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

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

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

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

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

Swine flu- move to recover cost of vaccine

The government is attempting to claw back tens of millions of pounds from flu vaccine manufacturers as it seeks to scale down an immunisation plan to protect the country from a severe pandemic.

Officials have cancelled further orders from Baxter, and are finalising a deal to limit purchases from GlaxoSmithKline, in an effort to recoup part of a £500m deal with the two companies for sufficient vaccine to cover the entire population.

Ministers have decided to abandon the aim of a universal flu vaccination programme, although they are pursuing the drive to vaccinate children under five as well as pregnant women, people with underlying health problems and health and social care workers.

The mild nature of the swine flu virus, the need for only a single rather than a double dose of vaccine and public suspicion and indifference to vaccination have led to lower take-up than anticipated in the UK and other countries.

The government's decision - in the context of severe pressure on public spending - comes at a time of similar moves by other countries including France, Germany, the Netherlands and Spain.

Sir David Salisbury, director of immunisation at the Department of Health, said a break clause had now been activated in the contract agreed with Baxter of the US, while discussions were under way with GSK, from which most of the vaccine had been purchased.

Similar formal break clauses were not included in many countries' contracts with vaccine suppliers, because they were drawn up at a time when governments and manufacturers expected demand would substantially outstrip supply.

However, GSK, like other large suppliers, including Sanofi-Aventis of France, is coming under political pressure to accept a scaling back of previously agreed volumes of orders.

GSK stands to lose tens of millions of pounds alone from the UK renegotiations and smaller amounts from other large purchasers such as France.

The drugmaker had previously estimated total sales of its pandemic flu vaccine across more than 70 countries at £2bn over 2009 and 2010.

It may be able to recover some losses from sales to other countries including in Latin America. Sanofi-Aventis, the world's largest supplier of flu vaccine, stands to lose significant sales, with smaller losses from Novartis, while other suppliers such as Baxter, CSL and MedImmune - part of AstraZeneca - had lower initial sales and much lower exposure.

The UK and other countries are in talks about making donations of surplus vaccine stocks available to poorer countries and selling excess stocks to richer ones - although there are concerns about the issue of liability in such cases.

Sir David said the UK would keep some surplus stocks, both to prepare for any possible third wave of the pandemic and for a future different infection.

The vaccine contains an antigen to protect the body against the current H1N1 virus which would not be useful against future mutations.

But it has an adjuvant stored separately until just before vaccination, which enhances the body's immune response and could be stored over longer periods to help fight a future pandemic.

The latest figures from England show that fewer than 3.8m people have been vaccinated against pandemic flu since last autumn, although 12.5m doses of vaccine have been sent out for health services ready to be used.

From:
http://www.ft.com/cms/s/0/182021e8-fe52-11de-9340-00144feab49a.html?nclick_check=1

Two catch Legionnaire’s disease at hospital attacked over hygiene

Two patients have contracted Legionnaire’s disease at a hospital recently condemned for poor hygiene, blood splattered equipment and an unusually high death rate among patients.

Both adults were at Basildon University Hospital in Essex when they began to show signs they were affected by the bacteria legionella.

A spokeswoman for the hospital said the patients, who were staying in different parts of the hospital, have responded to antibiotic treatment but one of them is still in a critical condition.

The bacteria is commonly found in sources of water such as rivers and lakes but can sometimes find their way into artificial water supply systems.

Alan Whittle, Chief Executive at the Basildon and Thurrock NHS Foundation Trust, said the hospital was the probable source of the infections, based on tests of water samples. No more suspected cases have been identified.

“Experts agree that the legionella bacteria is a common risk in large buildings with an extensive plumbing system,” Mr Whittle said.

“Based on the results of laboratory tests of water samples, we accept that the hospital is the probable source of the infection, despite our determined efforts to minimise the known risks of legionella.

In November, inspectors from the Care Quality Commission criticised Basildon and Thurrock University Hospitals NHS Foundation Trust after they found blood stains on floors and curtains, blood splattered on trays used to carry equipment and badly soiled mattresses in the A&E department, with stains soaked through.

