Patients' medical records go online without consent

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

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

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

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

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

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

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

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

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

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

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

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

in NHS IT will be further eroded."

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

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

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

and addresses are also included.

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

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

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

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

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

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

From:

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

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

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

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

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

and send it of NOW!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Free elderly care expansion promises spark row over affordability

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Ban on hospital flowers over MRSA fears are wrong

Many hospitals have banned fresh flowers on wards amid concern that they could harbour potentially harmful bacteria or pose a health and safety risk like MRSA and superbugs.

But new research and a survey among staff and patients at the Royal Brompton Hospital and the Chelsea & Westminster Hospital, both in London, found there is little evidence to support some of the concerns around the presence of blooms on wards.

In a study by Giskin Day and Naiome Carter of Imperial College London, and published in bmj.com, it was even claimed flowers could help improve a patient's health and recovery.

One of the reasons given to support the ban was that flower water contained high levels of bacteria, but subsequent research has found no evidence to suggest that it has ever caused a hospital acquired infection.

Southend University Hospital recently imposed a ban on flowers on the grounds that they posed a health and safety risk around high tech medical equipment.

But the report argues that flower vases are no more risky than having crockery containing drinks or food around bedsides.

Interviews with staff in this study however found that nurses were generally more concerned about the practical implications of managing flowers than risks of infection.

Other studies report that flowers have immediate and long term beneficial effects on emotional reactions, mood, social behaviours, and memory for men and women alike.

One trial found that patients in hospital rooms with plants and flowers had reduced systolic blood pressure and heart rate; lower ratings of pain, anxiety, and fatigue; and had more positive feelings.

The authors of the report said given that flowers and herbs have been used as remedies in the earliest hospitals, and as a means of cheering up the hospital environment for at least 200 years, it seems remarkable that flowers still tend to be treated in an ad hoc fashion in hospitals.

Although flowers undoubtedly can be a time consuming nuisance, the giving and receiving of flowers is a culturally important transaction, the report concludes.

In an accompanying editorial, Simon Cohn, a medical anthropologist at Cambridge University argues that flowers have fallen victim to new definitions of care.

Describing the decision to ban flowers, he said: “[The decision] seems to reflect a much broader shift towards a model of care that has little time or place for more messy and nebulous elements.”

Katherine Murphy, director of the Patients Association, said: "Most patients love flowers. The job of nurses is to be the patient's advocate and carer. Surely it is not beyond management capabilities in a trust to ensure that the needs of patients and staff are accommodated.

"If flowers on wards pose such a problem, it's no wonder that critical patient safety issues appear to be insoluble."

Flowers are just one of the items to have fallen foul of strict hospital health and safety regulations.

Mobile phones have long been forbidden on many hospital wards, even though a government report in 2007 said there was no justification for a blanket ban.

Doctors were banned from wearing watches and jewellery last year because of fears that they were an infection hazard.

An NHS Trust in Sheffield also banned nurses from wearing Crocs shoes at work, as the static electricity they generated could disable hospital equipment.

Perhaps the strangest ban, though, was at the Fazakerly Hopsital in Liverpool, where the controversial ITV television programme The Jeremy Kyle Show has been banned after complaints that it was upsetting patients. Well you win some, you lose some.

From:

http://www.telegraph.co.uk/health/healthnews/6824574/Hospital-flowers-not-harmful-report-claims.html

Website for patient waiting times virtually useless

Patients are being given out of date information by a flagship government scheme designed to reduce waiting times for hospital treatment.

The new website www.isdscotland.org/ — unveiled by Malcolm Chisholm, the health minister, was meant to allow patients to choose a clinic with the shortest waiting time but contains information that is up to nine months old.

The leader of Scotland’s GPs condemned the figures as “virtually useless” and patients’ groups described the initiative as “flawed”.

The database should provide the latest waiting times for first outpatient appointments at 3,030 clinics across Scotland. Until now the information had been available only to GPs.

Speaking at the website’s launch, Chisholm said: “This database is good news for patients and will support patient choice.”

However, detailed examination of the information has revealed that waiting times for more than 260 clinics are at least three months out of date.

The figures for outpatient clinics across Fife were last updated at the beginning of July. In Lanarkshire and Glasgow waiting times for more than 100 clinics dated back to February. Two clinics in Lanarkshire even listed waiting times for January. And most hospital waiting times were for early October.

Dr David Love, joint chairman of the British Medical Association’s Scottish GP’s committee, said information dating back several months was “virtually useless”.

