NHS managers need disciplinary body, latest inquiry urges

Senior NHS management should be turned into a profession, with an independent body created to discipline managers and board members, the latest inquiry into the Mid Staffordshire NHS Foundation Trust said.

Andy Burnham, the health secretary, who announced a fresh inquiry - the third - into the appalling standards of care at the Staffordshire hospital, said he would consult on the proposal, which was welcomed by the Patients Association.

"We must end the situation where a senior NHS manager who has failed in one job can simply move to another elsewhere," Mr Burnham said.

It was, he said, a "long-standing anomaly" that incompetent doctors and nurses can be disciplined and even struck off, but that there is no equivalent scheme for NHS managers, nor for the non-executive directors who, for salaries of a few thousands pounds a year, help make up the boards of NHS organisations.

The call to give NHS management the status of a new profession came as the inquiry by Robert Francis QC catalogued the most dire standards of care at Stafford hospital, which included needless deaths and staff leaving patients "sobbing and humiliated" while lying in their own faeces. 

The inquiry was highly critical of the Trust's board, which it said took too strategic a view of its function. Most of its members remained "in denial" about the hospital's problems, the inquiry said, even after a damning report from the NHS inspectorate.

The case "highlights the need for a proper system of ensuring the accountability of executive officers and non-executive directors" of NHS organisations, the inquiry said.

The NHS Leadership Council has already been examining the possibility of a regulatory body for NHS managers along the lines of the General Medical Council, which regulates doctors.

Nigel Edwards, head of policy at the NHS Confederation , said there was a good case for accrediting managers - which would establish, among other things, that they had had no major failures in the past - but was much more sceptical about full-blown regulation.

Both he and John Restell, general secretary of Managers in Partnership (MiP), the managers' union, questioned whether clear regulatory standards could be defined for good management as they are for doctors and nurses. Good human resources practice would go a long way to addressing managerial problems, Mr Edwards said.

Mr Restell said: "There is a risk of a big bureaucracy. And there is nothing to suggest that regulation of individuals would have prevented the systemic failures seen at Mid-Staffs and Maidstone and Tunbridge Wells [where patients died from hospital-acquired infections]. We would not want the public to be sold a pup."

There was also the risk that over-regulation of non-executive directors would deter good applicants, he said.

The new inquiry will look into the failure of communication that led Monitor, the trust regulator, to approve the hospital's application to become a foundation trust at the same time as the Healthcare Commission, the quality inspectorate, was becoming seriously concerned about the hospital's quality of care. It will also examine why the local primary care trust, which commissions the hospital's services, appeared unaware of how bad things were.

The department is aiming to produce a standardised measure of hospital death rates after apparently high ones first triggered the inspectors' concerns at Mid-Staffs. Disputes about how they are constructed meant it was "unsafe" to give any range for the excess deaths at the hospital, the inquiry found.

From:

http://www.ft.com/cms/s/0/6f5ee00a-21ae-11df-acf4-00144feab49a.html

Sexual health frankness is key to long relationship

Young people think frank conversations about their sex lives signal that a relationship will last, says a nanny state survey.

The government funded Populus poll of more than 1,200 15 to 24-year-olds cited talking about sexual infections and a person's sexual past as key.

They even thought this was a better sign of a relationship getting serious than meeting parents.

But 73% admitted that they did not talk about sexually transmitted diseases before having sex with a new partner.

And 30% said they felt uncomfortable asking a new partner to use a condom.

The research, which was conducted on behalf of the government's "Sex. Worth Talking About" campaign, provides a snapshot of the milestones that this generation think important for a lasting relationship.

Top of the list was "talking openly together about sexual history and discussing sexually transmitted infections tests together", which 70% thought important.

This was ahead of "meeting the parents", which was thought significant by 66%, and "not always having to wear make-up", cited by 47%.

Much lower down were "meeting friends", 40%, and "being given space in the cupboard to leave clothes", 30%.
 

The survey showed that while young people valued openness about sexual diseases, many were too embarrassed to talk frankly with their partners.

While half of respondents thought that a new partner who was unwilling to discuss these topics would not be around for long, a quarter confessed they were too embarrassed to talk to their partner about safe sex, sexually transmitted infections and contraception.

Paula Hall, from the relationship charity Relate, said she was not surprised that people thought openness about sexual health was important for the success of a relationship.

"If people are not intimate enough to be open about this, the relationship is unlikely to go far."

She said the findings were both "encouraging" and "depressing".

"The fact that discussion of sexual infection is so high up young peoples' agenda is really good," she said.

But she said it was "worrying that this is still an embarrassing topic, even among today's generation of kids who expect a high degree of openness in their relationships".

Modern relationships

Dr Catherine Hood, spokesperson for the "Sex. Worth Talking About" campaign, said: "These findings reveal much about the modern relationship game.

"While many young couples realise the significance of being able to talk openly about accepting tests for sexually transmitted infections, sheer embarrassment is preventing them from doing so, and potentially risking their sexual health as well as the future of their relationship."

She stressed the importance of young people being tested for chlamydia, a sexually transmitted infection which often doesn't have any symptoms.

"If left untreated, chlamydia can lead to infertility and other serious health problems, and so it's vital that new couples take responsibility for their own sexual health by talking openly about safe sex," she added.

From:

http://news.bbc.co.uk/1/hi/health/8549476.stmhttp://news.bbc.co.uk/1/hi/health/8549476.stm

Patients' medical records go online without consent

Patients’ confidential medical records are being placed on the controversial NHS database (NPfIT) without their knowledge, doctors’ leaders have warned.

At present 1.29 million people have had their details placed on the system. A further 8.9 million records are due to be added by June.

Those who do not wish to have their details on the £11 billion computer system are supposed to be able to opt out by informing health authorities.

But doctors have accused the Government of rushing the project through, meaning that patients have had their details uploaded to the database before they have had a chance to object.

The scheme, one of the largest of its kind in the world, will eventually hold the private records of more than 50 million patients.

But it has been dogged by accusations that the private information held on it will not be safe from hackers.

The British Medical Association claims that records have been placed on the system without patients’ knowledge or consent.

It follows allegations that the Government wanted to complete the project before the Conservatives had a chance to cancel it.

In a letter to ministers published today, the BMA urges the Government to suspend the scheme.

Hamish Meldrum, its chairman, writes: "The breakneck speed with which this programme is being implemented is of huge concern.

"Patients’ right to opt out is crucial, and it is extremely alarming that records are apparently being created without them being aware of it.

"If the process continues to be rushed, not only will the rights of patients be damaged, but the limited confidence of the public and the medical profession

in NHS IT will be further eroded."

At present 1.29 million people have had their details placed on the system. A further 8.9 million records are due to be added by June. By the end of next

year, the NHS hopes to have more than 50 million uploaded.

The "summary" records contain basic medical information including illnesses, vaccination history, and could include medication patients have been given. Ages

and addresses are also included.

Patients are supposed to be notified by letter at least 12 weeks before their details go live on the system and given the chance to opt out.

The BMA says that letters have gone to the wrong addresses and that many patients have been unsure what they mean.

Doctors point out that there has been no national advertising programme to explain the scheme, as has been the case with other government initiatives.

The BMA also criticises the fact that the information packs do not include the form which allows patients to opt out. It can only be obtained via the internet or by calling a helpline.

Katherine Murphy, of the Patients Association, said: "The Health Service should not put in place bureaucratic obstacles to patient choice because they are worried about what patients might choose to do."

Norman Lamb, the Liberal Democrat health spokesman, said: "The Government needs to end its obsession with massive central databases. The NHS IT scheme has been a disastrous waste of money and the national programme should be abandoned."

