Every household in the country will have a leaflet through the door from next Tuesday onwards

As five cases of swine flu were confirmed in the UK – including a 12-year-old girl – and 78 further people are being tested, labour ministers mounted a major offensive to contain the problem.

Adverts will run in newspapers, on radio and on TV from today giving information about swine flu and advising people that basic hygiene measures such as covering your nose and mouth with a tissue and washing your hands are the best ways to protect against the disease.

Every household in the country will have a leaflet through the door from next Tuesday onwards also giving information on the disease and what to do in the event of someone showing symptoms.

Health Secretary Mr Johnson said: “We are following the philosophy to hope for the best but absolutely prepare for the worst. It is inevitable there will be more cases. What is reassuring is that if you take Tamiflu early you make a full recovery. It is just like a dose of flu. It could get much worse but we are prepared.”

Sir Liam Donaldson, chief medical officer, said the last bad seasonal flu year was in the winter of 1999/2000 when 22,000 people died – ten times the norm – and he warned that a pandemic could be similar to that situation but ‘multiplied several times over’.

Mr Johnson announced a raft of new measures including boosting the stock of antiviral drugs, Tamiflu and Relenza, which reduce symptoms and severity of flu from 33m courses to 50m courses and extra antibiotics are being purchased to treat people who may develop secondary complications such as pneumonia.

Extra face masks with inbuilt filters are being bought for NHS staff and all front line health workers will receive their own course of anti-virals to take if they treat someone found to be infected with swine flu.

Health Protection Agency staff will be at all airports where flights come in from infected areas and all passengers on flights from affected areas to be given a leaflet with advice about seeking medical attention if display symptoms within seven days.

Airlines are being asked to keep passenger manifests for seven days instead of usual 24 hours to aid in contact tracing if necessary.

The public are being advised not to buy face masks as there is no evidence they prevent the spread.

Sir Liam, said: “So far all the cases in the UK have been imported cases from the main affected areas and we have not seen any ongoing transmission.”

He said the positive side of this situation is that the virus is so far not spreading easily between people and no onward transmission has been yet seen outside Mexico and the US with the only confirmed cases having caught the disease in Mexico.

He said: “The virus is giving us a bit of time. It may become fast and furious at a later stage.”

He warned that in past epidemics and pandemics children have been the ‘supercarriers’ so the school holidays, going back to school have been key factors in the spread.

This may be why health experts acted quickly to advise that the Paignton Community College be closed for a week after a 12-year-old girl there was confirmed as having contracted swine flu.

Ed Balls, the Schools Secretary egotist said: “We will put the health of children first.”

From:
http://www.telegraph.co.uk/health/swine-flu/5244796/Swine-flu-Mass-advertising-campaign-as-ministers-step-up-fight.html

Dr Jane Barton, who was the prescribing doctor in each case, was the subject of two lengthy police investigations into a total of 92 deaths which ended with the Crown Prosecution Service deciding there was insufficient evidence to charge her.

But after a 10-year campaign by families of the dead, an inquest in Portsmouth ruled that medication had been a factor in five deaths at the Gosport War Memorial Hospital between 1996 and 1999.

Relatives believed that their loved ones had, in the words of one man, been “intentionally executed” at the hospital’s Dryad and Daedalus wards.

The son of one elderly woman who died after being given an increased dose of diamorphine told the inquest that when he asked Dr Barton how long his mother was likely to be in the hospital, she replied: “Do you know your mother has come here to die?”

The inquest jury decided that Robert Wilson, 75, Elsie Devine, 88 and Geoffrey Packman, 67, were given medication which was not appropriate for their condition, and which contributed to their deaths, although it had been given for therapeutic reasons. They also ruled that medication had contributed to the deaths of Elsie Lavender, 83, and Arthur Cunningham, 79, but was appropriate for their condition.

Medication had not been a contributory factor in the deaths of five other patients whose deaths were examined at the inquest.

The inquest jury was not shown a report by Gary Ford, a professor of pharmacology at Newcastle University, who raised concerns that there may have been a “culture of voluntary euthanasia” on the wards.

Nor were they shown a report into allegedly abnormal death rates at the hospital written by Prof Richard Baker, who worked on the Harold Shipman inquiry, and whose findings have never been made public.

Some of the families believe there has been a “cover-up” by the NHS and demanded the CPS look again at the extensive evidence gathered by police.

Iain Wilson, whose father Robert died after telling his family doctors were “killing” him, said: “I feel absolutely ecstatic, and heartbroken at the same time, that my dad died knowing he was being killed. I will carry on now and make sure these people that are responsible for my father’s death are brought to justice.”

John White, a solicitor for three of the five families, said: “They feel vindicated by the verdicts and they believe the CPS should look again at the evidence. They don’t see this as the end of the story.”

Dr Barton is currently being investigated by the General Medical Council, which has imposed interim restrictions on her registration, including banning her from prescribing diamorphine.

The wards were nicknamed the “end of the line” locally because of its allegedly high death rates and suspicions of some families that loved ones who seemed to be in no immediate danger deteriorated rapidly after being admitted and often died within days.

Robert Wilson was admitted to Dryad ward in October 1998 after he suffered a broken arm. He also suffered from liver problems because of a long-standing drink problem and the cause of his death was given as heart and liver failure.

Iain Wilson told the inquest his father had made a good recovery at the Queen Alexandra Hospital in Portsmouth from the fall that broke his arm. But when he was transferred to Gosport, his condition deteriorated severely and he died four days later.

Mr Wilson said: “I went to give him a cuddle and he spoke his last words to me: ‘Help me son, they are killing me.’

“I said ‘No they are not Dad, they are trying to do the best for you’ and I left him there. When I went in the following day, he was in a coma.”

Prof Baker, of the University of Leicester’s department of health and science, told the hearing: “The initiation of the diamorphine was inappropriate and the starting dose too high. Mr Wilson might have left the hospital alive if he had not been started on diamorphine.”

Dr Barton, who was the main doctor in charge of the two wards, said that many relatives had “unrealistic expectations” for the health of their loved ones as they arrived at GWMH.

From:
http://www.telegraph.co.uk/health/healthnews/5189604/Families-call-for-fresh-police-investigation-into-Gosport-hospital-death-ward.html

Cases have also been confirmed in Spain, Canada, and several states in the USA.