He said: “It is a good idea and could be quite useful if patients do their homework before coming to the GP, but the whole thing hinges on the information being accurate. If it is not, it could create more work.”

Margaret Davidson, chief executive of the Scotland Patients’ Association, added: “This website is flawed. The figures have to be up to date for them to be any use.

“Questions also have to be asked as to whether patients will be treated at the hospitals they choose. I don’t think they will.”

Dr Ian Johnston, a member of the local GPs’ committee in East Lothian and a family doctor in Musselburgh, said waiting times should be no more than six weeks old if they were to be of any use. “There is no point in having something on a website that was done in February,” he added.

The launch of the website has been used by opposition politicians to highlight long waiting times of up to 2½ years. According to the target set by the executive, by the end of 2005 nobody should have to wait more than six months for a first outpatient appointment.

A spokeswoman for the executive said the Information and Statistics Division (ISD) of the NHS was responsible for the website. She added that most of the waiting times were up to date.

The ISD admitted that it had decided to launch the website even though some data was many months old. A spokesman said the out-of-date waiting times were the result of old data collection systems which were being modernised.

From;

http://www.timesonline.co.uk/tol/news/uk/scotland/article1006886.ece

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

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

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

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

Swine flu could lead to rise in MRSA

A second wave of swine flu hitting Britain could lead to a rise in MRSA infections, medics have warned.

The MRSA Working Group, together with National Concern for Healthcare Infection and the Patients Association, is calling for the early discharge of patients from hospital to try and prevent a rise in the killer superbug.

They said when hospital bed occupancy rates were high, MRSA infection rates increased.

The group has written to all NHS hospital staff, reminding them to review their policy for the early discharge of MRSA patients.

The also urge hospitals not to let increasing pressure on staff and rising bed occupancy rates during winter to reverse the good work they have done to date to reduce MRSA rates.

Department of Health research has shown that when a hospital's bed occupancy rate exceeds 90%, MRSA rates can be as much as 40% above average.

Dr Matthew Dryden, consultant microbiologist at the Royal Hampshire County Hospital and General Secretary of the British Society of Antimicrobial Chemotherapy, said: ''The NHS has been working really hard to plan for swine flu and ensure there will be enough hospital beds available for patients who need to be admitted.

''What we don't want to see is an increase in infections such as MRSA, which have been linked to high bed occupancy rates.

''A way to get around this is to support patients with infections to get out of hospital earlier with outpatient and home care and good antibiotic stewardship.''

The letter to hospitals outlines methods to help ensure sufficient critical care beds are available this winter through identifying MRSA patients and discharging them early. Studies have shown that providing IV treatment at home or switching eligible patients to oral antibiotics could free-up scarce hospital beds by enabling patients who are well enough to go home earlier.

''When faced with a difficult winter, it is vital that hospitals ensure sufficient beds are available,'' said Dr Dryden.

''Treating patients with infections such as MRSA at home can help by reducing their length of stay in hospital, freeing up much-needed beds and easing pressure on staff and resources.

''It also helps to improve a patient's quality of life.''

Katherine Murphy of The Patients Association, who co-signed the letter, said: ''There is a real risk that swine flu patients may block isolation beds resulting in patients with healthcare infections such as MRSA being treated on general wards.

''This coupled with a highly pressured and reduced workforce, could increase the risk of infections such as MRSA spreading to other vulnerable patients and throughout the hospital.''

Neil Manser, of the NCHI, added: ''Where possible and when it is clinically prudent, patients who have been infected or colonised with infections such as MRSA should be treated in the safety and comfort of their own homes.

''Only then can we be sure we are doing our best to effectively contain the spread of infectious diseases such as MRSA and prevent further infection of hospital patients during any winter bed crisis period.''

From:

http://www.telegraph.co.uk/Swine-flu-could-lead-to-rise-in-MRSA.html

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

Cancer sufferers face delay of weeks before receiving the test results in postal strike backlogs

Thousands of cancer sufferers will have to wait weeks for the results of diagnostic tests because of the likely national postal strike, patients’ groups said.
 

The news came as leaders of the Communication Workers Union met to discuss when to call the first national postage strike for two years. An announcement is now due on Tuesday, after talks went on all day.

The Patients’ Association also warned that many people would miss appointments with consultants because their appointment cards were likely to be caught up in the postal strike.

During the last national strike in 2007, 200 million items of post ended up in a mail mountain that took weeks to clear.

Michael Summers, vice chairman of the Patients’ Association, said the likely mail mountain caused by any strike would cause more anxiety and worry for anyone waiting for their GP to receive diagnostic tests for illnesses such as heart disease and cancer.

