The independent data security watchdog says it has taken action against 14 NHS organisations in the last six months.

Among the data subject to breaches were the medical details of more than 6,000 prisoners and of 700 hospital patients.

A Department of Health spokesman said action would be taken against anyone who breached data protection rules.

‘Inexcusable’

Information Commissioner Richard Thomas has written to the Department of Health’s top civil servant requesting immediate improvement.

Mick Gorrill, the assistant information commissioner, told the Independent newspaper that the “inexcusable” data losses within the NHS had become a cause of “great concern”.

The paper reported that between January and April this year there were 140 reported security breaches within the NHS – more than from central government and local authorities combined.

These included medical details of more than 6,000 prisoners in Preston Prison in Lancashire that were contained on a lost memory stick. The data was encrypted but a note attached to the stick gave the password.

Another memory stick with the details of more than 700 patients at Cambridge University Hospital was left in a vehicle. A car wash attendant was able to access the unencrypted material.

‘Secure network’

A Department of Health spokesman said the permanent secretary at the department would be replying “in due course” to Mr Thomas’s concerns and that action would be taken “against anyone responsible for breaching our strict data protection rules”.

“The chief executive of the NHS wrote to all senior health managers reminding them of their responsibilities,” he said.

“The department is also providing, through the National Programme for IT, electronic patient records systems that are protected by the highest levels of access controls and other security measures, a secure NHS network for exchanging information that is centrally monitored and strongly protected and secure NHS e-mail facilities that encrypts all data in its system.”

In December 2007, nine NHS trusts in England admitted losing patient records, thought to affect hundreds of thousands of adults and children.

From:
http://news.bbc.co.uk/1/hi/uk/8066609.stm

The contract, which individuals close to the talks estimated to be worth about £5 a dose, may spark international concerns as some richer countries negotiate with producers for privileged access to limited supplies of a pandemic vaccine .

The deal comes at a time when worried parents have raised the idea of “swine flu parties” – to expose the family to the virus while it remains relatively mild – and have made efforts to obtain the antiviral flu treatment Tamiflu through private prescriptions and the internet. Officials have advised against both approaches.

No vaccine is currently available to protect against the H1N1 virus first identified in Mexico, and there is considerable doubt that the current seasonal vaccines will provide any help.

With scientists close to preparing a “seed virus” from the current H1N1 strain isolated in Mexico, the UK funding will allow for production of a vaccine over the next few months – in time for a second wave of infection expected during the flu season towards the end of the year.

Alan Johnson, health secretary, said: “These additional arrangements provide the opportunity by December this year to have enough pre-pandemic vaccine to protect at least half of the population from swine flu.”

GlaxoSmithKline, which won the contract to supply 60m of the 90m British doses, said it had also sold a further 50m doses to France, 13m to Belgium and 5m to Finland. Baxter, which will supply the UK’s remaining 30m doses , said it had not finalised any other H1N1 vaccine contracts.

The UK already agreed two years ago to pay £155m for ” advance supply agreements ” which reserve manufacturing capacity for production of 132m doses of a future pandemic vaccine sufficient to cover the entire population. If the World Health Organisation raises its assessment of the current H1N1 virus to a full pandemic, this earlier contract will be triggered.

But with total annual seasonal flu production estimated at 400m doses globally, there is unlikely to be sufficient capacity to cover the entire world, even with new approaches and technologies to boost productivity.

From:
http://www.ft.com/cms/s/0/f7a80ecc-41b3-11de-bdb7-00144feabdc0.html?nclick_check=1

What a difference a day and the FT can make.

In the Health Direct blog post yesterday Swine flu: Government signs up for 90 million doses of vaccine Labour Ministers have signed agreements to secure up to 90 million doses of swine flu vaccine.

We asked why the costs of the new order were being kept confidential. Thanks to the Financial Times for uncovering the amount we are paying for the questionable cover.

The deals with pharmaceutical companies GlaxoSmithKline (GSK) and Baxter will secure “early supplies” of a vaccine for the newly identified H1N1 strain.

Enough “pre-pandemic” vaccine has been ordered to protect at least half of the population by December, at an estimated cost of £100 million.

This is in addition to the purchase of 500 million doses of anti-viral drugs that have already been stockpiled to help treat illness and deals to procure vaccine in the event of a pandemic.

So far only 184 cases of the newly identified H1N1 strain have been confirmed in Britain, with all those infected showing only minor symptoms.

However, experts predict that swine flu — which is actually a recombination of existing animal and human flu strains — could cause a second wave of more widespread illness in winter.

The Department of Health said that the agreement could provide enough vaccine to protect health workers and the most vulnerable patients before a pandemic arrived, without affecting the normal supply of seasonal flu vaccine.

The jabs could be given as a priority to the elderly, patients with chronic conditions as well as NHS and social care staff.

It may be that the vaccine would be supplied in two or more doses, necessitating the order for more treatment courses than the total population of Britain.

The Government has already signed agreements worth £155 million to supply up to 132 million doses of vaccine to inoculate people in the event of a pandemic.

It has also procured enough anti-viral drugs to cover 80 per cent of the population, at a cost of more than £500 million.

But it refused to disclose the additional cost of the new contracts signed.

The World Health Organisation’s official alert level remains at phase five out of six — one step away from declaring a global pandemic. But France, Belgium and Finland are among other countries that are stockpiling doses of potential vaccine as a precautionary measure for such an event.

The vaccines used before and during a pandemic would almost certainly be the same unless the strain mutates sufficiently to require an entirely new vaccine to be made.

Alan Johnson, the Health Secretary, said: “The localised cases of swine flu found in the UK have so far been mild, and our strategy of containing the spread with anti-virals appears to have been effective in reducing symptoms and preventing further spread of infection.”

But, he added: “Scientists tell us that as yet we don’t know enough about this novel strain, or whether it’s likely to mutate, but that this virus has the potential to become a pandemic and we can’t predict how serious that would be.”

Mr Johnson told the House of Commons that it could take four to six months before a vaccine could be manufactured in the event of a pandemic and more than a year until it would be available in sufficient quantities for the whole population.