Andy Burnham, the Health Secretary, told MPs last week that the more work needs to be done to improve standards at the trust.

From:

http://www.timesonline.co.uk/tol/life_and_style/health/article6980928.ece

Fall in clinical trials of drugs through NICE

Investment by drugs companies and access by patients to innovative medicines in the UK are coming under threat, as data show a decline in the number of clinical trials conducted in this country.

Bureaucracy, low recruitment rates and the slow uptake of new drugs are pushing pharmaceutical companies to undertake more research in other countries in Europe and North America, as well as increasingly in low cost developing nations.

In spite of efforts by the labour government to make trials cheaper, faster and easier to conduct, the UK's disproportionately strong historic role in the development of medicines is being undermined. 

Data show a declining role for the UK since the turn of the decade, with its share of global clinical trials falling from 6 per cent in 2002 to only 2 per cent in 2007.

The latest figures from the Department of Health show the number of mid-stage, late-stage and post-approval clinical trials fell from 728 in 2008 to 470 this year, its lowest level in the past decade. Early-stage trials fell to 210, the lowest in five years.

The data were corroborated by figures provided to the Financial Times by Quintiles, one of the world's leading clinical research organisations, which conducts trials for most significant drug companies. These show that the number of patients recruited into mid and late-stage clinical trials in the UK stagnated at 782 last year compared with 749 in 1999. 

By contrast, patient numbers during the same 10-year period almost doubled to 1,283 in France; trebled to 31,617 in the US and to 3,657 in Poland; and quadrupled to 2,117 in the Czech Republic.

Dennis Gillings, chief executive of Quintiles, which has continued to expand early-stage clinical trials in the UK, said: "We would be happy to invest more in the UK, but there's a feeling that the NHS has a negative attitude towards industry and a reluctance to pay for drugs."

The statistics come in spite of rising patient recruitment in some areas, including cancer trials, and a broader range of efforts in conjunction with industry to streamline approvals, reduce costs and encourage National Health Service doctors to participate in research.

The findings come as researchers lead calls for reforms to the EU's clinical trials directive. A consultation on revising the legislation closes in early January. But Kent Woods, head of the Medicines and Healthcare Products Regulatory Agency, the UK body that scrutinises new drugs, said only minor modifications were required to distinguish standards for high-risk and low-risk trials.

From:

http://www.ft.com/cms/s/0/acbd525c-f5ac-11de-90ab-00144feab49a.html?nclick_check=1

UK health groups look abroad to fight MRSA superbugs

UK companies developing products that fight MRSA hospital superbugs are complaining that there are few opportunities in their domestic markets, and focusing their sales efforts overseas.

In the UK, hospital acquired infections (HAI) such as MRSA and clostridium difficile affect 300,000 patients each year and cause about 5,000 deaths- nearly double the number of people killed in road accidents.

The problem is worse in the US, where HAIs are estimated to be one of the top 10 causes of death, claiming close to 100,000 lives every year.

And the costs are mounting. In the US, government studies estimate that the extra cost of treating a patient with HAI averages almost $9,000 (£5,600).

UK companies are among the leaders in the fight against superbugs but they say that they are encountering problems in getting their products adopted by UK hospitals. They complain that hospital managers lack accountability for deaths relating to HAIs.

In November, a report by the Department of Health criticised the NHS for not achieving “measurable reductions” in HAIs outside of MRSA and C.difficile.

“The heart of the problem is that whatever DoH says or decrees, it doesn’t necessarily impact hospitals,” says Nick Adams, chief executive of Bioquell, the decontamination technology provider. “In the US, a hospital can be sued and that’s a big deal because they’re desperate to keep it out of the press, so they’ll settle. In the UK, hospitals pass the issue very quickly on to the NHS litigation board, so it’s not the hospital’s problem.”

Synergy Health is another company that produces decontamination technology. It has concentrated its sales efforts in Asia and Europe.

One of Synergy’s decontamination products uses a disinfectant technology produced by another company, Byotrol, that has been tested by the NHS in an 11-month study. The Byotrol technology was deployed against a bleach-based product currently used by the NHS.

