One in 20 midwife positions unfilled

One in 20 midwife positions in NHS hospitals are unfilled despite a labour Government promise to would recruit 1,000 more midwives.

The NHS may not be able to give women a single dedicated midwife during pregnancy and labour, as promised by ministers.

Figures show that 583 midwife posts in NHS hospitals are vacant and 276 maternity support worker jobs are unfilled.

Barking, Havering and Redbridge Hospitals NHS Trust has the higest vacancy rate, 39 per cent. If its 76 full time midwife positions, 29 posts need to be filled.

One in five maternity units (22 per cent) across the country have cut midwife numbers in the past year and some have reported that their maternity unit has been cut in half. Heart of England NHS Foundation Trust has 101 full time midwives last year but this year has 47 which is a 54 per cent drop.

The figures were obtained using the Freedom of Information Act by the Conservatives.

This week, Professor Cathy Warwick, general secretary of the Royal College of Midwives, said tens of millions of pounds that were meant to increase the number of midwives have not been received by hospitals.

“On the very busy labour wards that are struggling to cope with the rising birth rate, midwives are having to look after sometimes two or three women in labour and that’s when the woman ends up being left alone. That’s not only unacceptable, that’s not safe,” she said.

The failure to pass on the money, part of a drive to improve maternity services, means the NHS will not be able to honour promises by ministers to give women a single dedicated midwife during pregnancy and labour.

Alan Johnson, the health secretary, in February pledged £330m of extra funding over the next three years to implement the Maternity Matters strategy whose guarantees include giving women the choice of whether to give birth at home instead of at hospital. He also promised that he would recruit 1,000 more midwives to the NHS by 2009.

Health Minister Ann Keen said: “Claims that midwife numbers are falling are complete and utter nonsense.

“Validated figures from the latest NHS workforce census show the number of midwives has surpassed 25,000 for the first time and we know there is continuing growth towards recruiting an additional 1,000 midwives by September 2009, rising to 4,000 in 2012. There has also been a 25 % increase in the number of students entering midwifery training since 1997.”


NHS trusts waste effort chasing EU working time directive

NHS Trusts are wasting millions of pounds and losing thousands of service hours over preparing for the European working time directive.

Others risk prosecution and fines because the way they are assessing junior doctors’ compliance with the directive does not match the EU measurement.

Data from 123 trusts shows the proportion of posts compliant with the directive using the EU’s legal definition is up to twice as high as the Department of Health’s figures.

NHS Employers head of programmes David Grantham said: “The situation may be better than people thought. Given the current drive for value for money you’d expect employers to be making every effort to make sure they’re not going beyond what’s necessary.”
“Individual clinicians will be able to bring prosecutions against their employers using the EU law”

The directive, due to affect trainee doctors next August, will cut the maximum working week from 56 hours to 48 hours.

Instead of using the EU measurement, around half of trusts are thought to calculate their compliance with the directive using pay banding data for junior doctors on the new deal contract.

Those on bands 1a, 1b or 1c are deemed to be working within the 48 hours limit, while 2a and 2b posts are assumed to doing more hours than the directive permits. If all NHS bodies in the sample – around half of trusts – moved doctors down a band to ensure compliance under the new deal, they would unnecessarily lose 11,801 service hours.

The study, by doctor management software company Zircadian, said it estimated this meant around 248 more posts would be needed, costing roughly £12.4m.

And up to 26 per cent of band 1 posts are actually non-compliant with the directive, known as regulation four, according to the analysis.

Mr Grantham said the figures chimed with anecdotal evidence that trusts were underestimating how many doctors were compliant.

However, some trusts may be deliberately overcompensating to provide “extra headroom” when the regulation comes into force, he said.

Papworth Hospital foundation trust associate medical director of education and workforce Martin Goddard said squeezing doctors down to band 1 often had no cost benefits and lost them time for training.

Equally worrying was the fear of trusts risking prosecution by unwittingly breaking the law.

He said: “We’ve had no guidance centrally as to which method we should use. It has become a management nightmare.”

The figures undermine statements made by Skills for Health, which is paid by the DH to help health service organisations achieve compliance. Skills for Health states on its website that discrepancies between the new deal and regulation four are “minor”.

