Hospital managers are planning to postpone thousands of non emergency operations today, because of the public sector unions striking over pension changes.Patients across the UK have been sent letters warning them of the disruption.

Diagnostic tests and outpatient appointments will also be delayed, but hospitals insist emergency and critical care will not be affected.

Managers say they are preparing as they would for Christmas or bank holidays.

An estimated 400,000 nurses and healthcare assistants, as well as paramedics, physiotherapists, and support staff like cleaners and administrators have said they will join the action on 30 November over changes to public sector pensions.

However, the main medical unions – the Royal College of Nursing, the Royal College of Midwives and the British Medical Association are not taking part.

The Department of Health in England said it was expecting at least 5,500 non-emergency procedures like hip and knee operations to be rearranged.

More than 12,000 patients are likely to have diagnostic tests postponed, and 40,000 outpatient appointments are expected to be rescheduled.

On an average day, 28,000 patients have planned treatments or operations in England and there are 60,000 diagnostic tests.

However, managers say they are putting plans in place to make sure people can still get emergency or urgent care, in the way they do on bank holidays or at Christmas.
999 calls

Patients needing urgent treatment like chemotherapy and kidney dialysis will still be able to get it, and maternity units will remain open.

Calls to 999 will still be answered, but patients are being urged to think hard and only call if it is a genuine emergency.

The Health Secretary, Andrew Lansley, said health service workers should not take action that harms the interests of patients.

“I would ask staff to consider carefully whether going on strike is the right thing to do,” he said.

Three out of four nurses lack the time to talk to patients, a major survey of NHS trusts has revealed.The results of a survey involving almost 3,000 nurses by researchers at King’s College London will prompt further alarm over the standards of care in the NHS.

A quarter admit they are too busy to administer drugs on time and more than 40 per cent said at least one patient under their care had suffered a serious fall in the last month.

The findings were based on unannounced inspections at 100 hospitals to check elderly patients were given enough to eat and drink and were treated with dignity.

In some instances, watchdog’s inspectors saw patients rattling bedrails or banging on water jugs in an effort to attract the attention of nurses.

The report also claimed that some hospitals were “putting paperwork over people” with patients being left for more than ten hours without a drink.

The latest study involving 2,943 nurses looked at 31 NHS trusts across England. Researchers found there was an absence of humanity as without regularly talking to their patients nurses had no way of knowing their needs.

The survey revealed that 76 per cent of nurses did not have enough time to talk to or comfort patients and 40 per cent of staff were too busy to carry out necessary checks such as taking their temperature.

Thirty-nine per cent admitted they did not have enough time to record details about patient care such as whether they had been given anything to eat or drink.

Twenty-six per cent said they were too busy to administer drugs on time and 24 per cent had not been able to check skin for signs of pressure sores.

A further 44 per cent admitted that in the past month at least one patient under their care had suffered a serious fall.

And 26 per cent said that at least one patient in the same period had been given the wrong dose of drugs or developed bed sores.

Professor Peter Griffiths, of the national nursing research unit at King’s College London, told the Daily Mail: “Talking and comforting patients is very important as nurses need to know how they are and how they feel.

“It’s about having humanity, having a relationship with people. It’s important to understand what patients need. Sometimes staff feel that paperwork has to come first.”

The Royal College of Nursing admitted it was “not surprised” that so many nurses lacked the time to talk to patients.

Janet Davies, its executive director of nursing and service delivery, said: “We know many nurses are wilting under the strain of longer working hours, taking on the burden on unfilled vacancies and reduced staffing levels.”

FroM: http://www.telegraph.co.uk/Three-in-four-nurses-dont-have-time-to-talk-to-patients

Nurses and midwives are being urged to get their flu jabs after figures reveal less than a third did last year.All front line healthcare workers are meant to be vaccinated to stop them going off sick with influenza and spreading the virus to patients.

Last year only 30% of hospital nursing staff in England got immunised compared with 43% of GP practice nurses, 38% of GPs and 37% of other doctors.

Nursing and midwifery groups say having the jab is a “professional duty”.

This is the first time the figures have given broken down by occupation.