Despite positive results showing superior effectiveness and lower side effects, the product has not been taken up, even by the Manchester Royal Infirmary where it was tested.

Richard Steeves, Synergy’s chief executive, says that his group is making more sales to countries where hospitals are encouraged to innovate, such as in the Netherlands, where “hospitals are competing for patients”.

Although there is state-funded national insurance for health care in the Netherlands, hospitals compete with each other to provide services for a number of private insurers.

Most UK hospitals are run by the NHS, and Dr Steeves points out that many of the UK’s private hospitals are owned by private equity, and that there is financial pressure to reduce costs.

However, there are those in the sector that say that innovation by UK companies is a direct result of the “laissez faire” environment.

Paul Swinney is chief executive of Tristel, which produces a chlorine dioxide-based disinfectant that treats everything from salads in supermarkets to surgical instruments and surfaces.

Its product is used throughout the UK, which Mr Swinney says is “de facto approval”. Moreover, he says, companies here do not have to pass the expensive regulatory procedure of the US Food and Drugs Administration or the Environmental Protection Agency.

From:
http://www.ft.com/cms/s/0/f989ee86-f405-11de-ac55-00144feab49a.html?nclick_check=1

Dramatic postcode lottery for cancer survival rates shock charities

Department of Health figures have shown a wide variation in cancer survival between different parts of the UK with lung cancer patients in Herefordshire three times more likely to die within a year than those in Kensington and Chelsea.

The country's biggest cancer charity has expressed shock at government figures revealing huge variations in patients' chances of surviving from one area of the UK to another. The biggest survival gap was in lung cancer, where Department of Health figures showed patients in Herefordshire were three times more likely to die within a year of diagnosis than those in Kensington and Chelsea. 

In the London borough, 44% of patients survived the first year after diagnosis, compared with only 15% in Herefordshire.

In bowel cancer there was also a big gap in survival – 80% in Telford and Wrekin after one year, but only 58% in Waltham Forest and Hastings and Rother. The gap was less pronounced in breast cancer, with the best rate in Torbay, where 99% survived for one year, compared with 89% in Tower Hamlets.

"There is no excuse for such a big difference between different areas," said Harpal Kumar, chief executive of Cancer Research UK. "It is appalling that someone with lung cancer in Herefordshire should be three times more likely to die within a year than a patient in Kensington, or that a person diagnosed with bowel cancer in Waltham Forest or Hastings should be 22% more likely to die within a year than a patient in Telford. This is the worst kind of postcode lottery."

Very few primary care trusts (PCTs) had survival rates that were as good as other countries in Europe now or even as good as Europe was achieving 10 years ago, which Kumar called "a disgrace".

"We're pleased that the Department of Health have been bold enough to publish these figures," he said. "The NHS now needs to take them very seriously."

One-year survival figures highlight the issues around delayed diagnosis of cancer. That can be partly the responsibility of the GP, who may not see many cancer cases in a year, but is often to do with the reluctance of the patient to seek medical advice when they suspect a problem.

The figures are contained in the Cancer Reform Strategy second annual report from national cancer director Mike Richards, who points out that cancer deaths continue to fall and that prevention efforts, such as the cervical cancer vaccination programme for schoolgirls and better screening, will further help.

Jeremy Hughes, chief executive of Breakthrough Breast Cancer, said the charity shared the concerns. "Although progress has been made in some parts of the country, in others key Cancer Reform Strategy initiatives are still yet to be implemented," he said. "In particular, urgent action must be taken to ensure that digital mammography is in place by the December 2010 deadline and that, as previously committed by the government, all women with breast problems referred by their GP will see a specialist within two weeks by the end of this year."