They were named in the Scottish press as honeymooners Iain and Dawn Askham, of Polmont, near Falkirk.

The World Health Organisation upgraded its pandemic alert level to 4 – two stages below the most serious threat – while the Foreign Office advised against all but essential travel to Mexico.

“British nationals resident in or visiting Mexico may wish to consider whether they should remain in Mexico at this time,” a statement on the Foreign Office website added.

It comes as WHO Assistant Director General Keiji Fukuda said it was “too late” to contain swine flu and countries should now focus on mitigating the effects of the virus.

Describing the significance of the level four threat, Mr Fukuda said: “What this can really be interpreted as is a significant step towards pandemic influenza. But also, it is a phase that says we are not there yet.”

It is believed twenty two other people who have been in close contact with the Scottish couple since their return who are receiving anti-viral drugs as a precaution. Seven of them are showing mild symptoms of influenza.

The seven with symptoms have been told to stay at home and will be tested to see if they have swine flu.

Fears were growing that the virus could cause a flu pandemic as a series of countries confirmed cases.

Officials in Mexico – the centre of the outbreak – said there were 1,455 probable cases and 149 confirmed deaths.

Cases have also been confirmed in Spain, Canada, and several states in the USA. More are suspected in New Zealand, Israel and Colombia. Four people in the Irish Republic were being tested for the virus.

The two British patients, from the Falkirk area of Scotland, returned from holiday last Tuesday and on Saturday developed symptoms and contacted doctors.

They are being kept in isolation at a hospital in Airdrie. They are being treated with anti-viral drugs and are said to be ‘‘recovering well’’.

Senior civil servants met in an emergency session in Whitehall to discuss the threat posed by the disease.

Nicola Sturgeon, the Scottish Health Minister, said every precaution was being taken to prevent further spread of the virus.

She said: “The seven displaying, and I stress, very mild symptoms will now be given anti-virals as treatment. The 22 that are not symptomatic will be given very extensive advice about minimising the spread.

“The focus is on the immediate contacts. Effectively, what we are trying to do is put a ring around this. We are trying to contain this as effectively as we can.”

Sir Liam Donaldson, the Government’s Chief Medical Officer, had earlier said that it was “inevitable” that the infection would reach Britain. “Hopefully, if we identify those early and treat people and their contacts, we might be able to reduce the spread,” he said.

Alan Johnson, the Health Secretary, told MPs there had been 25 suspected cases so far in Britain. Eight of them had subsequently tested negative for the disease.

A Canadian woman was taken to hospital in Manchester showing symptoms of flu, but officials said it was highly unlikely she had swine flu.

Mr Johnson added that Britain was – with France – one of the two best-prepared countries in the world to deal with a potential flu pandemic.

The Government had imposed “enhanced” port health checks in an attempt to identify passengers arriving in Britain with symptoms of the illness, he said, and measures were in place to allow the swift nationwide distribution of the drug Tamiflu, which can reduce the severity and length of flu illnesses.

In the Government’s pandemic plan the worst case scenario suggests that if half the population contracted pandemic flu there could be around 709,000 deaths.

Schools, sports events and concerts could be shut down to limit the spread of the illness. Doctors who come into contact with suspected cases should wear face masks, gloves and aprons, under protocols issued by the Health Protection Agency.

The World Health Organisation (WHO) has said the disease has ‘‘pandemic potential’’ and work has already begun on a vaccine against the potentially lethal virus – a variation of H1N1 swine flu – although this is likely to take months before it is ready for use.

Mr Johnson said: “Everywhere outside Mexico the symptoms have been mild and all the victims have made a full recovery.”

People who suspect they may have been infected should stay at home and seek medical advice over the telephone, he added.

The WHO increased the pandemic alert level from level three, where experts have identified little or no human to human transmission to level four indicating that it was spreading much more easily between people across large areas. A pandemic is declared at level six.

Since the alerts were introduced in 2005 it has never been higher than level three.

The Department of Health pandemic plan says that a likely scenario during a pandemic is that businesses should expect repeated waves of one in four employees being off work.

Stephen Alambritis, of the Federation of Small Businesses, said that this could be disastrous during a recession.

From:
http://www.telegraph.co.uk/health/swine-flu/5232846/Swine-flu-confirmed-in-Britain.html

The panel of five women and three men also found that two patients were given the correct medication but in doses which contributed to their deaths.

The patients’ families are now calling for a criminal investigation.

Some of the relatives had long believed morphine was being over-prescribed.

Police carried out investigations into 92 patients’ treatment at the hospital, but no prosecutions were brought.

The jury at Portsmouth Coroner’s Court decided that in the cases of Robert Wilson, 74, Geoffrey Packman, 66, and Elsie Devine, 88, the use of painkillers was inappropriate for their condition.

Arthur Cunningham, 79, and Elsie Lavender, 83, were prescribed medication appropriate for their condition but in doses which contributed to their deaths, jurors found.

In the cases of Leslie Pittock, Helena Service, Ruby Lake, Enid Spurgin and Sheila Gregory, the jury decided that the prescription of painkillers had not contributed to their deaths.

The jury heard evidence from members of the patients’ families, medical experts and staff at the hospital, including Dr Jane Barton.

She was investigated by police in connection with deaths at the hospital but she was not charged with any offence.

She said in a statement: “I can say that I have always acted with care, concern and compassion towards my patients.

“I am pleased the jury recognised that in all of these cases, drugs were only given for therapeutic purposes.”

In a statement after the verdicts, the families said: “This has been a 10 year emotional journey for the families, not just those families directly involved in the inquest but also the relatives of the 92 victims investigated by the police who are also still waiting for answers.

“We did not expect this inquest to be transparent, honest or fair and our expectations have been met in full.”

“Extreme drug overdoses were given without justification or logic that rendered our families comatose in a matter of hours and dead soon after, giving relatives no warning or opportunity to speak with them.

“The families’ journeys are not over. Once we have all the evidence as denied by this coroner, we will reflect on the last few weeks and decide our next steps.”

The families also said that a fresh criminal investigation by Hampshire police was needed. But in response to their call the force has said it will not reinvestigate any of the deaths.

Meanwhile, the patient safety charity Action against Medical Accidents (AvMA) called for a public inquiry.

