The declining role of GPs in maternity care is leading to some pregnant women feeling “abandoned” by the system, a leading think-tank has claimed.
Often expectant mothers do not know who to turn to if they suffer health problems during pregnancy, according to The King’s Fund.

Although family doctors frequently know a woman’s medical history best, their role in pregnancy care has become sidelined in recent decades, found the authors of the report, The role of GPs in maternity care – what does the future hold?

The King’s Fund concluded that GPs’ role in maternity care had “all but disappeared over the past 30 years, with recent policy and guidance omitting any reference to their role in caring for pregnant women”.

“Under the terms of the new GP contract introduced in 2004, GPs are no longer paid for each pregnant woman they look after,” it noted.

“In addition, many GPs have opted out of providing out-of-hours care, resulting in sick pregnant women going to A&E with pregnancy-related problems – or simply not knowing what to do if they are ill.”

Nick Goodwin, director of the Fund’s GP Inquiry, said such care was increasingly dealt with by specialists, which had led to a less connected service for pregnant women.

He said: “As a result of that you get reports that some mothers feel a bit abandoned at the beginning of their pregnancy. Who is looking after them?”

Sometimes pregnant women’s other health needs – like mental health issues and obesity – were not being dealt with, he said.

“More needs to be done to make sure that the whole person is treated.”

The report proposed that GPs should now take “a more active role”.

Anna Dixon, lead author of the report and director of policy at The King’s Fund, said: “It is right that those with specialist skills, such as midwives and obstetricians, take the lead role in caring for pregnant women but GPs have a vital role to play in pre-conception and shared ante-natal and post-natal care.”

The report has been widely welcomed by GPs’ groups.

Dr Laurence Buckman, chairman of the BMA’s GPs Committee, said: “GPs want to be more involved in maternity care because they see it as an important part of their job.”

Prof Steve Field, chairman of the Royal College of General Practitioners, welcomed the “timely” report, saying it made “a very compelling case for GPs to play a more central role”.

However, Belinda Phipps chairman of the National Childbirth Trust, which campaigns for less medical intervention during pregnancy and birth, said it would be better to “actively promote midwife-led care to women”.

From http://www.telegraph.co.uk/Pregnant-women-feel-abandoned-by-NHS

The NHS has been accused of scaring patients into agreeing to have their personal information included on the controversial NPfIT electronic records database.

The agency charged with rolling out the new system is warning of “adverse consequences” if people choose to opt out of the computerised network, which has been criticised as chaotic by doctors.

It is also claiming that the NHS currently has “significant problems” with lost records.

A document posted on the website of NHS Connecting for Health lists several dangers to patients if they continue to have their medical information stored on paper files.

It states: “Health-care staff treating you may not be aware of your current medications in order to treat you safely and effectively.

“Health-care staff treating you may not be made aware of current conditions and/or diagnoses leading to a delay or missed opportunity for correct treatment.

“Health-care staff may not be aware of any allergies/adverse reactions to medications and may prescribe or administer a drug/treatment with adverse consequences.”

While acknowledging confidentiality risks over the digital database, the document continues: “It is … misleading to suggest that not having such a record is risk free.”

The computerised record system, also known as the care summary record, is intended to make it easier for doctors and nurses to get access patients’ medical histories.

But the programme has been beset by technical problems and criticisms. Last month the labour Government halted the national roll-out after it emerged that data could have been logged on the system without patients’ knowledge.

Information about more than 1.25 million patients have already gone on to the database, which eventually could hold up to 50 million records.

The Big Brother Watch lobby group accused Connecting for Health of overstating the risk to patients if they opt out of the system, after a Department of Health spokesman said the problem of lost paper records was not “significant” as the agency claimed.

Dylan Sharpe, the Big Brother Watch campaign director, told the Daily Mail: “If you value your privacy ignore these false and misleading warnings and opt out.”

From: http://www.telegraph.co.uk/NHS-scaring-patients-into-accepting-electronic-records-database

Health Direct urges you to opt out of labour’s snoopers charter NOW- WHILST YOU STILL CAN!

