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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Stafford Hospital patients routinely neglected by cost cutting and targets

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

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

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

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

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

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

The Department of Health research revealed that:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Dementia costing UK £23bn a year

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Doctor Daniel Ubani unlawfully killed overdose patient

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tories to make GPs after hours care a priority

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

FAILURES

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

From:

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

Two catch Legionnaire’s disease at hospital attacked over hygiene

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

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

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

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

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

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

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

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

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

From:

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

NHS faces potentially serious problems from wrong prescriptions on the NHS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That meant that doctors were ill prepared, it concluded.

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

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

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

From:

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

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

Winter NHS deaths rise a national scandal

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Swine flu jab to be given to healthy children under five

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

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

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

Unoffical NHS euthenasia as daughter saves mother, 80, left by doctors to starve

An 80 year old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened.

Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

Fenton’s daughter, Christine Ball, who had been looking after her mother before she was admitted to the Conquest hospital in Hastings, East Sussex, on January 11, says she had to fight hospital staff for weeks before her mother was taken off the plan and given artificial feeding.

Ball, 42, from Robertsbridge, East Sussex, said: “My mother was going to be left to starve and dehydrate to death. It really is a subterfuge for legalised euthanasia of the elderly on the NHS. ”

Fenton was admitted to hospital suffering from pneumonia. Although Ball acknowledged that her mother was very ill she was astonished when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days.

Ball insisted that her mother was not dying but her objections were ignored. A nurse even approached her to say: “What do you want done with your mother’s body?”

On January 19, Fenton’s 80th birthday, Ball says her mother was feeling better and chatting to her family, but it took another four days to persuade doctors to give her artificial feeding.

Fenton is now being looked after in a nursing home five minutes from where her daughter lives.

Peter Hargreaves, a consultant in palliative medicine, is concerned that other patients who could recover are left to die. He said: “As they are spreading out across the country, the training is getting probably more and more diluted.”

A spokesman for East Sussex Hospitals NHS Trust, said: “Patients’ needs are assessed before they are placed on the [plan]. Daily reviews are undertaken by clinicians whenever possible.”

In a separate case, the family of an 87-year-old woman say the plan is being used as a way of giving minimum care to dying patients.

Susan Budden, whose mother, Iris Griffin, from Norwich, died in a nursing home in July 2008 from a brain tumour, said: “When she was started on the [plan] her medication was withdrawn. As a result she became agitated and distressed.

“It would appear that the [plan] is . . . used purely as a protocol which can be ticked off to justify the management of a patient.”

Deborah Murphy, the national lead nurse for the care pathway, said: “If the education and training is not in place, the [plan] should not be used.” She said 3% of patients placed on the plan recovered. 

From:

http://www.timesonline.co.uk/tol/life_and_style/health/article6869646.ece

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 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

UK children receive swine flu jab

The first children in Britain to receive a vaccine against swine flu have begun to be immunised.

Doctors at five sites in England are comparing vaccines from two manufacturers to see which works best and has the fewest side-effects.

Over the next two weeks 1,000 children aged six months to 12 years are being recruited in Oxford, Bristol, Southampton, Exeter and London.

Both vaccines are expected to be licensed in the coming weeks.

One has already been recommended for use.

Professor Andrew Pollard, from the University of Oxford, says vaccines are the best way to protect against flu and any side effects should be limited to sore arms or sometimes a fever.

This clinical trial comes just a month before more than 11 million people considered to be most at risk from flu will be offered the swine flu vaccine.

It will also be made available to more than two million front-line health workers.

From:

http://news.bbc.co.uk/1/hi/uk/8279826.stm

Women and older people less likely to receive heart attack drugs

Thousands of women and older people who suffer heart attacks are dying unnecessarily because they are not being prescribed the gold standard treatment which could prevent another attack.

One in five people who have had a heart attack in Britain do not receive all four drugs recommended to prevent a second, a study of 60,000 people have found.

NICE guidelines say heart attack patients should be prescribed two blood pressure drugs, a cholesterol lowering statin and aspirin to thin the blood.

However research based on a database of all surviving heart attack patients in England and Wales has found one in 20 people received only one or two drugs.

Women and older people are less likely to receive all four drugs, the study by University of Leicester has found.

Only 29 per cent of people leaving hospital on all four drugs were women. In addition the average age of those on one drug was 82 while the average age of those on four was 67.

Lead author Prof Iain Squire, professor of cardiovascular medicine at University of Leicester and consultant at the Leicester Royal Infirmary, calculated that 2,000 out of the 5,000 deaths over the two year study period had been undertreated and 'could potentially have been avoided'.

He said: "The patients who are most likely to get undertreated are the elderly and females but they get incremental benefit for each drug they take so we should not be withholding these therapies based on age and gender alone."

People aged 65 to 74 were 20 per cent less likely to get all four drugs compared with those under 55; while people aged over 85 were three times less likely to get all four medicines.