The number of healthcare workers getting the vaccine had increased from 26.4% in the 2009 winter to 34.7% in 2010.

However, the majority of nurses who work with the most critically ill over the winter months and midwives who work with pregnant women, were left vulnerable to flu, its potentially life-threatening complications and passing it on to patients and family, says the Department of Health which released the figures.

The data also shows that only 25.2% of youngsters aged six months to two years in at-risk groups were vaccinated last winter, compared with 51.7% of those aged 16 to 65.

Those at risk include people with conditions such as asthma, diabetes, heart disease and liver disease, as well as the over-65s and pregnant women.

Last winter people in at-risk groups were 11 times more likely to die from seasonal flu than people with no underlying health problems.

Chief Medical Officer Dame Sally Davies said: “It is never too early to start thinking about flu. So as NHS staff return from their holidays, I urge them to plan ahead and get vaccinated.”

Dr Peter Carter, of the Royal College of Nursing, said while NHS staff should not be forced to get immunised, they had a professional duty to do so: “Patients and healthcare staff suffer when nurses are off sick.

“It is vital that nurses do all they can to take responsibility for their own health and of those around them. The RCN will be working with our members to ensure they have access to all of the relevant information to enable them to make the right decision about the uptake of the vaccine.”

Louise Silverton, of the Royal College of Midwives, said: “Midwives are strongly advised to encourage all pregnant women to be vaccinated against seasonal flu.

“In addition midwives as key health workers should themselves seriously consider being vaccinated to prevent transmission of influenza to the women for whom they care and also to their own families.”

A National NHS Staff Seasonal Flu Vaccination Campaign launches later this month and will use resources like Twitter and Facebook, as well as leaflets, to encourage more healthcare professionals to get vaccinated.

From: http://www.bbc.co.uk/news/health-14792570

NHS managers are trying to restrict access to crucial tests and scans in a move that could mean diseases being diagnosed later. 

An investigation has found that a quarter of Primary Care Trusts are either investigating how many patients individual GP practices send for examinations or looking for ways to reduce the numbers.

In addition, a handful are identifying “excessive” use of the tests or setting upper targets while others have completely stopped letting doctors have direct access to the scans.

Experts said the tactics could lead to patients being diagnosed later with diseases such as cancer, which research shows lowers survival chances.

Dr Clare Gerada, head of the Royal College of GPs, said: “This is about money and finances driving behaviour by the PCT – not about putting patients first.”

Cancer Research UK’s director of policy, Sarah Woolnough, added: “It is very worrying to hear of PCTs setting referral targets and decommissioning direct access to tests that could speed up a cancer diagnosis.”

Meanwhile, official figures show that even patients who are being referred to hospitals for tests are being forced to wait longer than a year ago.

Department of Health statistics show that 10,700 patients were waiting more than six weeks for any one of 15 key diagnostic tests at the end of July, a rise of 7,000 on the figure for the previous year.

The Government has told health service managers to improve direct access to diagnostic scans such as MRI, CT and ultrasound in order to improve early diagnosis of cancer and heart disease.

But an investigation by GP magazine suggests that many trusts want to reduce the number of patients sent directly to tests at specialist centres in order to save money.

Of the 116 Primary Care Trusts contacted, 28 per cent said they had either started looking into how many referrals GPs carried out across their area, or were planning to do so. A quarter are helping practices reduce inappropriate access.

Nine trusts said they had found surgeries that either sent too many or too few patients for tests while two are considering introducing upper and lower targets.

Five PCTs have scrapped direct access altogether to at least one type of test.

Dr Chaand Nagpaul, a leading member of the British Medical Association, said restricting access to scans risks “turning back the clock” on plans to diagnose disease early.

“An intelligent approach would be to have guidelines for appropriate use of diagnostics and incorporate them into the pathway.”

The moves are the latest example of how managers are rationing patient care in an attempt to make unprecedented efficiency savings totalling £20billion across the NHS by 2015.

From: http://www.telegraph.co.uk/NHS-managers-restricting-access-to-crucial-scans-and-tests

Doctors are being warned to take extra care when using social media websites such as Facebook and Twitter.
The British Medical Association guidance highlighted a series of potential pitfalls doctors face.

