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 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

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

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

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

Doctors are addicted to every drug under the sun

Doctors are addicted to “every drug under the sun” the head of the first ever confidential GP service for health professionals has warned.

In its first year the clinic has treated NHS staff hooked on drugs including heroin, ketamine, a horse tranquilliser, and methadrone, a drug linked to amphetamines, said Dr Clare Gerada, medical director of the Practitioner Health Programme.

The service also uncovered six cases of undiagnosed psychosis, in which sufferers see things or hear voices.

The clinic was set up amid fears many health professionals were treating themselves or avoiding their local GP or hospital because of worries colleagues could learn of their health problems.

Overall, two of the doctors and dentists treated were reported to to the General Medical Council (GMC), because of fears that they could be putting patients in danger.

Another six were encouraged to report themselves to the regulator.

So far the service has operated only in London but there are plans to roll it out across the country, starting initially in Newcastle.

Two thirds of the 184 treated in the first 12 months had mental health problems, while one in three who came to the specialist service had some form of addiction.

Of these 51 were alcoholics and 16 drug addicts.

Dr Gerada said: “We are seeing every drug under the sun. Ketamine, methadrone, amphetamines, heroin, every drug you have ever heard of is coming through the door.”

The service has also treated unexpectedly high numbers of paediatricians, anaesthetists and psychiatrists.

The stress of the jobs, easy access to drugs, and the extra stigma attached to psychiatrists suffering from mental health problems could be reasons for the high demand, Dr Gerada said.

More than 80 per cent of those treated for drug or alcohol addictions were now sober, the first report on the service shows.

Prof Sir Liam Donaldson, the Chief Medical Officer for England, praised the success of the scheme.

“It has uncovered problems that would otherwise not have been seen and the interventions been highly effective,” he said.

From:

http://www.telegraph.co.uk/health/healthnews/Doctors-are-addicted-to-every-drug-under-the-sun

BMA cost warning on plan to scrap GP boundaries

The British Medical Association has fired a broadside at government plans to give patients a completely free choice of family doctor, warning that the proposals could cost "hundreds of millions of pounds a year".

Laurence Buckman, chairman of the BMA's family doctors committee, said that, at a time when the NHS was about to face the fiercest spending squeeze in its 60-year history, it was not clear that Andy Burnham, health secretary, should be giving the plans priority for extra spending.

Mr Burnham has declared that by September he wants to abolish existing GP practice boundaries , which can leave patients with a limited choice of doctors in fixed catchment areas. The policy would allow commuters to register with a practice near their work, and could drive up standards by increasing local competition between GPs.

However, the BMA has warned that, while the goal is "laudable", it is also expensive .

Both GP and hospital services are funded on the basis of resident populations in such a way that, in broad terms, the young and healthy subsidise the old and sick. If significant numbers registered away from home, the funding of both services would be disrupted. 

And if "dual registration" was allowed with a GP both at work and at home, costs could soar, Dr Buckman warned - even if the second GP was not given full funding.

"You could be talking hundreds of millions of pounds a year," he said, with further complications over home visits, continuity of care, child protection and who was ultimately responsible for a patient's care.

Mr Burnham's proposal was the fourth or fifth attempt to abolish practice boundaries since the mid-1990s, Dr Buckman said.

"When we last looked at this with the Treasury, pointed out the costs, and asked them if they were sure this was a good use of taxpayers' money, their answer was No," he said.

Some of the goals could, however, be achieved at much lower cost. Practice boundaries could be extended in urban areas so that a patient who moved not too far away could keep a GP. Greater use could be made of telephone and webcam consultations, as well as reforming the "temporary resident" arrangements so that a GP who saw a patient near work would be paid a fee.

The cost might then be "tens rather than hundreds of millions", depending on how many patients took advantage of that, Dr Buckman said.

From:

http://www.ft.com/cms/s/0/13ac30f8-0c75-11df-a941-00144feabdc0.html?nclick_check=1

Doctor Daniel Ubani unlawfully killed overdose patient

A coroner has demanded a review of EU agreements over the recognition of doctors when he ruled that the death of a 70-year-old patient who was administered a tenfold overdose by an "incompetent" German GP was unlawful killing.

William Morris called the death of David Gray "gross negligence and manslaughter" and issued 11 recommendations to the Department of Health for the improvement of out-of-hours GP services.

As well as the review of how EU agreements work in the UK, he said the government must issue guidance to all NHS trusts over checking doctors' English, their experience of the NHS and how they had acquired GP status.

Daniel Ubani, a Nigerian-born German citizen, was on his first UK shift as a locum when he killed Gray, whom he injected with 100mg of diamorphine – 10 times the recommended maximum dose.

Gray had been suffering from renal colic when he was treated by Ubani at his home in Manea, Cambridgeshire, on 16 February 2008.

After Gray's death, a national database of all doctors working as out-of-hours GPs will be set up in an attempt to avoid doctors such as Ubani working in Britain.

The database was recommended by Gray's family today, and Mike O'Brien, the health services minister, agreed to implement their suggestion.

He said better sharing of information by primary care trusts (PCTs) would help ensure that only competent and properly-qualified doctors were able to treat patients.

The recommendations are designed to ensure that doctors who have been refused permission to work on call at evenings and weekends in one part of England cannot then start treating patients in another.

They are intended to close the loophole that allowed Ubani to be refused permission to work initially in Leeds but then be approved to supply out-of-hours cover in Cornwall, where entry standards were less stringent, and because of that be employed in Cambridgeshire.

At the end of the inquest into Gray's death, Morris demanded "robust" clinical and management measures, including training and induction for non-UK doctors.

He said only the company actually running an out-of-hours GP service should recruit doctors in future – a blow to private recruitment companies.

Evidence to the inquest, held in Wisbech, Cambridgeshire, suggested Ubani had also inappropriately treated at least two, and possibly three, other patients.

Morris said: "It is clear to me that Dr Ubani, in his dealings with patients that fateful weekend, was incompetent, not of an acceptable standard."

He ruled that 86-year-old Iris Edwards, who also died on Ubani's first shift, had died of natural causes.