From:

http://www.telegraph.co.uk/Patients-medical-records-go-online-without-consent

Health Direct was warning of labour's duplicity, for example on Dec 16, 2009's post- Your medical confidentiality under threat again

Despite labour's promises to the contrary- their track record on snooping databases is appalling.

Having launched the Identity and Passport Service last week- which 96% of the population doesn't want, the labour govt are still going ahead with their health database.

Health Direct strongly recommends that you use the opt-out letter which was developed by with TheBigOptOut at http://www.nhsconfidentiality.org/optoutletter

and send it of NOW!

Labour's scramble to launch £11bn IT spending spree

Labour was accused of rushing through huge contracts before the election to safeguard the party's "nanny state pet projects".

The NHS computer scheme has cost £12.7bn; Home Secretary Alan Johnson with the aborted compulsory National ID card; the MOD computer system is £180m over budget.

Labour was accused yesterday of rushing through £11bn of spending before the general election in a "scorched earth" policy to prevent its pet projects being scrapped by an incoming Conservative government.

Despite the looming squeeze on public spending, ministers are trying to push through several massive computer contracts before ballot day, which is widely expected on 6 May. The "break clauses" in some deals may make them very expensive to cancel, locking in the new government.

Tory frontbenchers believe that, if they win power, they would discover "poison pills", making it harder for them to announce the immediate spending cuts they have promised. As well as contracts that are difficult to scrap, the Conservatives fear that Whitehall budgets have been drawn up to protect flagship Labour projects such as housing and children's services, so that any attempt to find small-scale savings would inflict maximum political damage.

Labour insists it has every right to carry on governing and argues that the new information technology (IT) contracts will provide value for money. Cabinet Office rules say that decisions on matters of policy and "other issues such as large and/or contentious procurement contracts, on which a new government might be expected to want the opportunity to take a different view from the present government, should be postponed until after the election, provided that such postponement would not be detrimental to the national interest or wasteful of public money". 

However, the guidelines do not kick in until the election is called – which Gordon Brown is not expected to do for three weeks. Although the Tories would call an immediate halt to all IT contracts if they won power, The Independent understands that last-ditch actions planned by the labour Government this month include:

*approving local supplier contracts for the controversial £12.7bn NHS electronic patient records scheme, the largest computer project in the UK, which the Tories would dismantle;
*signing a £1bn logistics software contract for the Ministry of Defence;
*speeding up a £600m contract to run new personal pension accounts due to start in 2012;
*completing an £800m agreement for communications equipment and services at the Serious Organised Crime Agency;
*starting to print the 30 million forms for the 2011 census, even though the Tories have said they would scale back the £482m project.

Labour denies acting irresponsibly and says an incoming government would be able to cancel the personal pensions contract at a cost of only £25m this autumn. But one minister admitted privately: "We are pushing hard on what we can get through by the end of March and asking civil servants to prioritise that, rather than medium- and long-term projects which could not be completed by the election."

However, some senior civil servants are frustrated that Labour and Tory frontbenchers will engage in frank talks with them about the spending cuts that will inevitably be needed to close this year's £178bn gap in the public finances. They say politicians fear their intentions would leak before the election.

Francis Maude, the shadow Cabinet Office Minister who heads an implementation unit planning the early work of a Tory government, said: "Labour's actions resemble a dying administration making reckless and irresponsible spending commitments to wreck the finances for any incoming government."

He added: "Once again we see Gordon Brown putting the Labour Party ahead of the country. Labour is unable to ditch its obsession with partisan dividing lines. The choice at the election will be clear: a responsible united government under David Cameron or a reckless irresponsible government under Gordon Brown who are only going to make things worse."

About £4bn is believed to have been spent already on the long-delayed NHS scheme for patient records to be available to any GP or hospital in England. The Tories want a local rather than a centralised scheme but fear the contracts would cost billions to unravel.

Labour insists the NHS contracts are being revised to save taxpayers £600m. The Health Minister, Mike O'Brien, said: "What we want to do is make sure we get these savings. I am certainly not going to get into a situation where because we are approaching a general election some day soon, the whole of government stops and we cannot make any contracts with suppliers of key NHS equipment. That would be complete nonsense."

But Stephen O'Brien, the shadow Health Minister, said: "At best it is a last-ditch attempt to tackle a deficit of Labour's own making. At worst it is an underhand effort to tie the hands of the next government."

From:

http://www.independent.co.uk/news/uk/politics/labours-scramble-to-launch-16311bn-spree-1917781.html

Labour hid ugly truth about National Health Service (NHS) neglect

Damning reports on the state of the National Health Service, suppressed by the labour government, reveal how patients’ needs have been neglected.

They diagnose a blind pursuit of political and managerial targets as the root cause of a string of hospital scandals that have cost thousands of lives.

The harsh verdict on the state of the NHS, after a spending splurge under Labour between 2000 and 2008, raises worrying questions about the future quality of the health service as budgets are squeezed.

One report, based on the advice of almost 200 top managers and doctors, says hospitals ignored basic hygiene to cram in patients to meet waiting time targets.

It says “several interviewees” cited the Maidstone and Tunbridge Wells [NHS Trust in Kent where 269 deaths during 2005-6 were caused by infection with Clostridium difficile bacteria].

“Managers crowded in patients in order to meet waiting-time targets and, in the process, lost sight of the fundamental hygiene requirements for infection prevention,” the report stated.

There were subsequent failings at health trusts in Basildon in Essex, and Mid Staffordshire. Filthy wards and nurse shortages led to up to 1,200 deaths at Stafford hospital.

Lord Darzi, the former health minister, commissioned the three reports from international consultancies to assess the progress of the NHS as it approached its 60th anniversary in 2008. They have come to light after a freedom of information request.

The first report, by the Massachusetts-based Institute for Healthcare Improvements (IHI), identified the neglect of patients as a serious obstacle to improving the NHS. “The lack of a prominent focus on patients’ interests and needs ... represents a significant barrier to shifting the trajectory of quality improvement in the NHS.”

One heading in the report says: “The patient doesn’t seem to be in the picture.” It adds: “We were struck by the virtual absence of mention of patients and families ... whether we were discussing aims and ambition for improvement, measurement of progress or any other topic relevant to quality.

“Most targets and standards appear to be defined in professional, organisational and political terms, not in terms of patients’ experience of care.”

This weekend it emerged the recommendations of the reports, intended to help the NHS improve, have not even been circulated.

The stark assessments, collected from leading NHS clinicians and managers, include:

A damaging rift between doctors and managers: “The GP and consultant contracts are de-professionalising, and have had the peculiar effect of simultaneously demoralising and enriching doctors. We’ve lost the volitional work of the doctors and far too many of us are now just working to rule.”

Pointless new structures. “Stop the restructurings. The only thing they generate is redundancy payments.” One body responsible for improving standards reported to five different ministers and had three different names in the space of 30 months.

A culture of fear and slavish compliance. “The risk of consequences to managers is much greater for not meeting expectations from above than for not meeting expectations of patients and families.”

The IHI report, whose interviewees included Lord Crisp, chief executive of the NHS between 2000 and 2006, also described a system of self-assessment where only 4% of trusts are externally inspected.

A similar picture emerges in the second report, by the US-based Joint Commission International. It says the “quality and integrity of [NHS]performance data is suspect”.

Dennis O’Leary, its lead author and an international expert on patient safety and improvement, said it was not intended as an exposé but as a series of useful suggestions for change.

“Our instructions were to pull no punches and tell it like it was, but the report wasn’t overstated,” he said. “It was how we saw things based on interviews with more than 50 people.”

The third report, by the US-based Rand Corporation, expresses surprise at the lack of a requirement to identify the specific drug involved when patient accidents are reported.

In 2008 Darzi issued his own blueprint for the future of the NHS, High Quality Care for All, but resigned from the government last July to return to his surgical commitments.