Zircadian found that in 54 trusts, compliance was up to twice as high as using the legal definition, 36 trusts showed no difference, and in 33 compliance was up to 40 per cent lower (see graph).

Mr Goddard, who is also a special adviser on the working time directive and new deal for NHS East of England, said he has highlighted the “fundamental differences” between the two calculations to the DH, but it was seen as “too difficult” to change.

The findings, showing around 60 per cent of posts are already meeting the 48 hour limit, also contrast with a Royal College of Surgeons survey last month warning fewer than half of trusts were compliant.

Individual clinicians will be able to bring prosecutions against their employers using the EU law.

Zircadian managing director Henry Carleton warned failure to recognise the difference between the two measures could result in “clinical services and training time being unnecessarily trimmed and large amounts of money being wasted on phantom issues”.

Main differences between new deal and EU measurement of compliance with the working time directive:
* Average working hours under the new deal are normally worked out over an eight week period and take into account “prospective cover” for doctors who work rotas normally carried out by colleagues away on leave.
* The European measurement does not include prospective cover and uses a 26-week reference period for doctors in training.


Sir Richard Branson accuses labour of failing over hospital superbugs

Sir Richard Branson criticised horrific hospital infection rates, accusing labour politicians and health bosses of “tinkering” with the problem.

The Virgin tycoon, who was recently appointed vice president of the Patients Association, called for all hospital staff to be screened for the superbug MRSA and receive immediate treatment if infected.

He has also said managers at failing NHS trusts should be fired.

Infection rates for MRSA are falling across the UK with the most recent quarterly figures showing a 33 per cent drop year on year, but Sir Richard is calling for far more to be done.

The entrepreneur – whose daughter Holly is a doctor – told the BBC: “There have been some improvements, but the facts speak for themselves – and the facts are still horrific.

“It feels like they have tinkered with the problem rather than really got to the heart of the problem. The hospitals are there to cure people. They are not there to kill people.”

He said the NHS could learn from the airline industry about how to avoid mistakes and improve.

“In the airline industry if we had that kind of track record we would have been grounded years ago,” he said.

“In the airline industry if there is an adverse event that information is sent out to every airline in the world.

“And every airline makes absolutely certain that that adverse event doesn’t happen twice.”

Sir Richard is helping to organise an international conference on infection control and patient safety early next year.

He argued that all hospital staff including doctors, nurses and cleaners should be checked for MRSA and treated if infected – even if that causes disruption to medical services.

He said: “You don’t necessarily have to ask them to leave the hospital while they are being treated.

“They can just not have any contact with patients for those two weeks while their treatment is taking place, and then they can come back and have contact with patients.

“That is far better than having people dying from unnecessary diseases, and all the misery and pain that that causes, and the cost to the NHS which is enormous.”

Official data from the Health Protection Agency (HPA) showed there were 725 MRSA cases in July to September, a 33 per cent drop on the same quarter in the previous year.

The number of C difficile infections in patients aged 65 and over between April and June this year also fell 38 per cent, to 8,683 cases.

Sir Richard, who became the vice-president of the Patients Association in September, called for more patient information about infection rates and a tougher standards for trust bosses.

He said: “The patient should have the right to know the track record not only of the hospitals, but the rate on wards, on departments, on surgeons, on clinicians. That shouldn’t be something which is hidden.”

“And I also think if managers of hospitals are not obeying the rules that have been set by the NHS, those managers should be replaced.”


Flu cases could be heading towards rates not seen for eight years

Flu cases in England and Wales could be heading towards rates not seen for eight years after they rose by more than 75 per cent in a week.

The number of cases identified by GPs is now also 73 per cent higher than at the same time last year.

The virus is also hitting greater numbers of elderly people, increasing the risk of fatalities, the Royal College of GPs warns.

Experts advised everyone over the age of 65 to ensure that they were vaccinated against the illness.

Around a quarter of elderly people are estimated to be unprotected from the bug, which can cause potentially deadly secondary infections, including pneumonia.

Cases of flu have risen significantly in recent weeks, placing the health service under increasing strain.

The latest figures from surveillance by the RCGP show that there were 69 GP consultations for flu per 100,000 people last week, up from 39.5 per 100,000 on December 14.