In particular, it said there was a risk the lines between personal and professional lives could be blurred.

It comes after a series of cases in which NHS staff and other public sector workers have got into trouble through their use of social media.

In 2009, a group of doctors and nurses were suspended for posting pictures of themselves on Facebook lying down in unusual places, including a hospital helipad.

And last year a civil servant found herself in the newspapers after using her Twitter account to make political points and saying she was struggling with a hangover.

Dr Tony Calland, chairman of the BMA’s medical ethics committee, said: “Medical professionals should be wary of who could access their personal material online, how widely it could be shared and how it could be perceived by their patients and colleagues.”

The guidance advises both doctors and medical students to adopt conservative privacy settings where they are available.

It also warns them against making informal or derogatory comments about patients or colleagues as well as not accepting current or past patients as friends on Facebook.

The message was echoed by the Nursing and Midwifery Council (NMC), which has also issued its own guidance this week.

NMC official Andy Jaeger said: “What you regard as just an amusing story could end up causing serious offence more easily than you think.”

From: http://www.searchclinic.org/doctors-warned-over-facebook-risks.htm

Nurses have suggested they should undergo an annual health and well-being “MoT”.
The physical and psychological assessment could take place alongside yearly appraisals, according to nurses at the Royal College of Nursing (RCN) conference in Liverpool.

They believe the plan would help staff set a healthy example to patients and argued that there are more checks on wheelchairs than NHS staff.

Claire Topham-Brown, a critical care nurse from Peterborough, said: “There is no denying that nursing is a physically demanding job. You do need a certain level of physical fitness.”

She told delegates during a discussion on the issue that one activist had “observed that we take better care of wheelchairs than we do of the staff.

“Bizarre but true – we now risk-assess everything, yearly, monthly, weekly and sometimes daily. But when do we ever assess that vital, delicate and most valuable part of the machine – namely me and you?”

She said it was not just about the physical and psychological nature of nursing work but also the culture and environment in which they operated.

“Don’t we deserve an annual MoT?” she said. “It would allow our employers to be more proactive and supportive instead of reactive.”

Ms Topham-Brown was supported by other nurses, including Karen Webb, the RCN’s director of the eastern region of England.

She suggested support was even more important given the expansion in nurses in training in recent years, which could lead to an increase in the numbers not fit for a career in nursing.

She said students had a health check before joining a course but their psychological suitability was not tested.

“It is about making sure people have the right attributes,” she added.

In her local area, screening had been launched to “make sure that the people coming in have the right attitude to what is essentially customer care”.

She said nurses also had a duty to deal with public health issues, such as obesity and well-being.

And those nurses who were overweight themselves could be supported.

“It would be about supporting those people in that position to help them lose the weight.”

The Government’s NHS Health and Wellbeing report, published a year ago, said the NHS needed to do more to improve the health of staff.

NHS staff take an average of 10.7 days off work a year – more than the public sector average and nearly double the 6.4 figure for the private sector. Staff sickness is thought to cost the NHS £1.7 billion a year.

From: http://www.independent.co.uk/call-for-annual-health-check-for-nurses

Looking uncomfortable and sounding contrite, Andrew Lansley came to face his nursing critics yesterday – apologising four times and promising to listen to them in future.
Just hours after members of the Royal College of Nursing had voted overwhelmingly in favour of a “no-confidence” motion in Mr Lansley’s management of NHS reforms, the Health Secretary spent an hour and a half answering questions and listening to their concerns.

During the meeting he hinted that when the Government outlined its concessions to the Health and Social Care Bill in June, nurses would be given a greater role, particularly in deciding where NHS funds are spent. Nurses are likely to be given a statutory role on the new GPs’ commissioning boards, ensuring that at least one nurse is represented. The boards are also likely to be renamed to show that they represent other healthcare workers.

Mr Lansley tried to reassure the 60 RCN representatives who had been chosen to meet him that he did care about the NHS. He ruled out accepting any other job in Government, suggesting he would resign rather than be moved in any cabinet reshuffle.