He told The Daily Telegraph: “It is worrying enough for patients, made much worse if they have to wait longer to receive the information. I hope the health service is alive to these problems.”

Mr Summers said that it would be better if the Department of Health allowed patients or GPs to receive the results of tests by email, or via a secure part of a website.

Asked about how hospitals would cope in the likely national postal strike, a spokesman for the Department of Health said that local health trusts would have their own contingency plans.

A spokesman said: “The local NHS should have contingency plans to cope with postal disruption.”

The Daily Telegraph understands that union leaders are considering proposals to hold a strike for 24 hours or 48 hours, followed by a series of rolling stoppages.

The rolling strikes, for 24 hours at a time, would hit mail centres, delivery offices and sorting offices on successive days, potentially paralysing the network for several days.

Sources described this strategy as the "nuclear option".

The CWU is legally bound to hold some form of strike action within 28 days of the result of last Thursday's ballot, at which CWU members voted by three to one to hold a national strike.

The union must give Royal Mail managers one week's notice of any strike action, which means that the stoppage could be held as soon as next week.

From:

http://www.telegraph.co.uk/Postal-strike-cancer-sufferers--face-delay-of-weeks-before-receiving-their-test-results

Health Direct thinks that it is ironic that labour's spin about new cancer targets is undermined by their own dithering and inability to make a decision. 

Does anyone remember the serial liar mandleson proclaiming in the summer that he would sort the mail's pension problem? Where is that lie now- in the gutter alongside millions of undelivered letters.

NHS mistakes are harming and killing thousands

More than 5,700 patients in England died or suffered serious harm due to errors ,latest figures for a six month period show.

The National Patient Safety Agency said there were 459,500 safety incidents from October 2008 to March 2009 - the highest rate since records began.

Patient accidents were the most common problem, followed by mistakes made during treatment and with medication.

Experts said the health service had to do more to eradicate errors.

The NPSA operates a voluntary reporting system whereby the onus is on hospitals, GPs and mental health units to record problems themselves.
   
It has meant that ever since the programme was launched in 2003 the number of mistakes being reported has been rising as more and more trusts join the scheme.

The last six months have been no different with the overall figure representing a 12% rise on the period before.

The NPSA now has 382 of the 392 trusts on board.

A breakdown of the latest figures show that in two thirds of cases - 303,016 - there was no harm to the patient, while a quarter - 122,246 result in low harm, which included minor injuries from things such as falls resulting from poor safety practices.

Another 28,521 - or 6% - resulted in moderate harm and 5,717 - 1% - in death or severe harm, which is classed as permanent injury or disability.

NPSA chief executive Martin Fletcher said the involvement of most trusts showed that the health service was willing to learn from its errors.

"This will help build an even stronger safety culture of reporting and learning to prevent harm to future patients."

Katherine Murphy, of the Patients Association, agreed the increasing involvement was encouraging. But she added some of the levels of mistakes being made were too high.

"Patients shouldn't have to face a postcode lottery on patient safety."

And Peter Walsh, of Action Against Medical Accidents, said the reporting of safety incidents should be made mandatory, adding: "Not to do so would be a travesty."

From:
http://news.bbc.co.uk/1/hi/health/8295417.stm

NHS dental crisis- can the rot be stopped?

New figures reveal over 40 per cent of the population has no NHS dentist. Can a new review finally fix the system once and for all?

Not that long ago we were queuing in the streets for an NHS dentist, with scenes of hundreds of patients camping overnight likened to the January sales. Now, new figures suggest that many of us have given up, and are paying for private treatment or simply going without care if we cannot afford it.

Data from the NHS Information Centre released last month shows that only 58.3 per cent of the population saw an NHS dentist in the two years ending March 2009, with the number of complex treatments, such as root canals and crowns, falling dramatically, by 40 and 50 per cent respectively, since 2004.

Ironically, the parlous state of NHS dentistry seems to have been exacerbated by the very attempt to overhaul it – labour's 2006 dental contract.

The new contract was intended to end the old "drill-and-fill" practice whereby dentists were paid for each treatment they carried out, so the more procedures they undertook the higher their earnings. The idea behind the new contract was to encourage dentists to spend more time on preventative work, teaching patients how to care for their own teeth, thereby reducing future treatment.

Dentists are now paid a fixed contract value for the amount of work they do each year. Work is measured in UDAs (units of dental activity). Dentists now essentially have "UDA targets" to meet each year. Under the new contract, their salaries have not been cut as they had been in the early Nineties, which led to an exodus to the private sector. 