“We have an opportunity to secure vaccine in advance of a pandemic wave… These additional arrangements provide the opportunity by December this year to have enough pre-pandemic vaccine to protect at least half of the population from swine flu.”

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6293951.ece

Health Direct is pleased that Alan Johnson seems to be on the ball with Swine Flu, but why the secrecy over the additional costs?

Surely Alan Johnson- one of the spposedly “saints” over MPs expenses, realises that silence is the devil’s friend. These extra costs will eventually be published. And will they met be from the NHS’s existing budget or the Treasury’s Contingency Fund?

Birmingham University researchers quizzed more than 1,000 health workers and found as many as 85% may be absent.

This is more than double the official predictions and the experts believe such a scenario could put too much strain on the health service.

Under contingency plans already drawn up, protocols are in place to allow the NHS to cancel non emergency treatment such as elective operations.

GPs have also been asked to develop networks to allow the sharing of resources to cope with pressures during a pandemic.

But the report, published in the BMC Public Health journal, questioned whether this would be sufficient.

Official estimates suggest the absence rate will be something between 10% to 35%.

But the Birmingham University poll found that in a severe pandemic where many schools were closed and transport disrupted the actual figure could be more than double that.

Researchers asked a range of staff ranging from doctors and nurses to support staff and managers about how they thought they would cope.

High absence rates were predicted for each group, although doctors were among the most likely to turn up.

The most important factor that would lead to an absence was caring responsibilities to children or elderly family members, the report said.

‘No easy answers’

Dr Sarah Damery, one of the report authors, said: “It raises questions about the ability of the NHS to cope. The problem is that there are no easy answers.

“Things such as transport and accommodation can be resolved, but the major factor that would influence people staying away is to do with caring responsibilities and these are not that easy to solve.”

The findings come as the UK is braced for a pandemic.

The World Health Organization currently rates the swine flu outbreaks at phase five – one level short of a pandemic.

Professor Steve Field, the president of the Royal College of GPs, which has helped draw up the contingency plans, said: “I think the plans in place are excellent and what we have seen so far is that health workers have risen to the challenge.

From:
http://news.bbc.co.uk/1/hi/health/8048554.stm

Primary care trusts have been commissioning some 260 “GP-led health centres”, or “polyclinics”, open 8am to 8pm, seven days a week – one in each primary care trust and a further 110 or so in areas short of doctors.

With just over 200 of the contracts awarded, 42 per cent have been won by partnerships of GPs, according to health department figures. Private sector companies have won 21 per cent, and consortia – usually a mix of GPs working with independent sector partners – have won 19 per cent.

The remainder have gone chiefly to third sector organisations, including social enterprise, with primary care trusts awarding 6 per cent of contracts to their own provider arms.

When the centres were announced, the British Medical Association ran a “save our surgeries” publicity campaign and petition, saying the labour government was seeking to privatise general practice and that many of the extra surgeries with longer opening hours were unnecessary.

The contract award figures show, however, that GPs locally have bid strongly to run them – even the practice in which Dr Hamish Meldrum, the BMA’s chairman of council is a partner, won one commission.

“How well family doctors and the private sector have done depends somewhat on how you want to look at the figures,” said Helen Parker, co-director of the Health Services Management Centre at Birmingham university.

If GPs working in consortia with independent sector partners are included in the total that are GP-run, family doctors have won 60 per cent of the contracts.

If, however, those consortia that include the independent sector are counted as privately run, private operators have a stake in 40 per cent. But even in this scenario, fewer than 100 of the 8,000 general practices in England will be run by the independent sector.

“This does not yet amount to a corporate takeover of general practice,” Ms Parker said.

Mark Britnell, the health department’s director-general of commissioning, said the outcome “is a good mix, and the fact that GPs have won a significant proportion of the contracts shows that the BMA was wrong to insist that this was bad for GPs”.

Mike Parish, chairman of the NHS Partners Network, which represents private providers, said it was broadly pleased with the outcome.

“It is a fantastic opportunity to build on the new relationships that have been established [with primary care trusts]”, he said. “We see these projects as the beginning rather than the end, or a one-off.”

Some £10bn of efficiency improvements would be needed over the next few years as NHS spending was squeezed, he said. Private sector investment could play a key part in moving services out of hospital to more convenient locations at lower cost.

From:
http://www.ft.com/cms/s/0/75aebad8-3db7-11de-a85e-00144feabdc0.html

Newly allocated funds aimed at improving end-of-life care are at risk of being spent on other medical priorities, the Public Accounts Committee (PAC) suggests.

Half a million people die in England every year; almost two-thirds of them are over 75. The vast majority of deaths follow a period of chronic illness such as cancer or heart disease.

About 60% of those deaths occur in an acute hospital despite the fact that “there is no clinical need” for the person to be there, the study says.

“Most people express a preference to die at home [surrounded by friends and family]. People should have the right to die in the place of their choice.

“[Health authorities should increase] the availability of community services, such as 24-hour district nursing, and access to advice and medication out of hours to help reduce the number of unnecessary hospital admissions.”

Those who die in hospital are often deprived of effective pain management and not accorded adequate “dignity and respect” in their last days and moments by NHS staff, the report states.

“Because someone is approaching the end of life it should not mean we abandon concern for their quality of life. End of life care should seek to sustain people’s quality of life as a priority.”

There should be more checks, the paper suggests, to ensure staff receive education and training in end of life care. Specialist palliative care teams should always be deployed to deliver pain relief.

Residential homes, especially those without qualified nursing staff, often feel ill equipped to care for people in the final stages of life and send them to hospital or refuse to take residents back after a hospital admission.

In one local study, the report shows, at least 40% of patients who died in a Sheffield hospital “did not have medical needs which required them to be admitted”. Many had been occupying a bed for more a month – suggesting that resources could be freed up and redirected to home care.

The National Audit Office has estimated the cost of caring for cancer patients (who account for 27% of all deaths) in the 12 months before death was £1.8bn. Reducing emergency admissions by 10% and cutting the average length of stay to three days would release £104m for redistribution to other end of life care services.

The Department of Health has allocated £286m over the next two years to improving end-of-life care. But the PAC warns “there is a risk that the additional [sum] will not be used as intended. The department should require primary care trusts to account for how the additional funding is spent.”