“I believe in the NHS,” he said. “I am in politics for that. I am not here to do some other job. If there is an ideology behind what I am doing it is a belief in the NHS and a desire to protect it and make it stronger.”

Asked how he felt about being the only health secretary to receive a vote of no-confidence from nurses, he said: “It’s not something I sought out.

“I think it’s a rebuke and from my point of view I take it as a rebuke and I think listening to nurses this afternoon it was very clear some of the reasons why that happened is because they thought I was too focused on general practitioners when I was taking about clinical commissioning, GP commissioning.

“I know that nurses are not only the largest healthcare profession but are responsible for the delivery of most healthcare, and are often in the best place to be able to see the whole of care.

“From that point of view is it a rebuke in the sense that I didn’t get to the right place? Absolutely.”

Many nurses appeared partially mollified by Mr Lansley’s approach. But they all said they would wait to see how his “listening” materialised into concessions.

One of the problems Mr Lansley faces, however, is that it is not just the contents of his contentious Bill that the nurses object to. In the earlier no-confidence debate most were angered at cuts to frontline services as a result of the Government’s plans to try to make £20bn worth of efficiency savings over the next four years.

This is not something Mr Lansley has much control over as an ageing population means that the NHS will have to do “more for less” and savings will have to be found.

Earlier in the day delegates in Liverpool had voted 99 per cent in favour of the no-confidence motion, to 1 per cent against.

The RCN’s leadership had attempted to amend the motion to delay any no-confidence vote until after the conclusion of the Government’s listening exercise. But amid angry and passionate scenes on the conference floor the amendment was dropped when nurse after nurse took to the stage to condemn the Government.

“What this is about is how Andrew Lansley has introduced these reforms,” said Geoff Earl. “They are being driven by ideological dogma, not by what is best for our patients. This [vote] is about our patients, not about us.”

Another nurse went on to the platform and played a tape of David Cameron’s promise in 2010 to “stop the pointless reorganisation of the NHS”. Birmingham nurse Bethann Siviter added: “If these reforms go through, the NHS is dying.”

Andrew Frazer, an emergency care nurse, said: “When Andrew Lansley addressed us last year we listened to him politely and decided to adopt a wait-and-see policy. Well, we’ve waited and we’ve seen, and I for one don’t like what I’ve seen.

“We’ve been trimmed to the bone for years. Trying our damnest to deliver excellent care with limited resources. Here’s a message for Mr Lansley: if you cut frontline services, in the short-term care may be a little cheaper, but in the long-term care will be poorer and people will die.”

From: http://www.independent.co.uk/im-sorry-lansley-tells-nurses-afternoconfidence-vote

The Government cannot afford to delay essential reform of Britain’s public services, David Cameron warned yesterday.
As ministers prepared to publish legislation to radically overhaul the NHS, the Prime Minister said that failure to modernise was draining resources away from the public sector.

The Government’s plans for the NHS were denounced by six health service unions – including the British Medical Association and the Royal College of Nursing – as “potentially disastrous”.

But Mr Cameron insisted that change was essential.

“Every year without modernisation the costs of our public services escalate. Demand rises, the chains of commands can grow, costs may go up, inefficiencies become more entrenched.

“Pretending that there is some ‘easy option’ of sticking with the status quo and hoping that a little bit of extra money will smooth over the challenges is a complete fiction.

“We need modernisation, on both sides of the equation. Modernisation to do something about the demand for healthcare, which is about public health. And modernisation to make the supply of healthcare more efficient, which is about opening up the system, being competitive and cutting out waste and bureaucracy.

“Put another way: it’s not that we can’t afford to modernise; it’s that we can’t afford not to modernise.”

With the Government also set to publish details of its school reforms next week, Mr Cameron cited the experience of Tony Blair, who found that delaying public service reform simply resulted in “institutional inertia” against change.

He acknowledged that in the past the Conservatives had not always shown sufficient respect for those who worked in public services, but insisted he would “revere, cherish and reward” an ethos of public service.

“I believe previous Conservative governments had some really good ideas about introducing choice and competition to health and education – so people were in the driving seat. But there was insufficient respect for the ethos of public services – and public service,” he said.

