Thousands of patients are being forced to go under the knife for a second time because as many as half the operations carried out by some NHS surgeons end in failure.The disturbing finding comes from a study of bowel surgery, one of the commonest operations carried out on the NHS.

Patients whose bowel operations fail and have to be redone – usually because of bleeding, infection or leakage from the gut – face a four-fold increased risk of dying from surgery – up from 2.9 per cent to 11.9 per cent – and spend more than twice as long in hospital (27 days compared with 11).

There is growing concern in the NHS over variations in the quality of care between NHS trusts and individual surgical teams and about how to improve the outcomes of the poorest performers.

Researchers from Imperial College, London, investigated re-operation rates following bowel surgery to discover how wide the variation was and what might be done to boost performance. They examined almost 250,000 bowel operations conducted between 2000 and 2008 in England.

Predictably, the results showed that the trusts performing the most operations had the best results. But even among these there were wide variations, with re-operation rates ranging from 3.7 per cent to 11.5 per cent.

Overall almost 16,000 patients required further surgery to correct something that had gone wrong – one in every 15 procedures.

The study is published in the British Medical Journal. The worst-performing trusts and surgical teams are not named in the report, but an earlier study last April identified Burton Hospitals NHS Foundation Trust in Derbyshire as having the highest death rate following surgery for bowel cancer at 15.7 per cent, or one death in every 6.3 operations.

Omar Faiz, consultant colorectal surgeon and lead author of the study, said re-operation rates should be used with death rates to measure the quality of care in the NHS across a range of operations, provided the data was proved to be accurate.

Re-operation rates of 50 per cent were rare and reflected very unusual circumstances, such as when non-specialist surgeons were required to operate in emergencies.

“If there really are differences in performance that can’t be explained then the professional organisations will have to look at that,” he said.

Professor Norman Williams, president of the Royal College of Surgeons said the overall re-operation rate (6.5 per cent) was “quite impressive” and compared well with other countries. “We shouldn’t be complacent. If some surgeons truly have a 50 per cent re-operation rate it is extremely worrying.”

The college had said specialist surgery should be centralised in fewer hospitals and had encouraged surgeons to monitor performance.

Katherine Murphy of the Patients Association said: “We are supposed to have an NHS with patients at the centre, but it is still far from a patient-led service. They might get a choice of hospital but they are never given details of individual consultant performance, except in cardiac surgery. If they can do it in cardiac surgery why can’t we have it right across the NHS?

“These findings also emphasise the need for consultants to have regular tests ["revalidation"] by the General Medical Council to ensure they are up to date – but we are still waiting for it to be introduced,” she added.

From: http://www.independent.co.uk/study-reveals-disturbing-rate-of-failure-among-some-surgeons

Serious concerns have been raised by the NHS care regulator about the way some hospitals in England look after elderly patients.
The Care Quality Commission said three had failed to meet legal standards for giving patients enough food and drink and treating them in a dignified way.

The CQC, which carried out unannounced inspections, also raised concerns about three other NHS hospitals.

The commission has published the first 12 results of 100 such inspections, called for by the health secretary Andrew Lansley after a long campaign by the Patients Association, which highlighted poor care for the elderly.

While its inspectors said there had been many examples of people being treated with respect and given excellent care, in other cases people had not been helped to eat and drink, “with their care needs not assessed and their dignity not respected”.

All six hospitals about which concerns were raised must now say how and when they will improve. The worst three offenders will have to improve or face action from the regulator.

The inspections looked at nutrition and found cases of patients not being helped to eat, poor monitoring of patients’ weight and people not being given enough to drink, with water being out of reach for long periods of time.

In one case, a member of staff at Worcestershire Acute Hospitals NHS Trust said they had to prescribe water on medical charts to ensure patients got enough to drink.

Inspectors also looked at dignity and respect, noting that elderly patients were sometimes not involved in their own care and were given no explanation of the treatment they were to receive or asked for consent.

