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

Bliar ally says Tories are best for NHS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

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

Whistleblower who criticised NHS cost cutting wins damages

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Hospitals use ploys to beat 4 hour deadline on A&E waiting times targets

More than five per cent of emergency patients are being admitted to wards to help hospitals hit waiting time targets.

Patients are being admitted to hospital to avoid breaching a labour Government target on waiting times, NHS figures suggest.

More than one in twenty patients attending hospital in an emergency are being admitted to wards just minutes before the maximum four hour wait.

Health unions have complained that staff are being “pressured” into manipulating data and admitting patients unnecessarily to meet the target, which aims to treat or discharge all accident and emergency (A&E) patients within four hours.

Figures from the NHS Information Centre show that almost all patients in England are seen within the four hour deadline, but there is a peak in the number of people admitted to a ward with just ten minutes to spare. Two-thirds of those treated as the deadline approaches are admitted to hospital, compared to just over one in five patients coming from A&E overall.

It is the first time such analysis has been done and the statistics are categorised as “experimental”.

The Royal College of Nursing warned that the four hour target meant some nurses were “pushed into practices” that were risky for patients.

It said that there were “negative consequences” for patient care, especially those needing treatment in A&E wards, but not necessarily requiring an overnight stay.

A survey of its members found that nine out of ten accident and emergency nurses claimed they had been unduly pressured to meet the four hour target.

Mark Porter, chairman of the British Medical Association’s consultants’ committee, said that the admission rates were worrying.

“This suggests that when patients have been waiting close to four hours, there is a rush to discharge or admit them so that the hospital meets the four-hour target,” he said.

“Patients must always be treated on the basis of their clinical need, not simply because they have been waiting close to four hours.”

Katherine Murphy, director of the Patients Association, agreed that the right patients are not always made a priority under the target.

“This results in doctors making rushed decisions at three hours and 50 minutes, with patients having to be admitted inappropriately at huge cost to the NHS,” she said. “We have heard instances of ambulance drivers being forced to wait outside A&E with seriously ill patients, until staff have cleared a backlog of people who need to be seen within the four hour target.

“It is unfair to make NHS staff feel like they have to put meeting this target ahead of what’s in the best interests of patients.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article6921466.ece

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

Postcode lottery for IVF treatment faced by patients

Couples seeking IVF infertility treatment in some parts of Scotland are having to wait up to three years longer than those in other areas, it was revealed.

Labour MSP Jackie Baillie called on the Scottish government to end what she described as a postcode lottery on IVF treatment.

Figures obtained by the MSP under a freedom of information request showed that the longest average waiting times among the 11 boards that responded were in NHS Lothian, where patients wait three years for treatment. Patients in the Borders, referred to the same unit in NHS Lothian, had no waiting time.

In Glasgow the average wait was 22 months, while couples from Lanarkshire were referred to the same hospital, Glasgow Royal Infirmary, within an average of six months.

In Fife the average wait for IVF treatment was two years. In NHS Highland and Tayside it was one year, and in Grampian a maximum of 18 months.

“This shows clearly that it is the board of residence that determines length of wait,” Ms Baillie said. “There is no consistency in the rules. NHS Borders will fund patients for treatment in neighbouring areas if they have shorter waiting lists, but other health boards refuse to consider such a sensible step.”

Although some boards, notably NHS Greater Glasgow and Clyde, did not reveal the number of patients, Ms Baillie’s figures indicate that more than 1,000 couples across Scotland are waiting to see a specialist.

Long waiting times have a particular resonance for inferitlity treatment, as a woman’s age is critical to success rates. One expert describes the age factor as “the most monumental challenge”.

Ms Baillie said national guidelines were needed to ensure that patients were treated fairly and had access to treatment as quickly as possible.

Shona Robison, the Public Health Minister said: “There is huge demand for IVF and we know it can be very upsetting to have to wait for treatment, but we are working to make access as fair as possible.”

Jackie Sansbury, of NHS Lothian, said: “We are investing an additional £180,000 to increase the number of IVF cycles we are able to offer by about 40 per cent during 2009-2010.”

From:

http://www.timesonline.co.uk/tol/news/uk/scotland/article6883053.ece

False waiting time figures probed

A hospital has apologised and launched an inquiry after hundreds of patients' records were altered to suggest NHS waiting time targets were met.

Records were changed to claim patients were treated within four hours at the Queen's Medical Centre, Nottingham.