AvMA chief executive Peter Walsh said: “It is now quite clear the refusal to hold a public inquiry was wrong.

“There were other deaths at Gosport which should have been looked into as well as the role played by various agencies, which may have prevented the poor practice at Gosport or it being investigated promptly and appropriately.”

From:
http://news.bbc.co.uk/1/hi/england/hampshire/8002641.stm

Sir Bruce’s move follows concern that failures at Mid Staffordshire foundation trust may have been spotted sooner had more attention been paid to its hospital standardised mortality ratio (HSMR).

The ratios are one way of measuring whether a hospital’s death rate is within expected limits given the mix of patients it treats. The method is disputed by some academics, including those commissioned by West Midlands Strategic Health Authority, where Mid Staffordshire sits.

Sir Bruce said: “It would be irresponsible of trust boards not to investigate high mortality ratios. The HSMR is one of many measures that will help them do this, but it is not enough on its own. [It is] a rather blunt, but useful, indicator of trouble.”

“Given the controversy around them on both sides of the Atlantic I have instructed NHS Choices to publish HSMRs with reliable information to help the public and boards understand their strengths and weaknesses.”

He said he had also asked NHS Choices to develop plans to publish a set of 250 more sophisticated measures of quality, which have been approved by the new National Quality Board for Health and Social Care.

A spokesman for the Department of Health said there was as yet no time scale for the publication of the HSMRs or 250 additional indicators.

From:
http://www.hsj.co.uk/5000581.article

Health Direct congratulates Sir Bruce Keogh on learning from a dozen years of labour spin- announce a new initiative but don’t bother to promise when it might actually be delivered.

If the NHS medical director really wants to know what state hospitals are in- why not do what the real world does and just ask the staff?

Labour stops asking the uncomfortable question- is your hospital OK?
Tue, 14 Apr, 2009- National Health Service staff are no longer being asked whether they would be happy to be treated in their own hospitals, because the answers don’t match labour’s spin.

The NHS has to make virtually half the savings – £2.3bn – on top of the 3 per cent a year savings with which it was already charged. Next year’s budget has been cut from a planned £104.6bn to £102.3bn, but that will still represent £4bn in growth over this year.

The reduction in health allocations was greeted with equanimity by Alan Johnson, the health secretary, who said the NHS was making the savings “in response to the current economic conditions” and already had plans in hand through shorter length of stay, better commissioning and better procurement.

The already announced allocations to primary care trusts for next year will not be affected, he said, and the department is sufficiently sure of its financial position to have released back to the Treasury an £500m contingency reserve.

The NHS Confederation, which represents health authorities and trusts, said it was “disappointed but not surprised” by a savings target larger than its share of public spending.

“The much bigger issue is the cut in planned public spending growth after next year,” Nigel Edwards, the confederation’s policy director, said. “Our fear is that 0.7 per cent growth in total spending is not going to translate into anything like 0.7 per cent for the NHS. If we are lucky it might be zero.”

The confederation said that would require “difficult decisions about priorities and change” if patient care were not to suffer through budgets being merely “salami sliced”.

Other sectors that bear a significant part of the £5bn cut are schools and families, which must find £650m, and work and pensions, which must find £120m even as its budget for the unemployed is boosted by £1.7bn.

Although health takes the biggest cash hit, analysis by the Institute for Fiscal Studies shows transport, the Home Office and environment facing the largest savings requirement as a percentage of budget.

From the Financial Times:
http://www.ft.com/cms/s/0/be915988-2fa0-11de-a8f6-00144feabdc0.html?nclick_check=1

The average overspend figure for PCTs contacted by HSJ this week was £7.6m, suggesting that nationally the total could be as much as £1.2bn.

HSJ asked a cross-section of 20 PCTs across all strategic health authority areas in England how they had performed against what they had planned in their 2008-09 acute contracts.

Commissioners have been warning of pressure on acute contracts since a spike in referrals by GPs began to drive up hospital activity last year.

PCTs are covering the extra costs using their surpluses or by dipping into next year’s funds.

At the start of March, Warrington PCT predicted in its board papers that its surplus would be half what it had envisaged at the beginning of 2008-09. The acute overspend is listed as a contributing factor.

Some have taken money earmarked in development plans for other areas of care to cover the shortfalls.

PCT leaders attributed the overspend to pressure to achieve the 18-week referral to treatment target, the increase in GP referrals and the bad winter weather increasing hospital activity.

But they also acknowledged that some commissioners had been optimistic when predicting how much money they could save from acute contracts by moving services into community settings.

Shifting treatment out of hospitals in order to provide care more economically was a cornerstone of the 2006 Our Health, Our Care, Our Say white paper.

PCT Network director David Stout said: “Therne has been a history of slightly optimistic demand management assumptions. PCTs need to avoid making optimistic assumptions about demand and capacity, unless they’ve got very worked-through plans about how they are going to [manage demand] that they are confident are deliverable.”

Mr Stout said PCTs needed to understand why the overspend was so high this year, including assessing whether assumptions that demand would go down in certain specialties had been too optimistic.

Birmingham East and North PCT chief operating officer Andrew Donald said shifting more services into primary care would bring returns, but PCTs must monitor activity “forensically” to make sure they were achieving the savings they had planned for.

He said: “You’ve got to have done the detailed business case and understand the consequences in terms of what you’re trying to do in primary care and model cause and effect.

“If it’s not delivering, you’ve got to be brave enough to stop it and say let’s do something else.

“It relies on PCTs measuring outcomes and the impact of what they are doing, which hasn’t been a strong point.”

Mr Donald predicted pressure to stay on top of spending would increase as budgets were squeezed in coming years.

King’s Fund deputy policy director Candace Imison suggested that shorter waiting times could have introduced an element of “supply induced demand”.

The “painfully” slow progress of practice based commissioning was also likely to be a factor in delays in providing more community based services, she said.

PCTs should be more proactive in tracking patients as they moved through the health service and in assessing the effectiveness of treatment.

She urged PCTs to study choose and book data to find out who was using alternative services and what was happening to them afterwards – for instance whether they were ending up in hospital following treatment in the community.

She said: “Maybe they have created services outside of hospital but they haven’t reduced acute activity and have supplemented acute care rather than replacing it.”