The NHS is sending millions of patient records and confidential medical notes to India for processing — despite a pledge by Labour that personal information would not be sent overseas.
It is the first time that databases of names, addresses and NHS numbers of patients have been sent abroad, along with private information about medical appointments.

NHS managers, under pressure to cut costs, are implementing the changes despite warnings about poor security in some offshore centres.

The Sunday Times has identified seven primary care trusts in northeast London, serving more than 1.5m people, that have begun to send patient details overseas. The databases are administered by about 200 workers in Pune, western India.

Although companies handling the records in India said security was “paramount”, there is a risk of patients being identified if the NHS numbers are matched with anonymised clinical notes carrying NHS numbers, already being sent to India by more than 30 trusts.

Typically, a set of clinical notes will be based on a consultant’s findings during a session with a patient, which he will read into a voice recorder during or after the appointment.

The recording is then transferred to a computer and sent to India, where it is transcribed. One source involved in processing the information said patient names can crop up during the appointment and may then inadvertently be included with the clinical data.

Workers in India are also producing letters for patients with appointments for cervical smear tests and breast screenings.

Pilot schemes for NHS offshore transcription services began more than four years ago and have rapidly expanded. The Royal Free hospital in London, the Derby hospitals trust and the Newham University hospital trust are among those sending clinical notes overseas.

Labour ministers have been anxious to allay concerns about the confidentiality of patient information since the launch of a £12 billion scheme to computerise health records.

In January 2007 Caroline Flint, then health minister, told parliament the project would “expressly preclude the transfer of patient information outside the United Kingdom”.

Trusts, however, believe they may send patient information outside the UK if it does not come under the electronic records project.

John Hemming, the Liberal Democrat MP for Birmingham Yardley and an expert on IT projects, said: “Given the government’s track record of losing data in this country, it is worrying that data are being sent overseas. Every transfer of information adds to the risk of it being lost.”

The possible risks of transferring patient data overseas were exposed last year when undercover reporters from ITV1’s Tonight programme were able to buy health records from a private hospital in London, processed in India. The sellers claimed to have access to thousands of UK medical records.

The transfer of primary care trust records is being handled by NHS Shared Business Services, a joint venture between the Department of Health and the IT company Steria.

From: http://www.timesonline.co.uk/tol/life_and_style/health/article7086816.ece

Health Direct urges you to opt out of labour’s snoopers charter- whilst you still can!

The NHS reported the highest number of serious data breaches of any UK organisation since the end of 2007, the Information Commissioner’s Office says.

David Smith, deputy commissioner at the ICO told the Infosec security conference the NHS had highlighted 287 breaches to it in the period.

That accounts for more than 30% of the total number reported.

The NHS – the UK’s largest employer with 1.7m staff – has only started the process of rolling out digital patient records.

Most of the breaches (113) were the result of stolen data or hardware, followed by 82 cases of lost data or hardware.

Mr Smith said the problems were not confined to the public sector and that results could be skewed because the public sector has a culture of reporting all breaches whereas not all private sector firms did.

Richard Vautrey, the deputy chair of the British Medical Association’s GPs committee thinks the number of breaches reflect the size and complexity of the NHS as well as its culture of openness.

“So many people have access to data and often human error is to blame. There is an increased attempt to be open and honest about what happens to data,” he said.

He added that he was not aware of a specific case where a data breach had affected patient privacy or care.

“We need to keep their breaches in perspective,” he said.

As part of its plans to digitise patient records, the NHS is asking patients if they want their data stored on national databases. It is important that people are given the chance to opt out, said Mr Vautrey.

Currently the reporting procedure for data breaches in the UK is voluntary although the ICO is “moving towards” a compulsory system.

In April the ICO introduced fines of up to £500,000 for serious data breaches.

The European Union’s Telecoms Package requires telecom firms to report data breaches and Mr Smith said he expected this requirement to expand beyond telcos.