Staff also treated people in a disrespectful way, spooning food into their mouths without engaging them.

The reports acknowledge examples of excellent care where treatment was explained in a way patients could understand and they were treated with respect and dignity.

Jo Williams, chair of the CQC, said the inspections had built a detailed picture of the care being received by elderly patients in NHS hospitals in England.

“Many of these reports describe people being ‘cared for’ in the truest sense. Sadly, however, some detail omissions which add up to a failure to meet basic needs – people not spoken to with respect, not treated with dignity, and not receiving the help they need to eat or drink.

“These are not difficult things to get right – and the fact that staff are still failing to do so is a real concern. These are the basics that help ensure every patient is treated like an individual – not a nuisance to be ignored or a task that must be completed.

“This is what we expect for ourselves and for our own families, and what every patient should expect from the people who care for them.”
Enforcement powers

Health Secretary Andrew Lansley said that everyone admitted to hospital deserved to be treated as an individual, with compassion and dignity.

More CQC reports will be published over the summer with the findings of the programme of inspections released in the autumn.

From: http://www.bbc.co.uk/news/health-13545780

A Labour motion, highlighting ”growing concerns” over the Government’s handling of the plan to give greater power and control over funding to family doctors, was defeated by 284 votes to 231, majority 53.Mr Lansley promised that significant changes would be made to the legislation implementing the reforms as he addressed a raucous House of Commons.

He insisted the Health and Social Care Bill would not allow private companies to ”cherry-pick” the NHS’s most profitable services.

He told MPs that while the Government had an electoral mandate for its reforms, the Bill would only implement changes which were best for patients.

And he claimed Labour would have cut £30 billion from the NHS budget while the coalition was only looking to make efficiency savings of £20 billion.

Mr Lansley said: ”Let me be clear, there will be substantive changes to the Bill in order to deliver improvements for patients, but there is only one issue for me: will it deliver better care for patients?

”That is why we are going to pursue NHS modernisation, that is why we will stick to our principles. It is equally why we are listening to improve the Bill. That is what the coalition Government is committed to do.”

The Government has announced a “pause” in the legislation’s passage through Parliament in the face of mounting concern over the scale of the changes.

The reforms have also added to tensions between the Tories and their junior Liberal Democrat coalition colleagues.

Deputy Prime Minister and Lib Dem leader Nick Clegg insisted at the weekend he would not allow through changes in the Health Bill unless he was personally satisfied that they would not result in a “disruptive revolution”.

In the Commons, Lib Dem Andrew George, a member of the Health Select Committee, said he would rebel on the Bill’s third reading unless his concerns were met.

He said: “The kind of changes I would like to see in the Bill would be so substantial that they would take the guts out of the Bill itself.”

Mr George (St Ives) said he was concerned about “handing all of that power” to a “very narrow group” of medical professionals – the GPs.

He said that there was reluctance “and at worst outright hostility” among GPs over what they were being asked to take on.

“I don’t go along with the view that they’re keen to get on with it. Well, they’re responsible people, they’re responsible.”

From: http://www.telegraph.co.uk/Labour-motion-against-NHS-reforms-fails-in-the-commons

Family doctors are being prevented from prescribing drugs for conditions such as diabetes, heart disease and osteoporosis as NHS managers attempt to make drastic budget cuts, an investigation has found.
Primary care trusts are adding more medicines to their so-called “red lists” which means they can only be prescribed by a hospital consultant and not a GP.

The measure is designed to save money by restricting access to drugs that are often among the more expensive. It also means that many patients find it more difficult to obtain the most effective drugs free on the NHS, even though they have been approved by the medicines rationing watchdog Nice.

Patients’ groups described the disclosure as “outrageous” and “extremely worrying”.

Examples of medications moved to red lists include a class of diabetes drugs called gliptins; treatments for Parkinson’s disease; a drug that helps lower the risk of fractures in osteoporosis sufferers; and certain types of statins for those at greater risk of heart disease.