Dentists are free to choose whether to provide NHS or private treatment, or a combination of the two. While many NHS dentists' basic pay is around £90,000 in large practices, but in areas where NHS practitioners are few and far between, they can make a lot more.

Around 400 practices earn up to £300,000 a year, shared among several dentists. Private dentists earn little more – one survey in 2005 by the Health and Social Care Information Centre estimated the gap at no more that £800 a year. Most claimed to have left the NHS due to the pressure of working harder for less money, with less time to spend on each patient.

Local Primary Care Trusts (PCTs) were given responsibility for providing dental care in their areas. It is they who employ dentists, and it means that managers can offer incentives to dentists to work in their area, and thus increase patient access, eradicating once and for all the problem of how to get on an NHS dentist's list.

But, despite these good intentions, the situation appears to have deteriorated further. According to figures from the NHS Information Centre, last year nearly 50 per cent of NHS dentists did not take on any new patients. In addition, 2,000 dentists have left the NHS since 2006. So what has gone so badly wrong?

The flaws are fundamental, says Liberal Democrat health spokesman Norman Lamb. "Many good dentists have become fed up with NHS bureaucracy, voted with their feet, and left the profession. So there is a danger that while not all the NHS dentists left are second rate by any means, we could end up with a two-tier profession."

Lamb believes that the financial disincentive to carry out complex work is so serious it threatens to "de-skill" the profession and that far from encouraging the public to look after their teeth, "there is no incentive for the dentist to do preventative work at all."

The public are not happy, says Dr Anthony Halperin of the Patient's Association."Simple procedures can end up costing the patient more than before, while there is no incentive for dentists to perform complex and time-consuming treatment. Most of all, the overwhelming public complaint is access."

The majority of dentists are unhappy, too. One complained: "If you take on a new patient who has not been to the dentist for a few years, they might need a lot of work, and you are effectively penalised for doing it. Under the new contract, whether a patient needs one filling or 10 fillings, the dentist gets paid the same."

Dr John Milne, chair of the British Dental Association, the professional association and trade union for dentists, adds that many complain that "the target-driven nature of the existing contract has made life difficult". If a PCT has set targets for the number of procedures it expects to be completed, many dentists are left with no time to teach their patients about hygiene.

So what is the answer? Professor Jimmy Steele, Head of the School of Dental Sciences at Newcastle University led the recent independent review of NHS dentistry, which has just published a set of recommendations aimed at redressing the problems of access and receiving appropriate treatment (for patients) and bureaucracy and pay (for dentists). It has been Prof Steele's unenviable task to pick apart the 2006 contract and put it back together, making it work at no extra cost to the taxpayer.

"The 2006 contract was intended to make fundamental changes in thinking. Dentistry had been pretty much unaltered since the birth of the NHS in 1948," he says. "The idea was that the PCT would be able to buy what they wanted on behalf of their patient, making better use of resources. Previously dentists had been able to move around to where they wanted there was no ability to fit services to local needs."

In effect, dentists could set up an NHS practice where they wanted to live, not necessarily where one was needed. "The idea of local commissioning is sensible," he adds. "Access problems should have been addressed in time."

The new contract also aimed to simplify payments. Previously, dentists billed the NHS centrally for any one of 400 different procedures. The more work they did, the more they got paid. "The new system, where contracts are paid on UDAs in three bands is probably too simple," says Prof Steele. "The payment bands are wide and differ depending on where the dentist is located, on their history, sometimes on their negotiating skills."

Dentists earn one UDA (worth between approximately £17 and £40) for a simple procedure such as a check-up, three UDAs (worth about £75 on average) for any number of fillings (in one appointment), or 12 UDAs (worth about £300) for crowns or dentures, in addition to any other treatment.

"The system is open to misuse," says Prof Steele. "It is possible to take one tooth out and make an impression for a denture and then charge 12 UDAs which is clearly not as complex or difficult as root canal work which pays only a quarter of the fee."

Incentives to take on new patients are not having the desired effect. Far from encouraging dentists to see more patients, it has become easier to make a living seeing existing patients more often. One of the biggest problems is taking time to put a mechanism in place for centrally collecting data, so it is difficult to know where and how the system isn't working.

So do we need to start again from scratch? Prof Steele thinks not: "When we carried out the review it became clear that access is improving, but there is a communication problem. The public didn't know how to find an NHS dentist. Meanwhile the PCT claimed that they were running plenty, and that all the public needed to do was ask. The public would then be saying, 'what's a PCT?' Better communication could sort that problem out easily."

