnt , come less than a fortnight after Stalinist Brown tried to show off his anti-drug credentials by signalling his desire to reclassify Cannabis from Class C to the more serious Class B. The Conservatives accused the Prime Minister of hypocrisy.

Why have ministers been sitting on a report that shows a dramatic link between outbreaks of hospital superbugs and high levels of bed occupancy?

The Financial Times understands that a report, commissioned by the Department of Health and based on research covering every hospital in England, reveals that MRSA rates are a staggering 42 per cent higher in hospitals with bed occupancy rates of 90 per cent or more than in those with occupancy rates below 85 per cent.

In hospitals where bed occupancy rates are 85-90 per cent, infection rates are 16 per cent higher. In spite of rising public anxiety about hospital infections, I am told that this research, which covered 2001-02 to 2002-03, has been gathering dust for more than two years.

Had ministers acted on the research instead of suppressing it, lives might have been saved – not least in hospitals run by the Maidstone and Tunbridge Wells Trust, where superbugs killed at least 90 patients. In a damning report on the Maidstone tragedy last week, the Healthcare Commission blamed “pressure on beds” and the trust’s desire to meet government targets.

Why is high bed occupancy directly linked to infection rates? Because it means that often there is not enough time to clean beds properly – sometimes the sheets are not even changed.

At Maidstone, nurses told patients with diarrhoea to “go in the bed” and then left some for hours in soiled sheets. If beds were cleaned superficially afterwards, it is little wonder so many died.

Crucially, the report indicates that there is no link between infection rates and bed occupancy provided the levels are below 85 per cent.

The pity is that in the past five years, with the labour government using targets to press hospitals into cutting waiting times and improving financial performance, the proportion of hospitals with more than 90 per cent bed occupancy has risen from 13 per cent to 20 per cent.

Had ministers not suppressed this report, might not some National Health Service trusts have thought twice about increasing patient throughput?

There are all the hallmarks here of labour ministers trying to cover up inconvenient truths.

Public discussion of the report might have forced them to take a more flexible approach to NHS targets. There is talk of bringing criminal charges against the Maidstone NHS Trust.

Perhaps the police should widen their inquiries to find out what ministers knew about superbugs and whether they gave adequate support and information to health workers on the ground.

From:
http://www.ft.com/cms/s/0/60794692-7c2f-11dc-be7e-0000779fd2ac.html

Health Direct continues the Police investigation point. In Superbug hospital may face criminal charges over 331 C difficle deaths on Fri 12 Oct 2007 we noted that hospital managers could face criminal prosecution for the worst ever recorded outbreaks of the superbug Clostridium difficile which killed at least 90 patients.

Inadequate staffing levels, dirty wards and too much focus on cost-cutting and government targets contributed to two serious outbreaks of C difficile in as many years at Maidstone and Tunbridge Wells NHS Trust, an investigation by the Healthcare Commission found.

It’s the most gruesome image accompanying the allegations that there’s a crisis in dentistry provision in the UK.

Mark Cowley is a furniture restorer from Wisbech in Cambridgeshire. After travelling long distances to get temporary procedures done, and having suffered the cracking of his tooth, he decided to take matters into his own hands.

He picked up a pair of mole grips, plier-like tools, and pulled the offending tooth out. “I just got a bit desperate and this tooth was waggling. There’s no pain in it now.”

His friends and family do “get a bit squeamish” when they hear about his DIY dentistry. But what do the experts advise about tackling your own gnashers?

Professor Liz Kay, dean of the Peninsula Dental School in Plymouth, stresses that anybody who is able to pull out their own teeth probably has extremely advanced periodontitis, a collection of diseases that cause the loss of the bone supporting the teeth.

Robert Jagger, senior lecturer in restorative dentistry at Bristol Dental School, says cases of people with periodontitis removing their own teeth are not unusual.

“It can sound absolutely horrendous, but in the case of periodontitis, one of the things is that they become very, very loose. It has been reported very frequently over the years. You could get some pain but I don’t know if there’s a greater risk of infection [than in a dentist's surgery].”

Of course, if you mess it up, leave a fragment of a broken tooth remaining, and you risk abscess and infection. And, as Prof Kay, points out, the complex anatomy of the head means one doesn’t want to be messing around in there for fear of doing something exceedingly bad.

However, while pulling out a waggly tooth is one thing, the reports of people who have used powerful household glue to put a crown back in place are not good.

“It is a very foolish thing to do,” Prof Kay suggests. “If you superglue it and there’s any problem you are going to lose the tooth.”

And if you’ve done a procedure in a permanent fashion and put your crown or filling in the wrong place, you are not likely to notice until it’s too late to get help.

“There are more insidious dangers. Things may appear to be OK but the filling is still leaking,” Mr Jagger adds.

At the other end of the DIY spectrum are the dental first aid kits, provided mainly for tourists and recognised as an option for emergencies by dentists, which contain the tools to deal with a dislodged filling or crown until you get back to civilisation.

A kit might contain zinc oxide powder and eugenol, effectively clove oil. Mix it together and you can improvise glue for a crown, or a filling. It can hold for a few days at least with the dentist removing the material and doing a proper job.

As a “very, very temporary measure” such kits are “useful” for people on holiday, says Prof Liz Kay.

Jenny Lees, managing director of Dentanurse, says her firm has doubled the sale of kits over the last five years, and suggests they are being used domestically as people cope with long waits for NHS dentists.

Sticking a crown back in place is safe and simple as long as people read the instructions. But they should do it themselves.

“Legally you shouldn’t get someone else to do it. If someone else does it for you they are breaking the law by practising dentistry.”

“It’s like making custard, as long as you read the instructions you are fine,” she says.

Rose Matthews, 24, found herself left in the lurch and needing the kits when her dentist stopped a procedure midway and told her it could not be completed on the NHS. Being unable to afford the fee, she endured an 18-month wait for NHS treatment. The hole in her drilled-out tooth was tackled using a kit once a month.

“It was quite difficult and quite painful and because I couldn’t do it properly the walls of the tooth were starting to break away.”

But despite the less than ideal solution, it was a lot better than plan A.

From:
http://news.bbc.co.uk/1/hi/magazine/7045263.stm

Health Direct feels that the plight of people needing urgent dentistry is both distressing and unnecessary.

On April 02, 2007 Health Direct posted: Labour’s dentistry health reforms ‘have failed’

Radical Labour Government reforms to improve patient access to NHS dentists have failed, it was claimed today. The charity Citizens Advice said there is “huge inequality” in access to dentists in England and Wales, and urged action to deal with “dentistry deserts” in many areas including some parts of Hampshire and Lancashire.

It claimed two million people are forced to put off treatment or go private because they can’t find an NHS dentist.

Susie Sanderson, chair of the BDA’s executive board, said: “When the Government is failing to meet even its own success criteria for the new contract, then it’s time for urgent action.

“We now have a reductive, target-driven system that is failing both patients and dentists. The future of NHS dentistry is becoming increasingly fragile and we need action now before it shatters altogether.”

On April Fools Day in 2006 Health Direct warned- The saddest April Fool joke of all- D Day for Dentists- 1,000 dentists expected to quit NHS in contract row.