From:
http://www.hsj.co.uk/5000506.article

More than half of the blunders – 2,221 – were considered serious, resulting in deaths, injuries and patients being left in severe pain, according to new figures.

They included surgeons operating on the wrong person or part of the body, doctors making wrong diagnoses and prescribing dangerous doses of medication.

The newspaper submitted Freedom of Information requests to all 172 NHS trusts to obtain details of Serious Untoward Incidents (SUIs).

Of the 97 that responded, most refused to give details and just listed fatal errors as “unexplained deaths”, it said.

The Patients’ Association described all the mistakes as “avoidable”.

In one case in the North West a patient under the care of the Aintree University Hospitals NHS Foundation Trust underwent the wrong urological procedure in May.

In July, a chest drain that had been wrongly inserted punctured a patient’s heart and in another case in October a tube was dislodged from the windpipe of a patient who later had a heart attack and died.

In the South East, where a total of 66 SUIs were reported, the wrong unit of blood was administered in January and a mother died of meningitis after giving birth in August.

Katherine Murphy, director of the Patients’ Association, told the newspaper: “These are all avoidable accidents. Patient safety must be paramount in every hospital. Saving money must not be put before patients’ lives.”

Dr Peter Carter, general secretary of the Royal College of Nursing, said staff shortages led to more errors.

“It is always deeply concerning to learn of any mistakes which have endangered the life of a patient,” he said. “But the fewer staff there are the more mistakes are made.”

According to the newspaper, the NHS paid out £264 million in compensation claims in 2008, plus £134 million costs.

The Department of Health said it was working with regulators to monitor improvements in patient safety.

“Unfortunately, as in any health service, unforeseen incidents occasionally happen.

“The independent National Patient Safety Agency, responsible for monitoring and reporting incidents, and the new independent regulator, the Care Quality Commission, with increased inspection and intervention powers, will help ensure we sustain improvements in safety and quality of care.”

The revelations come after the head of the former Healthcare Commission said in December that the NHS was only just out of the “starting blocks” when it came to ensuring patient care was as safe as it could be.

Sir Ian Kennedy said reporting mistakes and learning from them needed to be “internalised in the DNA” of NHS trust boards.

He added that there was a “black hole” in the information available about mistakes made in GP surgeries.

His remarks were made as the commission published a report calling for more coherent systems for reporting mistakes, saying the priority given to safe care varied among NHS trusts.

But the report said estimates suggested that one in 10 patients admitted to hospital would suffer harm as a result of an error.

In primary care, the report referred to a study carried out in 2001 which found that medical errors occur between five and 80 times per 100,000 consultations, “mainly related to the processes involved in diagnosis and treatment”.

The Healthcare Commission ceased to exist at the beginning of this month when a new regulator, the Care Quality Commission, took over its role and also adopted the work of the Commission for Social Care Inspection (CSCI) and the Mental Health Act Commission.

From:
http://www.telegraph.co.uk/health/healthnews/5147744/Overwork-blamed-for-medical-errors.html

The request was made by the Liberal Democrats. The party’s health spokesman Norman Lamb said the figures were “absolutely shocking” as the lay offs coincided with at least 400 unnecessary deaths at the trust and levels of care that the Healthcare Commission last month described as “appalling”.

Mr Lamb said the payout figures “demonstrate how much money was being wasted getting rid of staff who were desperately needed, at a time when hundreds of people were dying because of the inadequate care”.

Over the three year period the trust paid out an average of £433,000 a year in redundancy pay offs. Over the same period, payouts across the entire NHS totalled around £438m – so the Mid Staffordshire payouts represented 0.3 per cent of this.

The trust made its biggest payouts in 2007-08 when it spent £878,000 on redundancies, representing 0.5 per cent of the total £183m paid out on the 2,223 NHS redundancies that year.

From:
http://www.hsj.co.uk/5000491.article

Mr Flory said in the quarterly update on performance that he was “disappointed” that the NHS as a whole had missed its target to see 98 per cent of patients in accident and emergency departments within four hours.

He said: “We have had one of the coldest winters for over a decade, placing greater demand on services. Ambulance services experience elevated demand in winter and it is critical that the NHS maintains high levels of service and ensure the timely handover of patient care from ambulance to hospital.”

Mr Flory told HSJ that he expected most hospitals to recover their position over the remaining months of the year and so, overall, the NHS would still meet the 98 per cent target for the full year. However, he underlined the importance of better winter planning.

The forecast surplus remains £1.74bn, with only seven organisations forecasting real terms deficits – down from 11 in September.

From:
http://www.hsj.co.uk/news/2009/03/flaws_exposed_in_nhs_winter_planning

Their verdict comes as advisers to the Department of Health are promoting such schemes and as private health insurers are offering discounts to subscribers who go to the gym, eat more fruit and take other steps towards a healthier lifestyle.

In Dundee, smokers are being offered £12.50 a week by the NHS if carbon monoxide testing shows they have quit. In Essex, pregnant women can claim a £20 food voucher from the NHS after stopping smoking for one week, £40 after four weeks and another £40 at the end of a year if they have still quit.

Brighton offers children £15 for quitting smoking for 28 days, while overweight patients in Kent are also being offered incentives for losing weight. In the US and other countries incentives have been offered for weight loss, complying with diabetes treatment, or regularly testing negative for sexually transmitted diseases.

Such schemes are controversial with the public and professionals, say Theresa Marteau and Richard Ashcroft, professors of health psychology and bioethics at King’s College and Queen Mary universities in London.

Writing in the British Medical Journal, they say the programmes are attacked as “a form of bribery” and “rewarding people for unhealthy behaviour”, while others believe they undermine the doctor patient relationship and remove patients’ autonomy.

But they say evidence is emerging that some programmes may work, although research is needed to establish “the conditions under which change is achieved and sustained, and for whom”, and to identify unintended consequences.

“Using payments may be more powerful than providing information, and less restrictive than legislation [which attempts to ban or punish activities],” they say. “Ultimately, if incentives prove to be effective in only a few contexts, they may still offer an important means to improve health.”

Julian Le Grand, chairman of Health England, said the difficulty with prevention programmes was that the costs of unhealthy lifestyles could be far off in the future, while the pleasures from them were felt now. Policies were needed that provided some of the benefits of changing lifestyle in the present, he said.