Co-ordination between health and social care services in this area is “generally poor”, the report notes.

“That health and social care providers have traditionally given a low priority to end-of-life care is shown by the lack of training in basic end of life care among front-line staff,” the chairman of the PAC, Edward Leigh, said.

The catalogue of problems discovered in hospitals include poor support for basic comfort; lack of privacy for the patient and their family; poor communication by staff; and staff recognising too late that somebody is about to die.

“It is appalling that people dying in hospital are not always being given the end of life care they deserve,” Leigh said, “including effective pain management and being treated with dignity and respect.”

From:
http://www.guardian.co.uk/society/2009/may/14/end-of-life-care-report-nhs

The decision means that hospitals, clinics, schools, waste and local authority projects can continue to be built under PFI without counting against the government’s capital expenditure totals.

With public sector capital spending set to halve in cash terms after 2011, that will come as a considerable relief to public bodies.

They face seeing capital expenditure drop from £44bn ($68bn) this year to a mere £22bn a year in 2013-14, a reduction that would have had an even bigger impact if the billions of pounds of PFIs and PPPs that are in the pipeline had to count within that.

In spite of the widespread expectation that almost all PFI projects would go on the books as the Treasury fulfils a longstanding promise to move the public sector to international financial reporting standards, the Treasury has now issued all but final guidance to Whitehall departments indicating that, while they will count on departmental accounts, a different accounting standard will apply for the Treasury’s budgeting purposes.

That will be based on the European accounting standard that is applied by the Office for National Statistics to the national accounts. It has the effect that many projects will continue to count as off-balance sheet.

”The expected effect is that things will go on much as before,” a leading PFI accounting expert said. “There may be some changes at the margins over which projects count as on the books or off.

“But broadly speaking, where a project would have been off the books up to now, they will remain off the books.”

He added, however, that one effect of the guidance could be that departments would have to produce two sets of accounts, one complying with the IFRS standard and another to meet the European one.

Nick Prior, head of government and infrastructure at the consultants Deloitte, said: “This clarification is extremely welcome for the future of PFI and PPPs. Government departments should now be able to bring forward projects that have been delayed because of uncertainty over budgetary arrangements.”

About 60 per cent by value of PFI projects are currently off balance sheet. Critics, and even some supporters, of PFI have argued that the need to shift risks to the private sector – sometimes artificially – to achieve off-balance sheet treatment has been bad for public procurement.

A study last year by PwC, the professional services firm that advises both the public and private sectors on PPPs, said that if the projects all came back on the books it would ”frankly come as a relief” as some have been “distorted” to get them off balance sheet.

From:
http://www.ft.com/cms/s/0/143664c4-3f4a-11de-ae4f-00144feabdc0.html

A report from the Commons Health Committee recently attacked the way in which the National Institute for Curbing Expenditure (NICE) assesses costly cancer medicines as “both inequitable and an inefficient use of resources”.

The MPs’ inquiry was sparked by calls for cancer patients to be able to pay out of their own pockets for medicines that Nice advises the NHS not to use, leading to new guidelines issued late last year by Prof Michael Richards, the government’s “cancer tsar”.

After a series of decisions by Nice to reject new cancer drugs as insufficiently effective either clinically or on cost, Prof Richards called for the National Health Service to make more expensive drugs available.

However, the select committee argued that Nice had in response adopted a threshold for judging whether to approve “end of life drugs” that was too high, depriving the NHS of resources to spend on more cost effective drugs for other illnesses that had a more significant benefit.

It also criticised Nice for moving too slowly in assessing new drugs, and said the agency’s guidelines for selecting the types of costly cancer drugs to be reviewed was “too woolly”.

The committee questioned the increased threshold adopted by Nice for approving such drugs above the usual £30,000 per quality adjusted life year (Qaly), the measure it uses to assess the benefit a drug brings to a patient. Nice denied that threshold was as high as £70,000.

Kevin Barron, chairman of the committee, denied that the implication of the report was that Nice should reduce its Qaly threshold, arguing instead that it should make greater efforts to free up resources by finding other ways for the NHS to save money.

His committee said it was “extremely disappointed” little progress had been made by the government in following its previous calls for Nice to “disinvest” in obsolete technologies.

Prof Sir Michael Rawlins, chairman of Nice, said: “There is a balance between egalitarianism and utilitarianism. The select committee has fallen into the latter.”

He said Nice was reviewing the Qaly, but it was “the only game in town”, and that identifying savings for the NHS from older treatments and techniques was a difficult and “subtle” process.

The health select committee also expressed caution over the growing use of “risk sharing” schemes, whereby the government and pharmaceutical companies agree to reimburse some of the costs of medicines that prove less effective than initially believed.

The debate came as the National Audit Office identified one source of savings, estimating that NHS primary care trusts had saved £394m last year through more consistent use of lower cost, generic medicines for some common conditions such as high blood pressure, high cholesterol and gastric problems.

From:
http://www.ft.com/cms/s/0/3d1bce3a-3f57-11de-ae4f-00144feabdc0.html?nclick_check=1

Health Direct points out that NICE’s use of the phrases “difficult” and “subtle process” are similar to that of MPs’ expenses. A smokescreen for don’t ask me uncomfortable questions.

Until NICE publishes what it’s Qaly definition and it’s scientific analysis guidelines for evaluating drugs actually are- the killer quango will continue to have the disrespect it deserves.

The care services minister this morning announced he would write a cheque for £41,709 to cover the cost of the furniture and fittings he claimed for the property – a small two bedroom flat in south London.

The sum being returned by Mr Hope is the largest amount an MP has pledged to refund since the expenses scandal broke, but dozens of other members are expected to follow suit under pressure from their party leaders.

The Corby and East Northants MP said that his announcement was unrelated to fears over his slender 1,517 majority – and said he should be able to find the money “within a week or so”.

“It is going to be difficult, it is going to be challenging but this is a personal decision that we [he and his wife Allison] have made together,” he told Sky News.

In a statement, Mr Hope insisted his claims were within the rules, but said he wanted to correct the “dreadful perception” and he enriched himself with taxpayers’ money.