Data encryption firm PGP welcomed the tough new approach to data security.

“Finally the ICO, which has long demanded greater powers, will be able to severely punish those in serious breach of the Data Protection Act. For too long, organisations have continued to ignore the warning signs – risking both the privacy of their customers and the reputations of their brands,” said Jamie Cowper, European marketing director at PGP.

He anticipates “severe fines” for the next private sector company to be involved in a serious data breach although he does not imagine the ICO will pursue the NHS.

PGP calculated that data breaches cost companies, on average, £67 per piece of data lost.

From:

http://news.bbc.co.uk/1/hi/technology/10089066.stm

Health Direct asks- given that the NHS has the worst record of data security and that labour politicans have already sent 250,000 political letters to cancer sufferers- are you CERTAIN that your medical records will be safe on the Snoopers Charter database? If not OPT OUT NOW- whilst you still can!

The National Health Service’s £12.7bn scheme to create an electronic patient record will “no longer provide the comprehensive solution” originally promised, says a top NHS executive.

Until now, health ministers and officials have acknowledged that the world’s biggest civilian information technology project is running four to five years late, and have said they want to make £600m savings on the £4bn-plus worth of contracts held by CSC and BT to deliver it.

Up to now, however, no one has conceded that the programme will fail to deliver everything that was promised back in 2003 when the contracts were signed.

Following a revamped deal with BT – the London supplier, which has cut £112m or about 12 per cent off its contract – Ruth Carnall, the chief executive of the London strategic health authority, has said the spending reduction means “it will no longer be possible to provide the comprehensive solution that was anticipated in 2003″.

Not all NHS organisations in London will now receive the software needed to deliver the records, Ms Carnall makes clear in a letter to London chief executives.

Meanwhile, Christine Connelly, the health department’s chief information officer, has said that only about half of London’s 32 big acute trusts will now get the full solution. Others will be able to add clinical systems to existing patient administration systems.

In place of a dedicated means of sharing records across hospitals, and between hospitals and primary care – a key goal of the programme – London will have to rely on the national summary care record, Ms Carnall says. However, this contains little other than allergies and current medication, and does not yet carry referral or discharge information.

On top of this, the Tories have said they will scrap the national record if they win the election.

BT will no longer have to deliver new systems to London’s ambulance service or GP practices. And London can afford to pay for Map of Medicine, a decision support tool for treating patients, for only one more year, says Ms Carnall.

In much of the country, installations in acute hospitals are stalled after CSC missed a deadline to get its solution running at Morecambe Bay NHS Trust. The supplier risks being fired, but is likely to sign a similar, more restricted, deal if it does hit a new deadline for a successful installation.

Glyn Hayes, president of the UK Council for Health Informatics Professions, said it had been clear for some time that the programme was to be reduced. “But this is the first official admission that there are things it will not do that it was intended to do.”

It was unclear, he said, whether the Conservatives would in fact scrap the national record if they won. “But if they do, it knocks a hole in London’s plans,” because without it the capital had no easy means of transferring patient information between settings.

From: http://www.ft.com/cms/s/0/fba8e660-436d-11df-833f-00144feab49a.html

Muslim doctors and nurses are to be allowed to opt out of strict hygiene rules introduced by the NHS to restrict the spread of MRSA hospital superbugs.

Female staff who follow the Islamic faith will be allowed to cover their arms to preserve their modesty despite earlier guidance that all staff should be “bare below the elbow”.

The Department of Health has also relaxed rules prohibiting jewellery so that Sikh members of staff can wear bangles linked with their faith, providing they are pushed up the arm while the medic treats a patient.

The Mail on Sunday reported the change had been made after female Muslims objected to being required to expose their arm below the elbow under guidance introduced by Alan Johnson when he was health secretary in 2007.

The rules were drawn up to reduce the number of patients who were falling ill, and even dying, from superbugs such as MRSA and Clostridium difficile.

Revised guidance which relaxed the requirements for some religions was published last month.