Graeme Kelvin, the chairman of Take Care Now (TCN), the private contractor that operated the out-of-hours service that treated Gray, offered his sympathies to the family over the "tragic event".

He said he hoped the recommendations of the coroner would "reduce the chances of a similar event happening anywhere in England".

Paul Zollinger-Read, the chief executive of NHS Cambridgeshire, accepted a systems failure had taken place, and said: "We as an organisation have much to learn from this case."

One of Gray's sons, Stuart, said: "I could not have hoped for anything better [than the verdict]. I hope Andy Burnham, the health secretary, acts on this."

Rory, another of his sons, said: "This vindicates all the hard work we have put in."

Ubani did not want to comment on the verdict, a spokesman at his medical practice in Witten, Germany, said.

During the weekend of Gray's death, Ubani saw 13 patients before being called off his second shift when Gray's death was reported to his managers.

Police and doctors investigating what happened found the 66-year-old had given inappropriate treatment to two other patients, one of whom subsequently died.

Both should have been sent to hospital, but their cases did not form part of a criminal case later built against him.

The case has become a touchstone for public confidence – or otherwise – in out-of-hours GP services, which were revamped more than five years ago.

A new GP contract introduced then shifted responsibility for out-of-hours services from local doctors and put it in the hands of NHS bodies and private firms employing a mix of local GPs, locums from agencies, and sometimes doctors from abroad.

Despite the problems identified in recent months, ministers have insisted services are improving overall.

Ubani was paid £45 an hour for his first work as a locum in the UK, far less than the sums expected by British GPs. He also paid for his own flights, car hire and accommodation.

The story of Gray's death and the subsequent apology from Ubani to his family was first revealed by the Guardian in May.

It quickly raised concerns about EU rules on the registration of doctors from Europe, checks on competence by local primary care trusts, the way in which drug safety warnings are given within the NHS, and how European arrest warrants work.

Police and prosecutors from the UK looking to bring a possible manslaughter charge against Ubani were shocked last April when, by letter, the German authorities convicted Ubani of causing Gray's death by negligence, gave him a nine-month suspended prison sentence and ordered him to pay €5,000 (£4,400)

Ubani, a German national, is suspended from working in Britain but is still allowed to practise in Witten, his home town, where he specialises in cosmetic surgery and anti-ageing medicine.

In August, inquiries by the Guardian prompted the General Medical Council and the Royal College of GPs to demand a rewriting of EU rules that allow doctors from Europe to be registered in the UK without tests on their English or medical competence.

Doctors from the rest of the world already face such checks.

The following month, it emerged that Ubani had failed in his first attempt to work in the UK but was later approved to join a performers' list run by the NHS because a local health trust did not apply such stringent checks as the government demanded.

Soon afterwards, an interim report on the case by the NHS watchdog, the Care Quality Commission (CQC), prompted the Department of Health to order all 152 NHS organisations responsible for running out-of-hours services to do their own safety checks on induction and training of foreign doctors, call handling and prioritising of cases, clinical decisions made by GPs and other staff, and the management of powerful drugs.

In December, the scale of the communications breakdown between police and prosecutors in the UK and Germany over the handling of the criminal case against Ubani was laid bare.

From:
http://www.guardian.co.uk/society/2010/feb/04/doctor-daniel-ubani-unlawfully-killed-patient

Tories to make GPs after hours care a priority

The Conservatives have pledged to make GPs responsible for round-the-clock care after the scandal of foreign locum doctors putting patients’ lives at risk.

Andrew Lansley, the shadow health secretary, says he wants doctors to provide cover at night and weekends, or pay other GPs to provide reliable care. Performance targets which helped to boost the salaries of some GPs to more than £250,000 would also be renegotiated under a Tory government.

Under existing contracts agreed six years ago, GPs can opt out of providing after-hours services, shifting the responsibility to local primary care trusts (PCTs). One in three trusts struggles to find local GPs and flies in foreign doctors who are paid as much as £800 a shift to work unpopular hours.

Lansley confirmed a shake-up of contracts as an inquest last week examined the death of David Gray, a 70-year-old retired engineer from Cambridgeshire. He was killed by a massive overdose of diamorphine in February 2008 administered by Daniel Ubani, a Nigerian-born doctor who had flown in from Germany. Ubani had slept for only three hours before starting his shift.

“When Labour took responsibility for out-of-hours care away from GPs they made a serious error,” said Lansley.

“GPs should be collectively responsible for commissioning out-of-hours services. They are best placed to ensure patients are treated properly and that these awful events are never repeated again.”

Lansley could face a tough battle with GPs. One British Medical Association (BMA) representative said there was “not a cat in hell’s chance” of returning to the old system of the GP being ultimately responsible for out-of-hours care. He warned of mass resignations if contracts are to be torn up in this way.

For many years GPs considered themselves overworked and underpaid compared with hospital doctors. But in 2004 they successfully renegotiated their contracts with the National Health Service.

In what was seen as a coup for the profession, pay packets rose by 30% in the first year of the contracts, with the typical GP earning £106,000. Ministers later admitted they had blundered by seriously underestimating how many GPs would hit the pay-related targets included in the new contracts.

At the same time, GPs could opt out of providing round-the-clock care for patients if they gave up £6,000 a year in their salaries. Nine out of 10 GPs opted out. Out-of-hours cover is now provided by co-operatives run by GPs, private companies and PCTs.

“No one in their right mind would have designed the out-of-hours system in its current form,” said Peter Walsh, chief executive of Action Against Medical Accidents, which has campaigned for reform of the system. “There are a myriad different providers. The most common complaints are failures in making a proper diagnosis.”

Flaws in the system were highlighted by the case of Penny Campbell, 41, a journalist from north London who died in March 2005 despite six telephone calls and two face-to-face meetings with doctors working for an out-of-hours GP service. All failed to diagnose septicaemia.

Shortly before he became prime minister, Gordon Brown pledged to improve out-of-hours services. They started deteriorating in some areas in which trusts turned to foreign locums. One investigation found a third of PCTs were flying in GPs from Poland, Hungary, Italy and Switzerland.