From:
http://www.ft.com/cms/s/0/f29d891e-2630-11de-be57-00144feabdc0.html?nclick_check=1

The bid could be launched as a joint venture with the private sector and may form the model for other NHS organisations un­able to meet the qualification standards to become freestanding foundation trusts in their own right, said Stephen Dunn, director of strategy for the East of England strategic health authority.

The authority, which is already breaking new ground by seeking Treasury approval for private sector bids to take over and run Hinchingbrooke Hospital in Cambridgeshire, has set a deadline for all its hospitals to apply to become foundation trusts by the end of the year.

However, Mr Dunn said, it had become clear that the Bedfordshire and Luton Mental Health Trust would struggle to do that, so foundation trusts were being asked to bid to take it over. Whether that would involve a payment from them to the SHA, or a subsidy from the authority to the winner, or simply the takeover of the trust’s existing contracts, would depend on the negotiations, he said.

It is understood that the contest is being limited to NHS organisations while the Treasury decides whether to give the go ahead to potential private sector involvement in Hinchingbrooke Hospital.

There has already been one takeover of a mental health service by a foundation trust in Staffordshire, but this is thought to be the first time a health authority has sought to run a competitive process to take over an NHS trust.

From:
http://www.ft.com/cms/s/0/e194c236-23c9-11de-996a-00144feabdc0.html

The question, seen by some as one of the most revealing pointers to underperforming hospitals, has been dropped from an annual official survey.

The Healthcare Commission, which conducts the survey, cited employees’ unhappiness with care standards as one of the concerns at Mid-Staffordshire NHS Trust. A subsequent investigation concluded that hundreds of patients there died as a result of poor quality care.

Only 27 per cent of staff said they would be happy with the standard of care they would receive at the hospital. Almost half disagreed or strongly disagreed with the proposition.

But the question has now been removed from the Department of Health’s survey of 160,000 NHS staff.

Andrew Lansley, the Conservative health spokesman, said a Tory government would restore it. “One of the most telling indicators that things were going badly wrong at Stafford hospital was that too few staff said they’d recommend the hospital to their family or friends,” he said.

Questions in the survey are agreed between the health department and the Healthcare Commission. A spokesman for its successor, the Care Quality Commission, said the original question asked if staff were “happy to be provided care by my own organisation”. It was modified, as some staff answered “no” because they would seek treatment elsewhere on privacy grounds.

The question was then changed to whether staff would be “happy with the standard of care”. But that was dropped after 2006, as staff in mental health and learning disabilities trusts felt uncomfortable answering a question that did not directly apply to their condition, or felt they could not answer, as they felt some parts of a hospital’s service were good and others poor.

John Appleby, chief economist at the King’s Fund health think-tank, said it was a good question to ask. “If there is anybody who knows what the quality of care at their hospital is, it is the people who work there.”

He added: “At Mid-Staffordshire, 47 per cent said they would not be happy with the standard of care, but at some hospitals, fewer than 2 per cent said that. The numbers may require careful interpretation, but that sort of variation must be telling you something.”

From:
http://www.ft.com/cms/s/0/de4ca3b4-23c9-11de-996a-00144feabdc0.html

Health Direct reminds readers that the truth can be painful. If labour can’t stand the heat they shouldn’t be surprised when patients kick them out in a year’s time.

Freedom of information figures obtained by the Muscular Dystrophy Campaign found children were subject to a postcode lottery in terms of equipment.

Statistics from 54% of NHS trusts in England and Scotland revealed that disabled children in England are forced to wait five months on average for a wheelchair.

The worst performing primary care trust (PCT), East Lancashire, in the north-west of England, had an average wait of two years for an electric wheelchair.

The survey showed 58% of children in England had to wait at least three months for an electric wheelchair and 14% waited more than six months.

In the case of Westminster and Islington PCTs in London, children living just four miles apart could have a difference of 11 months in waiting time.

Overall, 50% of the PCTs that responded said they did not fund the full cost of a powered wheelchair for a disabled child.

Westminster PCT made an average contribution of only £700 towards the cost of a child’s powered wheelchair, it said.

Almost all PCTs contacted by the charity said the cost of a wheelchair was around £2,000 but in fact the true cost of a basic electric wheelchair would be around £3,000.

A separate patient survey of 237 children found one in three did not receive any funding at all for their wheelchair.

Philip Butcher, chief executive of the Muscular Dystrophy Campaign, said: “Today’s figures are nothing short of a national scandal.

“It is a damning indictment of the NHS that so many families across the UK are forced to rely on charities or be driven into financial hardship just to receive vital, life-improving equipment for their disabled children.

“It’s time the NHS stopped relying on charities to fill the gaps left by its inadequate funding.”

Two PCTs in the West Midlands – Birmingham East and North, and South Birmingham – have waiting times for a powered wheelchair of 18 months compared to a national average of just under five months, the report said.

From:
http://www.guardian.co.uk/society/2009/mar/04/wheelchair-wait-children

The NHS Health Checks aim to identify an individual’s risk of heart disease, stroke, type 2 diabetes and kidney disease with a personal assessment and tailored advice.

It is the first systematic programme to measure body weight in adults and GPs will be expected to test 2.25m people a year with each person called back on average once every five years for another check.

The Healthy Weight Healthy Lives; one year on report, outlines the labour Government strategy to tackle obesity with the ‘ambition’ of being the first nation to reverse the rising tide of obesity.

NHS staff will also be targeted as estimates show of the 1.2m people working in the NHS, 300,000 will be obese and a further 400,000 are likely to be overweight.

Personalised support for midwives, health visitors and other NHS staff will ‘boost the credibility of the healthy living messages they give to mums to be and families’, the report said.

Dawn Primarolo, Public Health Minister, said: “More than 60 per cent of adults in England are overweight or obese, leaving them at increased risk of type 2 diabetes, cancer, heart and liver disease. BMI checks will make sure people know they are overweight and will help to turn their health around

“Early signs show that we may be halting the rise in childhood obesity. But there’s still more to do in particular to tackle obesity in adults.”

Dr Laurence Buckman, Chairman of the British Medical Association’s GPs Committee, said: “Obesity is a serious problem for many people. GPs already advise obese patients about the best ways to lose weight – it’s an important issue and has a big impact on a person’s overall health and quality of life.