Unfortunately, not an April Fool joke but an exodus of about 1,000 dentists from the NHS in England was predicted last night by the chief executives of primary care trusts, who take over untried and untested management of the service from today.

The NHS Confederation provided the first hard evidence of how patients will be affected by a dentists’ contract that came into effect at midnight.

Since the NHS rolled out its smoking cessation programme in 2001, it claims that almost 1.4m people have given up smoking as a result of the £470m it has spent on stop-smoking clinics, nicotine replacement therapies and the anti-depressant Zyban, which reduces the craving for cigarettes.

But the proportion of the adult population that smokes in England has remained constant at 24 per cent, according to official figures. The actual number who smoke has, if anything, grown.

According to the Office for National Statistics, the number of adult smokers is up from about 9.5m in 2001 to nearer 9.9m in 2006, although that increase in part reflects a growth in the adult population. It may also reflect high rates of smoking among migrants from eastern Europe, according to the anti-smoking charity Action on Smoking and Health.

The sharp discrepancy between the numbers smoking and the NHS’s claim that 1.4m have quit comes because the Department of Health measures “quitters” as those who have stopped smoking for just four weeks – although its own research shows that 90 per cent of those who stop end up starting again within two years.

Colin Talbot, professor of public policy at Manchester Business School, said: “These figures suggest that not only has the government’s campaign not actually reduced smoking at all, but at the same time they were spending £500m the proportion smoking actually flat-lined when it had – up until then – been falling.

“Common sense alone ought to have told health department officials that a four-week cessation was likely to be highly misleading. The department clearly needs to review both the anti-smoking campaign and how it measures its effectiveness.”

The programme was defended, however, by Robert West, director of tobacco studies at Cancer Research UK’s health behaviour unit at University College London.

He estimates that only 20 per cent of the 1.4m are likely to have given up smoking successfully in the long term, and two-thirds of those might well have given up anyway. But even if the programme had stopped only 100,000 people smoking it remained “a very cheap way of saving lives – much, much cheaper than heart operations and tablets to control blood pressure”, Professor West said.

The Department of Health rejected the idea that the programme had been ineffective. It said independent academic research in the journal Addiction had judged it to be “extremely cost effective” and indeed “the most cost-effective of any intervention” provided by the NHS.

However, Alan Maynard, professor of health economics at the University of York, said it was “very sad that the NHS has spent so much money on this to so little effect”. Scottish evidence suggested the ban on smoking in public places recently introduced in England might have a far bigger health impact, he said.

The NHS is spending about £100m a year on the stop-smoking programme at a time when the growth rate of NHS spending is set to slow.

From:
http://www.ft.com/cms/s/0/e311008a-7ab9-11dc-9bee-0000779fd2ac.html

Whilst Health Direct acknowledges the importance of reducing smoking, why doesn’t labour target the more serious damage that drinking alcohol causes both to it’s imbibers and the NHS in treating the more resultant harm?

On Aug 02, 06 Heath Direct posted- Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal

Health Direct reproduced the first ranking based upon scientific evidence of harm to both individuals and society. It was devised by labour government advisers – then ignored by labour ministers because of its controversial findings.

The analysis was carried out by David Nutt, a senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council. Copies of the report have been submitted to the Home Office, which has failed to act on the conclusions.

The rankings concluded that Alcohol (Legal) was ranked at number Five, Tobacco (Legal) at number Nine and Cannabis (Class C) at Number 11.

The general picture in the watchdog’s annual health check of England’s trusts was, however, one of improvement. But regional divides persist, with the north performing better than the south.

Trusts were rated on two principle categories: quality of services and how they had managed their finances.

Nineteen trusts scored “excellent” on both parts of the rating, up from two last year.

But 20 were deemed “weak” – the lowest scoring – on both counts, four of these for two years in a row.

Health Secretary Alan Johnson said he had asked the commission to re-inspect the 44 trusts failing on infection.

He also said that if the chief executive of the NHS was unable to resolve the situation through talks with the boards at the four weakest hospitals, one option would be a takeover by a well performing trust.

The four comprise West Hertfordshire Hospitals NHS Trust, Surrey and Sussex Healthcare Trust, Northern Devon Healthcare Trust and Royal Cornwall Hospitals NHS Trust.

Meanwhile, the proportion of operations which were cancelled fell for the third year in a row.

But there were targets not being met: some 70% were failing on “convenience and choice”, which says patients should be able to choose from four different NHS providers.

This, the commission said, was primarily because GPs were not contractually obliged to offer the choice, and technical problems with the computer booking system were not uncommon.

The disappointing findings on infection control were partially mitigated by the fact that new and more rigorous standards were introduced in October 2006, the commission said.

“The bar was raised dramatically on infection control and that explains why trusts seem to be performing worse than in the past,” said chief executive Anna Walker.

But the findings on the failure of some trusts to ensure hygiene standards – including cleaning hands and instruments – comes just a week after serious such shortcomings at the Maidstone and Tunbridge Wells NHS Trust were blamed for the deaths of up to 90 patients from C. difficile.

Overall, the South West strategic health authority (SHA), one of the 10 covering the country, had the highest proportion of weak trusts. The South East Coast SHA had the lowest proportion of “excellent” trusts and the highest combination of “weak” and “fair”.

Health Direct also shows the good NHS news. The following were rated as excellent trusts
Basingstoke and North Hampshire
Birmingham Children’s Hospital
Calderdale and Huddersfield
Cambridge University Hospitals
Chelsea and Westminster Hospital
Chesterfield Royal Hospital
Frimley Park Hospital
Guy’s and St Thomas’, London
Heart of England
Liverpool Women’s Hospital
Papworth Hospital
Queen Victoria Hospital
Salford Royal
Sheffield Children’s
Sheffield Teaching Hospitals
Royal Marsden
Yeovil District Hospital
South Essex Partnership
South Staffordshire Healthcare
Trusts rated excellent in both principle categories

The East Midlands SHA had the highest proportion of “excellent” trusts and the North East SHA had the highest combination of “excellent” and “good” trusts.

From:
http://news.bbc.co.uk/1/hi/health/7048981.stm

Health Direct has long been warning about the disaster that is MRSA, Clostridium difficle and superbugs in general. What we want is CLEAN hospitals not clean ER hospitals. Until politicians develop a zero tolerance towards poor hygiene more people will continue to die unnecessarily.

On Thu 11 Jan 07 Health Direct posted NHS hospitals may never achieve MRSA superbug targets as the NHS is not on track to meet its MRSA target and perhaps never will, a leaked government memo says.

In November 2004, then health secretary John Reid pledged MRSA rates would be halved by April 2008. But the memo, sent to ministers by a Department of Health official, said it would only be cut by a third by then. It also reportedly recommended ways to handle the news in the media. Dr Mark Enright, from Imperial College, said the target was “unrealistic”.

The document went on to discuss six options for “handling” the target. Of the six, just one recommends simply trying to meet the current target – the other five discuss ways of changing the target or timescale, or dropping the target altogether.