In the early hours of February 16, 2008, Ubani, 66, flew into Britain for a shift starting at 8am with Take Care Now, an out-of-hours service. By his own admission he was exhausted. Gray died after Ubani gave him 10 times the correct dose of a painkiller for kidney stones. Later the same day Ubani failed to send another patient, Iris Edwards, 86, to hospital and she died of a heart attack shortly afterwards.

Take Care Now has promoted itself to health authorities as a cheap out-of-hours service but GPs claims its low prices have come at the expense of quality.

Spot checks by NHS Cambridgeshire, a primary care trust, found “deficiencies” in the cover as recently as last November. The trust subsequently ended its contract with the company.

Gray’s son Stuart, a GP in Kidderminster, Worcestershire, said: “My father was betrayed by the system. All patients are being let down by the NHS because of the lack of vetting procedures and rules in place for EU doctors. It is a national scandal.”

The Tories believe that handing back responsibility for out-of-hours care to GPs will ensure a better service.
 

FAILURES

* April 2004 New contracts introduced for GPs, allowing doctors to drop out-of-hours cover.
* March 2005 Penny Campbell, a 41-year-old mother, dies of blood poisoning after consulting out-of-hours GP service eight times. Official inquiry finds “major system failure”.
* May 2006 National Audit Office finds only one in 10 trusts clinically assesses patient within 20 minutes of phone call.
* February 2008 David Gray, 70, is killed by an overdose accidentally given by Daniel Ubani, a locum out-of-hours doctor who flew in from Germany.
* June 2009 Care Quality Commission report on Gray’s death calls for fresh scrutiny of use of “non-local” doctors and improved training.

From:

http://www.timesonline.co.uk/tol/news/politics/article6991090.ece

NHS- renowned experts but no world class hospitals

Britain lacks any world- class hospitals because the culture of the National Health Service is still too much one of central direction and control, according to William Moyes.

Having spent six years overseeing the creation and regulation of self-governing NHS foundation trusts - which in theory are Britain's best hospitals - the chairman of Monitor said that, while the UK had at least four or five real world- class universities, "I do not believe we have any world-class hospitals.

"They may have world experts here and there . . . but I just don't believe that any of our best hospitals could genuinely demonstrate that they are world class across the whole range of what they do."

Mr Moyes said he would probably come in for heavy criticism for saying that. But given how much is spent on the NHS "there's something wrong in a framework that doesn't produce that kind of quality".

In the US, he said, the universities of Oxford, Cambridge, the LSE and Imperial "would be recognised as on a par with anything in America". He was speaking on "a hunch and a feel" rather than hard data, but added: "I just don't think you would have that kind of reaction to British hospitals."

It was not money, he said, because hospitals were probably more generously funded than universities in the UK. It was that even self governing foundation trusts spent too much time worrying about what the government was doing and what the secretary of state for health wanted.

Mr Moyes said that when he was on the council of Surrey University, the council "acknowledged the existence of the government" and its policies. "But we felt very much that we were in charge of the university, and as long as we didn't do something manifestly stupid, we would be left to get on with running it. Whereas I don't think anyone in any hospital - foundation trust or not - feels they are that distant [from ministers]. They still feel the heavy hand of the secretary of state is coming in their direction."

That underlined the need to see through a reform of the NHS into a much more decentralised system - one "where you tell the hospitals what you want to buy, and you let them get on with it. Your political ambition is expressed as a commissioning ambition, rather than operational ambition" - the goal being a hospital system "as good as the university system in Britain".

From:

http://www.ft.com/cms/s/0/4a1dd216-ff1b-11de-a677-00144feab49a.html

Tax inspectors target health professionals such as doctors and dentists

Middle class professionals such as doctors and dentists are facing an unprecedented crackdown on tax evasion.

Previously, the HMRC has focused on people in blue collar jobs, such as publicans and taxi drivers, when fighting tax evasion.

However, it emerged that they are now focusing their attentions on the accounts of white collar professionals earning more than £100,000. Tens of thousands of professionals are set to be targeted.

Experts were surprised at the nature of the middle class clampdown, with the Governments tax inspectors accused of unfairly targeting middle class professionals as “easy pickings”.

They suggested that chasing middle-class professionals for unpaid taxes had been forced on HMRC by the Treasury, which is desperate to raise funds to reduce the national debt.

HMRC said a “significant” minority of medical professionals were engaged in tax evasion.

Examples included not declaring fees for private work done for medical care providers, payments for private consultation work or cash sums for drafting medical reports.

Under a three-month 'amnesty', hospital consultants, GPs and dentists now have until March 31 to make a voluntary disclosure about any income they have not declared to HMRC.

In exchange, they will have to pay the outstanding tax on the undeclared income. They will also face a 'fine' of 10 per cent of the amount they owe - but, as long as they have admitted their undeclared income, the action will stop there.

However, anyone who refuses to reveal their unpaid earnings, and tax and is caught after the deadline has expired, faces criminal prosecution. They could also find themselves 'named and shamed' on HMRC’s website.

In certain circumstances, those found guilty of tax evasion can face a prison sentence of up seven years.

HMRC inspectors can issue formal notices asking people to hand over personal bank statements and business records if they have suspicions about them. They can also legally inspect business premises using their civil powers.

Potential tax evaders could also be tracked down by examining their previous tax returns, which might reveal that their latest tax situation was wrong.

Mike Wells, HMRC’s director of risk and intelligence, said that once the amnesty had expired at the end of March, HMRC would be “using the information at our disposal to investigate medical professionals who have not declared their full income”.

Phil Berwick, director of tax investigations at law firm McGrigors, said tens of thousands of people could be hit across several different professions. Targeting the medical profession alone was “without precedent”, he said.

“You are dealing with people in a position of trust and responsibility who do not want to be named and shamed. It is people who are going to be averse to naming and shaming and probably in a position to make a payment to the revenue," he said.

“Compliance activity is usually costly and time-consuming for HMRC. By offering an amnesty HMRC is hoping to get a significant amount of tax into the Treasury’s coffers very quickly and at a reduced cost to itself.