“The anger of my constituents and the damage done to perceptions of my integrity concerning the money I have received to make my London accommodation habitable has been a massive blow to me that I cannot allow to continue,” he said.

Mr Hope is following in the footsteps of Hazel Blears, the communities secretary, and backbench Labour MP Margaret Moran in agreeing to refund questionable payments following a week of disclosures about expense system abuses in The Daily Telegraph.

Miss Blears has agreed to pay back £13,000 in capital gains tax from profits on a house paid for by the taxpayer, while Miss Moran will return the £22,500 she claimed for treating dry rot at a house 100 miles from her constituency.

Alan Duncan, the shadow leader of the Commons, will repay more than £5,000 in gardening costs; Andrew Lansley, the shadow health secretary, will repay £2,600 claimed for home improvements; and Oliver Letwin, the chairman of the Conservatives’ policy team, will refund £2,000 for getting pipes repaired under his tennis court.

Mr Lansley apologised to his South Cambridgeshire constituents for claiming “overgenerous” expenses in a letter to his local paper. “The public has every right to be angry about MPs’ allowances. I was part of that system and I’m sorry for my part in it,” he wrote.

The announcements come amid a growing acceptance at Westminster that politicians from the three major parties must act decisively to restore public trust in parliamentary democracy or risk a backlash from the electorate in the June 4 European and local council polls.

David Cameron has said that Tory MPs shown to have broken the rules could be sacked, and on Tuesday Gordon Brown has admitted that “extreme” action is needed to restore public trust in politicians.

The Prime Minister said an independent review of every claim made over the past four years would allow MPs to show they are “worthy of public trust”.

“I think the issue here with Hazel Blears is about the sale of a house where CGT could or could not have been paid,” Mr Brown said. “She has looked at what has happened, I have talked to her, she has repaid the money.”

Mr Brown said other ministers who had come in for criticism over their accommodation arrangements, including Chancellor Alistair Darling and Transport Secretary Geoff Hoon, were in a “different position” but could still face disciplinary action if the independent review found there were problems.

Mr Hope, who has also been criticised for employing his son Nick and daughter Anna for parliamentary work, said that he was repaying his expenses because the Telegraph’s disclosures had “fundamentally changed the view people have of me and that is something I cannot bear.”

The MP billed taxpayers for so much furniture for his second home in Southwark, south London – including a chest of drawers, a mattress, a television, a sofa, an armchair, a washing machine, three chairs, two bookcases, one coffee table, a wardrobe and a dining room table – that questions were raised about how it could have all fitted into the small flat.

His statement read: “I have worked very hard over the last 12 years to represent and fight for my constituents, and their opinion of me as a person matters hugely to both myself and my wife Allison.

“We feel very badly hurt by what has happened and although I kept to the rules laid down by Parliament I cannot allow this dreadful perception about what I claimed in allowances to continue.

“I have decided to try to restore the trust and relationships I have with my constituents. I am returning all of the money that I have claimed for fittings, furniture and household items that I received over a five year period – the sum of £41,709.

“This will be paid to the House authorities as soon as the necessary arrangements can be made.”

Speaking to Sky News, he added: “This is not about votes; this is about who I am. This is about me and this is a personal decision I am making.

“Whenever the election comes, whatever goes on there, I just want those people I represent to know, whether they vote for me or not, that I have personal integrity.”

From:
http://www.telegraph.co.uk/news/newstopics/mps-expenses/5317104/Phil-Hope-agrees-to-return-41000-as-MPs-retreat-on-expenses-claims.html

Personal Intergrity- Health Direct asks why it took him so long to pay back his fiddled expenses aftre they became public knowledge? And how come he has so much spare cash sloshing around- the equivelent of two thrids of his annual salary- before tax?

Health minister Ben Bradshaw also received attention from The Daily Telegraph, although the paper’s prime interest was in the fact that the second home for which he has claimed around £1,600 a month in mortgage interest payments is jointly owned with his civil partner. His total claims over the four year period were £56,568.

Health secretary Alan Johnson was absent from The Daily Telegraph’s detailed coverage, with no details reported.

In a report to trusts, the confederation says clinical issues such as healthcare acquired infections have the capacity to cause “enormous damage” to trust reputations.

With public, political and media interest in venous thromboembolism (VTE) increasing, checks for blood clot prevention could become part of future trust assessments, the report says.

The condition causes the deaths of around 40,000 hospital patients each year, as well as increasing treatment costs and hospital stay length.

The cost implications of risk assessing patients are likely to be minor when compared with the costs of treating post-surgical deep vein thrombosis and pulmonary embolism patients, the confederation says.

Policy director Nigel Edwards said: “Managers, clinicians and patients have a real chance to build on the success of reducing infections. If we work together we can save lives and reduce NHS costs by improving the assessment of all patients and using cost effective preventative measures.”

Hospital boards could include venous thromboembolism measurements in trust quality dashboards and appoint clinical champions to promote the issue to colleagues, as well as appointing lead non-executive directors for the condition.

Baseline assessments can be used to establish how trusts are performing on assessing patients and boards can ask whether venous thromboembolism prevention is included in staff training.

Primary care trusts could include risk assessments and prophylaxis targets in contracts with providers.

The report comes as a survey by thrombosis charity Lifeblood reveals the public is largely unaware of the risk of blood clots.

From HSJ:
http://www.hsj.co.uk/5001282.article

Health Direct is amazed that the public is largely unaware of the tens of thousands that deie risk of VTE, because Health Direct certainly is not.

Within only a few months of lauching the Health Direct blog we came across the terrible death toll that VTE causes in the UK.

On March 08, 2005 Health Direct posted- 25,000 die from preventable VTE
Each year over 25,000 people in England die from venous thromboembolism (VTE) contracted in hospital.

This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents, and more than twenty five times the number who die from MRSA.

And again, on October 31, 2006 we posted NHS patient safety ‘must improve’ says Healthcare Commission

More needs to be done to improve standards of safety in the NHS and independent sector, a watchdog says. The Healthcare Commission said that while most patients received safe care, standards were inconsistent in England and Wales.

The watchdog said there was no clear indication on the number of deaths that could be avoided.