The memo also warns that another superbug, Clostridium difficile, is now “endemic throughout the health service, with virtually all trusts reporting cases” and shows that 2004 saw twice as many deaths from the bug as were related to MRSA.

And it warns that efforts to combat MRSA, such as alcohol handrubs, have had no impact on C. difficile, which it describes as a “far bigger problem”.

In a scathing report into the Gershon efficiency drive, the Public Accounts Committee (PAC) argues that just £3.5bn of the gains “represent efficiencies”. The remainder of the savings are “uncertain” because departmental calculations are often inconsistent, unsustainable, unsound and incomplete.

Service quality may have deteriorated instead of improved in some instances, the report claimed. Patients spending less time in hospital were classified as an efficiency saving, for example, in spite of a rise in re-admission rates.

The committee’s conclusions echo the findings of an investigation by the National Audit Office this year. Edward Leigh, PAC chairman, said the Treasury claim “does not stand up to close scrutiny”. “Too much of the data on which claims of efficiency gains are founded is simply unreliable.”

As he underlined in Tuesday’s pre-Budget report, Alistair Darling, the chancellor, aims to make £30bn of savings by 2010 with departments making 3 per cent efficiency savings every year.

Many projects included one-off savings rather than long-term improvements, excluded ongoing costs to maximise the apparent gains and misrepresented staffing figures to show headcount reductions.

A £300m saving by the Department of Work and Pensions from paying benefits electronically, for example, failed to take account of the £164m cost of the Post Office card account, through which some of those payments are made.

The committee concluded that the Office of Government Commerce, which verifies efficiency claims, left many calculations “insufficiently challenged”.

From:
http://www.ft.com/cms/s/0/4558bfc0-7787-11dc-9de8-0000779fd2ac.html?nclick_check=1

On March 02, 2006 Health Direct posted Why is NHS productivity falling- yet Labour claims it could be rising? when the Office for National Statistics started a fierce disagreement over output and productivity in the National Health Service this week as it launched a consultation into the issue.

The ONS reported that different techniques could show NHS productivity rose by 1.6 per cent a year between 1999 and 2004 or that it fell by 1.5 per cent a year. Official figures show a decline of close to 1 per cent a year.

The Department of Health’s preferred view raises NHS output by 2.68 percentage points a year, while independent research by the National Institute of Economic and Social Research and the University of York recently estimated a more modest uplift to NHS output of 0.17 percentage points. This would not be enough to show rising health productivity.

The most controversial element in the department’s reasoning is an automatic 1.5 percentage point a year uplift in measured NHS output to reflect the increased value of public services as society becomes richer.

Another problem was the Department of Health’s assumption that patients’ satisfaction at cleaner hospitals has as much weight in its calculations as the NHS’s ability to save lives. Andrew Street, a senior research fellow at the University of York, said there was no “empirical basis for the weights” the department used.

At the same time the De­partment of Health is launching a review of the in­for­mation it collects from the service, aiming to gather less but use what it gets far better.

The department persistently refuses to say that the £12bn programme is formally under review. But senior figures in Connecting for Health were expecting the announcement of a review to go alongside Lord Darzi’s interim report last week on the “next stage” of the NHS.

That appears to have been pulled amid the general election fever for fear it would generate headlines about the government admitting mistakes over the multi-billion-pound 10-year programme.

However, one senior health department official said a study was under way to establish “will this actually work?” The big local service provider contracts held by CSC, BT and Fujitsu are being moved out of Connecting for Health, an arm of the health department, to local level in the NHS, he said.

He added that “a big step change is that we will give people more choice” about what systems are installed in hospitals, to go alongside the wider choice of systems being offered to GPs.

One of the main problems, he said, had been that “we have forced people to take systems that were either worse than those they had already got, or were ones that they didn’t want”.

As a result, installation of new patient administration systems that are needed to underpin the long delayed electronic patient record are themselves also running way behind schedule.

Instead contractors are expected to let hospitals locally choose from “best of breed” applications that suit their local circumstances, while remaining compliant with the communication standards that the national programme has set.

The big contractors are also accepting that they will have to give individual NHS trusts more support to get the systems in.

One effect of the change, according to programme insiders, is likely to be more concentration on getting local systems up and running, and less on the national summary record, which many clinicians see as having little relevance.

The move follows a call from the Commons health select committee last! month for hospitals to be offered a wider choice of systems.

From:
http://www.ft.com/cms/s/0/89fba648-7399-11dc-abf0-0000779fd2ac.html

Yippee Doo. A full eighteen months after Health Direct warned of the impending IT disaster, (April 17, 2006) Health Direct posted Anatomy of a £15bn gamble- CfH’s NHS IT busted flush

The new NHS computer system could be the biggest IT disaster in history, warn experts. Inside a leading hospital in Oxford, expensive new computers were humming away just before Christmas when disaster struck.

The Nuffield Orthopaedic Centre was at the forefront of a multi-billion-pound revolution to modernise the entire computer system of the National Health Service — and the screens had suddenly frozen.

Although the system was functioning again the next day, some patient files seemed to have disappeared completely. The trust was so alarmed that it sent a report to the National Patient Safety Agency, warning that it had posed a potential risk to patients.

Even CfH admitted that the cost of the scheme, now not due to be completed until 2010, could reach £15 billion. Outside experts suggest that £30 billion is more realistic.

It is that no amount of central guidance, top-down imposition of an annual steam clean of wards, the creation of extra matrons or ward sisters’ right to demand better cleaning – some of the government’s headline solutions – is going to solve the problem.

The Healthcare Commission’s investigation shows that copious existing guidance – on antibiotic use, on hand-washing and disinfection, on infection surveillance, on patient isolation – was simply not followed.

Nor does the easy explanation that the pressure of government waiting time targets, on their own, somehow “caused” the outbreak hold water.

C. difficile infections are on the rise, with hospitals struggling to control them. There may indeed be other, as yet undisclosed, scandals to follow those of Maidstone and Stoke Mandeville, where 33 patients died between 2003 and 2005.

But there are several hundred acute hospitals in England and, in the four years since the first Stoke Mandeville outbreak, the overwhelming majority have balanced the competing demands of finance, waiting times and infection control without such disastrous outbreaks of hospital acquired infection.

“The government does not want to admit there could be a conflict between lots of ­targets and hospital infections,” Richard James, Professor of Microbiology at Nottingham University says. “And I understand that many other trusts cope. But with such a large number of them, it is inevitable that some will be better than others.”

The most striking part of the commission’s investigation, he says, is the “mirror image” findings with what happened at Stoke Mandeville – parallels that the commission itself highlights.

These might be characterised as the risks of reorganisation. Both trusts had undergone difficult mergers, both were preoccupied with finance and both were trying to reconfigure services and build a private finance initiative (PFI) hospital.

Both had old hospitals with many large “Nightingale” wards and few single rooms in which to isolate patients.

Both had also cut nurse staffing levels and beds, producing very high occupancy levels, and both ignored the complaints of patients and relatives that would have highlighted the risks, and the outbreaks, earlier. And both allowed the governance arrangements, at board and infection control level, to be “over-ridden by other imperatives, including targets relating to finance and access”.