Last week he said: “The NHS is continuing a journey of improvements, moving from a service that has rightly focused on increasing the quantity of care to one that focuses on improving the quality of care.

However, Brian Jarman, emeritus professor at Imperial College London and an expert in hospital standards, said the findings should have been made available to Robert Francis QC, who led the inquiry into the Mid Staffordshire NHS Foundation Trust.

He said: “These reports have never seen the light of day. We desperately need a better monitoring system for the NHS which actually works.”

From:

http://www.timesonline.co.uk/tol/news/uk/health/article7052606.ece

Inquiry into NHS preferred provider rule halted

Primary care trusts across the east of England were ordered to suspend procurement for community services yesterday in a move that halted an independent investigation into the legality of Andy Burnham's "preferred provider" policy for the NHS.

The Co-operation and Competition Panel , the health department's advisory body on the application of competition , was left with no case to judge after procurement was halted.

The decision infuriated representatives of voluntary organisations and the private sector, who had brought the complaint.

John Appleby, chief economist at the King's Fund health think-tank, said: "This looks like a piece of naked politics to prevent the panel ruling on [the preferred provider policy]."

Mr Burnham, the health secretary, announced in September that NHS organisations were to be the service's "preferred provider" of care. At the time, under the existing NHS procurement rules designed to encourage competition, Great Yarmouth and Waveney PCT had invited any willing provider to tender to run its community services.

Following Mr Burnham's speech, however, it withdrew the invitation to the private and voluntary sectors, saying it was now "only able to accept bids from NHS organisations".

In December, the NHS Partners Network, which represents private providers, and Acevo, which represents voluntary organisations, complained to the panel that the move breached the NHS's existing procurement rules and almost certainly also breached European Union procurement law.

The panel reached an initial decision in private on Monday to take the case further. It is understood to have decided that there was a strong case for the complainants' view. Before it published, however, it was told by the health department that not just Great Yarmouth but all 14 primary care trusts in the east of England health authority had been told to suspend procurement, leaving no case to consider.

Peter Kyle, deputy chief of the Association of Chief Executives of Voluntary Organisations, said that three months after initial investigation had begun, "the department knew what the panel's verdict was likely to be, so they have pulled the plug on the investigation. It is pretty shaming."

Mike Parish, chair of the NHS Partners Network, said it would still press the case if "preferred provider' leads to other uncontested contracts. These would, the network believes, "run contrary to the principles of procurement law".

From:

http://www.ft.com/cms/s/0/8b719114-272d-11df-b84e-00144feabdc0.html?nclick_check=1

Government to clamp down on health tourists

A new clampdown on health tourism by foreigners who visit Britain for NHS treatment was announced by ministers.

Compulsory health insurance for visitors, refusal of treatment to failed asylum seekers who do not co-operate with the authorities, and a ban on entry for foreigners who have outstanding debts for previous NHS treatment are among measures proposed.

The Department of Health said the measures could save between £6m and £20m over five years. Emergency treatment and treatment for infectious diseases would remain free for all. 

The measures were condemned by human rights organisations but received a qualified welcome from the British Medical Association, which has previously refused to countenance the denial of treatment to patients in need.

A spokesman said: "The BMA appreciates that the NHS does not have infinite resources and that there is a need to restrict services to patients who are eligible to receive them."

"However, we will seek assurances from the Department of Health that, where there is genuine clinical need, doctors will have the discretion to provide treatment, irrespective of an individual's immigration status."

From:

http://www.independent.co.uk/government-to-clamp-down-on-health-tourists

NHS Hospitals to feel the axe as Treasury cuts £11bn

Alistair Darling will reveal details of how he plans to cut £11 billion from Whitehall spending in the pre election Budget.

The £11 billion is the first instalment of drastic cuts intended to slash £82 billion in four years from the record £178 billion deficit. Some hospital buildings face closure as the government seeks to save billions of pounds from more efficient services, Mr Byrne suggested.

Until Mr Byrne’s remarks it had been unclear whether precise cuts would be unveiled next month. The move is a victory for Mr Darling, who has been tussling with Gordon Brown about how far the Budget should detail Labour’s proposed cuts and whether any extra cash should go on spending or savings.

The £11 billion referred to by Mr Byrne was sketched out in the November Pre-Budget Report, but was criticised by some for lacking detail. It is part of the £20 billion savings that will be in place by 2012-13, according to government plans. The rest is made up from freezing public sector pay, curbing public sector pensions and cutting some spending programmes.

Mr Byrne suggested that hospitals will become vulnerable as trusts look to save money and improve efficiency by providing more healthcare in the community. “Some hospitals will have to start doing more of their care in the community rather than in big expensive hospitals,” he said.

Asked if this could mean some hospital buildings closing, he said: “Yes. A lot of hospitals are thinking of moving some of their business out into the community, because it is better care, more convenient, also cheaper. I think it’s possible to improove services, saving money.”

From:

http://www.timesonline.co.uk/tol/news/politics/article7043382.ece

Bliar ally says Tories are best for NHS

One of the architects of Labour’s NHS reforms is to become a key adviser to the Conservatives because the labour Government has “lost the plot” on improving patient care.

Professor David Kerr, a renowned oncologist who led efforts to cut waiting and give hospitals greater independence, said that the Tories now offered the best chance for the NHS, which had been driven into a “whirl of thoughtless tick-box exercises”.

Professor Kerr, a lifelong Labour supporter who campaigned with Tony Blair in the 2001 general election, told The Times that the key principles of giving patients a better choice of health services and a better understanding of how they were performing had been “driven into the sand”.

“To say that we have run out of steam, I would say definitely, definitely yes,” Professor Kerr said. “We have got lost in the blizzard of increasingly irrelevant targets. The position now is disenfranchising, dull and disconnected. That is the clinical reality.”

The doctor, a professor of cancer medicine at the University of Oxford, was a frequent visitor to Downing Street as Labour drew up its reform agenda in Mr Blair’s first and second terms. 

Before 1997 he conducted the first national audit of cancer services — identifying delays that allowed “patients’ cancers go from curable to incurable while they sat and waited”.

Under Labour he worked on ways to improve access as chair of the national Cancer Services Collaborative and became a founding commissioner of the Commission for Health Improvement, the first regulator to assess NHS clinical performance.

He was also one of the main drivers of the foundation trust scheme, offering the best hospitals the chance to become more independent, hold greater responsibility for their budgets and make clinicians more engaged in service improvement. A knife-edge Commons division on foundation status was won by 17 votes after Professor Kerr wrote to all MPs underlining the advantages that it would bring.

In 2005 he was given the task of developing a 20-year plan for the future of the NHS in his native Scotland, known as the Kerr Report.

Professor Kerr said that he felt “for the first time in [his] life” that the Tories offered the health service a better future. He said that the Conservative priority of getting NHS data out to patients in an understandable form, allowing them to choose the highest standard of service best suited to them, was a mission that disappeared with the departure of Mr Blair.

“[The Tories] are more committed to the NHS that we love and understand as free at the point of access and offering universal care. Only that degree of certainty would convince me to go and work for them.”

Professor Kerr would not be drawn on whether he had been a member of the Labour Party, but said that currently he was not a member of any political party.

He said that he hoped to push through the ideas of choice and the empowered patient, encouraging the NHS to make more high-quality information publicly available. “People need to be able to understand how their hospital is improving,” he said.

Another focus will be to allow patients to ask clinicians key questions about care standards without compromising the doctor/patient relationship.

“I firmly believe for the first time in my life that we have a Conservative leadership that is committed to the future of the health service. If I didn’t believe that I wouldn’t be there.”

On informed choice for patients, he said that under the Government “the whole big idea ended up in the foothills of dodgy websites. No one was really engaging with it.”