One health authority has added 32 drugs to its red list in the past year, while another said it intended to fine doctors who wrote letters requesting that such medicines be prescribed.

Last night, the Department of Health suggested that trusts should look to make savings elsewhere before trying to restrict access to drugs.

According to a survey carried out by Pulse, a magazine for GPs, 73 out of 134 primary care trusts which responded to Freedom of Information Act requests said they had put more drugs on red lists, or added new restrictions on GPs prescribing them, in the past year.

Drugs are prescribed using a “traffic lights” system. If a medication is deemed “green” then GPs are free to prescribe it; if it is “amber” they have to discuss prescription with a specialist; if it is “red” then only a specialist can do so.

Dr Bill Beeby, the chairman of the British Medical Association’s clinical and prescribing committee, said the status of drugs should be based solely on clinical grounds.

But he added: “There are lots of people who try to put drugs on these red lists on the basis of cost.”

With trusts under pressure to make savings estimated at £1.9 million each this year, the study suggests that increasing numbers are restricting access to drugs.

NHS Cambridgeshire has added 32 drugs to its red list over the past year, Pulse found, taking the total to more than 100.

NHS Warrington has added 25 “areas” of prescribing to its list, including the statins Crestor (also known as rosuvastatin) and Lipitor (atorvastatin).

The “areas” include drawing to a halt to “routine prescribing for longer than three months for patients who live abroad”.

NHS Derby City estimates that it will save £781,000 by “decommissioning” 13 drugs, including Intanza, a flu vaccine which uses a very short needle for those who dislike jabs, and Grazax, a grass allergy tablet.

Katherine Murphy, chief executive of the Patients Association, described the bans as “a real worry”. “What’s the point of Nice approving medicines if they are not being made available?” she said.

Barbara Young, chief executive of Diabetes UK, said: “People’s health must not be compromised with an attempt to cut costs. This would be a very short-sighted policy as complications of diabetes, such as kidney failure, are hugely expensive.”

Most drugs prescribed by GPs are so-called “generics”, meaning they are cheap versions of drugs that are no longer subject to a monopoly of production. However, there are no alternatives for some newer, more expensive drugs.

Dr Dermot Neely, an expert on statins at the charity Heart UK, said of the increased use of red lists: “It is an extremely indiscriminate and ill-advised policy, if it’s being used by PCTs to constrain costs.”

Studies show that switching from branded statins to generics results in more heart attacks and deaths, he added.

Richard Hoey, the editor of Pulse, said: “Many of the drugs approved by Nice or other national bodies are not only cost-effective, but are likely to recoup some of the price in the long-term by reducing rates of illness.

“These bans on prescribing drugs are therefore not only damaging to the care of patients, but quite possibly a false economy.” Although its budget has been protected, the NHS is committed to making efficiency savings of up to £20?billion a year by 2014.

Although the red list is only for guidance, GPs often feel pressured into following the advice because trusts hold the purse strings.

From: http://www.telegraph.co.uk/Patients-are-denied-high-cost-drugs-by-NHS-trusts

Economic problems may be fuelling a rise in depression in England, new research suggests.
Prescriptions for anti-depressant drugs such as Prozac rose by more than 40% over the past four years, data obtained by the BBC shows.

GPs and charities said they were being contacted increasingly by people struggling with debt and job worries.

They said financial woe could often act as a “trigger”, but added other factors may also be playing a role in the rise.

The rise has happened at a time when the government has been increasing access to talking therapies, which should in theory curb the demand for anti-depressants.

In the last year alone referrals for talking therapies rose four-fold to nearly 600,000, Department of Health figures showed.

Dr Clare Gerada, head of the Royal College of GPs, said some of the rise in prescribing was also likely to be due to increased awareness about the condition and doctors getting better at diagnosis.