Prof Steele is also recommending improvements in payment methods. "We need a blended contract, where a dentist is paid for every person on his list, and also for every treatment he carries out. We don't want people under-treated any more than over-treated. There also needs to be a reward for quality so we need to get data back into the system."

While Prof Steele approves of the scheme of local commissioning, Norman Lamb warns that PCT managers may not be ready. "We need to train them better, a lot of them are far too passive. You do get pockets of excellence but many don't have the skills they need."

Shake-ups, however worthy, cost money, and increased investment is unlikely. Dentistry is threatened by the spectre of financial cuts, as part of cuts in public services, regardless of who wins the next election.

So while the Patients Association has welcomed Prof Steele's review, Dr Halperin, a dental surgeon who does both NHS and private work in central London, says: "We are concerned that because of funding problems, once again there will be no real improvement in the dental contract and subsequently no improvement to the services for our patients."

The biggest challenge says Dr Milne, is to get all political parties to recognise the value of Prof Steele's report. "We need to embrace it; it is our best chance of providing a dental service of which we can all be proud."

Dr Milne is also optimistic: "The number of dentists in training is increasing, but we need to make the NHS an attractive place to work. And dentists who have left will only return if the NHS offers them the chance to treat their patients properly. Some might even be quite excited at the chance."

From:
http://www.telegraph.co.uk/health NHS-dental-crisis-Can-the-rot-be-stopped.html

NHS medication errors double in two years to 860,000 errors

The number of patient safety incidents involving medicines has more than doubled in two years, official figures showed.

A report from the National Patient Safety Agency (NPSA) found a “significant” rise in the number of errors and near misses reported by NHS staff in England and Wales, including cases of avoidable deaths or serious harm.

More than 86,000 such incidents reported in 2007, compared with 64,678 in 2006 and 36,335 in 2005, the agency said.

In 96 per cent of cases, the incidents caused “no or low harm” to NHS patients, but at least 100 were known to have resulted in serious harm or death.

Martin Fletcher, the agency’s chief executive, said the increase in the figures reflected a willingness by NHS staff to report errors and a more open reporting culture.

The figures are still thought to be a vast underestimate of the incidents involving the prescription or administration of medicines.

Professor David Cousins, a senior pharmacist at the NPSA, said it was well known that only about 10 per cent of incidents were reported in most voluntary systems around the world, including Britain.

This suggests there were as many as 860,000 errors or near misses involving medicines across the NHS in 2007.

Most of the errors (82 per cent) were made in the administration or dispensing of the medicines by nurses or pharmacists, rather than in the prescription of drugs by doctors.

The report listed the top five medication errors in the NHS in England and Wales as people being given wrong doses; medicines being missed or delayed; patients being given the wrong drug; the wrong quantity (such as too much chemotherapy), or mismatching, where patient A’s medicine is given to patient B.

Examples include an anticoagulant drug given in error to a patient with a similar name, a strong sedative given to a patient instead of insulin, and heart medicine given instead of an anti-inflammatory. One patient was reported to have received 100mg of morphine instead of 10mg.

The report comes after The Times revealed new guidance from medical regulators to ensure that undergraduate medical students receive more “hands-on” experience of working in hospitals and clinics before they graduate.

The NPSA’s figures are from reports filed by NHS staff in hospital trusts, mental health trusts and in primary care. Nearly three quarters (74 per cent) of the incidents reported in 2007 were in relation to hospital care, but the agency noted that primary care services, such as GPs and community nurses, needed to improve their reporting rates.

The NPSA is in charge of monitoring and helping to reduce patient safety incidents across the NHS. It releases rapid response alerts where particular problems are noted, such as the risk of overdoses with particular medicines.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6820090.ece

Health Direct applauds labour U Turn as NHS to end premium rate telephone call charges for patients

Health Direct has long campaigned for the end of a stealth tax on booking doctors appointments through the use of premium rate sex charge telephone calls.

Charges under which patients pay more than the cost of a local call from a landline are being scrapped in England after a consultation.

As we reported in 2007, many NHS organisations use numbers starting with an 0844 or 0845 prefix, which can be up to 30p a minute more expensive to call than a standard local number.

Patients will still dial 084 numbers to get through but tariffs will be adjusted to ensure that they pay only for the cost of a local call, ministers said.

Mike O’Brien, the Health Minister, said: “We have been concerned that some people are paying more than the cost of a local-call rate to contact the NHS. For people on low incomes, and for those who need to contact their doctor or hospital regularly, these costs can soon build up.