He identified the loss of momentum “around when the transition happened”, with things “starting to lose the plot” under Patricia Hewitt as Health Secretary, then Alan Johnson, “who is good on many fronts, but was more interested in keeping the NHS out of the headlines”.

Andrew Lansley, the Conservative health spokesman, said of Professor Kerr: “His expertise and knowledge will be crucial in helping us to create a NHS which has patients at its centre. That a key architect of the Blairite health reforms is now working with the Conservatives shows that under David Cameron’s leadership we have truly become the party of the NHS.”

From:

http://www.timesonline.co.uk/tol/news/politics/article7041772.ece

Failed Stafford NHS hospital bosses given pay rises while deaths crisis unfolded

Once again labour rewards failure as senior managers who oversaw one of the worst scandals in the history of the NHS at Stafford Hospital awarded themselves bumper pay increases at the same time as hundreds of patients were needlessly dying.

Board members at the Mid Staffordshire NHS Trust received pay rises running to thousands of pounds a year after successfully steering Stafford Hospital to Foundation status.

But an independent report into the catastrophic failings at the hospital has revealed how managers knew about the crisis at the same time as they were approving the increases.

Patients' groups last night said the idea they were giving themselves rewards as the elderly and vulnerable were dying was "sickening" and added insult to injury.

As part of the Trust's efforts to gain Foundation status a remuneration committee was established which oversaw the salary increases awarded to the Executive Directors.

The Chief Executive of the Trust, Martin Yeates saw his £145,000 salary rise to £169,538 between 2006 and 2008 at the same time as patients were suffering appalling standards of care.

Mr Yeates, who stepped down following a damning Health Commission report last March, was allowed to leave without any disciplinary action, a pension pot worth in excess of one million pounds and six months severance pay.

Julie Bailey, founder of the Cure the NHS campaign group, which helped bring the scandal of Stafford hospital to light said: "It is disgusting and sickening that while our loved ones were being treated so appallingly and hundreds were dying unnecessarily, the hospital bosses responsible were rewarding themselves with pay increases."

A spokesman for the Mid Staffordshire NHS Trust said Mr Yeates's pay increase had been agreed by the Remuneration Committee and said the rise had reflected the change in his responsibilites when the hospital changed to a Foundation hospital.

Last week's report, published by Robert Francis QC, revealed how patients were left unwashed for up to a month, were wrongly diagnosed, were abused and neglected by hostile uncaring staff and were often not fed properly.

During the same period several non-executive members of the board also received massive bonuses which saw their salaries more than double.

Toni Brisby Chairman of the NHS Trust, who worked three and a half days a week, increased her salary from – £18,000 to £40,000

Gerald Hindley, who was Vice Chairman of the Trust went, and worked two and a half days a week saw his salary rise from £5,900 to £15,000.

Other non-executive members of the board also got increases from £5,000 to £12,000.

The figures were revealed as a new report suggested that patients are still unhappy with levels of care at the Trust.

In a survey of outpatients, Mid-Staffordshire scored in the bottom fifth of trusts for general cleanliness, the level of respect and dignity with which patients were treated and their overall care.

Patients also complained of doctors and other staff talking as if they were not there, of a lack of privacy when they were being examined and when their condition was being discussed, and of not being told how long they would have to wait.

The newly released survey, published by the Care Quality Commission, was carried out between March and May last year.

It also found that the Trust scored in the lowest 20 per cent when patients were asked if they had received copies of letters between the hospital and their GP.

From:

http://www.telegraph.co.uk/Failed-hospital-bosses-given-pay-rises-while-crisis-unfolded

Stafford Hospital patients routinely neglected by cost cutting and targets

NHS Stafford Hospital patients were "routinely neglected" after management became preoccupied with cost-cutting and targets. Appalling standards of care put many patients at risk, and between 400 and 1,200 more people died than would have been expected in a three-year period from 2005 to 2008, the independent commission found.

The Mid Staffordshire NHS Foundation Trust, which runs Stafford Hospital, lost sight of its responsibility to provide safe care, the damning report found.

The probe was launched into events at Stafford Hospital after another report last March from the Healthcare Commission revealed a catalogue of failings at the trust, which also runs Cannock Chase Hospital.

The, inquiry chairman Robert Francis QC made 18 recommendations for both the trust and the government in his final report after hearing evidence from more than 900 patients and families.

But Julie Bailey, who founded the campaign group Cure The NHS after the death of her mother at the hospital, described the report as "absolutely outrageous", adding: "All he's done is recommended another independent inquiry."

Mr Francis, presenting his report at a press conference near Stafford, said: "I heard so many stories of shocking care. These patients were not simply numbers, they were husbands, wives, sons, daughters, fathers, mothers, grandparents.

"They were people who entered Stafford Hospital and rightly expected to be well cared for and treated. Instead many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives."

He said evidence gathered during the inquiry into events at the trust between January 2005 and March 2009 had shown clearly that for many patients the most basic elements of care were neglected.

Patients were left unwashed, at times for up to a month, and food and drinks were left out of reach of patients, the inquiry found.

Mr Francis also identified a chronic shortage of staff, particularly nurses, as being largely responsible for the sub-standard care give to patients.

He also said that while many staff did their best in difficult circumstances, others showed a disturbing lack of compassion to patients.

Mr Francis said: "The evidence gathered by this inquiry means there can no longer be any excuses for denying the scale of failure.

"If anything, it is greater than has been revealed to date. People must always come before numbers. Individual patients and their treatment are what really matters."

Health Secretary Andy Burnham said today: "This was an appalling failure at every level of the hospital to ensure patients received the care and compassion they deserved. There can be no excuses for this.

"I am accepting all of the recommendations in full."

Mr Francis recommended that the Department of Health launches an independent examination of how regulators and bodies such as strategic health authorities monitor hospitals, with the aim of learning lessons about how failing trusts are identified.

Today's report found patients were left in dirty bedding and were caused "considerable suffering, distress and embarrassment".

It said: "Requests for assistance to use a bedpan or to get to and from the toilet were not responded to. Patients were often left on commodes or in the toilet for far too long.

"They were also often left in sheets soiled with urine and faeces for considerable periods of time, which was especially distressing for those whose incontinence was caused by Clostridium difficile.

"Considerable suffering, distress and embarrassment were caused to patients as a result."

The inquiry also found that the attitude of some nurses "left much to be desired".

It added: "Some families felt obliged or were left to take soiled sheets home to wash or to change beds when this should have been undertaken by the hospital and its staff.

"Some staff were dismissive of the needs of patients and their families."

From:

http://www.telegraph.co.uk/Patients-routinely-neglected-at-Stafford-Hospital

Competition in NHS makes hospitals better, study says

Competition produces better managed hospitals which, in turn, produce better outcomes for patients, according to new research from the Centre for Economic Performance at the London School of Economics.

With the role of choice and competition in the National Health Service still highly controversial - the British Medical Association is currently running a large campaign against the commercialisation of the NHS - the research provides "clear cut evidence that competition between hospitals produces benefits," Carol Propper , one of the study's authors, said.

The study interviewed managers and clinicians at 100 big NHS hospitals, using a mildly adapted version of a standard measure of management performance that is widely used to assess private sector companies.

It compared the quality of management with a small range of clinical outcomes - such as deaths from heart attacks and emergency surgery, or hospital-acquired infections - and the scores given to hospitals for quality of care and financial management by the NHS inspectorate, the Care Quality Commission. It then looked at how many local rivals the hospitals had.

The conclusion, Professor Propper said, is that "better management produces better hospitals and competition between hospitals produces better management".

Hospitals "with higher management scores have better clinical outcomes, shorter waiting times, better financial performance and higher staff satisfaction," the study concludes.

Management was better where senior managers have some clinical training - a finding that reinforces repeated government attempts over recent decades to involve clinicians more in management. But it also concludes that "competition has a large effect in improving managerial quality in hospitals".