But she added: “Of course, in times of economic problems we would expect mental health problems to worsen – and GPs are seeing more people coming in with debts racking up, or who have lost their job and are cancelling their holidays.

“They feel guilty that they can’t provide for their family and these things can often act as a trigger for depression.”

Mental health charity Sane also said it had seen more people contacting its e-mail and phone advice lines with money worries.

Its chief executive, Marjorie Wallace, said: “It is impossible to say for sure that economic problems are leading to a rise in depression. But we are certainly hearing more from people who are worried where the next meal is coming from, job security and cuts in benefits – many who are getting in touch with us for the first time.

“It is a toxic combination, especially for those who already have darker thoughts and other problems.”

Emer O’Neill, chief executive of the charity Depression Alliance UK, said: “There is an increase in the number of people suffering from depression certainly, and the economic downturn has had an impact on that.

“But I think what’s happened is that a lot of the stigma has lifted on depression,” she told BBC Breakfast.

“It’s OK to say you have depression now – and people in general are getting much better information about what it is and they are coming forward and talking to GPs more about it.”

The figures, obtained from NHS Prescription Services under the Freedom of Information Act, cover anti-depressant prescribing from 2006 to 2010, during which time the country had to cope with the banking crisis, recession and the start of the spending cuts.

They showed the number of prescriptions for selective serotonin re-uptake inhibitors, the most commonly prescribed group of anti-depressants, rose by 43% to nearly 23 million a year.

The data also showed increases in other types of anti-depressants, including drugs such as Duloxetine which tends to be used for more serious cases.

As well as increasing demand for help, the rise could also be related to patients staying on the drugs for longer.

Care services minister Paul Burstow said: “The last recession has left many people facing tough times. If people do experience mental health problems, the NHS is well placed to help.

“We’re boosting funding for talking therapies by £400m over the next four years. This will ensure that modern, evidence-based therapies are available to all who need them, whether their depression or anxiety are caused by economic worries or anything else.”

From: http://www.bbc.co.uk/news/health-12986314

Leading health organisations have slammed the Government’s “responsibility deal” on alcohol and refused to sign up as partners.
The six organisations, including Alcohol Concern, the British Medical Association and the Royal College of Physicians, accused the Department of Health of allowing the drinks industry to dictate health policy.

Under the deal, the drinks industry would be asked to sign up to a number of alcohol pledges.

These reportedly include ensuring 80% of products on the shelf are labelled for unit content, raising awareness of the unit content of drinks in pubs and clubs and taking action to reduce under-age drinking.

There would also be a pledge to commit to action on advertising and marketing by promoting responsible drinking and keeping alcohol adverts away from schools.

But the six organisations which had been involved in the Government’s Responsibility Deal Alcohol Network (RDAN), which also include the British Association for the Study of the Liver, the British Liver Trust, and the Institute of Alcohol Studies, refused to support the deal.

They said the pledges were neither specific nor measurable, that they lacked scope and that there was no evidence such voluntary interventions would be effective.

The statement read: “We have not yet seen evidence that Government is working towards a comprehensive, cross-departmental strategy to reduce alcohol harm, based on evidence of what works, with rigorous evaluation metrics.”

The organisations called on the Government to provide:

• A clear and firm commitment on how it intends – via evidence based policy – to tackle affordability, availability and promotion of alcohol as part of a cross-government strategy;

• A clear presentation of the steps that will be taken if the current RDA objectives are not met in 12 months’ time;

• A firm commitment to consider change – including through regulation – if voluntary commitments from business are not met after an agreed time period.

Don Shenker, chief executive of Alcohol Concern, said: “This is the worst possible deal for everyone who wants to see alcohol harm reduced.

“There are no firm targets or any sanctions if the drinks industry fails to fulfil its pledges.  It’s all carrot and no stick for the drinks industry and supermarkets.”

“By allowing the drinks industry to propose such half-hearted pledges on alcohol with no teeth, this Government has clearly shown that when it comes to public health its first priority is to side with big business and protect private profit.”