Waiting times and finances are important, the commission said, but they should not be “at the price” of infection control.

The Maidstone trust closed wards at one hospital to transfer work to others but with “no evidence” that it sought the efficiencies needed to allow it to cope if demand for beds remained high.

More than 90 per cent of beds were occupied and, Prof James says, “it is well established that occupancy rates above 85 per cent make infection control difficult because staff are rushed and isolation is difficult to do”.

Newer hospitals with more single rooms make that easier, he says. But infection control, according to Prof James, is essentially about behaviour.

“The first thing that is needed is for politicians to admit the scale of the problem,” he said. “We let the genie escape the bottle in the early 1990s and it is going to take years to put it back.”

Screening patients for the superbug MRSA will help, he said “and we can model that, to show that rates of blood-borne MRSA infections would get down to the best in Europe over six years”.

But it is likely to take that long, he said, and even then other measures, notably isolation and hand washing, are needed to tackle C. difficile.

Doing so, and reducing excessively high bed occupancy, health professionals acknowledge, is likely to have a small, but measurable, effect on waiting times.

From:
http://www.ft.com/cms/s/0/f4e40090-7920-11dc-aaf2-0000779fd2ac.html

The damming verdict from the Healthcare Commission was echoed by the Lancet last month when Health Direct posted: Stalinist Brown’s superbug plans ignore scientific evidence claims Lancet on Fri 28 Sep 2007- Labour government plans for tackling superbugs, such as MRSA, have been condemned by a leading medical journal for not being based on scientific fact.

The Lancet said there was little evidence to support hospital “deep cleans” or short sleeves for medical staff as recently mentioned by Health Direct.

Instead of “pandering to populism” politicians should listen to the evidence, the editorial said.

The Lancet said a labour government working group had found no conclusive evidence that uniforms or other work clothes posed a significant hazard in terms of spreading infection.

Instead the focus should be on disinfection of high touch surfaces rather than deep-cleaning wards to get rid of visible dirt, the Journal said. “The main route of transmission of MRSA is person-to-person contact and this will be affected little by deep cleaning.”

This classic piece of management-speak was delivered in March 2001, when Miss Gibb was implicated in the first of a string of hygiene scandals at three separate NHS trusts.

The Daily Telegraph and Health Direct has learned that Miss Gibb, who rose to the £150,000-a-year post of chief executive of the Maidstone and Tunbridge Wells NHS Trust before she left the job last week, has an unenviable track record of presiding over dirty hospitals where infections have been able to spread.

Despite this, Miss Gibb has been richly rewarded by the NHS, which may yet give her £250,000 in severance pay if the Health Secretary’s attempt to block it is ruled illegal.

Miss Gibb, a former nurse with one grown-up daughter, refused to talk to the media yesterday at her £700,000 home in a secluded country lane in the village of Sole Street, near Cobham, Kent.

Her partner, Mark Rees, who was chief executive of Barking, Havering and Redbridge NHS Trust until Oct 1, told reporters: “No way is she going to talk to you. Why should she? If you want to ask questions why don’t you go to the trust – it’s got nothing to do with her.”

Miss Gibb worked her way up through the ranks as a nurse before becoming operations director at Bromley Hospitals NHS Trust, where she was in charge of hygiene.

In March 2001 an internal survey at the hospital found that the standards of cleanliness were “poor”. It was then that Miss Gibb was quoted as saying the trust had introduced an “action plan”.

Later that year she became chief executive of North Middlesex Hospital, which was named in 2001 as the worst in the country for MRSA.

In Oct 2001, shortly after the inquiry into the murder of Victoria Climbie began, Miss Gibb was one of six signatories to a letter in which she and others agreed with Haringey council to take a “joint and positive approach” to the inquiry, not attacking or blaming each other for failing to spot the abuse which eight year old Victoria was suffering when she was taken to hospital for treatment.

Miss Gibb moved on to her job as chief executive of the Kent trust in 2003, where she immediately pledged to sort out dirty wards. Yet the conditions remained so bad that Clostridium difficile became rampant, killing between 90 and 350 patients.

Years of broken promises

“The (Kent and Sussex) hospital has got cleaning problems, I’ve been aware of those for the last six months. I’ve put a massive amount of improvements into them, and I’m going to continue to put improvements into the hospital until we get it to the level we want it to be. It will take nine months.”

Rose Gibb, chief executive, Maidstone and Tunbridge Wells NHS Trust, June 2004

“This issue is receiving my full and personal attention.”

Rose Gibb, June 2004

“We have set down a new culture of what we expect from the cleaning staff.”

Rose Gibb, Sept 2004, at the trust’s annual meeting

“If we find anything can be further improved it will be a top priority.”

Bernard Place, then director of nursing for the trust, July 2006

“The trust takes the care and safety of its patients extremely seriously. The trust will now… identify, develop and implement any additional measures that can be made to further improve patient care and safety.”

Rose Gibb, Sept 2006

“Kent and Sussex Hospital has taken a range of additional infection control measures which include ward closures, additional ward cleaning and isolation of patients in side rooms.”

Trust spokesman, Feb 2007

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/10/12/nbugs212.xml

Health Direct has long noted labour’s policy of rewarding NHS failures. On July 20, 2007 Health Direct posted: NHS manager’s payout is nearly £1m

When an NHS manager has been given a redundancy package worth almost £1 million in what was described as “a lottery win rather than a payout”.

David Johnson, the former head of a regional strategic health authority, was one of about 70 staff who left the organisation when it was abolished as part of a restructuring programme.

The 50-year-old received a package worth £899,810 including salary and pension arrangements. The reorganisation was supposed to save £250 million a year in administration costs. However, the NHS is thought to have spent at least £320 million on redundancy packages to those who have lost their jobs.

Health direct then asked- given the current climate of tony’s cronies- Health Direct asks if there any relationship between David Johnson the NHS lottery winner and Alan Johnson the NHS boss?

Health direct also posted on August 24, 2007 Labour red tape shake up costs NHS 140 million Pounds as the reorganisation of strategic health authorities (SHAs) in England has seen the NHS pay out more than £80m in redundancy costs, Health Direct and the BBC has learned.

More than 700 staff lost their jobs in last year’s shake-up, which saw the number of SHAs reduced from 28 to 10. The cost of the average redundancy package for senior managers was more than £350,000.

Police have launched an investigation into the infection of more than 1,100 Kent hospital patients, after a report published blamed the spread of the disease on appalling hygiene standards.

The Health and Safety Executive and police officers are reviewing mismanagement by bosses at Kent and Sussex, Pembury and Maidstone hospitals to consider if it constituted a criminal act.

Inadequate staffing levels, dirty wards and too much focus on cost-cutting and government targets contributed to two serious outbreaks of C difficile in as many years at Maidstone and Tunbridge Wells NHS Trust, an investigation by the Healthcare Commission found.

Alan Johnson, the Health Secretary, “It’s a scandal. It’s awful,” he said rejecting the notion that Whitehall targets were responsible for the outbreaks.