A review found 765 records were amended between March and September.

The hospital previously said it met government targets of treating 98% of patients within four hours, but the review shows in reality it did not.

The actual figure is 97.4% rather than the published figure of 98.3%, which was based on the altered records.

'Small number'

Officials are now looking back even further to see whether records from other periods were altered.

Dr Peter Homa, chief executive of Nottingham University Hospitals NHS Trust, said: "The scale of the problem relating to the inaccurate reporting of breach numbers remains unclear at this stage.

"However our initial review, which was initiated on Friday when this first came to our notice, indicates this involves a small number of patients.

"We would like to reassure our patients and the public that this has not in any way affected the standard of care our patients have received at our hospital.

From:

http://news.bbc.co.uk/1/hi/england/nottinghamshire/8307100.stm

Couples are still being refused IVF treatment in a postcode lottery

Couples are still facing problems getting IVF treatment on the NHS, with some trusts refusing to fund procedures or comply with guidelines, such as a woman’s age.

Regional disparities mean that the same woman can be too old for treatment in one part of the country and too young in another. Two trusts have provided no IVF treatment in the previous two years.

Research suggests that eight out of ten primary care trusts are still failing to follow government recommendations set out in 2004 by the National Institute for Curbing Expenditure (NICE), allowing women three free cycles of IVF.

Other eligibility criteria, such as whether one of the couple has a child from a previous relationship, smoking habits and weight, also vary widely, the study shows.

The study, by Grant Shapps, the Conservative MP for Welwyn Hatfield, who has campaigned for better access to fertility treatment, was based on an 80 per cent response rate from trusts in England. It found that provision was worse than two years ago.

In the East Midlands, every trust offered one full cycle of treatment but, in the South East, 41 per cent did not offer IVF to women aged 23 to 39, as set out in the NICE guidance. Some trusts, such as North Lincolnshire, offered IVF only to women between 37 and 39, whereas at least four trusts have an upper age limit of 37. One in eight was failing to comply with guidelines on a woman’s age.

In the East Midlands, no trust would offer treatment to couples in which one partner had a child but 70 per cent would in the North East. Overall, 54 per cent of trusts excluded couples from IVF if one partner had a child from a previous relationship.

Almost half of all trusts said that they wanted couples to have been in a relationship for more than three years. Others wanted one or two years while some asked only if the relationship was “stable”. While many trusts refused IVF to couples who smoked, some allowed treatment if the man was the smoker.

The 2004 NICE guidance said that the NHS should fund three cycles of IVF for women under 40. John Reid, then the Health Secretary, said that couples would be offered one free IVF cycle by April 2005, with a view to three cycles being offered in the future.

By 2007 this was still not happening. Dawn Primarolo, the Health Minister, wrote to trusts in that year saying that they should be looking to fund three cycles.

Experts have said that the drive to cut the number of multiple births is also being hampered by the lack of access to free IVF. Couples who have the chance of only one cycle on the NHS might wish to have more than one embryo transferred.

The NICE guidance also said that trusts should allow frozen embryos to be transferred as part of one cycle. But very few offered this.

Mr Shapps said that the study, compiled from freedom of information requests, showed that IVF “remains a postcode lottery in this country”. He added: “Budgets are tight and the NHS must set its priorities, but it is wrong to raise expectations in couples who are desperate to start a family only for them to find out later that they won’t get the real help they expected.”

Clare Lewis-Jones, chief executive of the charity Infertility Network UK, said that although there had been an improvement recently in the provision of treatment by some trusts there remained a totally unjustifiable and unfair variation in the criteria used to determine whether couples could have treatment. “This proves that five years on from the issue of the NICE guideline, patients are still facing a postcode lottery when it comes to accessing NHS fertility treatment.”

She urged trusts to accept recommendations laid down in a document, Standardising Access Criteria to NHS Fertility Treatment, produced by Infertility Network UK and funded by the Department of Health.
 

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6740622.ece

Patients with suspected cancer forced to wait so NHS targets can be hit

Patients rushed to hospital with suspected cancer are having their treatment delayed so that managers can meet labour Government targets, an NHS investigation has found.

People arriving at Accident and Emergency departments with symptoms which could indicate the aggressive spread of the disease are waiting weeks for diagnosis and treatment while “routine” cases are prioritised.