“Extra resources are needed, as well as a public health campaign, much better food education at school and for new parents. We welcome any scheme that might help the NHS to help people tackle the problem of obesity.”

The checks will involve taking height and weight measurements and plotting body mass index on a chart with 18.5 to 25 classified as healthy weight, between 25 and 30 as overweight, and over 30 as obese. Other tests such as cholesterol, blood pressure and blood sugar may be taken as well.

However, at the same time a study published in the British Journal of Nutrition said body mass index does not accurately indicate body fat in different ethnic groups.

Dr Molly Bray, Associate Professor of Paediatrics at Texas Children’s Hospital, and author of the study said: “This scale was created years ago and is based on Caucasian men and women.

“It doesn’t take into account differences in body composition between genders, race/ethnicity groups, and across the lifespan.”

The report also outlines a number of initiatives aimed at children with mandatory nutrient content of school meals to be extended from primary schools to secondary schools in September, the publication of a recipe book of ‘picnic-style’ meals for the school holidays and investment in cycling.

The report said from this month subsidised gym membership for 16 to 22-year-olds will run for 12 months in pilot areas in Newcastle, Bristol, Torbay, Manchester and Bury St Edmonds in order to evaluate the ‘feasibility and effectiveness of financial incentive schemes targeted at this age group’.

Sue Davies, chief policy adviser at the consumer group Which?, said: “We know that four in five people want to eat more healthily, but more must be done to make the healthy choice the easy choice.

“We’re seeing really positive action in some areas but we can’t afford to be complacent; industry and the government are still skirting around contentious issues like promotions to children. Walk around any supermarket and you’ll see conflicting labelling schemes, shelves of fatty, sugary and salty foods targeted at kids, and the majority of price promotions are for the less healthy foods.

“To make this work, we need to go much further and faster to break down the barriers to healthy eating.”

The report suggests restrictions should be on putting unhealthy food at children’s eye height in stores, which was immediately dismissed by food industry representatives.

Andrew Opie, Food Director at the British Retail Consortium said. “Rules about which products should go on which shelves would be seriously misguided. It’s very hard to see how this could work in practice. How high is child’s eye-line anyway? It’s parents who buy children’s food. The idea that making particular foods hard to reach would make any difference is ludicrous.

“There are no bad foods only bad diets. This proposal risks demonising foods which can happily be eaten as part of a balanced diet.”

Mike Penning, Shadow Health Minister, said the health checks have been announced in different guises several times already.

He said: “Labour continue to be obsessed with chasing headlines rather than putting in place sound policies to improve our NHS.

“Obesity is a really serious issue that deserves a well thought out response. Instead all we get is a long line of re-announcements of tired old ideas from a Labour Government that has run out of steam.”

http://www.telegraph.co.uk/health/healthnews/5115679/Fat-tests-for-adults-over-40-in-new-Government-drive-to-tackle-obesity.html

The Care Quality Commission, which opened last week, is the third new quality regulator for health, and the fourth for social care, in only nine years.

“To lose one regulator is unfortunate, to lose two is downright careless – and to lose three would be pretty criminal in my view,” said Lady Young, its chairman, in an interview with the Financial Times.

The new CQC opens its doors only weeks after Mid-Staffordshire hospital was granted flagship foundation trust status by one regulator, during an inquiry by another that revealed “appalling” standards of emergency care. The Baby P case last year, in which a young London child died after dreadful neglect, raised serious concerns about the regulation of social care.

Lady Young, a former National Health Service manager who came to the CQC from the Environment Agency, which regulates everything from car scrap dealers to nuclear power stations, said the new, combined watchdog needed time to prove itself.

“Good regulators develop a track record,” she said. “We need a bit of time, 10 good years at least – preferably longer. Not for me but for the organisation”, she said.

“Look at the Audit Commission . . . They have tackled a whole range of new jobs, they have been flexible, they have been adaptive and they have done a good job generally. They know how to do it. They develop a track record.”

The new commission will be different, she said, not least because it will embrace both health and social care, along with the supervision of detained mental patients, in one organisation. Given the risks that more members of an ageing population will fall through the cracks between health and social care services, that had to be right, she said.

But, after the regulatory failure at Mid-Staffordshire NHS Foundation Trust, there will be other changes too, she said.

Mid-Staffordshire was granted foundation trust status by one regulator, Monitor, in the middle of the inquiry by another, the Healthcare Commission, one of CQC’s predecessors, that found “appalling” standards of emergency care from which, the commission said, patients died.

As well as the two bodies failing to communicate, the hospital’s services were rated “fair” – barely adequate but not dangerous – for two years during which, concluded the commission, patients had suffered and died.

A fresh data analysis technique to examine high death rates that will continue to be developed by CQC, eventually picked up the problem.

But as in the case of Baby P, where Ofsted rated Haringey’s social services as “good” at the time the child died, “that does raise questions about the balance between clever use of data and inspection,” Lady Young said.

“We need to get the balance right between data and inspection – and we will be out there sniffing the breeze, being on the ground and eyeballing staff and patients.”

A good regulator is there “to nip problems in the bud,” she said. A host of fresh data about the quality of care is on its way, which the commission will share, and which ought to make that easier.

But Lady Young warned against the current trend – “which is: when things go wrong, blame the regulator”.

“We do need to highlight where responsibility lies for the provision of quality care,” she said. First with doctors, nurses and care workers on the ground. Then with boards of organisations. And then with those who commission care and performance – manage the systems. The commission will provide independent oversight, information that will help address quality, and assurance, she said.

But “it will be a failure of the service if the management [does] not get to quality issues before we do”.

From:
http://www.ft.com/cms/s/0/8f51dc0a-1e53-11de-830b-00144feabdc0.html?nclick_check=1

In a first show of strength, the new Care Quality Commission has named 21 organisations which are failing to take sufficient action to prevent superbugs like MRSA and C. difficile.

The list contains eight trusts where there are high infection rates, persistent problems or a potential risk to patients has been identified. They will face further inspections by the regulator.

All the failing trusts have been warned they must improve within set deadlines or face further sanctions including warning notices, fines, and the possibility of wards or units being closed down.

Problems found included inadequate cleaning of ambulances, poor antibiotic prescribing practice, delays in isolating infected patients, lack of supervision of cleaning and infection control staff, dirty surgical equipment, lack of reporting of infection control measures to board level, delays in receiving laboratory test results and poor standards of cleanliness on wards.