“The parlous state of the public finances and the pressing need to reduce the deficit has probably forced HMRC’s hand to an extent.”

The middle-class initiative follows a previous HMRC amnesty scheme to allow people with off-shore bank accounts to declare how much tax they owed and pay a small fine. Around 10,000 people made use of the scheme.

Stephen Camm, tax partner at accountancy firm Pricewaterhouse Coopers, said: “In the past they looked at publicans, fish and chip shop owners and tax drivers – typical working class jobs. Now they are looking at professionals. And the middle classes will bear the brunt.”

Richard Limburg, from accountancy firm Vantis Medical Group, added: “It is likely that HMRC sees the medical profession, especially consultants, as easy pickings and this could raise substantial amounts.”

A British Medical Association spokesman said: “The BMA recommends that doctors who may have any concerns consult their financial adviser to ensure their tax affairs are in order.”

A spokesman for the British Dental Association said: “Dental practitioners work in NHS, private and mixed economy settings. Many are therefore used to dealing with their own tax affairs.

From:

http://www.telegraph.co.uk/Middle-class-professionals-such-as-doctors-dentists-lawyers-in-tax-evasion-crackdown

NHS paid doctor £375 an hour

NHS spending on agency workers has risen sharply in the past financial year in spite of attempts to control such expenditure, according to figures issued by the Conservatives.

Andrew Lansley, shadow health secretary, cited examples of NHS Trusts paying "hugely inflated" salaries to temporary workers for covering shifts.

A nurse in Yeovil was paid £146 an hour, another in Derby £136 an hour, and an IT manager in Whittington received £400 an hour.

The freedom of information disclosures also show that an agency doctor in King's Lynn was paid £375 an hour - equivalent to an annual salary of £660,000. Mr Lansley said that such payments divert funds from the front line and prove that Labour's attempts to control health agency expenditure are failing.

The NHS spent £1.25bn on temps in 2008-09, according to figures provided by the department of health to the Tories. This was a sharp increase on the £831m spent the previous year and the £785m in 2006-07.

But it is below the £1.4bn bill that agencies presented to the NHS in both 2002-03 and 2003-04, when agencies accounted for 5.5 per cent of the payroll.

Patricia Hewitt, former health secretary, described agency pay as "massively expensive" and called for hospitals to use permanent staff instead.

About 130,000 workers in the health service are not permanent staff.

While most trusts did not disclose fees paid to agencies, some of them received as much as 43 per cent of each payment, according to the Tories. The typical agency fee, among the 33 trusts that replied in detail, was 26 per cent.

Trusts and local authorities have been urged to pool resources to improve their purchasing power.

A report last year by Leeds university and the Economic and Social Research Council found that, although fees had dropped in recent years, temps were still generally more expensive than permanent staff.

The presence of temps, while "unavoidable", could also damage the morale of permanent staff because they were often given easier tasks.

But the National Audit Office said last year that agency workers could be used as a way for the NHS to control costs. Temps could be cheaper because they did not receive the same training and perks as permanent staff.

From:

http://www.ft.com/cms/s/0/ed1bd7c2-f4e1-11de-9cba-00144feab49a.html

GPs to get new IT in drive to prevent 10,000 cancer deaths

GPs are to start predicting whether a patient has the early symptoms of cancer using a computer program that calculates risk, under plans to prevent the 10,000 unnecessary deaths a year caused by late diagnosis.

The new approach by the NHS means that doctors will tell patients their percentage chance of having cancer, based on factors like their age, weight and symptoms such as bleeding or sudden weight loss.

Professor Mike Richards, the government's cancer tsar, who unveiled the move in an interview with the Guardian, said that within five years every GP in England should be using the software as part of a new drive to reduce the huge toll of avoidable cancer deaths.

Computer-assisted cancer risk assessment will help GPs estimate whether a patient's symptoms could indicate the presence of a cancer and decide whether they needed to refer them for urgent tests in hospital, Richards said.

The computer would assess a patient's age, weight and symptoms – such as rectal bleeding and constant fatigue – and if the risk were above a certain level, the person would be referred to hospital for urgent exploratory tests within two weeks.

Cancer is the UK's biggest killer after heart disease and strokes. Every year 293,000 people are diagnosed with cancer, and about 155,000 die of it. GPs are vital because they spot the signs of cancer in 90% of patients, with screening picking up the other 10%. But a typical GP sees only eight or nine cases of cancer a year.

Britain is far worse than many European countries at diagnosing cancer early, when it is more likely to be treatable and the patient has a much better chance of surviving. That is partly because some patients who develop symptoms delay seeking help, but also because GPs sometimes fail to correctly identify signs of cancer.

Support technology is needed because of that poor record, the difficulty of diagnosing cancer and the sheer number of other ailments that GPs have to know about, Richards said.

There are more than 200 forms of cancer, and many of their symptoms are the same as for a range of other, often less serious, conditions. Computers could help doctors get it right more often when deciding whether to investigate a patient further, discharge them or refer them to hospital.

"This is helping GPs because none of us can retain this sort of information [about cancer symptoms] and having to retain it for bowel cancer, lung cancer and ovarian cancer, as well as for heart disease, it would take a remarkable human brain to be able to do that, so why not get computers to support it?" said Richards.

"The benefit of this will be that GPs will know who should be investigated and who shouldn't. It will also help patients to know that whether they are being reassured, or referred, or getting a test, that is the right thing to do."

Richards said the system would mean "better decision-making by GPs, leading also to earlier diagnosis of cancer patients".

Professor Steve Field, chairman of the Royal College of General Practitioners, welcomed the move. "The future of medicine will be that GPs will be using more and more computer-aided diagnostic tools for more and more conditions, and ultimately in years to come genetic information will be part of that," he said.

"GPs will welcome this because it will make their diagnoses quicker and better. Over time this will save lives."

Family doctors rather than computers will continue to make the key judgments, even after software has become routine in surgeries, Richards emphasised.

"The GP will always have the final say. If he wants to refer a patient to hospital, he will always have the right to do so," he said.