Experts have blamed the unseasonably cold start to the winter for encouraging the flu virus to take hold.

Dr Douglas Fleming, director of the RCGP research unit in Birmingham, described the rise in cases as “significant”.

“In the past ten years, the only substantial outbreak was in 1999/2000,” he said. “I think we could be looking at something that approaches that this year.”

Professor David Salisbury, the Government’s director of immunisation, advised anyone eligible for the flu vaccine to ask for it from their doctor.

Professor Steve Field, chairman of the RCGP, said that the increasing instance of the illness among the elderly was “worrying”.

“Older people are more at risk of suffering dangerous complications, including pneumonia and serious chest infections and, of course, we know that influenza can kill the elderly,” he added.

Dr Lorna Layward, from Research into Ageing, the research arm of Help the Aged, said that influenza killed between 3,000 and 4,000 older people every winter but that that figure could reach 30,000 to 40,000 during an epidemic.

A flu outbreak officially becomes an epidemic when there are 200 cases per 100,000 people.

Andrew Lansley, the shadow health secretary, said: “In recent years the Government has rather complacently assumed that winter crises don’t happen anymore, but it has not been since 1999 that we have seen a serious flu outbreak over the winter.

“I know the NHS will respond well, but I continue to regret that ministers have allowed bed numbers to fall sharply and have talked of centralising accident and emergency capacity without paying proper regard to the risks of times of extreme pressure.”


Healthcare Commission warns NHS has some way to go on patient safety

NHS boards are devolving vital decisions on safety and failing to report serious incidents such as radiation overdoses, preliminary Healthcare Commission findings have revealed.

An upcoming review looking at governance systems and how NHS trust boards respond to information will show that the monitoring of safety issues is often poor.

The early analysis, due to be released in full next year, is contained in the commission’s annual State of Healthcare report.

It says boards vary in their approach to safety, but targets and finances still dominate their priorities. “In many cases, decision-making and acting on safety is devolved to local services or departments.”

Detailed scrutiny of the safety of care often takes place at committee level, “with only key facts and exceptions reported to the board”. While it is good to encourage local solutions to problems, the monitoring and auditing of safety improvements at senior level is “often poor”.
“The NHS has some way to go to ensure it properly learns lessons when things go wrong”

Acute trusts, especially foundation trusts, are best when it comes to acting on incident reports, but primary care trusts are weaker.

The commission found little evidence that PCTs are systematically monitoring the safety of providers.

Failure to report

In addition, the report says many trusts are failing to report serious safety incidents.

Between April and June this year, 7 per cent of acute trusts, 14 per cent of mental health trusts and 13 per cent of PCTs did not report a single incident. In the past two years, there have only been around 600 reports of radiation overdoses – out of about 25 million procedures.

The commission concludes: “The safety of care is improving as its fundamental impact on the quality of services and outcomes for patients is increasingly recognised. But the NHS has some way to go to ensure it properly learns lessons when things go wrong, anticipates and prevents harm where possible and has systems that ensure safe practice is followed every time, for every patient.”

The report also shows health inequalities appear to be narrowing, but progress in reducing the gap has slowed in the past two years.

This is based on a comparison of patients’ blood pressure and cholesterol in GP practices serving the fifth least deprived areas with those in the fifth most deprived areas, using quality and outcomes framework data.

Summarising the report, commission chair Sir Ian Kennedy praised improvements but highlighted the “small number of trusts which are trapped at a level of performance that is unacceptably poor”. The commission has “changed the face of whole areas of care”, such as infection control, over its lifetime, he said.


Premium rate phone lines to book GPs appointments to be reviewed

A ban on the use, by GP surgeries and other parts of the NHS, of premium rate phone numbers which begin with 084 is being considered, say labour ministers.

They have launched an England wide consultation to ask people whether they want to keep the numbers.

Doctors say the new systems enable them to offer patients a better service.

But campaigners argue using the more expensive numbers is against the founding principles of the NHS, which should be “free at the point of need”.

Increasing numbers of GP surgeries, hospitals and primary care trusts now have 084 numbers for patients’ use, such as when booking appointments.

Any revenue that is raised has to go towards the cost of the phone systems.