Hospital managers told researchers that treating desperately sick patients more quickly would “reflect badly” on their performance against Government cancer targets which only cover those referred to specialists by GPs.

Doctors, patients groups and politicians were appalled by what one described as a “breathtaking admission” which confirmed their “very worst fears” about how far the NHS target culture has gone in distorting clinical priorities.

Although most people with suspected cancer are referred to hospitals by their GPs, more than 30,000 people diagnosed with the disease each year are first alerted to tumours by violent symptoms, such as seizures, vomiting and jaundice, which cause such alarm that patients go straight to their local A&E departments.

The report by the NHS Institute for Innovation and Improvement, an official health service agency which issues advice to hospital managers, says that many of these emergency patients waited six weeks or longer for basic tests.

It said they were “often” not given the same priority as patients who had been referred by GPs, who were covered by two targets, ensuring that they see a specialist within two weeks, and start treatment, following diagnostic tests, within two months.

“As a result, they can end up with a very poor experience before finally receiving a diagnosis and the right care,” it warns.

The report, added: “Many trusts recognised the need to get some patients in this group onto the same pathway as people on the cancer two week wait [target] but were concerned this would reflect badly on their cancer figures”.

Some A&E departments failed to recognise the risk of cancer in seriously ill patients. In cases where the disease was suspected, patients were sent home to wait six weeks or longer for diagnostic tests. Others waited weeks on wards before seeing a specialist or having scans, the report, which is endorsed by the Government’s cancer tsar, found.

Nigel Beasley, the NHS Institute’s lead for cancer, and head and neck surgeon from Nottingham University Hospitals said: “Targets are very effective, but they do have side-effects. The risk is that these patients are not being prioritised because of the focus on the two-week target for patients referred by GPs.”

Mr Beasley said: “Patients can be stuck in hospital for a long time, waiting for scans, and other diagnostic tests. Once they are in hospital, they can end up waiting two, three, or even four weeks before there is a diagnosis and any decision to treat.”

The admission about the effect Government targets were having on emergency cancer patients horrified clinicians and patients groups.

Shadow health secretary Andrew Lansley described it as “one of the clearest examples yet of how Labour’s tick-box targets are failing NHS patients”.

He said decisions about which patients should be seen first must be taken by doctors, based on the patient’s clinical needs, not by managers following Government diktats.

Katherine Murphy, from the Patients Association, said the report provided “breathtaking” evidence of a confidence trick being played on the public, repeatedly told that waiting times for patients with suspected cancer are falling, while desperate cases were forced to the back of the queue.

She said: “This confirms our very worst fears, and exposes the scandal of what pernicious targets are doing to patients. We have seen other targets being used in ways that damage patient care, but of everything we have seen, this really is the cruellest of the cruel”.

Leading cancer specialist Prof Karol Sikora said: “I think it is absolutely horrifying that hospital managers are playing around with targets that can delay treatment for people who may well be at an advanced stage of the disease.”

“I know of many cases where people who have been admitted to NHS hospitals as an emergency have languished for weeks before even seeing an oncologist,” added Prof Sikora, Medical Director of independent company CancerPartnersUK.

The British Medical Association said many trusts were bullying doctors into delaying urgent referrals.

Dr Jonathan Fielden, chairman of the BMA’s consultants committee, said: “A number of our members have already expressed fears about the two-week cancer target, because it means all the cases referred by GPs are given the same priority, regardless of whether they are expected to be benign or high risk. When this same target is delaying patients who have been admitted as an emergency that is an even greater cause for concern”.

Several oncologists said they supported two-week waiting time targets for cancer patients referred by GPs, but called for the target to be widened to include all patients.

Ian Beaumont, from charity Bowel Cancer UK said it “beggared belief” that anyone would value statistics over efforts to save lives.

Dr Jane Maher, chief medial officer at Macmillan Cancer Relief described the revelation in the report as worrying, but said the biggest obstacle to getting the right care for patients admitted to hospitals as an emergency was getting the right diagnosis, as cases were often complex, meaning cancer could be mistaken for other conditions.

From:
Patients-with-suspected-cancer-forced-to-wait-so-NHS-targets-can-be-hit.html

Health Secretary Andy Burnham promises NHS targets massacre

The target culture that has driven NHS reforms over the past dozen years will be dismantled in a “deep clean” that removes alienating bureaucracy, the Health Secretary pronounced.