Dr Vivienne Nathanson, director of professional activities at the BMA, said: “The Government has talked the talk in respect of wanting to tackle alcohol misuse but when it comes to taking tough action that will achieve results, it falls short.

“Instead it has chosen to rely on the alcohol industry to develop policies – given the inherent conflict of interest these will do nothing to reduce the harm caused by alcohol misuse.”

Katherine Brown, Head of Research and Communications at the Institute of Alcohol Studies, said: “The most effective means of reducing alcohol-related harm is through adjustments in affordability, availability and promotion.

“These policies are supported by a broad evidence base and have been recommended to Government by a recent cross party House of Commons Health Committee report.

“The Responsibility Deal fails to address any of these policy areas and we are yet to see any real proof that Government is looking into developing a cross-departmental comprehensive alcohol strategy, based on evidence of what works.”

Alison Rogers, chief executive of the British Liver Trust, said: “For more than 10 years we have been persuaded to play the long game, sitting and watching the alcohol industry cultivate their relationship with the Government.

“Now it must stop for the sake of the 100 families losing loved ones each week from alcohol-related liver disease.”

And Sir Ian Gilmore, the Royal College of Physicians’ special adviser on alcohol, said: “The industry pledges published in various newspapers do not give practising doctors, who see the rising tide of health harm from drink in their daily practice, any confidence that they will get to the core of how we reverse this entirely preventable cause of illness and death.”

Sir Ian was among a trio of experts who recently warned the Government that up to 250,000 extra lives could be lost in the next 20 years in England and Wales unless tough restrictions on alcohol are introduced.

The liver death rate in the UK is 11.4 per 100,000 people, more than double that of other countries with similar drinking cultures, including Australia and Holland.

Health Secretary Andrew Lansley said: “We have made clear from the start that the responsibility deal is just one strand of the Government’s wide public health policy. It explicitly excludes cost and price competition to avoid conflicts of interest.

“The Treasury have already announced an introduction of a new tax on super-strength beers; the Home Office have made their announcement on a ban in sales of alcohol below cost and plans to tighten licensing laws; and, our public health strategy sets out how local areas will be given a ring-fenced public health budget to ensure alcohol misuse gets the priority it deserves.

“In tandem to this action, the responsibility deal is working with the industry on voluntary agreements to get speedier results. For example, to improve unit labelling. The Responsibility Deal has achieved more in the last six months than the previous Government’s Coalition for Better Health did in a year and a half. What is more, this is only the first step.”

From: http://www.independent.co.uk/health-bodies-attack-government-alcohol-plans

Hospitals are cutting back on routine operations like hip and knee replacements as the NHS budget freeze starts to take effect while waiting times are beginning to rise, new figures show.
A survey of more than 60 hospital trusts has found that they carried out almost 11,000 fewer planned or ‘elective’ operations in 2010 than they did in 2009.

The trusts that replied carried out 1,227 fewer knee replacements, a drop of six per cent, and 531 fewer hip replacements.

And they carried out 2,041 fewer hernia operations, down 7.25 per cent, and 1,770 fewer tonsillectomies, a drop of 11 per cent.

The figures are from Freedom of Information requests to England’s 170 NHS hospital trusts, made by the Patients Association, of which 62 responded.

The pressure group described the figures as “a disgrace” while doctors labelled them “worrying”.

The Patients Association also found that, on average, waiting times for hip replacements rose from 80 to 88 days and for knee replacements from 82 to 90 days.

The organisation undertook the research after receiving triple the number of calls in 2010 from patients saying they were having problems getting the surgery they needed, compared to 2009.

In December The Daily Telegraph reported how some trusts were postponing lower-priority procedures to save money.

Although the NHS is receiving a 0.5 per cent above inflation increase each year between now and 2014, critics say a commitment to make internal savings of up to £20 billion by then means front-line services are being affected.