“To suggest that in this particular incident, this reflects what’s happening in the NHS across the country is absolutely wrong,” he told the BBC. “There are nurses and clinicians across the country who have dealt with the targets. . . but kept the highest safety standards.”

Rose Gibb, the chief executive of the trust, left her job by mutual agreement with the board. Campaigners today demanded to know how much she was paid after stepping down.

The trust has refused to disclose the size of her settlement. Geoff Martin, of campaign group Health Emergency, said: “I have heard from Maidstone NHS staff this morning that chief executive Rose Gibb is rumoured to have received a massive pay-off from the trust.

“If it’s true, we have a right to know how much taxpayers’ money is involved and it would fuel the scandal even more if it turns out that senior managers have walked away from this carnage with their pockets stuffed with NHS cash.”

The commission found “significant failings” in infection control at three hospitals run by the trust between April 2004 and September last year, including unwashed bedpans, a lack of isolation units, beds being spaced far less than the recommended 3.6 metres apart to stop the spread of infection and nurses telling some patients with diarrhoea to “go in their beds”. Pictures taken as recently as February disclosed continuing hygiene concerns.

The failure to contain and treat infections at all levels contributed to 1,176 patients being infected with the bug at Kent and Sussex Hospital, Pembury Hospital and Maidstone Hospital, Kent, the watchdog said.

A total of 345 patients died while infected with the bacterium between April 2004 and September 2006. Of these 21 died as a direct result of infection, and for 69 patients it was probably the main cause of death, it added.

In addition, C difficile could also be considered a “contributing factor” in as many as 241 of the deaths, although the report said that patients, many of them elderly or frail, may well have died of other causes if they had not acquired the infection.

The trust had previously told the Healthcare Commission there had been “no deaths that were definitely caused by C diff” between April 2004 and March 2006.

The first big outbreak was between October and December 2005 but, despite the number of infected patients quickly doubling to 150, the trust did not identify the outbreak.

The second significant outbreak was between April and September 2006, in which 258 patients were affected, and was recognised as serious by the trust.

But despite these problems, the trust declared itself compliant with national government standards for hygiene and infection in May 2006.

At the time of the outbreaks the trust was carrying out a programme to save £40 million over three years in the face of huge debts. At the end of 2003, the trust had an accumulated deficit of £17.6 million. Last year, it reported a deficit of £4.5 million.

The commission said that there was evidence patients had been moved between several wards, increasing the chance of spreading infection. It said this was partly due to concerns over hitting the Government’s targets on waiting times for treatment in A&E.;

Anna Walker, the chief executive of the commission, said that the lack of infection control at the trust had been “unacceptable” but that conditions had improved as a result of monitoring by the commission.

Improvements included increasing the space between beds, appointing a new director of infection prevention and control and implementing a policy on the use of antibiotics which are known to help C difficile thrive.

“What happened to the patients at this trust was a tragedy,” Ms Walker said. “This report fully exposes the reasons for that tragedy, so that the same mistakes are never made again.”

She called for the NHS to treat C difficile as an illness rather than just an added complication.

A spokeswoman for the Health and Safety Executive said that it was working with Kent Police to consider the report.

Among the mistakes:

* Patients were treated on open wards instead of in isolation
* A former children’s ward was being used for adults. It contained an uncleaned shower, one wash basin for 12 beds and beds placed only 30cm (less than a foot) apart
* A shortage of nurses contributed to the spread of infection “because they were too rushed to undertake hand hygiene, empty and clean commodes, clean mattresses and equipment properly” and wear aprons and gloves
* High bed occupancy – over 90 per cent at Maidstone and the Kent and Sussex – led to less time for cleaning
* Staff used alcohol wipes, which are ineffective against C. Diff spores, to clean commodes instead of soap and water
* Old commodes were used despite the trust agreeing to replace them and setting aside £250,000 to do so

From:
http://www.timesonline.co.uk/tol/news/uk/health/article2637166.ece

Health Direct wonders whether the solids are about to hit the air conditioning.

On Jan 12, 2007 Health Direct posted: MRSA superbug claims may surge against NHS
when a flood of MRSA compensation claims could finally be realised as lawyers turn to workplace safety legislation to pursue hospitals.

To date it has been hard to pin the blame on the NHS, as it is never known exactly when a person becomes infected.

But recent successes have prompted a rethink in how lawyers tackle cases, with many making use of laws governing the control of hazardous substances.

But more fundamental reforms are needed and will take at least two to three years to implement, according to Sir John Tooke, who headed an independent inquiry into what proved the biggest administrative fiasco in NHS history.

Sir John said there was still no consensus on the educational principles guiding the reform of medical careers and postgraduate training was still hampered “by unclear principles, a weak contractual base, a lack of cohesion, a fragmented structure and, in England, deficient relationships with academia and the service”.

The “sorry episode” had caused great distress, he said, as the health department said the national IT system for applications will not be used next year and junior doctors will switch posts on up to three dates in the year rather than just one.

From:
http://www.ft.com/cms/s/0/f7776594-7601-11dc-b7cb-0000779fd2ac.html

On Sept 13, 2007 Health Direct posted: A terrible way to treat our doctors- Financial Times Comment on MMC’s MTAS recruitment disaster

Modernising Medical Careers (MMC) is a suitably Orwellian name for a Stalinist new system for training doctors in the National Health Service. The phrase is a perfect example of newspeak. To oppose a “modern” system is to be a conservative, if not a reactionary.

Yet, like all systems of centralised planning, this one has proved inefficient, inflexible and inhumane. It is an object lesson in the dangers of the ever-growing capture of hitherto autonomous professions and institutions by the state.

What, then, lay behind the fiasco that Modernising Medical Careers has become? There appear to be three causes.

First, the department resolved on seizing control over medical training from the professional colleges and consultants, who happen to know what doctors can (and should be able to) do.

Second, the bureaucrats made a mess of manpower planning: in England, for example, 29,200 doctors have been competing for the 15,600 training places they arbitrarily decided to create.

Third, they chose this moment of upheaval to introduce an inflexible and characteristically defective computerised system (the Medical Training and Application System) to allocate doctors across the country.

Allocations to training posts are within huge geographical areas. But doctors are dispatched, like so much meat, to one hospital. Do they live hours away? That is tough luck. Do they have a partner, or even children? That is just tougher luck. Do they wish to switch hospital or sub-speciality? They must be joking. Do they wish to know the terms and conditions of their employment before arriving? They must reallybe joking.

To put the point bluntly, these highly trained professionals, on whom you may depend for your lives or those of your loved ones, are being treated with contempt. Do you want to be looked after by someone so treated?

No less predictable is the fact that those who made these blunders are still in place. One might have expected resignations, starting with Sir Liam Donaldson, chief medical officer.

So is the NHS suffering from an excess of free market zeal, as many on the left believe? Hardly. Where it matters, the planners are in charge. As always, they are making a big mess and, as almost always, they look likely to get away with it unscathed.

It is not just in this year that failures in labour’s centralised, computerised doctor’s recruitment emerged. The Department of Health has been aware for over a year that it’s incompetence is leading to a road crash.