The inquiry into NHS failings, conducted by the Care Quality Commission and published today, concludes that doctors and other health professionals had contact with the little boy 35 times but every chance to raise the alarm was missed.

Any one of these professionals could have picked up that he was suffering abuse if they had been “particularly vigilant” and gone “beyond what was required” by the system, the health regulator said.

The commission examined the actions of four NHS trusts in London involved in the care of Baby P, who can now be named as Peter, before his death in August 2007 aged 17 months.

Investigators found a “catalogue of errors”, including chronic staff shortages, inadequate training, long delays in seeing the child and poor communication between health workers, police and social services.

The commission also raised concerns at how the four trusts — North Middlesex University Hospital NHS Trust, Haringey Teaching Primary Care Trust, Great Ormond Street Hospital for Children NHS Trust and Whittington Hospital NHS Trust — rated key services linked to child protection as compliant with core NHS standards.

Three of the four trusts declared themselves compliant in all relevant standards in each of the three annual health checks collated by the Healthcare Commission, the predecessor of the Care Quality Commission, before Peter’s death.

Peter was on the at risk register when he was found dead in his blood-spattered cot in Haringey, North London, on August 3, 2007. He had suffered 50 injuries despite receiving 60 visits from social workers, doctors and police over the final eight months of his life.

Last year his mother, her boyfriend and their lodger were convicted at the Old Bailey of causing or allowing his death. This month the boyfriend was also found guilty of raping a two-year-old girl.

The commission said that its findings had been sent to the trusts in March and action plans had been produced to address care shortfalls that had still not been addressed. Publication of the report was delayed until today to avoid prejudicing the related court case.

The report highlights a series of failings when Sabah al-Zayyat, a consultant paediatrician, saw Peter at St Ann’s Hospital in Tottenham, North London, two days before he died.

Dr al-Zayyat decided that she could not carry out a full check-up because the little boy was “miserable and cranky”, and she did not spot that he had serious injuries, probably including a broken back and fractured ribs.

The doctor had no contact with Baby P’s social worker before or after the appointment and was given no details about the child’s previous hospital admissions, the commission noted in a report.

She was one of only two consultants at the specialist children’s clinic at St Ann’s Hospital, when there should have been four.

On an earlier occasion, in April 2007, Baby P was discharged from North Middlesex University Hospital in Edmonton, North London, without a formal meeting to discuss concerns about possible abuse — contrary to standard procedures.

Sue Eardley, head of children’s strategy and safeguarding at the Care Quality Commission, said that it was a problem of system failures rather than “individual culpability” by the health workers who saw Baby P.

She added: “If somebody had been particularly vigilant and gone beyond their scope, beyond what was required, any one of those could have picked it up.”

Cynthia Bower, the commission’s chief executive, said it was vital that lessons from the case were learnt across the country as well as in North London. She added that stronger legal powers would ensure that, from next year, trusts could be held to account for inaccurate claims of competence.

“There were clear reasons to have concern for this child but the response was simply not fast enough or smart enough.

“The NHS must accept its share of the responsibility. Professionals were not armed with information that might have set alarm bells ringing. Staffing levels were not adequate and the right training was not universally in place. Social care and healthcare were not working together as they should.”

The commission is carrying out a review of all NHS trusts in England to check that they are doing enough to protect vulnerable children. It will be published in July.

The General Medical Council has suspended from practice Dr al-Zayyat and Baby P’s family GP, Jerome Ikwueke, over their involvement in the case.

The NHS trusts criticised in the report apologised for failings in the Baby P case and said that they had taken steps to address them.

Alan Johnson, the Health Secretary, said that the report highlighted “clear failures by local NHS organisations to communicate properly and share information and expertise”.

“These failures are unacceptable. The protection of vulnerable children requires the very highest levels of performance. We must do all we can to learn the lessons of this appalling case.”

Mr Johnson, who ordered the commission’s review in December, pledged that the recommendations would be “rigorously applied” across the health service.

Seen but not spotted

During the period March 1, 2006, to August 3, 2007, a number of health professionals had numerous contacts with Baby P, including:

6 visits by Baby P to an acute hospital (excluding his birth and death). Of these, two were to the North Middlesex University Hospital A&E; department, one was to the Whittington Hospital paediatric emergency clinic and three were outpatient appointments (one for paediatric assessment and two for X-rays)

14 visits to the GP practice

1 visit to the specialist child health service, where a consultant paediatrician saw Baby P two days before his death

5 visits by a health visitor in which Baby P was seen at home

6 visits to the child health clinic

2 visits to walk-in centres

1 contact specifically with the midwife

9 attendances by Baby P’s mother at Mellow Parenting sessions, of which five were with Baby P

16 contacts between Baby P’s mother and the primary mental health worker

Source: Care Quality Commission

From:
http://www.timesonline.co.uk/tol/life_and_style/health/child_health/article6276087.ece

Fifty two of 103 respondents – mainly acute managers – said they recognised parts of the poor management and governance highlighted by the Healthcare Commission in March.

Forty two said they recognised elements of the care standards that were criticised.

Examples given included shortage of senior medical staff, lack of protocols, planning and processes, lack of supervision in accident and emergency and junior doctors “used to prop up the service”. One respondent claimed receptionists also assessed patients at their trust.

However, one said: “Sporadic instances of some of these happen at most trusts. Mid Staffordshire seems to have experienced widespread, long term problems.”

Examples of governance problems cited include attention to waiting lists at the expense of care, poor communication, poor board use of benchmarking, lack of board focus on care quality.

The survey results show many trusts have made changes in reponse to the Mid Staffordshire report.

Fifty respondents to the poll said changes were planned or had already been made to information provided to the board following the scandal.

Eighty four respondents said they had read the report but only 60 said their board had already considered the implications. Another 24 planned to. NHS chief executive David Nicholson wrote to trusts telling them to “reflect on this report and the lessons within to ensure these failures cannot be repeated”.

Thirty seven said they planned to or had changed the design of emergency care, for example the use of clinical decision units or emergency care assessment units. Much of the way emergency patients were handled at Mid Staffordshire was criticised.