Here are the PCTs with the best and worst records for dealing with common types of cancer, in terms of the proportion of patients who are still alive one year after diagnosis:

Breast cancer- Worst
Tower Hamlets (89.3pc)
Hillingdon (89.5)
Barking and Dagenham (90.2)
Hastings and Rother (90.3)
West Hertfordshire (90.6)

Breast cancer- Best
Torbay Care Trust (99.0)
Darlington (97.9)
Stockport (97.6)
Warrington (97.6)
Western Cheshire (97.6)

Colorectal cancer- Worst
Hastings and Rother (57.8)
Waltham Forest (57.9)
Tameside and Glossop (61.5)
Derby City (62.6)
Enfield (62.6)

Colorectal cancer- Best
Telford and Wrekin (80.0)
City and Hackney (77.5)
Shropshire County (77.0)
Peterborough (76.7)
Plymouth Teaching (76.6)

Lung cancer- Worst
Herefordshire (15.4)
Milton Keynes (17.5)
Blackpool (18.3)
East and North Hertfordshire (20.3)
Hartlepool (21.1)

Lung cancer- Best
Kensington and Chelsea (43.7)
Hammersmith and Fulham (35.3)
Richmond and Twickenham (35.2)
Islington (34.8)
South Birmingham (34.6)

Health Direct has compiled this post from:

http://www.guardian.co.uk/society/2009/nov/30/cancer-survival-rates-figures
and
http://www.telegraph.co.uk/health/healthnews/6693438/Cancer-survival-rates-best-and-worst-trusts.html

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

Failing hospital condemns hundreds to death

Hundreds of patients died at an NHS hospital after suffering appalling standards of care, a report has found.

Poor nursing, filthy wards and lack of leadership at Basildon and Thurrock University NHS Hospitals Foundation Trust contributed to 400 avoidable deaths in a year.

Death rates at the Essex trust were a third higher than they should have been, said the Care Quality Commission, the health care watchdog.

Among the worst failings were a lack of basic nursing skills, curtains spattered with blood on wards, mould in vital equipment and patients being left in A&E for up to 10 hours.

Concerns about death rates at the foundation hospital trust were first raised a year ago, but an internal investigation failed to find anything wrong and senior managers dismissed the concerns.

But the new external report found “systematic failings” in the trust’s senior management team, who are still in their jobs. The CQC said its confidence in the management’s ability had been “severely dented”.

The watchdog’s report follows an investigation earlier this year into Mid-Staffordshire NHS Foundation Trust, which found similar problems, with up to 1,200 avoidable deaths.

Ministers assured patients at the time that it was an isolated incident. The failures at Basildon will raise concerns that similar problems are widespread in the NHS.

Among the CQC’s other findings were the avoidable deaths of four patients with learning disabilities; a lack of children’s nurses and doctors in A&E; a failure to feed patients properly or give medication correctly; and a high rate of bedsores among elderly patients. Concerns about standards at Basildon were raised as long ago as 2001, when the Royal College of Nursing described conditions there as “Third World” because of a shortage of beds. Since then the hospital has suffered a series of health scares and accusations of negligence.

The CQC report has been passed on to Monitor, the organisation in charge of foundation hospital trusts.

A statement by Monitor said there had been a “significant breach” by Basildon and a task force of experts would be sent into the trust.

Monitor has the power to replace the trust’s management but it was understood last night that none of the board members had been threatened with dismissal.

Katherine Murphy, the director of the Patients Association said: “Yet again patients are being neglected. Lack of monitoring, lack of help with feeding, lack of dignity, avoidable pressure sores. How many times do the public need to keep hearing about this before the Government is embarrassed enough to do something about it?

“We’re sick and tired of NHS managers and senior staff walking away unscathed when families are left with a life sentence of grief.”

Basildon was one of the country’s first foundation trusts in 2004, meaning it was given more freedom over its spending and did not have to answer to ministers. Mid-Staffordshire was also a foundation trust, raising concerns that the system is failing. It also emerged that Basildon was the first foundation trust to be issued with a warning notice about poor infection control earlier this month over hygiene in its A&E department and contamination of medical equipment.

The trust, which has a budget of £250 million and more than 700 beds at its main hospital in Basildon, has repeatedly pledged to improve but failed to do so, the CQC said.

Andrew Lansley, the shadow health secretary, said: “I am extremely disturbed by this news and the effect that these shocking conditions may have had on patients. It is unforgivable if any lives have been needlessly lost.