How it does so remains open to question, the study says. It may be that the market reforms in the NHS, with money attached to each treatment, mean "hospitals now have an incentive to provide better care to attract patients".

In areas with a relatively large number of competitors, it may be easier to assess performance by comparison with neighbours. Or it may be that a competitive environment provides an attractive market for good managers.

"With more hospitals nearby, it is easier for managers to look out for better employment opportunities."

From:

http://www.ft.com/cms/s/0/3099e87c-1cf6-11df-aef7-00144feab49a.html?nclick_check=1

Warning over primary care trusts in commissioning health services

Primary care trusts, which commission services for patients from the public, private and voluntary sectors, are at risk of breaching NHS competition rules in a "significant" number of cases. 

The warning comes from the panel set up to advise health ministers on the application of competition in the NHS.

It is the latest twist in a deepening row over whether the government is seeking to squeeze out non-NHS providers - including the not-for-profit sector - in the battle to win contracts for providing publicly-funded healthcare.

In September Andy Burnham, health secretary, appeared to overturn existing policy when he said the NHS should henceforth be regarded as the "preferred provider" of healthcare.

However, almost four months after Mr Burnham pledged the rules governing the bidding process would be rewritten to reflect the new approach, nothing has emerged. 

The Department of Health recently said that they would be published "in the coming weeks" - leading to speculation that they might not emerge before the election, or before the panel issues its initial judgment in March.

That means the panel must make its judgment based on the competition rules currently in force - prompting the warning from Andrew Taylor, the competition panel's chief executive, that PCTs may be making decisions that reflect Mr Burnham's rhetoric but flout current rules.

Mr Taylor said problems it had observed included "excluding potential bidders on grounds unrelated to their ability to deliver the services tendered, and failing to select the bestperforming service provider as the preferred bidder".

However, in a sign of the growing tension between the panel - set up by Alan Johnson, when health secretary - and current health ministers, the health department has publicly rejected that view.

A spokesman said it appeared to be based "on anecdote". The Co-operation and Competition Panel had presented "no evidence" from its casework in a report on its first year's work "to suggest poor procurement practice by commissioners", he said.

The spat comes as the panel is investigating a crucial test case in which Great Yarmouth and Waveney PCT said it could take bids only from NHS organisations to run its provider arm.

From:

http://www.ft.com/cms/s/0/efe144aa-1a99-11df-bef7-00144feab49a.html?nclick_check=1

Watchdog says failure by trusts to comply with alerts is unacceptable by risking patients' lives

Hospitals were accused of putting patients' lives at unnecessary risk after research revealed they were failing to comply with NHS orders designed to prevent deaths from mistakes involving drugs, surgery or equipment.

Information released by the ­Department of Health after a freedom of information request showed that hospitals were not complying with safety alerts issued by the National Patient Safety Agency (NPSA).

The NPSA's chairman, Lord Patel of Dunkeld, told the Guardian that the behaviour of the trusts was unacceptable and endangered the health of patients.

"It's not good enough," he said. "What's the point of us developing these alerts if they don't pay any attention to them? Alerts are produced to reduce risk and hopefully avoid many deaths, so not to implement them to me is alarming. If they aren't implemented then they run the risk of harm occurring and the danger will continue."

The Department of Health research revealed that:

• 104 hospitals and other providers of NHS care in England have not confirmed they have implemented an NPSA alert issued in March 2007 to ensure that ­injectable medicines are used more safely – even though new systems are meant to be in place by March 2010. 

The alert came after 25 patients died and 28 others experienced serious harm in 18 months.

• 25 NHS organisations have not ­confirmed compliance with an NPSA safer-practice notice designed to reduce the risk of patients ­falling out of bed. It was issued after about 90 patients who rolled out of bed on to the floor in ­hospitals, mental health and learning disability units, fractured their neck or femur; 11 of them died.

• 81 hospitals and other care providers had not taken the "required actions" outlined in patient safety alerts covering opioid (painkilling) medicines. The alert was originally issued in July 2008 with a deadline of January 2009; the 81 had not complied by 29 December 2009.

• 10 NHS trusts have not said they have complied with a February 2005 alert on nasogastric feeding tubes, which can sometimes be wrongly placed into the lungs during insertion. Errors involving the feeding tubes caused at least 11 deaths before the alert came out, according to the NPSA.

Patel acknowledged that complying with alerts can be difficult for the NHS. "They can't be implemented overnight because they involve system changes, for example to IT systems or clinical practice. But having said that, the level of implementation is not good enough and needs major improvement," he added.

The research, sought by the patient safety charity Action Against Medical Accidents (AvMA), also reveals that 50 trusts have not showed they have ­followed the NPSA's advice in 2008 on hand hygiene, which is a major source of hospital-acquired infections; 37 have not taken steps set out in 2006 to improve the safety of blood transfusions; 56 did not comply with 2009 advice on reducing the risk of children being injured or killed by parents with mental heath conditions; and six have not implemented a 2008 alert on avoiding patients undergoing brain surgery accidentally having burr holes drilled in the wrong side of their head, as at least 15 did between 2005 and 2008.

Peter Walsh, AvMA's chief executive, said: "The fact that so many NHS bodies are failing to act on potentially life-saving alerts from the NPSA is shocking. It is putting lives at unnecessary risk and adds insult to injury for patients who have been harmed or lost loved ones as a result of NHS lapses in safety."

Lisa Richards-Everton, whose husband, Paul, died in July 2007 after a drugs blunder while he was a cancer patient in Birmingham's Heartlands hospital, said the report was shocking. 

"It shows how the government and the NHS are failing everyone," she said. "The systems that are currently in place are inadequate and urgent changes need to be made. These are people's lives we are talking about; everyone deserves to be safe in hospital. We trust adequate safety measures are in place, but clearly this is not the case."

In addition, a total of 119 trusts did not comply with a 2008 NPSA alert on the risk to patient safety of not using the NHS number as the method of identifying patients nationally across England. That was despite the NPSA declaring that local hospital patient numbering systems involved "real danger to patients of serious harm or death".

The Department of Health revealed which NHS trusts had confirmed they had complied with the 53 patient safety alerts the NPSA issued between 2004 and 2009. University Hospitals Coventry and Warwickshire NHS Trust had not implemented the largest number: 37.

However, after becoming aware that the charity planned to publicise the department's data, the trust recently told the NHS's central alerts system that it had in fact complied with most of the 37. A trust spokesman said that its adherence to NPSA alerts had been examined by the Care Quality Commission (CQC), the NHS watchdog in England. "The CQC found absolutely no issues of concern and gave the trust a clean bill of health," he said.

Lewisham Hospital NHS Trust in south London had not acted upon the joint second highest number of alerts: 31. Joy Ellery, its director of knowledge, governance and communications, said it had delayed notifying the central alerts system because it took the alerts so seriously.

"We are so thorough with implementing safety alerts that until we've complied with them fully, we don't sign them off. We have now signed off a number of the 31 and are down to 18 that haven't been implemented." Asked if 18 was still poor, Ellery replied: "I would like it to be better."

The DH said it expected all NHS trusts to comply with safety alerts and to record and action them. It will issue the health service with a reminder about the need to update the alerts system reliably and as soon as possible, a spokeswoman said.

The new responsibility on all NHS trusts from April to register with the CQC will make mandatory the reporting of threats or potential threats to patient safety, she added.
 

From:

http://www.guardian.co.uk/society/2010/feb/15/hospitals-nhs-patient-safety-orders

Hospital made profit on NHS drugs sold abroad

A Surrey hospital sold millions of pounds worth of NHS medicines abroad during the past year, despite official warnings calling for an end to such arbitrage for fear it could lead to shortages for British patients.