Nineteen said their trust was planning, or had already, increased numbers of nurses or doctors. Sixty-five said their trusts were now giving more consideration to mortality rates.

In response to government’s new requirement for trusts to publish an annual statement on patient and public involvement, 54 said they did not believe it would help avoid standards becoming so poor elsewhere.

Results are based on an HSJ internet poll completed by 103 respondents.

From:
http://www.hsj.co.uk/5001033.article

Formal processes to ensure boards can be certain legal and regulatory standards are met have been reduced to a “paper chase”, risking a repetition of the major failures at Maidstone and Tunbridge Wells and Mid Staffordshire foundation trust, it says.

Audit Commission chief executive Steve Bundred told HSJ the commission’s study, Taking it on Trust, was undertaken in the wake of concerns aired by the foundation trust regulator Monitor about the way boards were working at some applicant trusts, the high profile failures at a handful of NHS hospitals, and discrepancies between what trusts tell regulators about their performance and what inspectors find.

The commission studied governance structures and processes at 15 NHS trusts. It found an abundance of formal controls and processes designed to ensure non-executive board members could hold the trust to account on its performance.

But many of these had been reduced to a “paper chase rather than critical examination,” and had become “disassociated” from the day to day running of the trusts.

“The controls are in place. Everywhere we looked they were there,” Mr Bundred said. “But they are not always being operated as rigorously as they should. If boards don’t get this issue right then patients can be at risk.”

“We are not saying things are going wrong, but that things could be much better,” he added. “Mid Staffordshire and Birmingham [Children’s Hospital foundation trust] are examples where things did go wrong. Because they happened, it’s incumbent on all boards to ensure they are working effectively.”

“In some instances boards might not know where the weaknesses are because the controls they have in place to give them assurance are not working as they should.”

From:
http://www.hsj.co.uk/5000855.article

Even now, problems with staffing and equipment persist at the hospital where the Healthcare Commission said last month that emergency patients died because of chaotic care, the reports said.

The findings came as Alan Johnson, the health secretary, said that primary care trusts will have to publish an annual statement showing how they involve patients in decision making.

Hospitals will have to publish the number of complaints that they receive and how many they successfully resolve.

Health authorities will have to seek explicit assurance from the new NHS regulator, the Care Quality Commission, that the quality of care is acceptable before trusts are put forward to become NHS foundation trusts.

In the case of the Stafford hospital, Monitor, the foundation trust regulator, was unaware of mounting concerns at the Healthcare Commission about the quality of care at the time that it was approved for flagship foundation trust status.

In addition, Mr Johnson announced that a question that has been dropped from the annual staff survey – whether staff are happy with the standard of care their organisation provides – is to be reinstated.

Low scores at Mid-Staffs, where just 27 per cent of staff said they were happy with the care provided, was one factor that alerted the Healthcare Commission to problems there and the decision to drop the question has been fiercely criticised.

Extra nurses were being drafted in to the hospital as Mr Johnson said that while there have been “significant improvements” at Stafford, it was “clear there is more to do”.

He also reminded staff that they have a duty to blow the whistle about poor quality care and are protected under the Public Interest Disclosure Act.

Andrew Lansley, the Conservative health spokesman, said the reports by the health department’s accident and emergency and primary care tsars “are neither open nor independent enough” and neither, he said, “gets to the heart of why staff did not feel they could speak out”.

The Patients Association said it was considering applying for a judicial review of the decision not to hold a formal independent inquiry into what happened at the hospital.

The studies showed that as the local strategic health authority and primary care trust were reorganised in 2006, key information was not transferred and there was “a loss of organisational memory”.

http://www.ft.com/cms/s/0/cd056222-35e8-11de-a997-00144feabdc0.html?nclick_check=1

Health Direct is pleased with Alan Johnson’s U turn on asking the “difficult questions” about hospital standards.

However, it was only a month ago that his department dropped the common sense requirement:
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.

If the seven month deadline is not met, “we will look at alternative approaches”, Christine Connelly, the Department of Health’s chief information officer, told the Financial Times.

Asked whether that could involve termination of the billions of pounds’ worth of important contracts held by BT, CSC, Cerner and Isoft, she said: “At this point, we are not ruling anything out.”

She stressed, however, that “it is in all our interests to make the systems and solutions we currently have a success”.

Her comments came as she outlined the latest plan to get back on track the troubled records programme, which is running at least four years late. Under the plan, she said:

• All hospitals will be given greater freedom to configure the system to their local needs.

• A “library” of such adaptations will be built, so trusts can choose which version is closest to their requirements and then, if need be, adapt it further.

• In the south, a nine month competition is to be held to let additional suppliers bid alongside CSC and BT to install and run the record in some 30 trusts where progress was halted after Fujitsu was fired from the programme last May.

• An approach modelled on Apple’s iPhone “apps store” will be allowed, so that any supplier can provide additional functions. That will mean earlier adopters of the BT and CSC systems will be able to exploit what is installed without having to wait “months or years” for the next software release.

Margaret Shepherd died in Leeds General Infirmary, West Yorks, 10 days after she was hit by a car reversing into a parking space.

The 88-year-old relative of Tindall, who is the boyfriend of the Queen’s granddaughter Zara Phillips, suffered minor fractures in the incident in Kirkgate, Otley.

However, on the eighth day of her hospital stay in March 2006, she suffered a blood clot in an artery which led to a stroke.

West Yorkshire Coroner David Hinchliff yesterday issued a damning verdict of standards at the hospital after hearing that there was no record of Mrs Shepherd being seen by a doctor in her last 48 hours.

Recording a narrative verdict, Mr Hinchliff said: “Certain aspects of treatment were unacceptable and the notes were woeful.

“In the two days between her cerebral event and collapse Mrs Shepherd was not attended, examined or diagnosed by a doctor. This represents a serious omission by the clinicians.”

During the inquest at Leeds Coroner’s Court, doctors and consultants who dealt with the case maintained that Mrs Shepherd had been attended to, but that no notes had been made in her file.

Giving evidence, Dr Katrina Topp, a consultant physician on the case, said she had no explanation for the omission on Mrs Shepherd’s file on March 9 and 10.