Giving his first speech since taking office, Andy Burnham said that while the challenges faced by the NHS were substantial, the opportunities to streamline reforms and focus on the prevention of ill health could bring savings.

He added that he would reward the best primary care trusts with even greater control over how they operated, and a “lighter touch performance management”.

Mr Burnham, who was speaking at the NHS Confederation’s annual conference, said he could not make pledges on future spending or budget cuts, but insisted that he would not cut back on agreed funding programmes.

His statement followed revelations in The Times of Government advisers withholding money from a £750 million programme set aside for the building and refurbishment of community hospitals.

A letter sent between health chiefs highlights a Department of Health strategy to divert health authorities away from the programme - which still has £500m to spend - because “the Treasury is unlikely to agree further releases of funding”.

Mr Burnham again sought to allay fears of substantial cuts after a report from the NHS Confederation warned of a multibillion-pound budget shortfall over the next decade. The report, published yesterday, prompted angry exchanges in the Commons as Gordon Brown accused the Tories of planning deep cuts in public services to allow for real-terms increases in health spending.

Mr Burnham refused to say if a Labour Government would allow real-terms growth, saying that he “could not pre-empt Treasury decisions”. But he added that the NHS would improve from stripping away unhelpful targets and concentrating on preventive public health measures.

“I want to deep clean the target regime,” he said.

“Targets have their time and place but where they have served their purpose and they are subsidiary to wider objectives, they should now be removed. And believe me I will do that.”

Mr Burnham said that core targets - such as the 4-hour waiting time target in A&E and the 18-week target from GP referral to treatment - would remain in place as “minimum standards”, but others which had served their purpose and now “alienated people” would be up for review. He said that targets surrounding inpatient waiting times - which include a 13-week target from decision to operate to hospital admission - might be expected to be removed.

“I think there’s scope really now to take away stuff that does not need to be there any more,” he said.

The Health Secretary said that “prevention” needed to be added to the bywords of “quality, innovation and productivity”, adding that smoking, drinking and obesity related admissions to hospital accounted for £10 billion of NHS costs per annum.

“We have, at times, possibly been too timid on public health. Health trusts should not feel they have to wait for permission to invest in prevention. If we believe in investing in people’s health we should go on and do it.

“The Department of Health is in a position of great health,” he added. “There are challenges ahead, as always, but let’s not talk ourselves into a crisis. This is a moment of opportunity not threat.”

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6479588.ece

Many hospital bugs neglected by MRSA targets

The NHS in England is neglecting the threat from many healthcare acquired infections not covered by labour government targets, a watchdog has warned. Efforts to tackle MRSA and Clostridium difficile have been a success, but they account for only about 15% of cases, the National Audit Office said.

Pneumonia and urinary tract infections are among those which deserve more attention, its report said.

The Care Quality Commission said they would "keep up the pressure" on trusts.

Two previous reports from the NAO have played a big role in highlighting the problem of healthcare-associated infections in the NHS.

It led to targets to reduce rates of MRSA and C. difficile - a pressure which has successfully cut those infections.

But they account for only a small proportion of the one in 12 patients admitted to hospital who end up with an infection they did not have before.

Urinary tract infections, largely associated with the use of catheters, are responsible for 20% of these.

Other bloodstream infections with bacteria such as E. coli are also important, the NAO said, and limited data suggests they are on the rise.

Compulsory monitoring of healthcare-associated infections should be widened to cover far more infections and checks should be done to ensure that antibiotics are being used effectively, it concluded.

Karen Taylor, report author, said MRSA and C. difficile rates started to come down only once targets were imposed, although local goals may be more appropriate for other infections.

"It's looking better for MRSA and C. difficile, which have been subject to targets, but the main focus of our report is they only account for about 15% of healthcare associated infections in hospitals and in the rest of the infections there's very poor data.

"Some of the bloodstream infections are just as significant on the impact on the patient."

The report also found that government funding for tackling infections had saved the NHS money overall.

It added that the controversial "deep clean" programme had boosted staff and patient confidence - but it was impossible to measure what effect it had had on the number of infections as other strategies were being implemented at the same time.

HOSPITAL INFECTION BREAKDOWN
Urinary tract infections - 20%
Lower respiratory tract infections - 20%
Gastrointestinal infections - 22%
Surgical site infections - 14%
Bloodstream infections - 7%
Skin and soft tissue infections - 10%

However, even with MRSA and C. difficile there was variation, with 12% of trusts reporting an MRSA infection.