All healthcare providers, except GP and dental surgeries, must be registered with the Care Quality Commission by 2010, in what is in effect a ‘licence to practice’, and the first step has been to register compliance on infection control measures.

All 388 NHS organisations that provide direct care to patients have been registered but the 21 trusts judged to be failing have been given conditional registration.

Barbara Young, chairman of the CQC, said: “Most trusts have stronger systems to protect patients from infection than a few years ago, and trusts’ boards are taking the challenges seriously. We commend them for that.

“In 21 trusts we need further assurance that they are meeting the regulations. We have placed rigorous conditions on these trusts’ registration and will monitor them closely.

“While infection rates at these trusts are not necessarily higher, they can do more to strengthen their approaches to infection control and help prevent outbreaks. We will monitor their performance throughout the year and will not hesitate to use our enforcement powers to protect patients’ safety where needed.

“This is only the beginning of our work with NHS trusts. We aim to ensure they strive for continued improvement and that patients receive the same consistently high service wherever they receive care.”

In eight cases, the trust failed to achieve required standards for infection control on repeated occasions and/or had a high infection rate and/or a potential risk to patients’ safety was found on inspection.

The eight trusts are: Barnet, Enfield And Haringey Mental Health NHS Trust, Barts And The London NHS Trust, Kettering General Hospital NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust, North Bristol NHS Trust, Plymouth Hospitals NHS Trust, South West London And St George’s Mental Health NHS Trust, United Lincolnshire Hospitals NHS Trust.

Registration on healthcare associated infection is the first step towards full registration on all basic standards, a regime that will come into force from April 2010.

For the first time the regulator has the power to impose fines of £4,000 on the spot and up to £50,000 through the courts. The Care Quality Commission also has the power to close wards, services or a whole hospital in extreme circumstances.

From:
http://www.telegraph.co.uk/health/healthnews/5095540/Worst-NHS-trusts-for-hygiene-threatened-with-fines-and-closure-by-super-regulator.html

A Healthcare Commission study of more than 130 healthcare organisations and 170 user groups in England found that patients did not feel they had enough input into what services were provided or how they were delivered.

Vulnerable people and those in poorest health often found it most difficult to engage with health services. Many patient groups were not convinced that the health service wanted their views or would act on them.

The report says: “Few trusts could demonstrate that people’s views routinely influence their decision making.”

This is despite 98 per cent of healthcare organisations telling the commission they sought and took into account patient views in last year’s annual health check.

The watchdog said it found “some excellent practice” in primary care trusts, particularly around major reorganisations of services, but also increasingly on service reviews and procurements.

But it said PCTs were making slower progress in driving public influence on GP practices and there were few examples of PCTs writing into contracts that providers must engage with local people.

There were “good examples” of acute and ambulance trusts involving patients in changes to how services are delivered.

And mental health and learning disability trusts in particular demonstrated how users of services could “participate more actively and form partnerships with service providers”.

The independent sector was less likely to capture “qualitative” information about patient experience or to share ideas in patient discussion groups.

Local involvement networks (LINks) were seen as an advantage, because they could bring patient and user groups together across local areas and across health and social care.

The commission has called for a national development programme for the NHS and the private sector to support improvements in public engagement. It says staff – including clinicians – must be supported to develop engagement skills. The Department of Health should incorporate patient experience feedback into initiatives such as quality accounts.

NHS organisations should be able to demonstrate a minimum level of performance on patient engagement.

Health minister Ann Keen said: “I welcome the Healthcare Commission’s report and will study its findings closely. Many NHS staff already work hand in hand with patients to provide safer, more effective care but we want to make this the norm for all services.”

She pointed to the next stage review, the NHS Constitution, and information prescriptions as evidence the department was committed to patient engagement.

From:
http://www.hsj.co.uk/news/2009/03/nhs_must_give_patients_more_input_on_services

Health Direct points our that it was patients’ relatives that initially blew the whistle on the Mid Staffs disaster where up to 1,200 people met early deaths.

The Conservatives, the Telegraph, the Patients Association- and now even the Healthcare Commission recognise the importance of listening to patients.

All the labour government can say is that their discredited constitution is concerned.

How many more thousands of people are doing to die early because of labour’s incompetence, waste, red tape and discredited targets?

It is almost beyond belief. In just two decades or so, the National Health Service has gone from having virtually no formal management structure, just administrative staff, to this week’s announcement that out of a total staff of 1.36 million, 39,900 are managers.

Let me put that in context: there are 5,000 more people now employed to tend to organisation than there are consultants – a mere 34,900 – tending to the sick.

And if that were not enough to savour, new figures from the Incomes Data Services show that chief executives of NHS foundation trusts now earn an average of £158,000. Across the board at executive level within the NHS, salaries rose by 7.6 per cent in foundation trusts, and 5.7 per cent in non-foundation bodies. It is the starkest of all illustrations of just how far the pendulum has swung from medicinal to managerial.

Not that I am against management, nor high salaries – far from it. I am a passionate believer in management. In my career, as a former chairman of Granada, Allied Domecq, and the Arts Council, I spent much time analysing, writing about and teaching management skills. But in the case of the NHS, what we need are far fewer – albeit far better – managers.

I do not base my opinion on the latest statistics, which the labour Government is defending as making a “significant contribution to tackling unemployment” – a rather curious reason for hiring more managers in my view – but on the six months I spent advising Brian James, the chief executive of Rotherham Foundation Trust hospital for a BBC documentary in 2006.

The aim was to see if proven management techniques could overhaul one hospital’s waiting lists, where more than 200 patients were waiting longer than the Government’s recommended 18 weeks. I wanted to see if we could come up with a template for hospitals all over the country.

The experience was both salutary and shocking; the hospital staff, including management and consultants, was eager to make it a better, more efficient place. There was enormous goodwill and huge pools of talent.

But there was simply no process to pull it all together in a cohesive, sensible way.

When I meet people in the health service now who saw the BBC series, they say the same thing: how typical my experience was of their own hospital – and how the problems I identified persist throughout the NHS today.

I’m afraid this failure of management explains how a hospital such as the Mid-Staffordshire NHS Foundation Trust, which saw 400 needless deaths between 2005 and 2008, continued to function for so long before someone noticed.