“We want to reassure the public that when they contact their GP or hospital, the cost of their call will be no more expensive than if they had dialled a normal landline number.”

A letter will be sent to NHS organisations informing them of the changes this week, while amendments will be made to GP contracts over the coming months.

Richard Vautrey, deputy chairman of the British Medical Association’s GPs committee, said: “Patients who call their surgery because they’re ill shouldn’t be penalised because they have to call an 084 number, so we’re pleased that the phone companies who supply these lines to practices have agreed to ensure that their tariffs are in line with local charges.

“Combining the benefits of 084 numbers with an assurance that they won’t cost more than a local phone call is the best solution for patients and practices.”

Katherine Murphy, director of the Patients’ Association, said: “It’s great that the Department of Health has listened to patients. Asking them to pay extra costs for phone calls was unreasonable. Patients have had to wait long enough for the ruling-let’s hope the change happens as quickly as possible.”

Whilst the U turn spin is welcome, no definitive date was given for the time by which these stealth tax charges should be abolished.

Sentenced to death on the NHS by NICE red tape

Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors have warned.

In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

But this approach can also mask the signs that their condition is improving, the experts warn.

As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others.

“Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong. As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients."

The warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS.

The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours.

Developed by Marie Curie, the cancer charity, in a Liverpool hospice it was initially developed for cancer patients but now includes other life threatening conditions.

It was recommended as a model by the National Institute for Curbing Expenditure (Nice), the labour Government’s health scrutiny body, in 2004.

It has been gradually adopted nationwide and more than 300 hospitals, 130 hospices and 560 care homes in England currently use the system.

Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor.

They look for signs that a patient is approaching their final hours, which can include if patients have lost consciousness or whether they are having difficulty swallowing medication.

Patients can become semi-conscious and confused as a side effect of pain-killing drugs such as morphine if they are also dehydrated, for instance.

When a decision has been made to place a patient on the pathway doctors are then recommended to consider removing medication or invasive procedures, such as intravenous drips, which are no longer of benefit.

If a patient is judged to still be able to eat or drink food and water will still be offered to them, as this is considered nursing care rather than medical intervention.

Dr Hargreaves said that this depended, however, on constant assessment of a patient’s condition.

He added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die.

He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in. It is supposed to let people die with dignity but it can become a self-fulfilling prophecy.

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.”

He added: “What they are trying to do is stop people being overtreated as they are dying. It is a very laudable idea. But the concern is that it is tick box medicine that stops people thinking.”

He said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition.

Prof Millard said that it was “worrying” that patients were being “terminally” sedated, using syringe drivers, which continually empty their contents into a patient over the course of 24 hours.

In 2007-08 16.5 per cent of deaths in Britain came about after continuous deep sedation, according to researchers at the Barts and the London School of Medicine and Dentistry, twice as many as in Belgium and the Netherlands.

“If they are sedated it is much harder to see that a patient is getting better,” Prof Millard said.

Katherine Murphy, director of the Patients Association, said: “Even the tiniest things that happen towards the end of a patient’s life can have a huge and lasting affect on patients and their families feelings about their care.

“Guidelines like the LCP can be very helpful but healthcare professionals always need to keep in mind the individual needs of patients. There is no one size fits all approach.”

A spokesman for Marie Curie said: “The letter highlights some complex issues related to care of the dying.

“The Liverpool Care Pathway for the Dying Patient was developed in response to a societal need to transfer best practice of care of the dying from the hospice to other care settings.

“The LCP is not the answer to all the complex elements of this area of health care but we believe it is a step in the right direction.”

The pathway also includes advice on the spiritual care of the patient and their family both before and after the death.

It has also been used in 800 instances outside care homes, hospices and hospitals, including for people who have died in their own homes.

The letter has also been signed by Dr Anthony Cole, the chairman of the Medical Ethics Alliance, Dr David Hill, an anaesthetist, Dowager Lady Salisbury, chairman of the Choose Life campaign and Dr Elizabeth Negus a lecturer in English at Barking University.

From:
http://www.telegraph.co.uk/Sentenced-to-death-on-the-NHS

Cruel and neglectful care of one million NHS patients exposed

One million NHS patients have been the victims of appalling care in hospitals across Britain, according to a major report released last week.

In the last six years, the Patients Association claims hundreds of thousands have suffered from poor standards of nursing, often with 'neglectful, demeaning, painful and sometimes downright cruel' treatment.