“When the appalling standards of care at Stafford Hospital were revealed, we were assured by Labour ministers that it was ‘an isolated case’ — that sort of complacency is simply not good enough.”

Andy Burnham, the Health Secretary, has proposed a change in the law to allow trusts to be stripped of foundation status if they fail.

The CQC had been aware of problems at Basildon for more than a year and was in contact with managers to correct the situation. Repeat inspections found no improvement. From next April, the CQC can take action, including fines, and, if necessary, closures of departments or the whole hospital. Cynthia Bower, the watchdog’s chief executive, said: “We want to act swiftly at Basildon to nip problems in the bud, working closely with other regulators. The trust has taken our concerns seriously but improvements are simply not happening fast enough.

“Our confidence in the management’s ability to deliver on commitments and to turn the situation around has been severely dented.”

From:
http://www.telegraph.co.uk/Failing-hospital-condemns-hundreds-to-death

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

Nanny state wants NHS to provide free marriage guidance

Couples are to be offered marriage guidance counselling for free on the NHS, in a move which has drawn strong condemnation from patients and doctors' groups.

Couples with relationship problems will be offered free sessions for up to six months, as part of a £270 million programme to increase the provision of "talking therapies" for the public, Andy Burnham, the health secretary, announced.

Doctors and patients' groups said they were "horrified" by the use of NHS resources for relationship advice when patients with cancer and dementia were being denied treatment they desperately needed.

Currently, most people seeking help from services like Relate pay between £45 and £60 per session, meaning the free counselling packages will be worth around £1,000 per couple.

The NHS is expected to have to pay existing marriage guidance services, and newly-trained counsellors to provide the therapy.

Doctors and patients groups last night attacked the recommendation, contained in guidance by the National Institute for Health and Clinical Excellence (NICE). NICE has repeatedly come under fire for decisions to reject life-extending drugs for cancer and treatment to reduce symptoms of dementia.

On Thursday, NICE was accused by charities of "condemning patients" to an early death by rejecting the use of Nexavar, a drug which can extend the lives of liver cancer, arguing that its £9 million annual cost – £3,000 a month per patient – could not be justified.

Nick James, professor of clinical oncology at the Cancer Research UK Institute for Cancer Studies said: "I am horrified, in particular because of the way these decisions are taken without public debate.

"I think most people would say treatment for those who are sick with cancer should be top of our list, and I would really question whether these kinds of efforts to preserve marriages are a matter for the state."

NICE has previously restricted the use of drugs to limit the effects of Alzheimer's, costing £2 a day, while provoking further controversy in May when it ruled in favour of alternative therapies like acupuncture for back pain, despite admitting there was little evidence they worked.

Michael Summers, Vice-President of the Patients Association, urged NICE and the Government to "get their priorities right". If we had the luxury of untold sums of money, maybe we would think about paying for couples counselling," he said.

"As things stand, people are still waiting for urgent treatment, being denied drugs for cancer, and dementia, and it seems inappropriate at the very least to start using public money in this way".

From:

http://www.telegraph.co.uk/health/healthnews/NHS-will-provide-free-marriage-guidance

Winter NHS deaths rise a national scandal

The highest winter NHS deaths figures in almost 10 years should act as a "deafening wake-up call" for the labour Government, charities said today.

There were an extra 36,700 deaths in England and Wales from December 2008 to March 2009, compared with the average for non-winter periods, figures from the Office for National Statistics (ONS) showed.

This was the highest number since the winter of 1999/2000 and a rise of 49% compared with 2007/08.

Andrew Harrop, head of policy at Age Concern and Help the Aged, said: "It is a national scandal that the UK has more older people dying in winter, compared to the rest of the year, than countries with more severe weather, such as Sweden and Finland.

"Excess winter deaths of older people have remained stubbornly high in recent years, but last winter's huge spike sounds a deafening wake-up call about the older population's well-being if we have another cold snap.

"To end this national scandal, the Government must do much more to tackle fuel poverty, which currently affects one in three older households."

Fuel poverty charity National Energy Action (NEA) warned that a combination of high energy prices, low incomes and poor insulation will continue to pose a serious threat to the health of millions of people, especially pensioners, during the coming months.