The Royal Surrey County Hospital in Guildford confirmed a report in the Health Service Journal that it had made £300,000 in profit by exporting £4.6m in medicines in the 10 months to January.

The revelations precede a conference convened next month by Mike O'Brien, the health minister, designed to clamp down on such "parallel trade" after pressure by the pharmaceutical industry. They provide a clear example of NHS entities trading for profit, despite a statement by the Department of Health to the Financial Times last week that it was unaware of any particular examples.

The weakness of sterling against the euro has turned the UK into a low priced source of medicines in the past two years, allowing intermediaries to buy them for resale at a higher price elsewhere in Europe, such as Germany.

The UK was formerly a net importer of drugs from lower-priced countries such as Greece, as part of the widespread practice of parallel trade, transferring potential drugs company profits into the hands of intermediary traders.

While individual pharmacies and some drugs wholesalers have long taken part in this cross-border arbitrage, which is legal under European Union law, the government became concerned in recent months at the possible involvement of NHS hospital pharmacies. The chief pharmacist wrote to them last July, calling the practice "irresponsible".

The arbitrage runs the risk of creating medicine shortages in the UK. Officials were particularly concerned because of extra pressure on medical services caused by the flu pandemic. 

Bad weather in recent weeks also caused breaks in the normal drugs supply chain, causing stock shortages that could have threatened patients' lives.

Monitor, the hospital regulator, said it had inspected the Royal Surrey's practices in preparation for its conversion into a foundation trust in December but found no fault with the practice.

"As long as what they are doing is not illegal and doesn't affect their ability to focus on NHS patients, it is not an issue for us," Monitor said. It cited other commercial activities, such as childcare, while saying that car parking had become subject to ministerial  scrutiny.

The hospital said it had discontinued the parallel export of medicines last month in response to negative publicity and when a shift in exchange rates made the practice less lucrative. It said it was satisfied it did not run the risk of forming any medicine shortages for NHS patients.

The Department of Health told the FT last week that it had "received anecdotal evidence of NHS trusts being approached to become involved in such activities but has no concrete evidence that NHS trusts are involved".

The department said that it was "aware of a report that a hospital has considered trading in medicines for short-term financial gain. Such activities are wrong and threaten the medicines supply chain and patient care."

From:

http://www.ft.com/cms/s/0/ecf3b51a-1b62-11df-838f-00144feab49a.html

Victims misdiagnosed by doctor paid £4m in compensation

The victims of a doctor who reduced children to "zombies" after misdiagnosing them have been paid more than £4m in compensation.

Dr Andrew Holton mistakenly declared more than 600 patients epileptic during one of the biggest cases of misdiagnosis in the history of the NHS.

Many of them were prescribed a debilitating cocktail of drugs when in fact they were only suffering from headaches or simply badly behaved.
 
In total, 105 pay-outs have been made to former patients of Dr Andrew Holton who were treated by him at Leicester Royal Infirmary between 1990 and 2001.

The amounts paid out have varied from sums of just a few thousand pounds to one of around £240,000.

Dr Holton was suspended in 2001 after a series of complaints dating back to 1995.

An inquiry found he had misdiagnosed 618 cases and put 500 children on the wrong doses of medication.

In January 2006 the General Medical Council's Fitness to Practice Panel ruled that his professional performance was "seriously deficient".

But he was later allowed to return to work with certain conditions - including one banning him from working with children - placed on his registration.

Dr Holton, now 56, misdiagnosed 618 youngsters while working as a paediatric neurologist, prescribing many a mix of anti-convulsant drugs.

Even his own colleagues raised concerns about his "individualist" methods as early as 1998, yet he was allowed to continue working in virtual isolation.

Only afterwards was it revealed he had no formal qualifications in paediatric neurology.

Parents said the medication caused their children to suffer side-effects, such as black-outs and drug-induced hazes.

Solicitor Jane Williams, from law firm Freeth Cartwright which has handled most of the compensation cases, said: "The families have been able to sit down round a table with three independent consultants and it takes as long as it needs to.

"Invariably, some parents feel guilty about what happened. With the panel, they get independent experts telling them it was not their fault."

A total of £4.4m has been paid out since legal proceedings began in 2003. A further 89 compensation cases are expected to be decided by the end of next year.

An independent inquiry commissioned by the Department of Health criticised the hospital's response and lack of effective management.

It found Dr Holton should have had extra training when he joined Leicester University Hospitals NHS Trust from Charring Cross Hospital, London.

Dr Holton now works as a consultant neurophysiologist at Leeds Teaching Hospitals Trust. A  spokesman for the trust said: "Dr Holton does not feel it is appropriate for him to comment."

Last night a Leicester hospitals spokeswoman said: "Our solicitors are working hard to fully co-operate with claimants so that all outstanding matters can be brought to a conclusion."

From:

http://www.telegraph.co.uk/health/healthnews/7204490/Victims-misdiagnosed-by-doctor-paid-4m-in-compensation.html

Dementia costing UK £23bn a year

Dementia costs the country £23 billion per year- more than cancer and heart disease combined but receives a fraction of the funding, according to a new "wake-up call" report.

The number of sufferers at 822,000 is also 17 per cent higher than has previously been estimated and will pass the one million mark before 2025, the Alzheimer's Research Trust (ART) said.

Revealing stark differences in research funding, it calculated that for every pound spent on dementia studies, £12 is spent on investigating cancer and £3 on heart disease.

Rebecca Wood, chief executive of the ART, called for greater resources to fight the condition, saying: "The true impact of dementia has been ignored for too long.

"The UK's dementia crisis is worse than we feared. This report shows that dementia is the greatest medical challenge of the 21st century."

She added: "If we spend a more proportionate sum on dementia research, we could unleash the full potential of our scientists in their race for a cure.

"Spending millions now really can save us crippling multi-billion pound care bills later."

According to the report, which was prepared with experts from Oxford University, dementia's overall annual cost dwarfs the £12 billion cost for cancer care and the £8 billion for heart disease.

The £23 billion is made up of £9 billion in social care costs, £12 billion in unpaid care and £1.2 billion in health care costs.

Each dementia patient costs the economy £27,647 each year, researchers found, nearly five times more than a cancer patient and eight times more than someone suffering from heart disease.

The expense is driven mainly by the extent of unpaid carers and long-term institutional care - in contrast to cancer and heart disease whose costs are mainly taken care of by the NHS.

Big differences in research funding were also revealed in the study, called the Dementia 2010 report.

At £590 million, cancer research funding is 12 times the £50 million devoted to dementia, while heart disease received more than three times as much. Only stroke research received less.

The report calculated that £295 is spent on research for every person with cancer, compared with just £61 for each person with dementia.

Alastair Gray, professor of health economics at Oxford University and report author, contrasted the perception of the disease with cancer.

He said: "Many of us know people who have had cancer or heart disease but have been successfully treated and survived, so there is a perception that something can be done, and that more research will allow even more to be done.

"In contrast there are no cures for dementia at present; there are not even many ways of delaying it or slowing it down, so there may well be a feeling of inevitability surrounding it.

"However the lack of of effective treatments is surely an argument for devoting more effort to research, not less."

The report also documents a "diagnosis gap", between the expected number of people with dementia and the number of patients with dementia on GP registers.

In England, it is estimated only 31% of people with dementia are registered on GP lists.

Reasons for the low rate include GPs' lack of training and low confidence in diagnosing dementia.

Health minister Phil Hope said on BBC Radio 4's Today programme: "I would fully agree that dementia is one of the most important issues we face as a population, particularly as more and more people are living longer."

From:

http://www.independent.co.uk/life-style/health-and-families/health-news/dementia-costing-pound23bn-a-year-1887987.html

NHS’s major trauma services - not good enough

England has an unacceptably poor service for dealing with major trauma, in spite of 20 years of reports identifying the problem, and a real terms doubling of NHS spending in the past decade, the National Audit Office found.