Katherine Murphy, chief executive of the Patients Association, said: “It is a disgrace that patients are being denied access to surgical procedures that they would have had if they had needed them a year ago.”

She added: “With the NHS needing to make £20 billion of savings by 2014, we are worried that this situation is only going to get worse – how many more thousands of patients are going to be denied operations this time next year?

“This research backs up what patients are telling us every day on our helpline, less operations are being carried out, and those fortunate enough to get an operation are having to wait longer for it to take place.”

John Black, president of the Royal College of Surgeons, described the figures as “worrying”.

He said: “Patients must be seen on a clinical need, rather than a financial basis. Any cost savings this may bring in the short term will be negated as these patients present with more serious conditions further down the line.”

However, the Department of Health said official hospital statistics for all trusts in England indicated that NHS activity went up in 2010, not down.

For example, from April to October 2010 there were 41,863 hip operations, compared to 39,114 for the corresponding six months in 2009; while the figures for knee operations were 45,463 and 43,454 respectively.

A spokesman said: “There is no justification for asserting that quality of care is slipping. Official figures show that the NHS is delivering more for patients and that waiting times are stable.”

From: http://www.telegraph.co.uk/Hospitals-cutting-operations-while-waiting-times-rise

One in four NHS trusts has cut spending on out of hours care, new figures disclose.
At least 20 trusts have reduced their budgets for doctors to visit patients in the evenings and at weekends by a total of £4million.

The cuts in after-hours budgets led to warnings of a repeat of the case of Daniel Ubani, the incompetent German locum who killed a Cambridgeshire man with a morphine overdose in 2008.

About 78 of England’s 152 primary care trusts released information on their out-of-hours spending after Freedom of Information Act requests by the magazine GP. Twenty said they had cut their budgets.

The cuts, made in the trusts’ 2010-11 budgets, come before the start of the next four-year spending round, which will require the NHS to find efficiency savings worth £20 billion.

Across the remaining trusts that released information, total spending on out of hours care rose by only £3.6 million.

Health experts said some trusts might have been able to make savings without affecting services, by renegotiating inflated contracts.

However, doctors and patients’ groups said that in many cases lower spending would add to concern about the quality of care.

A study commissioned by the Department of Health last year found wide variations in the quality of care provided by out-of-hours contractors, including GP groups and private health care firms.

Katherine Murphy, the chief executive of the Patients’ Association, said the latest cuts would reduce the quality of care, risking “a repeat of the case of Dr Ubani”.

She said: “By pressuring providers to look for ever cheaper options, the Government is forcing them to enter a race to the bottom.

“Out-of-hours services need to be staffed by doctors who are as trained and experienced as their colleagues who work during the day. Cutting funds to pay for them will mean fewer and possibly less able doctors.”

Dr Fay Wilson, who chairs an out-of-hours group in Birmingham, said cutting out-of-hours care was a “false economy” for trusts because more patients would be forced to seek care from accident and emergency wards.

“If you are going to reduce the cost, then you will be reducing the number of clinicians you have on,” she said. “That leaves gaps. You also don’t get the same level of supervision and support.”

Richard Vautrey, of the British Medical Association, said cutting costs could harm services.

“There is a concern that you can pare a service down to such a level and reduce funding to such a level that you put patient safety issues at a higher risk,” he said.

The Department of Health said the Coalition was improving out-of-hours care. A spokesman said: “This is not about cutting costs – we are investing an extra £10.7 billion in the NHS – it’s about ensuring GPs, not bureaucrats, are responsible for securing safe and appropriate out-of-hours care.”

The BMA also published a poll which it said showed that most GPs opposed government plans to give them control over £80 billion of NHS budgets.

About 65 per cent of family doctors believe competition between providers, including NHS and private companies, will reduce the quality of patient care, while 61 per cent said the Government’s reforms mean they will spend less time with patients.

The Department of Health said the survey showed some doctors had “misconceptions” of the planned reforms. Andrew Lansley, the Health Secretary, said there was no alternative to his reforms to make the health service more efficient.