England is understood to be the first country in the world to move to introduce such technology, according to the Department of Health. A number of GP practices across the country will take part in a pilot programme to assess the effectiveness of assisted cancer risk assessment, starting in the spring.

GPs have recently begun using similar software to help them assess a patient's risk of developing cardiovascular disease. It analyses blood pressure, family history, cholesterol, smoking history and current symptoms before producing an odds ratio.

The plan to extend the approach to cancer is underpinned by a series of recent DH-funded research studies by Dr Willie Hamilton, an Exeter GP and expert in cancer diagnosis at Bristol University. Richards said the tests had shown, for example, that a man aged over 40 who develops diarrhoea has less than a 1% chance of that indicating bowel cancer, but two visits to the GP with the same symptom produce a 1.5% risk. This rises to 3.4% if there is a combination of diarrhoea and rectal bleeding and 6.8% if he visits his GP twice with rectal bleeding.

Sarah Woolnough, head of policy at Cancer Research UK, said: "We welcome any initiative that encourages the earlier diagnosis of cancer. Late diagnosis is the reason behind thousands of avoidable cancer deaths every year so it has to be a huge priority to make every effort to diagnose cancer earlier. We need to think imaginatively and innovatively about how we encourage earlier diagnosis, so initiatives like this are very promising for the future."

From:
http://www.guardian.co.uk/society/2009/dec/29/cancer-diagnosis-computer-programme

Health Direct questions the sanity of this new spin.

Firstly, labour has an appalling track record on IT projects- the failed NHS records £12 billion NPfIT project is a prime example.

Secondly, this scheme undermines GPs, doctors and health professionals in general. If this new technology really does work- there will be a logic to save money by sacking them all.

Is this yet another example of hope over adversity. Having utterly failed UK patients with some of the worst cancer rates in europe over the past 13 years- is this a dying labour spin clutching at a straw?

NHS faces potentially serious problems from wrong prescriptions on the NHS

Patients face potentially serious problems because of the piecemeal training given to young NHS doctors in giving out prescriptions, claim medicine experts.

Junior doctors on average fill out five or six prescription forms during their whole time in medical school only to have to complete dozens on their first day on the wards.

The inadequate preparation helps contribute to almost one in 10 prescriptions containing errors that could harm patients, it was said.

Now the British Pharmacological Society (BPS) is calling on the doctors to take an exam called the National Prescribing Assessment before being qualified.

They also want a "prescribing simulator" to be introduced to the curriculum so that medics are better prepared when they start in hospitals.

Professor Simon Maxwell, chairman of the BPS, said: "Everybody thinks that the system should and can be overhauled.

"We would not accept this kind of error rate in other industries such as aviation. It is a recipe for problems."

The call for change, outlined in a blueprint by the BPS, comes after the General Medical Council revealed that 10 per cent of all prescriptions issued by doctors contained errors.

The mistakes included omitting drugs, wrong doses, not taking account of a patient's allergies, illegible handwriting or ambiguous orders.

When the hospital doctors were interviewed about their mistakes, some admitted that they used pharmacists or nurses as a "safety net" to correct them afterwards.

The most senior doctors made the fewest mistakes, while doctors in their second year after qualifying made the most, it was found.

In the study, 124,260 prescriptions were checked by pharmacists in 19 hospital trusts in north-west England and 11,077 errors were detected.

While doctors are trained in a "piecemeal way" on symptoms and treatments, they rarely actually fill out a prescription forms before they start work, said the BPS.

A recent survey showed that in training they filled out as little as one a year whereas on the job that jumped to 50 or 60 a day.

That meant that doctors were ill prepared, it concluded.

Prof Maxwell, and his chairman Dr Jeff Aronson, said that it was hoped that the new assessment would be ready for the 2011 intake of medical students.

It was also hoped that an online training programme - including a prescription simulator complete with virtual patients - would be ready by the following year.

Prof Maxwell said: "It doesn't take to much of a wrong dose or too long for the monitoring to be left before there are potentially serious problems. There is a big push now to eliminate this high risk."

From:

http://www.telegraph.co.uk/NHS-faces-potentially-serious-problems-from-wrong-prescriptions-on-the-NHS

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.

The Department of Health has declared it will push ahead with a mass roll-out of its controversial Summary Care Record (SCR) - uploading parts of your medical record and personal details to a centralised system that is ultimately intended to hold your complete medical history.

So far, only London and the East of England have been mentioned but other regions may be targeted too.

A University College London report found scant evidence for any of the claimed benefits in SCR pilot areas but it appears the Department of Health still wants to ride roughshod over patient consent and medicalconfidentiality.

Having outraged medics and patients with its 'implied consent' model - where it is assumed you have consented to having your sensitive information uploaded if you do not respond to a single notification
letter - the Department has adopted a bizarre approach it calls 'consent to view'.

Under this scheme, you will still only be sent a single letter. If you do not respond, your details will still be uploaded onto the system where they will be accessible to all sorts of non-clinical staff including administrators, bean-counters and bureaucrats, without your knowledge or consent. 

Once on the system, you will not be able to have your details taken off - but you will have to give permission for your OWN doctor to view your record!

It is clear that 'consent to view' will not protect medical confidentiality. And the roll-out may be coming to you, sooner than you think.

Please be on the alert and, if you haven't done so already, think about opting out now. You can always opt in later, if the government can prove its system works. 

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

NHS hospitals face four year spending squeeze after labour's cuts

NHS hospitals are to face a four year spending squeeze in an attempt to drive up their productivity.

The so called tariff, or price paid per treatment, which covers about 70 per cent of the income of a typical NHS hospital as well as private ones that take NHS patients, is to be frozen for the next year. It will go up by a “maximum” of zero per cent for the subsequent three years – implying that it could actually be cut.

NHS hospitals will also have to make efficiency savings of 3.5 per cent next year. Where they treat more unplanned admissions than in 2008 they will be paid only 30 per cent of the tariff price – a move aimed at getting them to work with their primary care trusts to prevent unnecessary unplanned admissions.