The charity has disclosed a horrifying catalogue of elderly people left in pain, in soiled bed clothes, denied adequate food and drink, and suffering from repeatedly cancelled operations, missed diagnoses and dismissive staff.

The Patients Association said the dossier proves that while the scale of the scandal at Mid-Staffordshire NHS Foundation Trust - where up to 1,200 people died through failings in urgent care - was a one off, there are repeated examples they have uncovered of the same appalling standards throughout the NHS.

While the criticisms cover all aspects of hospital care, the treatment and attitude of nurses stands out as a repeated theme across almost all of the cases.

They have called on Government and the Care Quality Commission to conduct an urgent review of standards of basic hospital care and to enforce stricter supervision and regulation.

Claire Rayner, President of the Patients Association and a former nurse, said:“For far too long now, the Patients Association has been receiving calls on our helpline from people wanting to talk about the dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses.

“I am sickened by what has happened to some part of my profession of which I was so proud. These bad, cruel nurses may be - probably are - a tiny proportion of the nursing work force, but even if they are only one or two percent of the whole they should be identified and struck off the Register.”

The charity has published a selection of personal accounts from hundreds of relatives of patients, most of whom died, following their care in NHS hospitals.

They cite patient surveys which show the vast majority of patients highly rate their NHS care - but, with some ten million treated a year, even a small percentage means hundreds of thousands have suffered.

Ms Rayner said it was by "sad coincidence" that she trained as a nurse with one of the patients who had "suffered so much".

She went on: "I know that she, like me, was horrified by the appalling care she had before she died. We both came from a generation of nurses who were trained at the bedside and in whom the core values of nursing were deeply inculcated."

Katherine Murphy, Director of the Patients Association, said “Whilst Mid Staffordshire may have been an anomaly in terms of scale the PA knew the kinds of appalling treatment given there could be found across the NHS. This report removes any doubt and makes this clear to all. Two of the accounts come from Stafford, and they sadly fail to stand out from the others.

“These accounts tell the story of the two percent of patients that consistently rate their care as poor (in NHS patient surveys). If this was extrapolated to the whole of the NHS from 2002 to 2008 it would equate to over one million patients. Very often these are the most vulnerable elderly and terminally ill patients. It’s a sad indictment of the care they receive.”

The Patients Association said one hospital had threatened it with legal action if it chose to publish the material.

Pamela Goddard, a piano teacher from Bletchingley, in Surrey, was 82 and suffering with cancer but was left in her own excrement and her condition deteriorated due to her bed sores.

Florence Weston, from Sedgley in the West Midlands, died aged 85 and had to remain without food or water for several days as her hip operation was repeated cancelled.

The charity released the dossier to highlight the poor care which a minority of patients in the NHS are subjected to.

Ms Murphy said the numbers rating care as poor came despite investment in the NHS doubling and the number of frontline nurses increasing by more than a quarter since 1996.

The personal stories were revealed to prevent their cases being ignored as only representing a small portion of patients.

The report said: "These are patients, not numbers. These are people, not statistics."

Dr Peter Carter, Chief Executive of the Royal College of Nursing, said he was concerned that public confidence in the NHS could be undermined by the examples cited and it would affect morale in hardworking staff.

He said: “The level of care described by these families is completely unacceptable, and we will not condone nurses who behave in ways that are contrary to the principles and ethics of the profession.

"However we believe that the vast majority of nurses are decent, highly skilled individuals. This report is based on the two per cent of patients who feel that their care was unacceptable. Two per cent is too many but we are concerned that this might undermine the public’s confidence in the world-class care they can expect to receive from the NHS."

Barbara Young, Chairman of the Care Quality Commission, the super-regulator, said: “It is absolutely right to highlight that standards of hospital care can vary from very good to poor.

“Many people are happy with the care they receive, but we also know that there are problems. I am in no doubt that many hospitals need to raise their game in this area.

“Where NHS trusts fail to meet the mark, we have tough new enforcement powers, ranging from warnings and fines to closure in extreme cases. We will not hesitate to use these powers when necessary to bring improvement.

"We will be asking NHS trusts and primary care trusts how they are ensuring that the needs of patients and their safety and dignity are kept at the heart of care.”

From:
http://www.telegraph.co.uk/Cruel-and-neglectful-care-of-one-million-NHS-patients-exposed

Death toll from MRSA hospital bugs hits new high

More than 30,000 people have died after contracting the hospital infections MRSA and Clostridium difficile in just five years, official figures show.

Between 2004 and 2007 there were more than 20,000 deaths linked to C. diff and more than 6,000 associated with MRSA.