“The impression was given that there was a clear dividing line running through our economy, with the wealth creators of the private sector on one side paying for the wealth consumers of the public sector on the other.

“This analysis was – and still is – much too simplistic. Public sector employees don’t just provide a great public service – they contribute directly to wealth creation.”

He denied he was planning “a kind of public service version of a laissez-faire economic policy” with the Government’s reforms for schools and hospitals, “where winners are created at the expense of those who get left behind”.

“The state has a hugely important responsibility to ensure clear, basic standards are met, the rights of users are maintained and independent inspection is carried out in our public services and we are in no way abrogating that,” he said.

The Prime Minister also rejected suggestions that the Government was trying to do “too much at once” in pushing through change.

“Every year we delay, every year without improving our schools is another year of children let down, another year our health outcomes lag behind the rest of Europe, another year that trust and confidence in law and order erodes,” he said.

“These reforms aren’t about theory or ideology – they are about people’s lives. Your lives, the lives of the people you and I care most about – our children, our families and our friends. So I have to say to people: if not now, then when? We should not put this off any longer.”

Mr Cameron also explained comments in which he appeared to describe the NHS as a second rate National Health Service as a slip of the tongue.

His slip-up came during a radio interview this morning on BBC Radio 4′s Today programme.

Asked if he would apologise for using the term, Mr Cameron said: “I think if you listen to the interview, I immediately said we shouldn’t settle for second best and that is exactly what I meant to say.

“I speak often quickly, I don’t just have a pre-arranged order of saying things and sometimes you can get a little word out of place and I immediately said, if you listen to the clip, we shouldn’t settle for second best, that was the point I was making.”

To widespread guffaws from the assembled media, he added: “We shouldn’t settle for second best is what I meant, it’s largely what I said, if you skip over a quick word in the middle.”

In a letter to The Times today ahead of Wednesday’s publication of the Health and Social Care Bill, the heads of six health unions expressed their “extreme concerns” about plans to create greater commercial competition between the NHS and private companies within the health service.

The signatories, including BMA chairman Hamish Meldrum, RCN chief executive Peter Carter and the heads of health for the Unison and Unite unions, said: “There is clear evidence that price competition in healthcare is damaging.”

It follows a report by the NHS Confederation which acknowledged the potential benefits of the changes, which will give GPs power over commissioning treatment, but warned they were “extraordinarily risky” at a time when the NHS is facing its toughest financial constraints for a decade.

From: http://www.independent.co.uk/we-cannot-afford-not-to-reform-nhs-says-david-cameron

Nursing care must be strengthened and the complaints system overhauled because of continued poor care of older people in hospital, says the Patients Association.
The patient lobby group has highlighted 17 cases in England and Wales where patients were left lying in faeces, or desperately hungry and thirsty.

It said it had been inundated with similar stories.

The Patients Association acknowledged that most patients do get good treatment, but said some were still being denied the essentials of nursing care, even though it highlighted serious problems last year.

A national survey of hospital experiences in England suggests that nearly half of all patients rate their care as excellent, and just 2% said it was “poor”.

The Patients Association said the 17 cases highlighted wider failings in NHS nursing care.

It is calling for the introduction of independent “patient safeguarding champions” at every hospital to check that nursing standards are maintained. It also wants the NHS complaints process to be overhauled.

“Surely the essentials of nursing care are what every patient deserves and should get?” said Chief Executive, Katherine Murphy.

“It’s a scandal, and it’s outrageous that it has been persisting for years.”

The family of former Patients Association president, Claire Rayner, who died in October, is backing the calls for change.

“If she were here today she would have been hollering from the roof tops about it,” said Claire Rayner’s son Jay.  “Any health system is only as good as its failings, and those detailed in these pages are truly dismal.”

The Royal College of Nursing said there was no excuse for poor care.

General Secretary Peter Carter said: “Neither the RCN nor the overwhelming majority of committed and caring nurses can possibly condone the neglect, rudeness and in some cases outright cruelty outlined in this report.”

However, he said problems often arise when staffing levels are cut.

Care Services Minister, Paul Burstow said the report painted a disturbing picture.

“It is an unacceptable legacy that this government is committed to tackling. The NHS must become much more tuned into patient views and experience.”