The moves “will drive all providers to become as efficient as the highest performers”, Andy Burnham, health secretary, said in a document that sets out how he believes the NHS needs to change over the next five years.

Family doctors, who face a pay freeze next year, will also be told they have to hand back at least 1 per cent of their expenditure to primary care trusts in ­cash-releasing efficiency savings.

The strong pressure on prices will either help drive the productivity improvements that the NHS needs to achieve savings of £15bn to £20bn over the next few years, or plunge hospitals that fail to adapt into financial crisis.

Mr Burnham denied that this could mean hospital closures, but said “that hospitals will have to change” with more patients treated in the community.

The best Foundation Trusts were to be allowed to take over community services in an attempt to provide more integrated care, possibly including GP services. And over the next few years up to 10 per cent of the treatment price would depend on surveys of patient satisfaction, the aim being to create “a people-centred service”, Mr Burnham said.

The NHS was to be protected from inflation after 2011, meaning the big spending rises of recent years were being “locked in”, he added.

The Conservatives, however, pointed out that NHS employers would have to pay more than £400m in higher national insurance contributions from that year, creating “a real terms cut” in NHS spending.

Across the country, it will raise more than £9bn, while the Treasury says the inflation protection the NHS is being offered will add about £3.7bn to spending by 2012-13.

From:

http://www.ft.com/cms/s/0/947c7940-e592-11de-81b4-00144feab49a.html

Swine flu chaos for children over vaccinations

Plans to vaccinate healthy children under the age of five against swine flu are in disarray after doctors refused to sign up to a deal.

GPs are already immunising people with health problems and pregnant women.

But the British Medical Association and labour government have ended talks on children after they failed to agree a deal.

Health visitors and district nurses are now to be asked by local NHS managers to step in - but the programme may will now start in December as planned.

However, the vaccination of the first wave groups, which also include health workers, is continuing as normal as they were covered by a deal that was brokered in early autumn.

It is thought the latest talks broke down over the amount of flexibility the government was willing to give doctors over the rest of their workload.

Negotiators had offered doctors £5.25 per dose - the same as they are getting for the first priority group.

But the BMA had argued doctors should be given leeway over fulfilling their obligations on access to appointments.

Under the terms of their contract, doctors are paid bonuses to give most patients appointments within 48 hours as well as allowing them to book in advance.

Without this, the BMA argued vaccinating 3m children during the busy winter period would leave doctors out of pocket - doctors consider young children to be time-consuming as parents often have to be reassured.

Dr Laurence Buckman, chairman of the BMA's GPs committee, said: "We sincerely wanted to be able to reach a national agreement. Unfortunately this has not been possible, because the government would not support adequate measures to help free up staff time."

"At the busiest time of the year for general practice, with surgeries already dealing with the additional work of vaccinating the first wave of at-risk groups, we felt this was vital in order to ensure this next phase could be carried out quickly."

Health Secretary Andy Burnham said the breakdown of talks was "disappointing", but he still hoped to get the vaccination of children going by Christmas.

It is still possible that some doctors will agree to vaccinate children if they can reach individual deals with their local health managers.

However, the government has asked health chiefs to focus their attention on other NHS workers.

District nurses routinely carry out vaccinations for housebound patients as part of other immunisation programmes, but it remains to be seen whether they will be able to vaccinate large numbers of children.

Health visitors are also likely to be asked to help, but many of them do not have experience of vaccinating and will need extra training.

The British Medical Association believes it will be "very difficult" to get this all in place this year.

And David Stout, of the Primary Care Trust Network, which represents local health managers, agreed there was still a lot of work to do.

"It is more complicated to get separate agreements in place and will take several weeks. We don't know who will want to do this so from that point of view it is untested. I can't see it happening before Christmas."

From:

http://news.bbc.co.uk/1/hi/health/8402096.stm

12 NHS hospitals at centre of safety scandal

The true scandal of NHS hospitals failing to comply with basic safety standards is revealed. 

Research that ranks every general hospital in England against a range of safety measures has named 12 NHS hospital trusts judged to be "significantly underperforming".

This is despite the fact that last month the Care Quality Commission, the health service regulator, judged overall care at eight of the trusts to be good or excellent. Today's study by Dr Foster, an NHS partner organisation that collates and analyses healthcare data, also highlights 27 trusts with unusually high death rates. Almost 5,000 more patients in their care died in the past year than was expected.

Revelations of such widespread safety failings will send shockwaves through the NHS, already reeling from scandals at two trusts last week. Poor nursing care, filthy wards and hundreds of unnecessary deaths were exposed at Basildon and Thurrock University NHS Hospitals Foundation Trust, and the chair of the NHS trust in Colchester was fired.

Now the new data proves that key safety failings are occurring in 11 more hospital trusts across England. They include Scarborough and North East Yorkshire Healthcare Trust, South London Healthcare Trust, Weston Area Health Trust, Hereford Hospitals Trust, Lewisham Hospital Trust and University Hospitals Coventry and Warwickshire Trust. Eighteen were found to have death rates the same or higher than at Colchester. Ministers want to know why seven in particular have had persistently high death rates over five years.

The Department of Health yesterday ordered the CQC to investigate if any other trusts needed urgent attention. The CQC said it was "monitoring closely a number of other trusts", but had no evidence there was another case in England where it would take action of the kind taken at Basildon.

John Black, president of the Royal College of Surgeons, last night told the Observer that patient safety had been neglected by hospitals too busy meeting NHS-imposed financial targets: "Too many hospitals are too concerned with meeting financial targets at the expense of clinical standards, and we are seeing patients suffering as a consequence."

Today's research exposes systemic failures in large parts of the NHS during the last financial year and finds:
¦ 39% of trusts failing to investigate unexpected deaths or cases of serious harm on their wards.
¦ At least 209 incidents in which "foreign objects", such as swabs and drill-bits, were left inside patients after surgery.
¦ At least 82 cases in which medical staff operated on the wrong part of the patient's body.

It finds that 5,024 people died after being admitted for "low-risk" conditions such as asthma or appendicitis, of whom 848 were under 65. A proportion of those deaths will be linked to safety errors.