Jenny Saunders, NEA chief executive, said: "The Government needs to step up action that will end these shameful statistics and comprehensibly tackle fuel poverty in the UK."

The winter of 2008/9 had the coldest average winter temperature since 2005/6, one of the factors which affects the number of so-called excess winter deaths, an ONS spokesman said.

He added that the Health Protection Agency (HPA) said influenza activity started early and reached moderate levels during the winter of 2008/9.

Temperature and levels of disease in the population are two of the key factors which contribute to the number of deaths.

The greatest number of excess winter deaths occurred in people aged over 85, the ONS figures showed.

Women accounted for the highest number of excess winter deaths, a fact mostly explained by the higher number of women than men aged over 85, the ONS said.

There were 21,400 excess winter deaths in women and 15,300 in men in the winter of 2008/9, the ONS said.

But the largest increase - 59% - was in men aged 75 to 84, with the overall rate for men 44% higher than the previous year.

Among women, the overall rate increased by 52% compared with 2007/8.

A Department of Health (DH) spokesman said: "The causes of excess winter deaths are very complex. Last year was a colder than average winter, which explains some of the extra deaths seen.

The NEA called for an extension of the winter fuel payments "to include other vulnerable households and not just those who are over 60".

It also urged the Government to increase the budget for the Warm Front Scheme - which provides a package of insulation and heating improvements up to the value of £3,500 - to £530 million next year.

Ms Saunders said: "As it stands, the budget for 2010 is set to be cut back by around 50% on this year's budget.

"I urge the Chancellor in his Pre-Budget Report on December 9 to increase support for the life-saving heating and insulation measures available to low income households under this flagship programme.

"People need to be aware of the help that is available to them through the various grants and schemes from DECC, energy companies and our own Warm Zones where we have established these with local authorities.

"Pensioners in particular are often anxious to avoid debt and turn their heating down or even off, often unaware that they are putting their health in danger."

She said there were more than five million households who cannot afford to heat their homes, putting them at risk of serious health problems like heart disease, strokes, respiratory illnesses - such as asthma and bronchitis - and exacerbating common ailments like colds and flu.

She added that the increase in excess winter deaths was "sadly expected but remains extremely worrying".

From:

http://www.independent.co.uk/winter-deaths-rise-a-national-scandal

Swine flu- strain resistant to Tamiflu spreads between UK hospital patients

A strain of Tamiflu resistant swine flu has spread between patients in a hospital as five patients on a unit for people with severe underlying health conditions at the University Hospital of Wales, in Cardiff, were diagnosed with swine flu that is resistant to the drug.

Three appear to have acquired the infection in hospital, the National Public Health Service for Wales (NPHS) said.

Two of the five have recovered and have been discharged from hospital, one is in critical care and two are being treated on the ward.

The service said the resistant strain does not appear to be more severe than the swine flu virus circulating since the spring.

All patients on the unit have been tested and patients diagnosed with Tamiflu-resistant swine flu have been given other antivirals.

Patients have been isolated or are being cared for in a designated area for influenza cases.

Cardiff and Vale University Health Board has put appropriate infection control measures in place on the unit, the NPHS added.

Staff and patients have been offered swine flu vaccinations, and patients due to come into the unit for treatment are being warned to get the jab from their GP.

Close contacts of the patients are being warned to make sure they are treated quickly if they show any symptoms.

Dr Roland Salmon, director of the NPHS Communicable Disease Surveillance Centre, said: “The emergence of influenza A viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.

“In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April. For the vast majority of people, Tamiflu has proved effective in reducing the severity of illness.

“Vaccination remains the most effective tool we have in preventing swine flu so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery.”

It comes after it was announced that more than 3million healthy children under five across the UK are to be offered the swine flu jab.

Parents will be invited by their GPs to bring their children into surgeries, with vaccinations expected to start in December.

Health ministers across the UK agreed children aged six months to five years should be included in the next phase of the vaccination programme after GPs have finished vaccinating at-risk groups, including people aged six months to 65 with conditions like asthma, diabetes and heart disease. Pregnant women and frontline health workers are also currently being given the jab.