Amyas Morse, head of the NAO, said that in 2004 the problem with MRSA and C. difficile had seemed to be "an intractable problem" and hitting the targets was a "significant achievement".

"Inevitably, with a focused and centrally driven initiative of this kind, the improvements are not uniform across the NHS and we still don't know in any meaningful way what impact there has been on other healthcare-associated infections."

Health minister Ann Keen said: "We remain totally committed to eliminating all preventable healthcare-associated infections.

"As a nurse myself, I am especially pleased to see that the National Audit Office has recognised the contribution that nurses and the reintroduction of matrons onto our wards have had in delivering the reductions in MRSA and C. difficile infections."

From:
http://news.bbc.co.uk/1/hi/health/8095074.stm

Junior doctors asked to lie about working hours to meet red tape targets

Misleading data is being submitted to comply with a directive that restricts junior doctors' hours to 48 a week to meet eu targets.

Junior doctors are being asked to lie about their working hours to meet new European rules, research suggests.

A survey of 31,360 junior doctors who comply with new limits on their working week found that one in 10 had actually worked longer hours, with some asked to submit different data.

Of the 3,938 junior doctors who said in the survey by the Health Service Journal (HSJ) that their hours were not compliant, 17% said they had been asked to submit hours that showed they were in line with the new rules.

The new European Working Time Directive (EWTD), which fully comes into force on 1 August, limits the number of hours that junior doctors can work each week to 48.

Richard Marks, a consultant who is also head of policy at the campaign group Remedy UK, said the findings were interesting and should not be ignored.

But he said his own experience of talking to junior doctors had revealed that many wanted to work more than 48 hours, to ensure good patient care and maximise their training.

He said: "I've been asking lots of trainees about this question. It's true that they are being economical with the truth but it's because they think reduced hours, in line with the EWTD, is bad for patient care and it's also bad for their training.

"They want things to stay as they are – they want good training and exposure."

The Liberal Democrat health spokesman, Norman Lamb, said: "This demonstrates just how ludicrous the imposition of these rules are on the NHS.

"Doctors have been warning for months about the chaos that will happen in the summer when the rules are applied.

"The labour government must take its head out of the sand and recognise the damage that will be done to patient care if it insists on imposing these working hour restrictions. It is vital that we don't see another repeat of the farce that engulfed the recruitment of junior doctors two years ago."

From:
http://www.guardian.co.uk/society/2009/may/28/junior-doctors-working-hours

Hospital managers worry after Mid Staffs failures

Around half of hospital managers and other staff believe elements of poor standards found at Mid Staffordshire foundation trust exist at their own organisation, a straw poll by HSJ suggests.

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

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

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

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

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

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

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

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

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

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

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

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

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

NHS governance 'reduced to paper chase' - Audit Commission

Many NHS trust board members cannot be sure whether or not their hospital is operating within the law, the Audit Commission has found.

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

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

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

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

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

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

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

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

NHS trust's emergency care 'appalling', say reports

Poorly handled reorganisations, a failure to take patient complaints seriously, a "closed culture" and a "hugely disappointing" failure to blow the whistle lay behind "appalling" standards of emergency care at Mid-Staffordshire NHS Trust, two reports said last week. Health Direct will this week examine the fallout from the preventable deaths.

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

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

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

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

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

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

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

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

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

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

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

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

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

Health Direct is pleased with Alan Johnson's U turn on asking the "difficult questions" about hospital standards.

However, it was only a month ago that his department dropped the common sense requirement:
Labour stops asking the uncomfortable question- is your hospital OK?

Tue, 14 Apr, 2009- National Health Service staff are no longer being asked whether they would be happy to be treated in their own hospitals, because the answers don't match labour's spin.

Bullying- the corrosive problem the NHS must address

Sir Ian Kennedy’s parting shots and last month’s staff survey both warn of a culture of bullying in the NHS. The HSJ analyses where and why the bullies are found.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NHS patients must have more input on services

NHS organisations are still not giving patients enough say on health services.

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

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

The report says: "Few trusts could demonstrate that people's views routinely influence their decision making."

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cure the NHS with far fewer managers- Sir Gerry Robinson

Recent crises in patient care stem from excessive bureaucracy and poor quality leadership, argues Sir Gerry Robinson.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Plans to safeguard NHS patients' lives

Health Direct reproduces the Conservatives and the Telegraph's plans to safeguard patients' lives in the face of labour's NHS targets and red tape.