Eighteen months ago Health Direct posted on March 06, 2006 Junior Doctors’ new IT MMC MTAS recruitment system is a disaster

It is an irony that many of the questions junior doctors must answer when they fill in the new form to apply for hospital jobs relate to their leadership skills and ability to work as part of a team. The form is part of a new applications procedure, called Modernising Medical Careers (MMC), which involves no human interaction whatsoever.

Hospitals are banned from holding interviews, having to rely instead upon a computer “dating” system that supposedly matches the applicant to the job.

As 80 eminent doctors have been moved to protest to the Department of Health, the results have been disastrous. Sixty junior doctors recruited in this way have failed to demonstrate a basic level of medical competence, while many others have had to be retrained at huge expense.

The way some trusts deal with grievances is fragmented and inconsistent, it says.

In its first audit of how complaints are managed, the watchdog sent warnings to 30 NHS trusts and told 12 of them there had been a “significant lapse” in how they handled patients’ concerns.

In the first instance, patients with a grievance must raise it with the healthcare provider involved, such as their GP, NHS trust, dentist or optician.

If they are not satisfied with the response, they can ask the Healthcare Commission to review their case.

The watchdog receives about 8,000 requests each year, and nearly a third of them are sent back to the trust for further action.

The final stage of the complaints procedure is for the Health Service Ombudsman to carry out an independent investigation. There were 1,139 such cases in 2006-07.

In June the Department of Health proposed that local NHS organisations should have greater responsibility for resolving complaints, and that the Healthcare Commission’s role in the process be abolished.

But Anna Walker, the commission’s chief executive, said the report cast doubt on whether trusts were fit to take on such a role.

She said: “There are serious questions about whether trusts are in a position to ramp up their systems in time to provide the necessary standard of service.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/10/08/nnhs108.xml

On Sept 04, 2007 Health Direct posted: New NHS complaints service launched by the Citizens Advice Bureau when a new NHS complaints service was being launched by the Citizens Advice Bureau (CAB) and will be rolled out across Scotland ahead of a national roll-out of the service. The confidential scheme helps patients take forward grievances about the NHS.

CAB said the fear of being struck off a surgery’s patient list can often deter rural residents from filing a grievance through the NHS complaints system.

Mr Montgomery who will run the service for the CAB said “There is a perception, particularly in rural areas, that complaining about services like local GPs could jeopardise access to the local doctor in the future.

“Many people have to complain in the first instance directly to the surgery and it could be the GP’s wife who is the surgery manager.

“So that can create a perception that complaining may cause problems for the patient. We can advice patients of their rights, write letters on their behalf and liaise with the NHS.”

Previously, patients were guided through the NHS complaints process by Health Councils, but they were abolished in 2005. At the time, the Scottish Public Services Ombudsman (SPSO), said that this gap in support was “a cause for concern”.

The dangers of childbirth in the modern health service are highlighted by figures showing that £665m has been paid out over the past three years to settle medical negligence claims where obstetric deliveries have gone catastrophically wrong.

The size of the payout – enough to hire 1,000 extra consultants – reflects the enormous and growing burden of medical negligence on the health service, which is diverting scarce resources from patient care.

In a major report published by the Royal College of Obstetricians says that too little is being done to reduce the risks of childbirth and make it safer for mothers and babies. It will blame shortages of consultants and midwives, increasing pressure from a rising birth rate, and lack of training.

The report, Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour, will highlight how a tiny error during labour can result in oxygen deprivation and brain damage to the baby, leading to lifelong disability and a compensation payment of millions of pounds.

Professor Sabaratnam Arulkumaran, the head of obstetrics at St George’s Healthcare NHS Trust in Tooting, south London, and the vice-president of the Royal College of Obstetricians and Gynaecologists, said: “We are pressing the Government to increase the number of consultant obstetricians in busy units so that we can provide 24-hour cover.

“If there is a consultant present they are better able to deal with emergencies and prevent disasters. If you save 20 disasters costing £5m each that is £100m. Rather than have more [negligence] cases and pay out on more claims we should spend on more consultants and reduce the number of cases.”

Childbirth is claimed to be safer than it has ever been, yet NHS trusts have to pay a £450 “insurance premium” for every baby that is born in case they are sued for negligence if things go catastrophically wrong with the birth.

The payments, totalling £280m for the 618,000 births in 2005-6, are collected by the NHS Litigation Authority, which handles negligence claims against NHS Trusts. The authority received 5,700 claims and paid out a record £560m in compensation in 2005-6, more than half of which (£259m) was for obstetric cases, up from £163m in 2003-4 – a rise of 59 per cent (£96m) in two years.

The figures were released to The Independent in response to a Freedom of Information request.

Last year, for the first time, the NHS Litigation Authority ranked maternity units in a league table according to their level of risk, based on a new standard for maternity care. Out of 154 maternity units in England, 18 are currently ranked Level 3 (the safest) and 54 are ranked Level 1 (least safe), with the remainder ranked Level 2.

Two poorly performing trusts, the Isle of Wight and the Royal Bournemouth, were upgraded earlier this year from the lowest Level 0 to Level 1.

NHS Trusts are not required to improve their risk rating but have a strong financial incentive to do so as it reduces their insurance premium – by 10 per cent for Level 1 rising to 30 per cent for Level 3. A trust delivering 5,000 babies a year and paying a £2.5m annual premium could save £750,000.

Steve Walker, the chief executive of the authority, said the high premiums charged to NHS trusts were necessary because of the “gold-plated” awards made by the courts.

“A judge may award £5m compensation if something goes wrong. I am not disputing that these kids need it – they are going to need teams of carers to look after them round the clock for life. But a minor shortcoming in their care can have the most devastating consequences for the child and the financial consequences for the NHS trust, if it is proved to be due to negligence, are astronomical.”

He said the rising cost of compensation was due to legal changes that had inflated settlements and efforts to settle claims more quickly. “It doesn’t mean obstetricians are more negligent. It means claims are becoming more expensive.”

Compensation is a lottery, with the lucky minority who can prove negligence winning huge sums.

Efforts to reform the medical negligence scheme by the Government’s chief medical officer, Sir Liam Donaldson, in a report in 2003, foundered after agreement could not be reached on how to implement his proposed no-fault scheme without massively increasing costs. The high cost of compensating some children diverts resources that could be used to reduce the risks for all.

The annual Confidential Inquiry into Stillbirths and Deaths in Infancy last year found that sub-standard care was to blame for more than 77 per cent of deaths during labour, and more than half might have had a different outcome with greater supervision and better management.

The Healthcare Commission, the Government’s NHS watchdog, warned in its annual report in 2005 of poor standards in maternity units. It blamed “weak managerial or clinical leadership” and said some maternity services were “not as good or as safe as they could be”.

The commission ordered all health trusts to review their maternity care.

The Royal College of Midwives said a poll carried out earlier this year of 102 maternity department heads (from a total of 216) found two-thirds thought their units were understaffed and one in five had lost staff in the past year.

Dame Karlene Davis, the chief executive, warned that the midwifery service was “heading for meltdown” as midwives struggled with staff shortages, service cuts and a rising birth rate.