Figures released on Thursday showed an estimated 53,000 new cases of swine flu in England in the last week, down from 64,000 in the week before. In Scotland, the figure was 21,200, down from about 21,500 in the previous seven days.

The rate of flu-like illnesses diagnosed by GPs in Wales dropped to 36 cases for every 100,000 people from 65.8 the previous week.

Seven swine flu-related deaths were recorded in Wales in the previous week, taking the total to 21.

Wales’s Chief Medical Officer Dr Tony Jewell said people with suppressed immune systems were designated as a priority group for vaccination because they were known to be more susceptible to the virus.

“We have stringent processes in place for monitoring for antiviral resistance in the UK so that we can spot resistance early and the causes can be investigated and the cases managed,” he said.

“Identifying these cases shows that our systems are working so patients should be reassured.

“Treatment with Tamiflu is still appropriate for swine flu and people should continue to take Tamiflu when they are prescribed it.

“It’s also important that good hygiene practices are followed to further prevent the spread of the virus.”

Meanwhile, Norwegian health authorities said they had discovered a potentially significant H1N1 mutation that could be responsible for causing the severest symptoms.

The mutated virus was found in the bodies of two people who died of the virus, although medics do not believe it has been transmitted between humans.

From:

http://www.telegraph.co.uk/Swine-flu-Strain-resistant-to-Tamiflu-spreads-between-UK-hospital-patients

Sharp rise in England swine flu deaths

The latest weekly bulletin showed a sharp rise in patient deaths and the number of children being admitted to hospital.

The overall number of new cases showed a second successive weekly fall. Health officials estimate there were 55,000 new cases this week in England compared with 64,000 last week. There was a slight drop in Scotland.

The number of people who have died from swine flu in the UK has reached 214. There were 18 deaths in England last week. The figures since the start of the outbreak in May are 142 fatalities in England, 21 in Wales, 38 in Scotland and 13 in Northern Ireland.

The number of people needing hospital care for the virus is 783, down slightly from 785, in the previous week. Of those in hospital, 180 were in intensive care, up from 173 in the previous week.

The Conservative party has been pressing the government to give vaccinations to healthy children because those under the age of 16 are in one of the more vulnerable groups.

About 21% of all H1N1 deaths in the UK have been among under 14s.

So far the priority groups have included those with pre-existing medical conditions, their carers and pregnant women. Children with asthma or diabetes are already being vaccinated. Now, children aged six months to five years are to be offered the vaccination from next month.

From:

http://www.guardian.co.uk/world/2009/nov/19/swine-flu-vaccines-healthy-children

Swine flu jab to be given to healthy children under five

Healthy children aged under five are to be given the swine flu jab, the Government has confirmed.

Currently people in priority groups - including young children with asthma or diabetes - are being vaccinated.

But the programme will now be rolled out to children with no underlying health issues, aged over six months and under five .

The UK-wide policy was officially confirmed by the Scottish Government today ahead of a similar announcement in England, expected later.

Nicola Sturgeon, the Scottish Health Secretary, said: "I am able to announce today that the next group in the population that will be vaccinated, or offered vaccination, is children aged over six months and under five years."

The announcement came as it emerged that an 11-year-old girl from Berkshire who had tested positive for the H1N1 virus died on November 11.

NHS figures show that children under 16 are the age group most likely to be admitted to hospital with swine flu, and 21 per cent of deaths in England are among under-14s.

Last week, the death toll in the UK stood at 182, with 124 deaths in England, 33 in Scotland, 11 in Northern Ireland and 14 in Wales.

Currently nine million people in priority groups are being vaccinated against swine flu including those with long-term illnesses and pregnant women. Frontline health and social care workers are also being offered the vaccine.

Britain has ordered enough vaccine for everyone to have two doses, but data from clinical trials has shown that one dose is effective.

Children have been hardest hit by swine flu and are the under fives are the most likely age group to be admitted to hospital with the virus.

Researchers warned that intensive care beds for children could run out in Britain this winter due to swine flu.