“Unless we modernise, every year the relative costs of running the NHS will go up,” he said. “Demand will grow, the bureaucracy will expand and inefficiencies will become entrenched.

“There is no easy option. Sticking with the status quo and hoping that a bit more money will be enough to meet the challenges ahead is a complete fiction.”

From: http://www.telegraph.co.uk/Patients-at-risk-as-health-trusts-trim-out-of-hours-care

The National Health Service is condemned over its inhumane treatment of elderly patients in an official report that finds hospitals are failing to meet “even the most basic standards of care” for the over-65s.
A study of pensioners who suffered appalling treatment at the hands of doctors and nurses says that half were not given enough to eat or drink.

One family member said the maltreatment amounted to “euthanasia”.

Some were left unwashed or in soiled clothes, while others were forgotten after being sent home or given the wrong medication.

In several cases considered by the Health Service Ombudsman, patients died without loved ones by their sides because of the “casual indifference” of staff and their “bewildering disregard” for people’s needs.

The damning report warns that extra money will not help the NHS meet required standards of care and that more problems are likely as the population ages.

Ann Abraham, who as health ombudsman carries out independent investigation of complaints against the health service, said: “The findings of my investigations reveal an attitude – both personal and institutional – which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism.

“The reasonable expectation that an older person or their family may have of dignified, pain-free end of life care in clean surroundings in hospital is not being fulfilled. Instead, these accounts present a picture of NHS provision that is failing to meet even the most basic standards of care.

“These often harrowing accounts should cause every member of NHS staff who reads this report to pause and ask themselves if any of their patients could suffer in the same way.

“I know from my caseload that in many cases, the answer must be ‘yes’.”

Michelle Mitchell, charity director at Age UK, said: “The inhumane treatment of older people described in this report is sickening and should send shock waves through the NHS and Government.

“It’s difficult to imagine us allowing any other group of people to suffer this indignity and neglect, yet we know this is just the tip of the iceberg. Appalling treatment of older people in the health service is far too common.”

Under Labour, health spending in England tripled to reach more than £100 billion a year. A new “NHS Constitution” set out the service’s commitment to human rights, high-quality care and respect for patients and their families.

Yet the Ombudsman said her office’s investigations into the cases of 10 people over 65, which took place between 2009 and last year, showed the “stark contrast” between the NHS’s stated principles and the treatment patients received.

The patients had all been loving, active people of a generation that “didn’t like to make a fuss”. They had simply wanted to be cared for properly and die peacefully – but they all suffered “unnecessary pain, indignity and distress while in the care of the NHS”. As a result, “they were transformed from alert and able individuals to people who were dehydrated, malnourished or unable to communicate”.

Half of them did not consume adequate food or water, some were not washed, others were discharged in a “shambolic” fashion, while in many cases their suffering was ignored.

Nine of the 10 died while in NHS care or soon afterwards, and the Ombudsman upheld the complaints made about the care received by all 10.

The report says it is “incomprehensible” that the NHS needs to be told that its patients should be provided with clean and comfortable surroundings, assistance with eating, drinking water and the ability to call for help. “Yet the most basic of human needs are too often neglected.”

The Ombudsman warned that the cases detailed in the report were not exceptional, with almost one in five of the 9,000 complaints it received last year concerning the care of older people.

The report notes that by 2034, 23 per cent of the population will be over 65, with rising levels of dementia placing additional burdens on care. But “extra resource alone will not help” as some staff are guilty of an “ignominious failure to look beyond a patient’s clinical condition”, and an “apparent indifference” to “appalling standards of care”.

The Ombudsman said that “real and urgent change” was needed, including listening to older people and their families, as well as learning from mistakes.

Paul Burstow, the care services minister, said: “This report exposes the urgent need to update our NHS. We need a culture where poor practice is challenged and quality is the watchword. The dignity of frail older people should never be sidelined.”