She said: “We are looking to Alan Johnson [the Health Secretary] to put maternity issues at the top of his agenda, halt the decline in the service and deliver the first-class maternity care the Government promised.”

‘It is one of the most poignantly tragic cases’ – Kerstin Parkin, dancer

Kerstin Parkin, an internationally known Latin American dancer, received one of the largest compensation settlements in the NHS’s history when she was awarded £7m and £250,000 a year for life in 2002 for injuries sustained during the birth of her son, Dylan.

She suffered brain damage following a heart attack in labour brought on by pre-eclampsia, a condition linked to high blood pressure that can trigger convulsions.

The accident happened at what was then Farnborough hospital in Bromley, Kent, in November 1996. The High Court found that hospital staff had failed to take basic steps to prevent the damage and a cardiac emergency team was unable to reach her because they did not know the security code to enter the ward.

The judge, Mr Justice Buckley, said at the time: “It is one of the most poignantly tragic cases I have dealt with.”

Today Mrs Parkin lives with her husband, Mark, and son, Dylan, now aged 10, in a large house near Godalming in Surrey, and is cared for round the clock by a team of staff.

Though profoundly disabled she is able to use her limited movements to control a computer and a wheelchair and to play games.

Mr Parkin, speaking earlier this year, said: “The compensation has made an enormous difference because it has enabled Kerstin to live at home with me and our son. It has allowed her to be cared for properly and to be provided with all the therapies and equipment that she needs.”

Initially she was only able to move her head and eyes but constant care and therapy have helped her condition to improve.

Mrs Parkin and her husband became dance partners in 1989, the year of their marriage, and went on to international success in the Latin American dance world. They had planned to retire from dancing and concentrate on teaching and choreography when the accident happened.

http://news.independent.co.uk/health/article3038383.ece

Health Direct posted NHS is facing £4.5bn compensation bill over babies damaged at birth by hospital blunders on 24 Sep 2007- The NHS is facing £4.5bn in compensation claims over alleged blunders by midwives and doctors that have left babies suffering severe brain damage, The Observer and Health Direct reveals.

The disclosure that such large amounts of NHS cash could potentially have to be spent settling such claims has reopened the debate about the quality and safety of Britain’s maternity services.

Professor Sabaratnam Arulkumaran, the incoming president of the Royal College of Obstetricians and Gynaecologists, last night accused hospitals of putting babies and pregnant women at unnecessary risk by not employing enough senior staff on labour wards.

The number of consultants and midwives at up to half of hospitals ‘aren’t adequate’ and women using those hospitals are at greater risk of a problem arising, Arulkumaran said.

She had to make a 150-mile round trip to Nottingham to get the drug.

Along with the Leeds Teaching Hospitals NHS Trust, he has asked the government to stop it happening to other patients.

“Potential life expectancy should not depend on the location where the person resides” Mike Tomlinson

Mrs Tomlinson died in September, aged 43, after a seven-year cancer battle.

While terminally ill, she raised more than £1.75 million for charity by running in three London Marathons, several triathlons and The Great North Run.

Mr Tomlinson said his wife’s medical team in Leeds decided Lapatinib was her best option. It costs £6,700 per patient, per year.

However, Leeds Teaching Hospitals NHS Trust had taken the decision not to participate in a GlaxoSmithKline-sponsored access study of the treatment.

He said: “Clearly it was quite distressing for Jane to find that she would no longer be able to have the treatment that everyone thought would be most suitable for her. It caused a lot of distress to her and a lot of upset.”

Mr Tomlinson said further approaches were made to the drug company itself and to the NHS in Nottingham, where she was eventually accepted on to the trial in April.

However, he said the delay in getting on to the trial in Nottingham severely affected her health.

“There was no doubt in our minds that delay and inability to get treatment had a long-term impact on Jane’s health at that time,” he said.

“This is the National Health Service. Potential life expectancy should not depend on the location where the person resides.

“She was extremely cross that there were inconsistencies across the health service which allowed some patients treatment and some patients not treatment.”

‘Deeply disappointed’

Mr Tomlinson said his wife had asked him to speak out after her death.

Mr Tomlinson said making his wife travel to Nottingham for treatment was “inhumane” and “caused unnecessary aggravation to Jane at a time when she was at her most vulnerable”.

He said: “Jane has been fundamentally let down by an unjust system. She has received many tributes over the last month. The most fitting would be the resolving of this issue.”

Dr Phil Ayres, deputy medical director of the Leeds Teaching Hospitals NHS Trust, said: “We were deeply disappointed not to be able to offer Jane the treatment she and her consultant wanted.

“We support Jane and Mike’s views that we need a debate about access to drugs that have not yet been licensed or nationally approved.

“It is currently a difficult and uncertain process to make investigational drugs appropriately available.”

From:
http://news.bbc.co.uk/1/hi/england/7029234.stm

Health Direct is disgusted with the way the NHS treated Mrs Tomlinson- especially as she raised so much money for cancer care. Hopefully change may eventually to be on the way:

On Sept 06, 2007 Health Direct posted: NHS Postcode lottery to be challenged in the courts
as the European Commission has been asked to investigate whether a local health authority can refuse to pay for drugs when funding is available elsewhere.

Tory MEP Chris Heaton-Harris claims the so called NHS postcode lottery breaks European anti-discrimination laws.

Mr Heaton-Harris said: “If you’re being withheld treatment because of where you live, it could be as similar as being denied treatment because of your religion or colour.”

The fund, run by a Health Innovation Council, is aimed at persuading the NHS to acquire, adopt and spread cost-effective new technologies. The announcement comes just days before the NHS looks set to emerge as the biggest winner from the government’s comprehensive spending review, publication of which is now expected next week.

The NHS is expected to win at least an average 3 per cent annual real-terms rise in spending over the next few years. That is half the current rate of growth – but appreciably more than any other big department or service will secure over the next three years.

Almost a year late, ministers also plan to announce on Friday the winners of a new framework contract that will make it easier for primary care trusts to bring in private sector help with healthcare commissioning.

Lord Darzi’s interim report set out his vision for a 21st-century “world class” health service, although the professor of surgery said on Wednesday that details of how the vision would be turned into reality would have to await his final report next spring.

A first step is the Health Innovation Council, which follows a recommendation from last year’s Cooksey report for “a more systematic approach to the adoption of new technologies”.

It was not immediately clear on Wednesday night, however, how the new council will dovetail with, or revamp, the existing NHS Innovation and Improvement Institute, which itself was created after the abolition in 2005 of the NHS Modernisation Agency.

That was scrapped after ministers declared that “modernisation is now embedded in the NHS” and that the agency was no longer needed. On Wednesday, however, health department sources acknowledged that the NHS still struggled to adopt new technologies swiftly.

Mark Walport, the director of the Wellcome Trust, which will jointly administer the fund with the health department, said its aim was to “bridge the gap from discovery to application”.

Lord Darzi said the council “will provide leadership and advocacy with key decision-makers in the NHS on the benefits to patients, the NHS and the country, of adopting cost-effective new technologies and models of care”.