She said: “I think in this individual case there is no entry on the 9th and 10th but I think the entries on the other days show good housekeeping. They are cases of concern as individual incidents.

“I don’t have an explanation but I agree it’s very poor. Some doctors have done a ward round and not recorded it in their notes, that needs to be addressed.”

Mr Hinchliff said: “If it is not in the notes then it hasn’t happened, if it is not in the notes there is no way I can speculate. This was a woeful absence, this is extremely unacceptable and the Trust will reap its own problems if this continues to exist.”

However. he added that if Mrs Shepherd’s condition had been diagnosed and treated, it would not have altered the outcome.

Following the verdict, Mrs Shepherd’s daughter, Linda Tindall, said: “It is now clear that reported concerns were not acted upon during these days. I would not wish anyone to be treated as my mother was as a patient on Ward 34 at the LGI. Nor would I wish their family members to suffer the aftermath of such an event.”

Leeds Teaching Hospitals NHS Trust issued a statement apologising to Mrs Shepherd’s family but denied that the problem was due to a systematic failure.

From:
http://www.telegraph.co.uk/news/uknews/5252761/Coroner-criticises-unacceptable-treatment-of-Mike-Tindalls-grandmother.html

Ms Gibb left her position as chief executive of Maidstone and Tunbridge Wells trust in October 2007 after agreeing severance terms.

But this week the High Court turned down her bid to enforce this contract, ruling the trust had shown “irrational generosity” in agreeing to pay her £175,000 above the £75,000 she was contractually entitled to in lieu of notice.

Mr Justice Treacy accepted that Ms Gibb had received assurances of the payment’s approval further up the NHS hierarchy. However, even this was not sufficient for her to be awarded any of the outstanding £175,000.

Ms Gibb left the trust days before the Healthcare Commission published a critical report on two C difficile outbreaks which contributed to at least 90 deaths.

Jon Restell, chief executive of Managers in Partnership, Ms Gibb’s union, said the outcome would make it more rigorous in checking compensation agreements were properly authorised.

“If people have been given reassurances this case is a wake-up call to double check,” he said.

He questioned whether it served MiP members’ best interests to enter discussions on severance payments, or whether it would be better to go through a disciplinary process and potentially launch unfair dismissal claims at an employment tribunal.

“Maybe we will see a lot more litigation. That could lead to interesting arguments around whether people are culpable. In the past we would have been sitting down to discuss a compensation agreement. That may not happen in the future.”

Employment tribunals could consider whether a chief executive was responsible for problems, or whether wider, systemic issues such as targets were involved, he said. And he warned that chief executive jobs could look increasingly unattractive.

One foundation trust chief executive in the North of England said the case, combined with the recent turnover of chiefs, added to the unattractiveness of the positions.

“We have got a double whammy,” he said. “There is a great propensity to fire the chief executive and there has been a tightening up on pay-offs.”

County Durham and Darlington foundation trust chief executive Stephen Eames said: “The verdict reinforces the accountability of senior public servants like ourselves.”

The judge awarded costs against Ms Gibb and refused her leave to appeal.

MiP – which gave her legal advice – said options being considered included asking the Court of Appeal directly for permission to appeal and asking an employment tribunal to hear the case, even though it is technically out of time.

In a statement issued by the union, Ms Gibb said: “The evidence showed that senior NHS people made decisions and acted in ways that they themselves agree were both unjust and unfair to me. They said they would not have defended a claim of unfair dismissal. The judge’s ruling has been made over a contentious and complex point of law. This matter has been difficult for all parties and there can be no winners.”

From:
http://www.hsj.co.uk/5000912.article

Health Direct is delighted that Rose Gibb has lost her appeal for more blood money after presiding over the deaths of 90 patients in her dirty hospital.

What were the “NHS hierarchy” thinking of when they tried to pay off Mrs Gibb with another £175,000?

Perhaps they will now be similary generous to the relatives of those who died an early death as a result?

A Department of Health document warns that the health service is already working close to its capacity, leaving little scope to meet the demands of a mass outbreak of swine flu, which could force doctors to turn away patients needing intensive care.

The document, seen by The Daily Telegraph, says cuts in the number of beds since Britain last underwent a pandemic in 1969 – combined with an ageing population and changes in the way patients are treated – mean intensive care units “could be rapidly overwhelmed”.

The disclosure of the document last week came as:

Nicola Sturgeon, the Scottish health minister, reported that there has probably been the first British case of swine flu in someone who has not travelled to Mexico, indicating that the virus has begun to pass between people here;

Three new cases were confirmed in Britain;

Countries around the globe continued to report new cases of H1N1, with new confirmed cases in Holland. the Republic of Ireland and Germany.

Authorities in Mexico, the source of the outbreak, asked for a five-day shutdown of non-essential business and travel in an attempt to slow the spread of the disease.

The world is now on the brink of the first flu pandemic in 40 years, with the World Health Organisation’s (WHO) alert status at five out of six.

The Department of Health is printing leaflets to put through every door urging people to find “flu friends” who can bring them groceries and supplies if they fall ill.

However, the Department of Health (DoH) document seen by The Daily Telegraph warns that, during the peak of a flu pandemic, complications such as pneumonia could mean there are 10 times as many people requiring ventilators as the NHS can supply.

If demand cannot be met, it recommends doctors deny treatment to the weakest patients so that resources can be shared among the greatest number.

The draft document, which was written in September before the outbreak of swine flu, acknowledges that its recommendations open “controversial ethical issues” and could cause anger and violence from relatives of those refused care.

Doctors taking decisions to deny care are urged to fully document their decisions to protect themselves from litigation, while hospitals are warned that “additional security decisions may be necessary because of the risks of violence directed at staff making triage decisions”.

The document, Pandemic Influenza: surge capacity and prioritisation in health services, sets out the criteria which doctors should use to determine which patients receive intensive care.

If there is competition for places in intensive care units, patients suffering from advanced cancer could be refused beds along with pensioners suffering from severe burns, those with multiple organ failure and children suffering from advanced cancer, severe burns or trauma.

If patients competing for life support are likely to have an equal benefit from treatment, decisions should be taken by lottery, the guidance concludes.