Some 450 to 600 lives a year could be saved, and much long-term disability prevented, if the NHS had an effective network of centres to deal with multiple injuries from road crashes, burns, blasts, serious falls and major crush injuries, the NAO said.

Death rates from major trauma are 20 per cent higher in the UK than in the US, which has well organised trauma centres, and almost certainly higher than in Germany and some other European countries, according to spending watchdog’s research.

Victims of major trauma need specialist surgical teams that may include orthopaedic, cardiac and neuro-surgeons, but such consultants are not normally on duty at night and weekends when most major trauma occurs. 

Few hospitals have sufficient CT scanning available round the clock to help with diagnosis, and what data there is shows that barely a third of patients who need moving to a more specialist centre in fact get transferred.

Not enough of the patients who need a critical care bed get one, and access to rehabilitation services which can improve quality of life and reduce hospital stays varies widely, the NAO said.

Major trauma services are simply “not good enough”, Amyas Morse, head of the NAO, said. They “have not significantly improved in the last 20 years, despite numerous reports identifying poor practice”.

The result is unnecessary deaths and disability and poor value for money, and while the health department has just appointed a national director for trauma it and the NHS “must get a grip,” Mr Morse said. Co-ordinated trauma networks need developing, with much better information on costs and outcomes. 

The performance of 40 per cent of hospitals cannot even be measured because they do not submit data to the voluntary network which does audit trauma care.

The NAO’s warning came as the department told primary care trusts they must do a better job of monitoring the quality of care delivered by out-of-hours GP services following the death of David Gray, a patient given a fatal overdose by Dr Daniel Ubani, a German flown over as a weekend locum by Take Care Now, Cambridgeshire’s private contractor for out-of-hours care.
 

From:

http://www.ft.com/cms/s/0/581d0e9a-11a4-11df-bceb-00144feab49a.html

NHS spending squeeze to hurt PFI hospitals most

NHS hospitals built under the private finance initiative will face a much tougher time making the productivity and efficiency gains that are needed as public spending is squeezed, PFI experts and NHS managers are warning.

Under PFI, hospitals pay a single annual charge, typically for 25 or 30 years. It covers the cost of the capital, maintenance of the building and often other “soft” services such as cleaning, catering and laundry and sometimes equipment replacement.

While the soft service contracts are usually renegotiated every five or seven years, the main payments are fixed at the interest rates prevailing when the deal was done. In the current financial climate there is no possibility of refinancing them to produce lower annual payments, and the cost of buying out the contracts is prohibitive, according to PFI specialists.

Figures published by the Department of Health this week show big variations in the percentage of annual turnover that hospitals pay for their PFI buildings, largely depending on how extensive the rebuild was.

For some it is only 1-3 per cent but for others it is 10-12 per cent. For Walsgrave Hospital in Coventry, Dartford and Gravesham and Queen Elizabeth, Woolwich, it is 16 per cent and more. For Bromley Hospital it is almost 20 per cent of turn­over.

Traditionally, when spending has been tough, NHS hospitals have put back maintenance to retain doctors and nurses and other services.

“If you do that for too long, it is a thoroughly bad thing,” Nigel Edwards, head of policy for the NHS Confederation, said. “But for a year or two it can help you cope.

“But a hospital with a PFI scheme does not have that option. They are contractually bound to keep the maintenance up – and if you are spending 10 or 15 per cent on your buildings it means all the other efficiency and productivity gains you need have to come out of only 85 or 90 per cent of your budget.”

Hospitals without PFIs still paid a capital charge, so the comparison was not quite that bad, Mr Edwards said. “But some of these hospitals with PFIs are going to find it incredibly tough” to make their share of the £15bn-plus savings that the health department says are needed, he said.

Treasury officials privately acknowledge that there is an issue and hope PFI providers will prove flexible as public spending gets tougher. But David Florry, director-general of NHS finance, told MPs that while the level of cleaning of back-office areas, for example, could be reduced at the break points in the soft service contracts, there was no evidence yet that payments had gone down as a result.

William Moyes, chairman of Monitor, the foundation trust regulator, said lack of maintenance in the past had left the NHS estate in an appalling state. “On balance, having to keep up the maintenance is not a bad thing because it means patients will be treated in buildings that have been kept up to scratch.”

From:

http://www.ft.com/cms/s/0/b366ad6a-078b-11df-915f-00144feabdc0.html?nclick_check=1

More patients die as lone GPs cover thousands in opt out services

Some parts of Britain are relying on just one out-of-hours GP at night to serve more than 240,000 residents.

An investigation by The Sunday Times into the inadequacy of round-the-clock cover has established two further deaths, including that of a three-year-old boy, after failures in the system.

Brighton, Bolton and Wigan are among the areas where a lone doctor is responsible for dealing with late-night emergencies. The news follows revelations last weekend that just two GPs provide cover for Suffolk and its 600,000-strong population on some nights.

Mark Simmonds, the Tory health spokesman, said repeated warnings about out-of-hours cover had gone unheeded by ministers: “It’s disgraceful that the government hasn’t taken action over this before.”

Brighton and Hove primary care trust (PCT) has one GP to cover an area with 248,000 residents on most nights. It claimed the doctor can receive as few as 10 calls each evening. However, in one case involving the trust, a three-year-old boy from Hove died from blood poisoning after the failure of the out-of-hours service.

The frantic parents of Joseph Seevaraj phoned the duty doctor at 11pm on a Sunday and asked whether they should take their son to hospital because he was vomiting and suffering from diarrhoea.

Joseph was already taking antibiotics for tonsillitis and the doctor advised his parents, Jean and Nicola, to wait for those to take effect. They watched over the toddler closely, but he died a few hours later.

A consultant in paediatric intensive care later said she believed the child would have survived if his parents had received proper advice from the out-of-hours service.

“He needed basic medical attention,” said Veronica Hamilton-Deeley, the coroner, at the inquest. “The failure to provide it was gross failure.”

South East Health, which provides round-the-clock services for Brighton and Hove PCT, said it had learnt from the incident in January 2008.

This weekend it emerged that only one GP serves 310,000 residents in the Wigan area on most nights, while 270,000 residents in the Bolton area also have to routinely rely on a single out-of-hours doctor.

In North Somerset there is just one GP for 200,000 residents on a week night. Cambridgeshire has three GPs at night, Norfolk has four and Cumbria has six.

Such skeleton cover was introduced when labour negotiated new contracts with GPs in 2004, boosting their average salary to more than £100,000 and allowing them to opt out of providing round-the-clock care.

While some PCTs say that just one or two GPs can adequately cover a population of more than 250,000, others have more doctors available for home visits.

Under South Birmingham PCT there are 11 doctors on overnight duty, each covering an average population of about 35,000.

Hampshire has 13 GPs on duty at night and Devon has eight, working at medical centres across the county.

Patients are often unaware if their local service is in crisis because most trusts do not publish performance reports. NHS Bristol said last week that a report on the quality of its out-of-hours GPs’ service was “confidential” and “commercially sensitive”.

Most round-the-clock services struggle to fill shifts with local GPs. Instead they use doctors from other parts of the country or foreign GPs who fly in for their shifts. A parliamentary debate was told last week of a case in Cornwall in which a patient had been confronted with a foreign doctor who used “an electronic word converter” to communicate. Other patients have complained of waiting eight hours for a doctor to arrive.

There have also been complaints that out-of-hours GPs do not have access to patient notes and sometimes fail to diagnose serious conditions. In one case, a doctor working as a duty GP in West Yorkshire was suspended from the General Medical Council register after he failed to examine an elderly patient properly. She died the next day.