Some Muslim staff and those from other groups may be allowed to use disposable plastic over-sleeves which cover their clothes below the elbow and allow the skin to remain covered up.

Derek Butler, chairman of MRSA Action UK, said: “My worry is that allowing some medics to use disposable sleeves you compromise patient safety because unless you change the sleeves between each patient, you spread bacteria.

“Scrubbing bare arms is far more effective.”

From: http://www.telegraph.co.uk/health/healthnews/7576357/Muslim-staff-escape-NHS-hygiene-rule.html

Labour has become embroiled in a row about the use of personal data after sending cancer patients alarmist mailshots saying their lives could be at risk under a Conservative government.

Personalised cards addressed to sufferers by name warn that a Labour guarantee to see a cancer specialist within two weeks would be scrapped by the Tories. Labour claims the Conservatives would also do away with the right to be treated within 18 weeks.

The offending mailshot
Cancer patients who received the personalised cards, sent with a message from a breast cancer survivor praising her treatment under Labour, said they were “disgusted and shocked”, and feared that the party may have had access to confidential health data.

Labour sources deny that the party has used any confidential information. However, the sources admit that, in line with other political parties, it uses socio-demographic research that is commercially and publicly available.

The postal campaign started last month before the general election was called. This is the first election in which parties have been able to use internet databases and digital printing to personalise their mailshots.

Labour has sent out 250,000 “cancer” postcards, each addressed to an individual, asking: “Are the Tories a change you can afford?” Many of those receiving the cards have undergone cancer scans or treatment within the past five years.

- In the Labour constituency of Sherwood, Nottinghamshire, two of a group of eight women friends received the breast cancer card. They are the only two to have undergone cancer treatment. One of them, Phyllis Delik, 80, described it as “callous” and “despicable”. The second woman, Shirley Foreman, 58, who received the card a fortnight after undergoing surgery, said: “It is bad taste after what I have been through.”

- In the marginal east London constituency of Poplar and Limehouse, the card was sent to a 44-year-old television producer who had a potentially cancerous lump that turned out to be a cyst. She appeared to be the only person who received the mailshot among 50 neighbours. She said: “It’s crude and insensitive.”

- A card was sent to a woman who has died of breast cancer. Her 33-year-old husband was so upset that he sent a message to the Facebook page of Diane Dwelly, the woman whose case is featured in the mailshot, accusing her of being a pawn for the Labour party.

This weekend Dwelly, 48, from Rugby, admitted she had “probably been used by Labour”. She believed her photograph had been taken for use in a magazine for the National Health Service, not as part of Labour’s election campaign.

The cards are being distributed by Ravensworth, part of Tangent Communications, which has won accounts sending out mail for the Department of Health and Cancer Research UK.

Tangent claims that it specialises in “highly targeted marketing”.

The cancer cards are part of a wider postal campaign targeting various groups. Others are aimed at parents whose children attend Sure Start centres, pensioners and the owners of small businesses.

Labour has so far sent out 600,000 cards. It plans to distribute 4.5m during the election campaign.

Janet Arslan, 40, a graphic designer who also lives in the Sherwood constituency, said: “When I received the breast cancer card at first I thought it was from the hospital.

“I did not think Labour would be that crass to deliberately target a terminal cancer patient like me.”

Damian Bentley, managing director of Tangent, said: “Our company does a lot for the Labour party but I don’t work on that side of the business.”

He failed to respond to a list of questions on how the addresses of the cancer victims were obtained.

Emilie Oldknow, 29, the Labour candidate in Sherwood, worked for the NHS before she became the regional organiser of the East Midlands Labour party. She is the fiancée of Jonathan Ashworth, Gordon Brown’s deputy political secretary and a member of his “kitchen cabinet”.

Oldknow has denied all knowledge of the cards.

“I had not seen the mailshot before and it wasn’t sent out by my campaign,” she said.

In an email to Arslan’s mother, she said her details had been “obtained from the electoral register, which is available to political parties”.