The Conservatives reacted by promising a complete overhaul of the regulation system, which rated Basildon "good" only weeks ago. Andrew Lansley, the shadow health secretary, said: "Labour's failed health inspection regime is more interested in targets than patients." 

He also questioned the timing of the Basildon announcement. Officials knew of the hospital's failings weeks ago but decided to publicise them last Thursday, just days before the Dr Foster research was due to be published in the Observer.

The study paints a picture of large variations in the hospital standardised mortality ratio, a measure used by Dr Foster. The measure, which was used last week by Monitor, the regulator for NHS foundation trusts, looks at the likelihood of individual patients dying, given their underlying condition, age and economic background, then compares that to the actual number of deaths.

Cynthia Bower, the CQC's chief executive, said improvements had been made, but added: "The NHS cannot stand still on safety. It must be able to look the public in the eye and say safety is top priority for the leadership of every NHS trust in the country – no ifs and no buts."

Roger Taylor, from Dr Foster, responded: "We have used the most credible available data to assess patient safety. CQC ratings are not designed to just assess patient safety and instead use broader indicators, including measures of effectiveness and patient experience. The hospital guide is focused on patient safety, and mortality ratios are used alongside other indicators."

From:

http://www.guardian.co.uk/society/2009/nov/29/nhs-hospitals-safety-report

Swine flu deaths in England reach highest level

Deaths from the swine flu pandemic in England rose to their highest peak yet last week, new figures have shown.

The number of confirmed deaths for the week ended November 26 were 21, three higher than the week before and two higher than the previous high a fortnight ago.

However at the same time the overall number of people catching swine flu in England fell to an estimated 46,000 new cases in the last week, 7,000 less than the week before.

There has also been a drop in the number of people in hospital, from 783 to 753.

A total of 154 of those being cared for are in intensive care.

The figures are dropping so low that the government said that it was reviewing its online and telephone flu service with a view to withdrawing it after Christmas.

Sir Liam Donaldson, the chief medical officer for England, said that the number of people who have had swine flu or died means the current pandemic is comparable with a normal winter flu season.

But he said: "If you look at the levels you would say they are comparable with a winter flu outbreak but a winter flu outbreak does not kill young people and does not take under-fives into hospital and intensive care on this scale."

Meanwhile more than a million people at high risk from swine flu have been vaccinated, according to Government estimates.

About a million people in England and thousands more in Scotland, Wales and Northern Ireland have received their jab in the first month of the programme.

GPs are currently vaccinating people at risk – such as those with asthma, heart disease and diabetes – before moving on to the under-fives.

The number of deaths in England now stands at 163 and the UK total stands at 242, up from 214 last week.

Sir Liam said the one million figure did not include health care workers, who have also been having the vaccine.

One million is about one in 10 of all the people in at-risk groups who are being offered the vaccine.

So far, 10 million doses of the jab have been sent out to GP surgeries, primary care trusts and acute hospitals in England.

A total of 14 million doses of the vaccine Pandemrix have been delivered to the Government, with another 2.3 million doses of Celvapan also delivered.

From:

http://www.telegraph.co.uk/health/swine-flu/Swine-flu-deaths-in-England-reach-highest-level

150,000 dementia sufferers being prescribed anti-psychotic drugs unnecessarily

Up to 150,000 people with dementia are being prescribed anti-psychotic drugs unnecessarily, a Government ordered review disclosed.

Only around 36,000 of the 180,000 people on the drugs in the UK derive any benefit from them, it said. Overprescribing of the drugs is linked to an extra 1,800 deaths a year among elderly people.

Anti-psychotic medicines are licensed to treat people with schizophrenia and are used off-licence for dementia patients in care homes and hospitals.

In his review, Sube Banerjee, professor of mental health and ageing at the Institute of Psychiatry at King's College London, said the rate of use of anti-psychotic drugs could be cut to one third of its current level with appropriate action.

Jeremy Wright, chairman of the All Party Parliamentary Group on Dementia, called for more training to be given to care home staff and for greater involvement of the patient's family and friends over the decision on whether to prescribe.

He told BBC Radio 4's Today programme: "We need to give people other ways of avoiding the problem and that means making sure staff who work in care homes are properly trained in dementia.

"We need to involve family members and friends and loved ones much more in the decision to prescribe and the decision to keep prescribing these drugs."

He added: "If we can deal with training, if we can deal with regular reviews and if we can involve family and friends much more often, we will start to reduce the incidence of this very widespread over-prescription."

Nadra Ahmed, chairman of the National Care Homes Association, said the blame did not lie solely with care homes.

She explained it was GPs who made the decision to prescribe dementia sufferers with anti-psychotic drugs.

She told the programme: "One of the things we need to get absolutely clear here is these drugs are prescribed by general practitioners, they are not prescribed by the care home providers. This is about medical conditions which are obviously reviewed by GPs.

"We have clients who come into our homes, sometimes already on these drugs and actually very good providers do tend to use their initiative and try to manage the conditions and wean people off drugs.

"Very often what happens is that GPs are just not giving us enough time in our services to come and review the medication and people can be on this medication and once they're on it, people, quite rightly, are reluctant to take them off."

She also rejected claims that some care home providers sedate dementia sufferers as it makes them easy to manage.

There are around 700,000 people with dementia in the UK. That figure is expected to soar in the coming decades as life expectancy lengthens.

Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: "It's critical that the dangers of wrongly-prescribed anti-psychotics are understood and Government action is taken to prevent putting more people at risk.

"Alzheimer's Research Trust scientists at the Institute of Psychiatry are investigating alternative safer means of reducing agitation among dementia patients.

"We must urgently develop safe and effective treatments for people with dementia.

"Unless researchers develop new treatments, within a generation 1.4 million people will live with dementia in the UK alone."

Paul Burstow, a Liberal Democrat MP who has led a 10-year campaign highlighting the risks of over and inappropriate prescribing, said: "This review comes much too late for thousands of elderly people whose lives have been cut short by the reckless prescribing of anti-psychotic drugs.