From:
http://www.ft.com/cms/s/0/f95d07be-7206-11dc-8960-0000779fd2ac.html

Health Direct wonders quite where the creation of yet another health quango in addition to NICE and the NHS Innovation and Improvement Institute is going to lead?

Tackling infections which can be acquired both in an outside of hospital, is a key theme of Sir Ara Darzi’s interim review of the NHS in England.

Nurses will be required to swab all patients admitted for planned and emergency procedures, to test for life-threatening infections which could put other patients at risk. Those with positive results will be placed in isolation and given creams and body washes to clear the bugs.

Lord Darzi, a Health Minister and part-time surgeon, is conducting a review of services across England and Wales and also aims to improve patients’ access to their local GPs. Gordon Brown and Alan Johnson, the Health Secretary, attended the launch of an interim report on his review in London.

The report was published amid claims by campaigners and opposition MPs that it had been brought forward for publicity purposes amid mounting speculation of a snap election. Doctors and Opposition parties accused the Government of using the NHS as a “political football”.

Lord Darzi’s study sets out how local Primary Care Trusts could work with new and existing GP practices to ensure greater flexibility on opening hours.

Family doctors have come under fire in recent months after nine out of ten decided to “opt out” of providing care on evenings and weekends.

Lord Darzi announced today that the Government’s aim was that at least half of all GP practices would open on Saturday mornings or one or more evenings per week.

A total of 150 GP-run health centres that open seven days a week, 8am to 8pm, will also be established in prominent locations around the country.

In addition, more than 100 new GP practices with up to 900 GPs, nurses, and health care assistants will open in the quarter of primary care trusts with the poorest provision, he said. The aim is to improve the health of people living in deprived areas.

Under measures aimed at tackling hospital bugs, all patients entering hospital for planned and emergency procedures will be screened for MRSA.

The Government’s aim is to screen all elected admissions for MRSA next year, rising to include all emergency admissions over the next three years.

The Lancet, a leading medical journal, said the only way to beat infection was through hand-washing.

Lord Darzi said: “Cleanliness is not just about wards being clean. It’s about preventing the spread of infection. I wash my hands for at least five minutes before I carry out an operation. I tell patients not to let anyone touch them unless they have washed their hands.”

The Darzi review was announced in the summer with the final report expected next year in time for the 60th anniversary of the NHS. But doctors and political parties are sceptical about the Government’s motives, as the interim report was not expected for another week.

Jonathan Fielden, of the British Medical Association, said: “We hope it will set out a clear vision for the NHS and be about engaging with clinicians. But my concern is that it will be about getting good news about before an election.”

Shadow Health Secretary Andrew Lansley said: “Bringing forward Darzi’s findings so soon is yet another example of this labour government using our NHS as a political football.

“How can NHS professionals feel confident and how can patients feel safe when they know that this report must have been cobbled together without consideration for clinical evidence.”

Norman Lamb, Liberal Democrats’ health spokesman, said it had only been three months since Gordon Brown launched the review.

“How much can he have listened while engineering all the talk about elections? The key to providing better services to patients is making the NHS more responsive to local communities, not a plan imposed on the whole country by ministers sitting in Whitehall.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article2588491.ece

Stalinist Brown’s MRSA superbug plans ignore scientific evidence claims Lancet On 28 Sep 2007 Health Direct posted that the Labour government plans for tackling superbugs, such as MRSA, have been condemned by a leading medical journal for not being based on scientific fact.

The Lancet said there was little evidence to support hospital “deep cleans” or short sleeves for medical staff as also recently mentioned by Health Direct.

Politicians practise politics. So it was understandable that Alan Johnson, UK health secretary, allowed his remarks at the Labour party conference last week to be seen as a sign that he was lukewarm about the healthcare reforms many union members dislike.

On the same day came news that a group set up to advise the government on how to improve buying private sector services for the National Health Service had disbanded. Both events add to concern that the impetus for change is on the wane.

Since its members believed they were wasting their time, the decision of the NHS commercial advisory board to wind itself up has some merit. Public bodies have a habit of staying on well past their shelf life.

The temptation is often to carry on as though their advice matters – even when it falls on deaf ears. In this case, members recognised that ministers had stopped listening and they could use their time and talents more profitably. On this, they should be congratulated.

There is, however, a real worry that the government is now cooling on moves towards choice and competition in the health service.

A reduced commitment to the reforms under way would matter less if it were part of a broader debate that generated ideas about more radical changes to healthcare provision.

That discussion is entirely absent in the two main political parties. They are both so busy pledging allegiance to the NHS that they do not move beyond the undoubted affection it commands in the UK.

They fail to consider why it is that few countries in the rest of the world have followed the British model.

So if the government is disposed to retreat from market reforms within the present structure, its only Plan B looks like the notion that it can improve the NHS through centralised control.

This is a non-starter. On Monday, Gordon Brown, the UK prime minister, spoke about personalising healthcare provision and other public services.

Personalising must mean moving decisions much closer to the individual rather than handing them to suits in Whitehall.

The proper role for central government now is to drive through the market-like reforms in healthcare that Tony Blair’s administration introduced after spending its first years tearing up the Tories’ version of the same system.

Primary care trusts are often far from eager to pick up the phone to private sector businesses who could provide services: it requires a strong push from Whitehall. When Mr Johnson is back behind his ministerial desk he must make clear he will provide that push.

From:
http://www.ft.com/cms/s/0/89a52162-6cfd-11dc-ab19-0000779fd2ac.html

Austria outstripped the Netherlands and France as the most consumer-friendly system overall, while the UK ranked just 17 out of 29 European nations in the latest assessment produced by the Health Consumer Powerhouse, a Swedish-based private healthcare analyst.

The report claims “Bismarck”-style healthcare systems, such as Germany’s, funded by a series of insurers independent of healthcare providers, do better than “Beveridge”-style systems such as the UK’s National Health Service, where finance and provision are contained in a single organisation.

The study argues that better outcomes reflect stronger consumer choice between different insurers.

Overall, the report rates the UK a “mediocre” performer, which does well for heart problems and provision of healthcare information, but poorly on access to new cancer drugs, five year cancer survival and direct access to specialist doctors.

From:
http://www.ft.com/cms/s/0/fcc7cd02-7081-11dc-a6d1-0000779fd2ac.html

On April 05, 2006 Health Direct posted: Doctors For Reform- NHS is failing and unsustainable

Doctors For Reform once believed the NHS was the finest healthcare system in the world. Today few healthcare professionals would make that claim. Britain is the world’s fourth largest economy. But it does not enjoy standards of healthcare consistent with its status.

On measures such as life expectancy, infant mortality, premature mortality and cancer survival rates the UK continues to perform poorly compared to other countries and there is a significant gap with the best performing countries.

The time has come to look at new ways to supply and fund healthcare.

The NHS cannot meet public expectations today (2006). It is highly unlikely that it will meet them tomorrow. Future generations will seek rapid access to care, greater choice and more information about their treatment.

We need a healthcare system which is equal to rapidly rising costs and demand, and which enables professionals to retain the essential bond of trust with their patients.