Experian, the data management company, confirmed that both Labour and the Conservatives use its Mosaic database, which divides voters into 67 groups. The databases can use anonymised hospital statistics, including postcodes and the diagnoses of patients, to identify the likely addresses of those with particular illnesses.

It cannot identify potential breast cancer sufferers because the disease affects adult women of all ages and backgrounds.

Andrew Lansley, the shadow health secretary, said: “For Labour’s campaign to deliberately distress or scare sufferers from breast cancer is shameful. Because we are going to increase the NHS budget in real terms and cut bureaucracy and waste, we will have the capacity to ensure that cancer patients are seen sooner than they are at the moment and to meet the quality standards that they expect.”

From: http://www.timesonline.co.uk/tol/news/politics/article7094308.ece

Health Direct doubts labour spin about this approach being a “one off” as they have given themselves the right to snoop on all of your medical data- as well as their nightsoilmen at the Deptament of Health.

Highlighting once again the need for you to opt out of their expense white elephant that is the NPfIT propgram.

Private companies get access to millions of NHS medical records

September 29, 2008 By: Dr Search- Principal Consultant at the Search Clinic

The confidential medical records of millions of NHS patients could be handed over to private companies under controversial plans being drawn up by labour ministers.

Patients’ postcodes, medical conditions and treatments – and in some circumstances, their names – could be passed on to third parties without their consent.

http://www.healthdirect.co.uk/2008/09/private-companies-get-access-to-millions-of-nhs-medical-records.html

The biggest single supplier to the £12bn NHS NPfIT white elephant programme is on the brink of being fired from a key part of its contract after failing to meet a deadline to install systems at hospitals in the north west.

CSC, which holds the contract for two-thirds of England, missed the deadline to get the Lorenzo electronic medical record product up and running at the Morecambe Bay NHS Trust’s hospitals.

CSC originally said the system would go live almost two years ago, in June 2008.

The failure is the latest crisis for the much-troubled programme which is running at least four or five years late.

CSC and BT, which covers London, had each been given a deadline to get new systems running smoothly in a big, acute, hospital, with the Department of Health warning last year that it would “look at alternative approaches” if that failed to happen.

BT has since installed a system at Kingston Hospital to the health department’s satisfaction. Christine Connelly, the department’s chief information officer, said it now needs to go through a due process under its contract with CSC which could yet see a new deadline set and met.

But if progress is not made, she told the Financial Times, the department has the option of cancelling CSC’s contract to install the systems in acute hospitals and letting hospitals choose from other suppliers.

Morecambe Bay, she said, remained keen to continue and under the contract CSC has to be given time to propose a fresh deadline for deployment, with the programme then assessing the credibility of that and whether to agree it.

“We have to walk through this step by step,” Ms Connelly said. “In a contract as large and complex as this we cannot just set a deadline and say that’s it. We have to act responsibly and not expose the department and the taxpayer to risk.”

But, she warned bluntly, “we cannot wait for ever”.

CSC has contracts worth about £3.3bn to install hospital, community, mental health and GP systems, with the latter elements progressing much better.

But Ms Connelly said if CSC’s plan was not credible the NHS had the option of cancelling the acute hospital part of the deal, thought to be worth around £1bn. CSC did not respond to attempts to contact it last night.

BT, having hit its deadline, has agreed a contract variation, signed yesterday, which the department said would save the NHS £112m, or about 12 per cent of the contract value, as part of the £600m savings the health service is seeking on the programme as a whole.

As part of the deal, BT is now signed up to install much fewer full systems in London, with about half the hospitals likely to add clinical systems to their existing IT arrangements, rather than replacing everything, Ms Connelly said.

Allowing hospitals to choose other suppliers is already starting to happen in the south of England, although the first contracts for that have yet to be signed. That should start to take place from May this year, she said.

From: http://www.ft.com/cms/s/0/6a9f7ee2-3d26-11df-b81b-00144feabdc0.html