Data from the Office for National Statistics covering 2004 to 2008 shows record numbers of deaths linked to the superbugs in England and Wales.

Opposition politicians said the labour Government had allowed "a horrifying death toll" because of its "slow and sloppy" response to spiralling levels of infection in NHS hospitals.

Official data shows a doubling in the death toll linked to MRSA during the period 2004 to 2007, compared with the previous four years, and a quadrupling in deaths linked to C. diff, when two sets of three-year figures are compared.

Norman Lamb, the Liberal Democrat health spokesman, said: "These figures describe an absolutely horrifying death toll, and many of these people have lost their lives because of infections which could have been avoided if firm action on infection had been taken a long time ago".

Annual deaths linked to MRSA quadrupled between 1997 and 2007, while those associated with C. diff quadrupled between 2004 and 2007, figures show.

Katherine Murphy, from the Patients Association, said the statistics showed the gulf between "flowery" Government rhetoric about a war on infection, and poor hygiene which had been allowed to continue unchecked.

"The NHS has been told to put other targets ahead of safety, and this is the inevitable outcome," she added.

Infection experts have repeatedly warned that assessments based on the number of death certificates which record the presence of MRSA and C. diff are likely to underestimate the scale of the problem, because doctors are reluctant to admit that basic infections have caused fatalities.

Earlier figures published by the ONS have shown that the worst hospital for C. diff deaths in England or Wales was the Royal United Hospital in Bath, which had 268 deaths from the infection between 2002 and 2006.

The George Eliot hospital in Nuneaton, Warwickshire, the Walsgrave Hospital in Coventry and the Royal Infirmary in Leicester all had more than 200 deaths caused by the infection over the same period.

The worst-ever outbreak of C. diff in this country occurred between 2004 and 2006 at Maidstone and Tunbridge Wells NHS Trust, where the bug was linked to the deaths of 331 patients.

More than 5,000 people have backed The Sunday Telegraph's Heal Our Hospitals campaign, which is calling for a review of hospital targets to make sure they work to improve quality of care.

From:
http://www.telegraph.co.uk/Death-toll-from-hospital-bugs-hits-new-high

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

Public services waste £1.5m on 'non jobs'

Health boards and other quangos have been accused of wasting more than £1m of public money every year on “non jobs”, including a wellbeing unit manager, events planner and buddy project worker.

Despite concern over a shortage of police officers on the beat and frontline medical staff, an investigation by The Sunday Times has revealed that £1.5m a year is being lavished on unnecessary jobs.

The roles, which have little to do with the delivery of core services, include a £40,000 a year wellbeing unit manager and £22,000 a year events planner employed by Lothian and Borders police. The force also pays £17,000 a year for a chauffeur for David Strang, its chief constable.

NHS Fife has a buddy project worker “to support volunteers who help people stop smoking” (between £20,000 and £26,000 a year), a graphic designer (£25,000-£33,000) and a librarian, to help ensure “professional staff keep up to date” (£20,000-£26,000). In the past, the health board has also employed an artist-in-residence.

Most health boards employ chaplains or “spiritual care providers” on salaries of about £30,000 a year. NHS Dumfries and Galloway also has an organist. The National Secular Society has called for an end to NHS funding for chaplains, and says the cost should be borne by churches.

Matthew Elliott, the chief executive of the Taxpayers’ Alliance, said the jobs were evidence of unacceptable public sector profligacy at a time when private firms were shedding jobs or imposing pay cuts.

“We’re in the grip of a recession, and it’s high time those in the public sector started cutting back on these ridiculous non-jobs that would be an extravagance even in good economic times,” he said.

“The public sector must wake up and realise taxpayers want value-for- money, frontline public services, not unnecessary frills that are of no tangible benefit to most ordinary people. Any right-minded person can see this money would be far better spent on more nurses, doctors and bobbies on the beat.”

Margaret Watt of the Scotland Patients Association added: “This is quite obscene when we are short of GPs, consultants, nurses and midwives.

“The health boards seem to have their responsibilities all back to front — these jobs should not be a priority. It is more important that we have the staff to take care of our patients than anything else.

“They should be dealing with the core business at the moment where we have insufficient staff in hospitals across the country.”

NHS Fife said it did not consider any of the jobs “nonessential”.

“The modern NHS requires a range of staff to work together to enable it to develop a service for the 21st century,” said a spokeswoman.

From:
http://www.timesonline.co.uk/tol/news/uk/scotland/article6301788.ece

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.