All of Britain's 303 intensive care beds for children could be filled with swine flu patients this winter and this would leave no beds available for children suffering other illness, recovering from surgery or accidents, according to a study conducted by Dr Art Ercole, of Cambridge University and colleagues.

The research was published online ahead of the print edition of the journal Archives of Disease in Childhood.

Dr Ercole said over half of admissions to paediatric intensive care units (PICUS) are unplanned and respiratory illness is the second largest cause of admission, accounting for around one in four cases.

From

http://www.telegraph.co.uk/health/swine-flu/6606561/Healthy-children-below-age-of-five-to-get-swine-flu-jab.html

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

MRSA superbugs not the only threat to NHS warns MPs

The labour government has taken its "eye off the ball" on hospital infections other than MRSA and Clostridium difficile, a cross-party group of MPs says.

The Public Accounts Committee said setting targets in England for the two infections had led to a fall in cases.

But they warned there were signs other bugs, such as E. coli, were becoming more common and they called for better surveillance to curb the problem.

In England, MRSA rates are now a quarter of what they were at their peak in 2004, while C. difficile rates have fallen by nearly a third in the past year, following the introduction of targets.
   
THE OTHER THREATS
E. coli
Pneumonia
Surgical site infections
Urinary tract infections
Gastrointestinal infections
Skin infections

But the MPs said these only accounted for about a fifth of the total number of all infections seen in hospital.

While MRSA is the most high-profile bloodstream infection, E. coli is much more common and has actually increased by a third in the past four years, the report said.

It also highlighted surgical site infections, which were twice as common as bloodstream infections, and respiratory and urinary tract infections, which were three times as common.

MPs warned there was still no robust data on the extent and risks of at least 80% of bugs linked to hospital care.

Committee chairman Edward Leigh said this report was the third time the committee had warned about the threat of other infections, adding it was "disappointing" the issue had yet to be addressed.

"The government has taken its eye off the ball regarding all other healthcare associated infections - which actually constitute most by far of all infections."

The report suggested hospitals start reporting all types of infection and that they look to curb the use of antibiotics.

Professor Mark Enright, an infections expert at Imperial College London, said: "I can understand why the government focused on the infections it has, but now we are getting to grips with those it is time to look elsewhere.

"There are some strains of infections, such as E. coli, where we are seeing increasing levels of antibiotic resistance and that is concerning."

Nigel Edwards, of the NHS Confederation, which represents trusts, agreed it was time to review other infections.

But he added: "We would want to know the balance of costs and benefits from additional surveillance."

Katherine Murphy, director of the Patients Association, said: "This target culture is just like squeezing a balloon - if you squeeze one end it will bulge out at the other.

"But the problem for patients is that the balloon stays the same size. The problem of patient safety will stay the same huge size as long as it is regarded as an optional extra by some."

From:
http://news.bbc.co.uk/1/hi/health/8351269.stm

Five die in hospital superbug outbreak

An outbreak of the Clostridium difficile (C. diff) superbug has killed two hospital patients and contributed to the deaths of three more.

The patients were among a total of eight elderly people who contracted the infection at Ninewells Hospital in Dundee over an 18 day period.

All of those affected had been in the hospital's ward 31, which generally cares for geriatric patients.

Seven of the patients had contracted the more dangerous 027 strain.

NHS Tayside said it carried out regular testing in order to detect C. diff outbreaks early.

Dr Gabby Phillips, lead infection control doctor for Ninewells Hospital, said the ward remained closed to new admissions.

The hospital has been dealing with the outbreak since September, over a 10 week period.

The deaths occurred between 19 October and 6 November.

'Appropriate measures'

Dr Phillips added: "We have comprehensive infection monitoring procedures throughout our hospitals and these are able to rapidly identify any emerging trends of infection which then trigger a rapid response from our infection control teams.

"These cases of C. diff infection were detected very early which meant we were then able to identify the 027 strain rapidly and reinforce all appropriate infection control measures.

She added that the hospital had sought external advice over its policies and procedures, and had been "reassured that our surveillance systems are robust".

From:
http://news.bbc.co.uk/1/hi/scotland/tayside_and_central/8352612.stm