The document describes the pressures that the NHS suffered during the last two pandemics, in 1957 and 1969, which caused a total of 3 million deaths worldwide.

It states that the impact of the 1969 outbreak was lessened by a high number of spare hospital beds at the time. The document says cuts to spare bed capacity, so that the health service is now working “at or near capacity”, a 31 per cent increase in the number of over-65s, a more complicated out-of-hours system for GPs and more widespread use of critical care would all make it more likely that intensive care units could be “rapidly overwhelmed”.

Meanwhile, NHS Direct took a more than 10,000 calls in total on Wednesday and almost 3,000 of them related to swine flu – more than double the calls received on Monday about the virus, reflecting how public concern is growing.

A spokesman for the DoH said: “We have published this draft guidance to help clinicians to work within an ethical framework during a pandemic.”

From:
http://www.telegraph.co.uk/health/swine-flu/5254149/Swine-flu-hospitals-could-turn-away-critical-patients-in-a-pandemic.html

Sir Ian Kennedy issued a sombre warning about the “corrosive” impact of bullying among NHS staff last month.

In a farewell interview as he stepped down from his role as Healthcare Commission chair, Sir Ian said bullying worried him “more than anything else” in the NHS and was “permeating the delivery of care”, before calling on managers to stamp it out.

His fears regarding the scale of the problem appear to be well founded if the annual staff survey, published last month, is anything to go by.

Twelve per cent of staff surveyed said they had suffered bullying, harassment or abuse at work by colleagues in the previous year and 8 per cent said this was by managers or team leaders.

At some trusts the problem is more widespread. The highest rates were at St George’s Healthcare trust in London, where 23 per cent of staff said they had been bullied, harassed or abused by their colleagues.

A spokeswoman said the figures were “of great concern” and the trust was looking at how to address the problem. A joint letter from the chief executive and a staff representative will go out with this month’s pay slips stating the trust’s commitment to tackling bullying and encouraging staff to speak out if they experience or witness bullying behaviour.

It is reassuring to see trusts taking action, but why is bullying so widespread in an institution devoted to caring?

Managers in Partnership chief executive Jon Restell says it is embedded in the culture of the NHS. “People tell themselves they do it for patients,” he says. “But to think we have to be brutal [to our colleagues] to be nice to patients – I don’t see how that works.”

To make matters worse, top doctors have had bullying “hardwired” into their training, he says. This is borne out in the 2007 survey of junior doctors by the Postgraduate Medical Education and Training Board, which found half of trainees in non-foundation posts who reported being bullied said it came from consultants.

Department of Health director general of workforce Clare Chapman says undergraduate and postgraduate medical programmes must be adapted to discourage the behaviours that lead to bullying.

However, far from being an isolated issue, many feel the problem is systemic in the medical profession.

Ms Chapman says there is a recognition that action must be taken but “the challenge is that not all trusts are tackling it”.

The Pacesetters programme is working to tackle bullying and discrimination, and the NHS constitution sets out the right to an environment free from harassment, bullying or violence.

Another barometer will be the review of the health and wellbeing of the NHS workforce, which is being led by Dr Steve Boorman and is due to report back by the end of this year.

Given the frequency with which NHS chief executives face sudden departures and complain about harsh performance management, is bullying being driven by the target culture?

There are also questions for regulators: Mr Restell asks whether they perpetuate the problem through their “tough” interactions with organisations.

While bullying occurs at all levels of the health service, close examination of the staff survey reveals stark disparities. For example, 11 per cent of white British staff complained of bullying, harassment or abuse from colleagues in the past year, compared with 19 per cent of Bangladeshi employees.

Bangladeshi staff are followed by Asian/Asian British and Pakistani staff (both 15 per cent), black African, black British, Chinese and Indian staff (14 per cent), and white Irish and black Caribbean staff (13 per cent).

In acute trusts, the proportion of workers saying they were bullied by colleagues was more than a fifth (21 per cent) among staff from white and black African backgrounds as well as employees classing themselves as “other Asian”, meaning they did not define themselves as Pakistani, Bangladeshi, Indian, Chinese or Asian British.

For white British staff the figure was 13 per cent. These statistics will fuel fears that the NHS does not always treat staff from different ethnic groups equally, backing up findings by HSJ and the NHS South East Coast black and minority ethnic network.

Evidence shows the NHS also needs to provide more support to staff with disabilities, who were almost twice as likely to say they had been bullied, harassed or abused by managers (13 per cent) than those who had no disabilities (7 per cent).

In acute trusts, one in five of the 7,486 disabled staff surveyed said they had been bullied by colleagues, compared with 13 per cent of non-disabled workers.

An Equality and Human Rights Commission spokesman said the figures were a “cause for concern”. A report by the commission last year highlighted the “profoundly different” experiences at work of people with long term illnesses or disabilities from their colleagues.

There are also clear distinctions between staff from different professional groups.

Social care managers were the group most likely to say they had suffered bullying, harassment or abuse by their managers in the past 12 months – 16 per cent compared with 4 per cent among arts therapy staff, the group with the lowest figures.

The figure was 13 per cent for midwives, who are also the occupational group most likely to say they have suffered bullying, harassment or abuse from colleagues – 17 per cent, compared with 8 per cent of physiotherapists.
Pressure cooker

Royal College of Midwives director of employment relations Jon Skewes puts this partly down to the “pressure cooker” atmosphere of busy maternity units and acute trusts in general.

However, this is no excuse for bullying, he says. “The midwifery profession has to work towards exemplary behaviour, but it’s also the responsibility of senior managers and boards.”

Investing in organisational development, bringing experts in from outside if necessary, will help tackle bullying, he says. But where will the money come from in a recession?

Mr Skewes says this is a moot point. “Last time the NHS was struggling with deficits there was no money for organisational development and training. That might be a problem again if spending gets cut.”

Before slashing budgets, finance directors may want to read an unpublished report carried out for the DH and released last year under freedom of information legislation.

It calculated that the cost of bullying and harassment to the NHS, taking account of sickness absence, replacement costs, productivity losses, litigation, service delivery, damage to employer brands, and bullying by patients and their families, was an “immense” £325m a year.

From:
http://www.hsj.co.uk/5000577.article