He said that was why the government would soon start publishing details about complaints.

From: http://www.bbc.co.uk/news/health-11889342

The Summary Care Record IT program  is to go ahead, but its content will be limited to core information with an opt out form will be included in patient information packs.

The Department of Health has published the results of two simultaneous reviews of the SCR, covering the content of the record and the information patients receive before their record is uploaded.

The reviews were set up by the coalition government this summer, following concerns about patients’ awareness of the SCR and the kind of information added to it. This had led to the suspension of further patient information programmes.

The review of the content of the record, led by NHS medical director Sir Bruce Keogh, concluded that the core record should only contain a patient’s demographic details, medications, allergies and adverse reactions, and that these should continue to be copied from the GP’s medical record.

The review group said the DH should only consider expanding the content of the record “when we have built trust in the system and when patients request that we should do so.”

Sir Bruce said: “In an advanced national health system, it is reasonable for citizens to expect that when they arrive in accident and emergency or require treatment out of hours, the clinicians treating them have access to enough basic medical information to prevent anyone making wrong or even dangerous decisions.”

The separate Patient Information and Preference Review group, led by national director of patient and public affairs Joan Saddler, concluded that an opt-out form should be included in the patient information packs, and that these should also be simplified.

It said services such as HealthSpace should also continue to provide access to SCRs.

Almost 30m patients have already received information about the SCR but the review concluded that there should be no requirement to send another letter to those patients.

However, it said but there should be awareness raising campaigns at local, regional and national levels to ensure patients realise that an SCR is being created for them unless they choose to opt out.

Health minister Simon Burns said he was pleased that a consensus had emerged about the importance of the SCR in supporting safe patient care, so long as the content of the record was limited to core information.

He added: “Coupled with improvements to communication with patients which reinforce their right to opt out, we believe this draws a line under the controversies that the SCR has generated up to now.

“We see this review as having taking a significant step towards the goal of patients owning their records and using them to share decision-making with healthcare professionals.”

A BMA spokesperson said: “We welcome the progress that has been made towards an emergency electronic record that supports urgent care, yet recognises many of the understandable concerns of patients and clinicians.

“Much will depend on the way the amended scheme is put into practice, and the BMA looks forward to continuing our work with government on its implementation. It is essential that patients have genuine control over who has access to their records, and when changes are made to them.”

The review groups concluded that patients should play a key role in deciding the evolution of the record and that new arrangements should be introduced to define responsibility for decisions about the introduction of any new content to the record.

They said the principle should be that any change to the scope of the record should be driven by citizens and patients with appropriate advice from professional bodies and in line with the IT capability.

Saddler said the availability of core information when patients need care was essential if patients were to be at the heart of care but it should also be easy for patients to opt-out.

She added:”Patients must be the ones who decide if any additional information should be included in their SCR, supported by appropriate professionals. This is the only way we will build trust in the SCR and its use.”

The SCR Content Review group said standards should be defined to support a patient’s wish to add information to their SCR such as end of life preferences, a care plan for patients with long term conditions or the inclusion of a patient’s significant medical history.

The review groups, which between them took evidence from almost 50 bodies, said it had heard strong opinions that the use of smartcards was not universal within GP practices which had implications for accurate updating of the SCR.

The reviews said use of smartcards was outside their remit but recommended that further options were investigated to mitigate the risk of practices not using smartcards.

The review group on Patient information and Preferences also recommended that the outer envelope that patients receive should have clear emphasis that the information contained in the envelope is about “Your health records, you need to make a choice.”

John Heyworth, president of the College of Emergency Medicine, said the college welcomed the decision to proceed with the SCR.

He added: “Clinicians working in emergency departments are currently often deprived of key background and patient information, particularly during the initial phase of time critical treatment and this may significantly compromise the quality and safety of care provided.

“Immediate access to such records will lead to better and safer care for our emergency patients.”

The review’s conclusions were backed by a range of bodies including the Patients’ Assocation, The Royal College of Nursing, Asthma UK and Sue Ryder Care.

From: http://www.e-health-insider.com/summary_care_record_given_go-ahead