The findings, based on an analysis of the national registry called the Myocardial Infarction National Audit Project collected between January 2004 and December 2005, were presented at the European Society of Cardiology Congress in Barcelona.

It is thought doctors believe the drugs are less beneficial and more difficult to use in older people, and that women do not gain as much as men from them.

But the study showed that the survival benefits are similar in women as in men and in the elderly, the research showed.

The chances of surviving for one year after a heart attack increased with the number of drugs prescribed.

When other factors such as age, gender, and other illnesses were taken into account, people on four drugs were 54 per cent more likely to be alive one year later compared with people on just one drug.

Those on three drugs were 42 per cent more likely to be alive 12 months on than people on one drug; and people on two drugs were 27 per cent more likely to survive for one year than patients receiving one drug.

The effect was the same in men and women and the graded benefits of multiple drugs remained evident for patients aged 80 and over, the authors said.

Prof Squire said: "Our data indicate that provision of equitable management in these high-risk groups has the potential to deliver major improvements in prognosis for patients with acute myocardial infarction."

Prof Adam Timmis, co-author and professor of clinical cardiology at the London Chest Hospital, said the majority of people are receiving all four drugs but improvements could still be made.

He said: "If you optimised the use of exisiting drugs and people were all managed appropriately across the country that would have a very large effect on cardiovascular outcomes."

Prof Timmis said the guidelines, complied by the National Institute for Curbing Expenditure, Nice, are clear that there should be no discrimination on the basis of age or gender.

He said: "There is a general feeling that women don't get this [heart attacks]. But we are not dealing with a condition that is rare in women, but there has been this perception."

Prof Peter Weissberg, Medical Director of the British Heart Foundation, said this data was four years old.

He said: "We can pretty reasonably assume we are better now then we were then. We are getting better because we have this audit, hospitals are named and shamed when they are poor performers.

"There is a way to go and, generally speaking, women get a poorer deal in cardiovascular disease. That is improving but still less than perfect."

Around 113,000 people in Britain each year suffer a heart attack and about one in three die before reaching hospital.

From:

http://www.telegraph.co.uk/Women-and-older-people-less-likely-to-receive-heart-attack-drugs

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

It's Monday, so it must be Swine Flu- Swine Flu rise points to Monday sickies

A weekly rise in cases of swine flu across the country on Mondays suggests that employees are using the pandemic as an excuse for throwing a Monday morning "sickie".

While the rate of infection in recent weeks has risen and fallen in line with experts' predictions - and a similar if staggered trend for flu elsewhere in the world - health specialists have found the weekly fluctuations more puzzling.

Regardless of the total number of cases recorded each week, data from the official National Pandemic Flu Service show a consistent pattern for a maximum number of cases on Monday, declining steadily on every subsequent day before peaking again seven days later.

"We just don't know why," said Sir Liam Donaldson, chief medical officer, last week when asked to explain the "Monday effect", adding that there was no obvious medical reason. The World Health Organisation also said it was unaware of any weekly pattern.

One possible explanation is that people socialise more over the weekend, increasing their likelihood of infection. But with flu symptoms typically taking two days to develop, any peak in demand for help should come on Tuesdays or Wednesdays. Friday evening socialising is often with colleagues, suggesting little more risk of infection than on other days of the week in the workplace.

With clinics closed or open for only limited hours over the weekend, many doctors' show a surge in consultations on Mondays for all sorts of ailments that have developed over the weekend.

But the government's dedicated pandemic flu service, which began operations in July, operates by both telephone and internet around the clock, including on weekends, offering no such barriers to access outside working hours.

People might wrongly believe that the service is closed on weekends and wait until Monday before getting in touch. But data from NHS Direct, open 24 hours a day for phone consultations on all medical conditions, shows the proportion of calls is roughly equal on each working day of the week, with peaks at weekends.

On Mondays, those calling in specifically with suspected colds or flu in the 12 months to May accounted for 13 per cent of weekly calls, against 12 per cent for the rest of the working week, rising to 19 per cent on Saturdays and 20 per cent on Sundays.

One difference between NHS Direct and the pandemic flu line is that the latter offers a code allowing access to the antiviral drug Tamiflu, and a receipt that can be used to justify sick days and insurance claims.

Aaron Ross, chief executive of FirstCare, a consultancy that manages sickness-related absences from the workplace, said 43 per cent of all his calls each week for all causes take place on Monday. "The only natural conclusion is that people are using the service as a reason to take time off work," he says.

"A number of employers we have spoken to are suggesting employees are calling the hotline, requesting Tamiflu and then using it as justification to phone their manager to start an absence."

That does not explain the steady decline over the rest of the week. But if a second "wave" of flu takes place later this year as predicted, employers should be braced for a new peak in absences, especially on Mondays.

From:

http://www.ft.com/cms/s/0/bbd95eb8-9821-11de-8d3d-00144feabdc0.html?nclick_check=1

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