"The evidence that anti-psychotic drugs do more harm than good has been mounting for years. There is next to no benefit for the older person and prolonged prescribing can lead to premature death.

From:

http://www.telegraph.co.uk/150000-dementia-sufferers-being-prescribed-anti-psychotic-drugs-unnecessarily

NHS accused over illegal gagging of doctors' safety concerns

Outlawed gagging clauses are still being used by the National Health Service to silence concerns about patient safety the British Medical Journal has found.

The Public Interest Disclosure Act provides protection for people who blow the whistle, providing they have raised concerns with their employer, and it specifically overrides any agreement aimed at preventing proper disclosure.

Furthermore, even before the 1998 act came into force, it was the health department's policy that confidentiality or gagging clauses should not be used in the NHS, a stance they have since reinforced.

But the case of Peter Bousfield, a consultant who raised fears about patient safety at the Liverpool Women's NHS Trust, illustrates that such clauses are still in use, the BMJ said. Equally, some consultants who leave their NHS Trust "under a cloud" - because colleagues are worried about their competence - are inserting confidentiality clauses into their departure agreements that prevent the hospital or colleagues disclosing their worries to future employers.

Mr Bousfield, a senior consultant and former medical director, was given early retirement and a pay-off when the hospital rejected his concerns. It inserted a confidentiality clause that prevented him raising concerns with anyone other than the hospital board and the secretary of state for health.

The journal also cites an anonymous case where a consultant reported concerns about a newly appointed colleague's work, only to find when contacting the doctor's previous hospital that it had "seemingly been keen to be relieved of the doctor's services whatever happened in future" but had agreed a gagging clause over the departure so that "nothing could be discussed".

When the doctor quit his new hospital "another gagging clause" was imposed. The consultant says: "I felt incensed that even when two trusts were aware of repetitive behaviour they did not, or could not, join forces to save a third from employing this person."

Dr Mark Porter, chairman of the British Medical Association's consultants committee, said that in a recent survey 15 per cent of doctors who had reported concerns said their employers had indicated that "speaking up could negatively affect their employment".

Public Concern at Work , the charity that helped engineer the Public Interest Disclosure Act and which runs a whistleblowers' helpline, said it was aware of other cases in the NHS.

Dr Porter said staff should not be able to take vendettas to the media before employers had had a chance to deal with the concerns. But "to say there are no circumstances in which a concern for patient safety can be raised outside the organisation, or to attempt to enforce silence through a contractual mechanism, is appalling".

From:

http://www.ft.com/cms/s/0/37819d76-c362-11de-8eca-00144feab49a.html?nclick_check=1

National swine flu vaccination to start this week

A national swine flu vaccination campaign will begin this week, with high risk patients and frontline health workers the first to receive a single dose jab, the Chief Medical Officer has announced.

Sir Liam Donaldson said that from today hospitals would start vaccinating priority patients, such as people receiving cancer treatment, with the first deliveries to GPs for other at-risk groups including those with chronic conditions and pregnant women from October 26.

Sir Liam said that while overall rates of infection were rising slowly, and at similar rate to recent weeks, he was more concerned at the proportion of people ending up in critical care. Of the 364 patients currently in hospital, 74 are in critical care – the highest total in the pandemic so far.

The death toll also rose at a sharper rate, with 10 recorded in the last week, taking the UK total past 100. 

There have been a total of 83 deaths in England, 4 in Wales, 4 in Northern Ireland and 15 in Scotland. The announcement came as it was confirmed that a 17-year old pregnant woman from the Borders had died after contracting swine flu in the last 24 hours – the second pregnancy fatality of the week.

Professor David Salisbury, the Department of Health’s head of immunisation, said that Pandemrix, the vaccine made by GlaxoSmithKline, would be used for the first roll-out. He dismissed suggestions that as an adjuvant vaccine it carried more risks for pregnant women, and said that the fact that it could offer immunity with a single dose - rather than the more lengthy time period required with the UK’s other supply, the two-dose Celvapan – made it far more preferable.

Sir Liam added that postal workers’ decision to stage a national strike was “extremely unwelcome piece of timing” which, though it would not impact on vaccine delivery, would disrupt GPs’ letters sent out to those being called up for vaccination.

“While the rates of infection are not increasing more quickly, I am concerned at the relatively high proportion of patients in hospital in a serious category,” he said, adding that there was a school of thought suggesting that while the virus had not changed, it might carry a greater impact now the country was entering its seasonal flu period. “I also remain concerned at the rates of child hospitalisation," he said.

On the topic of vaccinations for pregnant women, he added: “While the disease is mild for the majority of people including pregnant women, pregnant women are at higher risk of complications caused by flu. I know they wish to reduce risks to themselves and their unborn babies and therefore the sensible would be to have the vaccine. I do not want to see pregnant women dying from a preventable disease, and that is the bottom line.”

From:

http://www.timesonline.co.uk/tol/news/uk/health/Swine_flu/article6876657.ece

Labour blows more money on websites as patients urged to rate GPs online

Patients will be able to praise or criticise their doctor on a health website- but the nanny state will not allow us to actually name the person.

Patients are being encouraged to rate their GP surgeries on a new NHS website designed to drive up standards in primary care.

At www.nhs.uk, patients will be able to post comments ranging from how they were treated to whether it was easy to book an appointment.

But mentioning staff by name will not be allowed, say health officials.

The website will compare the 8,269 GP practices in England only.

The health minister Mike O'Brien said the website was part of plans to modernise the health service.

He said: "As we open up real choice in primary care, it is vital we equip patients with enough information to make the right choice for them. This new tool allows every single GP practice in the country to see the patient's view on what they are doing well and what needs to be improved.

"It will help drive up quality across the board, and is another step in ensuring we have a modern NHS which reflects the needs of the patient," he added.

There are 23 million visits to GP practices and related services every month.

In September, ministers announced they wanted to abolish GP boundaries, allowing patients to register with a practice of their choice.

Yet another similar site to compare the performance of hospitals is already up and running.

From:

http://news.bbc.co.uk/1/hi/health/8306041.stm