Katherine Murphy, of the Patients Association, said: “Attitudes need to change. Older patients need to be treated with respect and compassion, not as an inconvenience. It is a sick joke that we have an NHS constitution that tells us what rights we have when being treated by the NHS – but it is clear that to the majority of older patients it is not worth the paper it is written on.”

From: http://www.telegraph.co.uk/NHS-shamed-over-callous-treatment-of-elderly

Patients will have to contact a call centre to arrange GP appointments under plans for NHS Health Direct to handle bookings for local doctors’ surgeries.Anyone wanting an appointment will first have to contact NHS Direct by dialling 111, which will be used as the new non-emergency medical number.

Call centre staff would then make their booking remotely, meaning patients would no longer speak to a GP receptionist directly.

The scheme is being tested by 20 practices in Surrey, and appears to have the backing of Andrew Lansley, the Health Secretary.

Doctors behind the proposal believe it will make booking appointments easier, but patients’ groups fear that many will find having to book through a call centre “hugely frustrating”.

There are also concerns that it could erode the role of dedicated GP receptionists – many of whom build up a close rapport with their doctors’ patients – with people having to deal with anonymous call centre staff with little medical experience instead. Unions believe thousands of receptionists could lose their jobs.

The move follows a report commissioned by the Department of Health last year that said millions of pounds could be saved each year if national or regional call centres were set up to handle GP appointments.

Exact details of the Surrey pilot have yet to be decided, but under one option patients would ring 111, ask for NHS Direct and then speak to a call centre worker who would book their appointment remotely. The doctors involved insist it will free receptionists to carry out other administrative duties.

Dr Joe McGilligan, a doctor in Redhill, Surrey, said: “Everyone in the NHS has to become more efficient and this is one way of doing that.”

Emphasising that he wanted to make life easier for patients, he said: “People complain about telephone services in GPs’ surgeries all the time. We only have a fixed number of lines.”

Patients would still have the option to ask to be put through directly to the surgery if they wanted to speak to a receptionist, he said. Another option was for the 111 number to run in tandem with GP surgery numbers.

“If it was up to me I’d launch this tomorrow, but it will be within six months,” Dr McGilligan told Pulse magazine.

Papers from NHS Direct show that the service is now in talks about handling GP appointments for hundreds of thousands of patients.

NHS Direct has already held talks with GP consortia in Northamptonshire, Nottinghamshire, Cambridgeshire and London, according to Pulse, while managers also plan to discuss the idea with doctors in Birmingham, Torquay and south Gloucestershire.

NHS Direct is already booking out-of-hours GP appointments in several areas.

Dr Brian Gaffney, medical director of NHS Direct and a GP in Downpatrick, Co Down, said doctors were “keen to work with us”. “We know as GPs we can’t cope with demand for our practice appointments,” he said.

But other doctors and Unison, which represents receptionists, fear any move to centralise bookings could harm patient care. Karen Jennings, head of health at Unison, said: “We’ve all waited on the phone to get through to a call centre, with irritating muzak playing in the background. It’s a hugely frustrating, depersonalised, even upsetting experience, made even worse if you are ill or caring for a sick child or elderly relative.

“A properly funded receptionist, who knows their patients and can treat them with dignity, respect, and urgency, is what patients want.”

Dr Philip Cox, a GP from Buxton, Derbyshire, called the idea “ludicrous”. He said: “It will cause chaos and patients will be totally frustrated.”

Katherine Murphy, chief executive of the Patients Association, cautioned that people would not want their receptionist to be replaced. “Patients want local services with people that know them.”

Before Christmas, the Department of Health distanced itself from the idea of centralising bookings, saying there were “no plans” for a national call centre. But last month, Mr Lansley indicated he was in favour, saying he hoped patients “will be able to make bookings” through the 111 number.

From: Call-NHS-Health- Direct-if-you-want-to-visit-your-doctor