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

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

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

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

The Telegraph suggests:

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

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Poll reveals public distrust of NHS governance

As Health Direct posts that the majority of British voters want an independent inquiry into the supervision of NHS hospitals today- over the rest of the week we will examine the chronic state of paperpushing, targets fixation and waste under labour's maladministration.

An opinion poll by ICM Research found that 78 per cent of the public back our call, in conjunction with the Patients Association, for an independent inquiry into the supervision of NHS hospitals.

It comes as The Sunday Telegraph's Heal Our Hospitals campaign has attracted pledges of support from more than 1,000 readers.

The call has been backed by Dr Phil Hammond, the writer and broadcaster, and by MPs from all three main parties.

Norman Lamb, the Liberal Democrat health spokesman, said "An independent inquiry is needed so that we can learn the lessons from this scandal."

Nine out of 10 people per cent agree that nurses should focus on patient care rather than form filling, while eight out of 10 per cent want a review of hospital targets to ensure they work to improve quality of care.

Stafford's former chief executive Martin Yeates was suspended on full pay following the scandal and could receive a generous pay off.

The poll also found that two-thirds of people want a stronger voice for patients in the running of their hospitals, following claims that local NHS watchdogs lack the power to hold chiefs to account.

Six out of ten per cent back the routine publication of comprehensive mortality rates.

It can also be revealed that Stafford Hospital is unable to give stroke patients and pregnant women vital scans over the week-end because of a shortage of qualified staff.

Patients presenting with a stroke on a Friday evening have had to wait 48 hours for a scan, thereby reducing their chance of a full recovery. Women suspected of suffering from potentially life-threatening ectopic pregnancies face similar delays.

In a blow to Labour the ICM poll found opinion evenly split on which party could be most trusted to run the health service.

The labour Government and the Tories polled 35 per cent each, despite Labour having long been regarded by voters as the party of the NHS.

One NHS campaign group warned that a repetition of the Stafford scandal was "absolutely inevitable".

Geoff Martin, head of campaigns at the Health Emergency pressure group, said: "NHS Trusts are run as managerial fiefdom."

From:
http://www.telegraph.co.uk/health/heal-our-hospitals/Poll-reveals-public-distrust-of-NHS

Ten NHS trusts have worse death rates than shocking Mid Staffordshire

Ten health trusts have worse death rates than the hospital where at least 400 patients died needlessly because of “shocking and appalling” standards of care.

A damning watchdog report detailed a catalogue of failings at Mid Staffordshire NHS Foundation Trust, including dehydrated patients being forced to drink out of flower vases while others were left in soiled linen on filthy wards.

The scandal of poor care at Mid Staffordshire was only uncovered when unusually high death rates at the hospital triggered secret NHS alerts.

The Healthcare Commission has not investigated any of the 10 trusts that currently have worse scores than Mid Staffordshire, and the Care Quality Commission, which takes over from the Commission this week, has no plans to do so either.

Campaign groups and leading experts last night called for the trusts to be investigated. Professor Sir Brian Jarman, a former member of an inquiry into the deaths of heart patients at Bristol Royal Infirmary and an expert on Hospital Standardised Mortality Ratios (HSMRs), said routine investigations of high death rates could "undoubtedly" save thousands of lives every year.

Warning that some trusts were reluctant to admit failures because of a "blame and shame" culture within the NHS, he said: "Of course the regulator should be looking into these trusts, and others with high scores.

"It is important to work with these trusts to identify any possible failures and work towards improvements."

The Sunday Telegraph's Heal Our Hospitals campaign is calling for mortality rates to be published widely and in more detail.

Figures from Dr Foster, the independent health information firm, show that at the height of its problems, in 2007, Mid Staffordshire's hospitals had the fourth highest rate of unexpected deaths in Britain.

The Trust had an HSMR of 127, meaning that 27 per cent more patients died than might be expected.

When the most recent annual figures were compiled last November, Mid Staffordshire's HSMR score had fallen to 116.

By contrast, the worst death rate was at Basildon and Thurrock University Hospitals NHS Foundation Trust, in Essex, with a score of 132.

A spokeswoman for the Basildon trust said it had responded quickly to the finding by employing more doctors and creating a dedicated ward for cancer patients.