It explains why the care of seriously sick children at Birmingham Children’s Hospital was so gravely compromised as the Healthcare Commission found earlier this month. It also goes some way to explain the appalling treatment received by four disabled people whose deaths were investigated by Health Service Ombudsman and the Local Government Ombudsman whose report was published this week.

Yes, you will get senior people at any hospital – or in any organisation – who lose the plot, who manage things badly.

But while Health Secretary Alan Johnson is blaming the recent spate of crises on “understaffing and poor management”, it is the lack of any normal system of checks and balances on a much wider scale that leads to failings of this magnitude.

In any “normal” organisation, there would be a “normal” management process. The whole would be broken down into constituent parts: one hospital would report to a head of a group of, say, 10 hospitals, who in turn would report to a regional manager, before reporting to national level. Progress would be measured, mistakes noticed and rectified promptly. That’s how huge and successful companies such as Tesco manage.

The chain of command is clear so that it is easy to spot when something is going right or wrong – and to implement change when necessary. Follow-up meetings along the chain are so regular that problems get picked up when they are still manageable, and lessons learnt in one part of the group can be applied simply throughout.

In the NHS, staff may spend hours filling in paperwork and ticking boxes to cover their backs. But who is assessing what they do? Who follows it up afterwards? Some Foundation hospitals don’t have to report to anyone who will challenge their procedures – as long as they are filing their regular reports. Trusts may appoint chairmen but I discovered they cannot control, and have little influence over, chief executives. No one ever sits down and asks: “How did it go last month?” No wonder it is chaos.

I understand how this culture of multiple managers develops; I think chief executives get to a point where it is easier to manage other managers than it is to deal with medical and nursing staff, especially consultants, who can be resistant to being told what to do by those with no medical background.

Instead, chief executives surround themselves with a safe set of managers who tell them what they want to hear, and perhaps they look to hire more – for business development or finance or new initiatives. Increasingly, the man or woman at the top of the tree is distanced from the reality of leading doctors, nurses and other staff, and delivering care to patients.

In Rotherham, I tried to persuade Brian James to have fewer managers – and I do think he took my suggestions on board. Certainly, recent figures show Rotherham to have among the lowest waiting lists for inpatients in the country.

But that is the exception: the NHS as a whole continues to employ ever greater numbers of managers with no clear evidence that it is being managed better as a result. I want to shake it all up.

We need a system in which regional heads must account for a budget, a cure rate, waiting lists etc – certain defined measures – every month. If they don’t succeed or improve over time, they will find themselves replaced.

Health professionals need managing, they need rules, regulations, vetting; they need someone examining how they are handling their waiting lists. They need praising or criticising where necessary; and they need great leadership to help them change. It might take five or six painful years but I don’t think it would take much additional money.

It is galling to think that we, the public, are paying for the current highly risky system – in which some hospitals are brilliant and some dire.

With good management, none of them would be dire. That’s the truth of it. I’m not a fan of centralisation, but you do need a reporting system that can reveal why hospital A is not a patch on hospital B which is just 15 miles down the road.

The news is not relentlessly grim; the NHS has improved in the past five years – indisputably so. Targets have worked to a degree as they have focused attention on areas that really needed attention. We have also made great advances in the treatment of many diseases, especially cancer.

However, we still rank behind other European nations despite the billions and billions of pounds this labour Government has given to the NHS since 1997. I would argue that poor management is a factor in this. Until we learn to manage the NHS more effectively, we will never have the health service we pay for – and deserve.

From:
http://www.telegraph.co.uk/comment/personal-view/5062266/Cure-the-NHS-with-far-fewer-managers.html

Andrew Lansley issues five point plan to avoid another Mid Staffs:

Shadow Health Secretary Andrew Lansley has issued a set of five proposals to ensure another healthcare crisis of the kind we saw at the Mid Staffordshire Hospital is avoided in future.

1. Tougher inspection: Additional scrutiny powers for the ‘Local Involvement Networks’ that represent patients and the local community. ‘LINKs’ will also be given independence from local authorities so that they cannot be swayed by politics.
2. Empowerment of patients: “Conservatives will establish a strong, independent, national consumer voice for patients: HealthWatch.” HealthWatch will help LINKs to hold local hospitals to account and will escalate concerns to national prominence, if necessary.
3. Empowerment of GPs: Rather than Primary Care Trusts holding budgets for buying treatment from local hospitals, the Conservatives would give the power to GPs. GPs, say the Conservatives, are closest to patients and best-placed to keep an eye out for things going wrong.
4. Scrapping targets: Abolition of bureaucratic targets will ensure that “doctors and nurses should never be put in a position where they have to choose between meeting a target and doing what is best for their patients.”
5. Greater transparency: The Mid Staffs catastrophe only became apparent after the hospital’s mortality rates were published – not something that is routine. A Conservative government will require more information on mortality and survival rates at each NHS trust.

From:
http://conservativehome.blogs.com/torydiary/2009/03/andrew-lansley-issues-five-point-plan-to-avoid-another-mid-staffs.html

The Telegraph suggests:

1 An independent inquiry into the regulation and supervision of NHS hospitals
We, the Patients Association and ‘Cure the NHS’ demand an inquiry, chaired by a judge, into both the failings in Staffordshire and the way hospitals are supervised nationwide.
2A review of hospital targets to ensure they work to improve quality of care
Doctors have warned that the four-hour waiting time target for A&E; is attainable only by delaying admissions or forcing some patients through too quickly, to the detriment of their care.
3 Nurses to focus on patient care – not form-filling – as their central duty
Nurses have complained that they are sometimes too busy filling in forms to carry out basic nursing duties that are crucial for the wellbeing of patients.
4 Routine publication of comprehensive death rates for hospitals
Secrecy over mortality rates for particular treatments keeps patients in the dark about failing hospitals.
5 Patients to be given a stronger voice in the running of their hospitals
The local NHS watchdog system has been reformed repeatedly under Labour but there are concerns that the current structures lack the power to hold hospital chiefs to account.
6 Assurance that senior hospital staff will not be rewarded for failure
Martin Yeates, the chief executive of Mid Staffordshire NHS Trust, is now suspended on full pay and could receive a payoff, despite a previous pledge by the Government to clamp down on such payouts.

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