Dr Krzysztof Robak, 62, commuted more than 175 miles from Surrey, where he worked for a diet clinic, to his Yorkshire employer, Local Care Direct. When he visited the 86-year-old patient, he failed to check her blood pressure or take her temperature and did not consider her seriously ill.

Local Care Direct, a non profit organisation which provides out-of-hours care services for 2.5m people in Yorkshire, said it had vetted Robak rigorously before employing him.

It said it did not consider that he had contributed to the patient’s death in July 2007, but it had raised concerns about his conduct.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article7009692.ece

Call for social care reform as costs escalate

Radical reform of social care is needed both to contain costs and improve the quality of a system that is "fundamentally broken" say leading academics.

Rather than extra spending being seen as "dead money" or a "necessary evil", social care expenditure should be seen as "a form of social and economic investment", according to the study commissioned by Downing Street and the health department.

Effective spending on social care for the frail elderly and for adults with disabilities could generate savings elsewhere in the welfare state, says the report from Birmingham University's Health Services Management Centre and the Institute of Applied Social Sciences. 

It could produce savings in National Health Service expenditure and on social security benefits, while bringing in tax and national insurance income.

Furthermore, "doing nothing to change the way things work is not a viable option", according to Jon Glasby, professor of health and social care at Birmingham University, and the study's lead author.

If the means tested patchwork of poorly co-ordinated services continued unreformed, "costs will double over the next 20 years and that money will be spent on a system that is now widely seen to be delivering poor quality results", he said.

The study argues that better commissioning of social care, more collaboration with the NHS, more support for carers, and greater use of personal budgets, telecare and other forms of IT would cut the rate of growth while producing better quality care.

It makes its case using initiatives from across the country - including the joint management of health and social care in Torbay , Devon; studies that suggest people given personal budgets spend less on social care; and other evidence, and scales up potential savings.

The report is littered with caveats about the certainty with which that can be done and the reliability of some data. But it concludes that undertaken with real vigour, such approaches will improve care and cut the rate at which costs increase - and so should be seen as an investment.

"The savings come primarily from reducing the number of emergency hospital admissions among the frail elderly," said Professor Glasby, "and from supporting a much greater number of adults of working age who have a disability back in to work. There they will earn, pay taxes and claim fewer benefits, while savings also come from supporting informal carers much better, many of whom are struggling to balance work and caring."

From:

http://www.ft.com/cms/s/0/6bd5fd7e-1452-11df-8847-00144feab49a.html

Free elderly care expansion promises spark row over affordability

Plans to expand free home care for the elderly sparked furious exchanges at Prime Minister's questions yesterday as a new report said "radical changes" were needed to maintain the care system in the face of increasing demands.

The Care Quality Commission's (CQC) annual report on health and social care services in England said a predicted 1.7 million more adults will need care by 2030, putting pressure on already stretched public finances.

The Government's Personal Care at Home Bill, which would provide 400,000 vulnerable elderly people with free care in their homes, was criticised by council leaders earlier and Tory leader David Cameron accused Gordon Brown of using it to promote "cheap dividing lines" between the parties ahead of the general election.

Mr Cameron demanded to know where the funding was coming from and insisted the Prime Minister wanted the "benefits" of the policy before the election, leaving the costs to afterwards.

But as Speaker John Bercow struggled to keep the noise down, Mr Brown hit back, attacking the Opposition leader for breaking cross-party "consensus" on the policy.

Mr Cameron asked the Prime Minister if he could rule in or rule out a compulsory levy on the elderly to pay for care, but Mr Brown sidestepped the question and said developing a "full social care system" would take time and needed consensus.

The CQC report, which was published yesterday, said tailoring services to meet people's individual needs would help save money while allowing people to remain independent.

CQC chairwoman Dame Jo Williams said: "We all know that the context is changing. Trends such as increasing demand and rising expectations will be exacerbated by pressure on finances. That means we cannot go on as we are. To cope, we need some radical changes in the way that we organise and deliver services.

"This means shifting the culture away from a one-size-fits-all approach to care that puts the needs of individuals and carers at the centre of everything. A key part of this will involve helping people maintain their independence and health."

The Government has said around £2.7 billion could be saved every year by helping patients avoid making unnecessary hospital visits.

But the CQC said this would require "a fundamental cultural shift" allowing patients to control their own care.

Stephen Burke, chief executive of the charity Counsel And Care, said "an honest and serious" debate was needed about funding.

He said: "Politicians, nationally and locally, owe it to older people, their families and carers to prioritise care reform and funding. As the University of Birmingham has highlighted this week, there are massive economic and social benefits to be gained from a new, properly funded care system.

"Older people and their families want to know what care they will get and how much they will have to pay.

"One way to fund better care would be a care duty on estates but it must be done fairly through a percentage on all estates above a certain value. For example, 2.5% on estates above £25,000 would raise enough to meet the current shortfall in care funding. And it would help older people and their families who currently face losing their home to pay for care."

Director of the Patients Association Katherine Murphy said she welcomed the report's "clear direction" that the NHS and social care services had to start working more closely.

She said: "It is vital this approach becomes widespread if we are to make the most of increasingly restricted budgets and ensure users get a responsive service."

Simon Lawton-Smith, Head of Policy for the Mental Health Foundation, said: "There has been a lot of talk about person-centred services and joined-up health and social care over the last 20 years, so in a way it's disappointing that the CQC still has to make these arguments.

"The hope now is that the likely need to reduce funding might concentrate minds on reform. An often-overlooked benefit of treating people as individuals and focusing on maintaining their independence and health is that it has the potential to save money."

From:

http://www.independent.co.uk/news/uk/politics/free-elderly-care-expansion-plans-spark-row

Whistleblower who criticised NHS cost cutting wins damages

A consultant urologist who was suspended after speaking out against cost cutting at an NHS hospital has won damages at an employment tribunal in a landmark case.

Ramon Niekrash, 50, was removed from duty at the hospital and called a "troublemaker" after he questioned the effects of cost-cutting on patients at the Queen Elizabeth Hospital in Woolwich, South London.

A tribunal ruled that he was entitled to damages because he has been acting as a whistle-blower in the public interest when he wrote letters to hospital management raising his concerns about the health of patients.

The verdict also placed blame on government targets for raising tensions between management and clinical staff at the NHS hospital.

Mr Niekrash claimed he was the victim of bullying and harassment after he criticised cutbacks at the hospital, which he said included a shortage of senior medical staff and the closure of the specialist urology ward.

At one point a senior doctor at the hospital allegedly said she wished that Mr Niekrash, who was trained in Australia, was "in chains on a plane in Heathrow back to Australia."

Mr Niekrash's lawyers said the case revealed the way in which senior NHS whistleblowers are punished for speaking out.

One case he raised was of a prostate cancer patient who was allegedly not told that he had the disease, nor given treatment for six months after he was diagnosed.

In a letter, he also accused hospital management of behaving like a "plantation owner" towards doctors, The Independent reported.

A 50-page ruling from the tribunal found that Mr Niekrash's suspension from the hospital breached laws put in place to protect whistle-blowers.

Judge Burton, sitting at the tribunal, said: "We have no doubt that the exclusion of a consultant, being a rare occurrence, must have an adverse impact on the claimant's reputation," adding that Mr Niekrash had been "hurt" and that his health had suffered.

The judge said tensions had arisen between the claimant's desire to provide health care and "the requirement of management to reduce or limit costs and also comply with varying targets laid down by the Department of Health from time to time."

A hospital spokesman said: "We are considering this judgment very carefully ... There are nearly always lessons to be learned from cases like this, and as soon as we have carefully considered the judgment, we will respond in full."

From:

http://www.telegraph.co.uk/Whistleblower-who-criticised-NHS-cost-cutting-wins-damages