The second worst mortality rate, of 126, was at Wrightington, Wigan and Leigh NHS Trust, in north-west England, which has now launched an action plan to tackle the problem, including moves to treat more patients on specialist wards.

Andrew Foster, chief executive of the Wrightington trust, said: "We recognised what the figures were telling us and we are delighted with the progress we have made in reducing our HSMR and to have a sustained improved performance which we intend to continue."

The other eight trusts whose mortality rates are worse than Mid Staffordshire – based on the most recent annual data from Dr Foster – are Blackpool, Fylde and Were Hospitals (123), George Eliot Hospital, Nuneaton (120), Swindon and Marlborough (120), North Middlesex University Hospital (119), Bolton Hospitals (118), Queen Mary’s Sidcup (117), Tameside Hospital (117) and Mid Cheshire Hospitals (117).

Since the data was prepared, Swindon and Marlborough has been renamed Great Western Hospitals NHS Foundation Trust and Bolton Hospital has been renamed Royal Bolton Hospital NHS Foundation Trust.

Health trusts are not obliged to investigate or act on their own HSMR scores, and many choose instead to dismiss high scores as statistical anomalies. All of the trusts contacted by the Sunday Telegraph insisted they had made improvements in the standards of care.

Campaigners warned that the scandal of Mid Staffordshire could be repeated unless high HSMRs were examined as a matter of course.

A spokesman for the Patients Association said: "We are amazed that trusts could have these high mortality rates and yet not automatically face any action. HSMRs are a blunt instrument but even a simple follow-up might uncover wider problems."

Geoff Martin, of the Health Emergency campaign group, said: "There should be an investigation into these trusts and others with high mortality rates and the rates should be a matter of clear public record."

Ben Bridgewater, a leading consultant cardiac surgeon and an expert on mortality rates at the Royal College of Surgeons, said: "You might look at 10 hospitals and find nine of them are actually doing a good job, but you would at least find the one that wasn't, and that is surely the point of regulation.

"It is hardly ever the case that high mortality rates do not indicate hospitals where patient care could be improved. Publication of mortality rates was one of the recommendations of the Professor Ian Kennedy inquiry into death rates at Bristol back in 2001, and it hasn't been achieved for reasons I don't understand. This information is known within the NHS but hard for patients to find."

Cardiac surgeons already have their individual mortality rates published but this is not the case for other treatments.

Ben Bradshaw, the health minister, hinted that the labour Government was reconsidering, saying: "I have asked the medical director to review available measures that can be used by trust boards and to accelerate their publication on NHS Choices."

Professor Sir Bruce Keogh, medical director of the NHS, ruled out investigation of the 10 trusts with high HSMRs but said: "It would be irresponsible of trust boards not to investigate high mortality ratios.

"The HSMR is an aggregate measure of mortality for the organisation and hence a rather blunt, but useful, indicator of trouble."

The Health care Commission launched its investigation into Mid Staffordshire after receiving seven alerts about potentially serious failures of care between July and November 2007.

The alerts, based on mortality for particular conditions such as kidney failure or stroke, are sent to trusts and watchdogs but not made public.

They are compiled by experts at Imperial College, London, led by Professor Jarman, under a system introduced in May 2007.

The investigation found that Mid Staffordshire managers failed to act quickly enough because they were convinced the HSMRs were incorrect.

It called for trusts in future to "conduct objective and robust reviews of mortality rates and individual cases rather than assuming errors in data".

Professor Jarman added: "If HSMRs are acted upon promptly then undoubtedly thousands of deaths could be avoided. We are always open to hearing ways of improving the reliability of the figures, but for now high ratios are a solid indicator that something is going wrong."

Andrew Lansley, the shadow health secretary, said: "The public has a right to know the extent to which patients benefit from treatment in each hospital, patients' views on the standard of care they receive as well as the views of staff about how good a service the hospital provides."

A spokeswoman for the Healthcare Commission said it did not agree that all high HSMR scores should be investigated. She said: "We would expect a trust that had a high HSMR to already have a sense of why that would be.

"It is not a matter of 'forcing' them – good managers generally have a sense of why their death rates are what they are. There are many reasons why a trust's mortality rates may be high – that is why we do not use them in our annual ratings of performance."

From:
http://www.telegraph.co.uk/Ten-NHS-trusts-have-worse-death-rates-than-shocking-Mid-Staffordshire