However complaints over the use of the numbers – which are usually more expensive than local calls – have led to a government rethink.

In theory the numbers should cost about 5p a minute, but they tend not to be included in calls packages which people often have on their landlines.

For people using a mobile, the additional charge can be as high as 40p per minute.

Over the next three months people in England will be able to give their views on whether the practice should be allowed to continue.

The NEG (Network Group Europe) company, which supplies 084 numbers to the NHS, says 10 million patients across the UK are registered with a doctors’ practice that uses the system.

One such surgery is the Meanwood Practice in Leeds, where Dr Richard Vautrey is based.

Dr Vautrey, deputy chair of the British Medical Association’s GP Committee, said: “Before we put in the system, patients were concerned about the difficulty they had in getting through on the phone.

“Surveys showed it was an area of weakness for us. It’s never going to be perfect but the 084 number has given us a dramatic improvement and certainly made a big difference. “

“Any idea that GPs make money from these numbers is a myth. The cost to our practice has in fact increased since we put in the new system. Before it was £7,000 a year and now it’s £10,000.”


But phone campaigner David Hickson said the use of the numbers was “completely unacceptable.”

He said: “The NHS is supposed to be free at the point of need.

“The difference in each call may be only a few pence for some people, but the costs can really mount up for others – especially for people who are using mobiles because they don’t have a landline.

“I find it bizarre that the government is doing a consultation on this now.

“It’s more than three years since the Department of Health banned GPs from using 0870 and other higher cost numbers. 084 numbers should have been stopped then.”

One solution could be to use 03 numbers across the NHS. These offer the extra functions of automated 084 systems, but without patients having to pay extra.

However some GP surgeries are locked into phone contracts lasting as long as seven years.

Health Direct asks if you don’t like being ripped off by the NHS when making a doctor’s appointment, please complete the form at:

The closing date to have your say is 31 March 2009.

Comply with NICE or pay, Care Quality Commission tells trusts

Healthcare providers could be shut down for failing to comply with National Institute for Curbing Expenditure (NICE) guidance under plans to make adherence a requirement of the Care Quality Commission’s registration scheme.

CQC chair Baroness Young has revealed that organisations from hospitals to GP surgeries will be expected to prove they are complying with national guidelines on clinical effectiveness as part of the new regulator’s registration process.

Speaking at NICE’s tenth anniversary conference in Manchester last week, Baroness Young said clinical guidance would be “built into” the registration system.

She said: “There’s an opportunity for the registration system and the assessments that follow it to raise the profile of NICE guidance, to highlight [its] importance and to track some of that through the assessment process. The danger here is that we confuse essential entry requirements from providers with gold standards”

The plan is likely to be controversial as clinical guidelines are not currently compulsory and uptake is patchy.

Hardening tone

A CQC spokesman later said providers would be expected to demonstrate compliance with NICE and other national guidance “unless they can show a good reason to vary from them”. He said: “The steps that we can take range from a formal warning notice to prosecution and imposition of restrictions, or even closure of a service.”

The news marks a hardening in tone at the CQC: in August, Baroness Young told HSJ that health service organisations ignoring guidelines faced marked down annual assessment ratings and lower pay.

Foundation trust network director Sue Slipman said: “The danger here is that we confuse essential entry requirements from providers with gold standards.

“Entry level was never meant to be gold standard – that isn’t to say that we don’t want everyone to get there, but that’s a developmental issue.”

Variable quality

And Royal College of GPs chair Steve Field warned that NICE guidelines varied in quality and members had some concerns. He said: “You need to make sure that the guidelines are usable and appropriate.”

NICE itself is gathering data on guidance uptake, but is not able to estimate current compliance levels across the board.

Implementation director Val Moore said uptake often varied within hospital trusts, as well as across PCT areas.

She said NICE had been “knocking around themes” on guidance uptake with the new watchdog but added: “For NICE to work with the regulators but not be a regulator is an important strand.”


Too many people still admitted to mixed sex sleeping areas, says Healthcare Commission

Too many people are still admitted to mixed sex sleeping areas in NHS hospitals, the health watchdog has warned.

One in ten patients find themselves in mixed sex areas when admitted for planned operations and 29 per cent when admitted as emergency cases. Three in ten patients said they had to use bathrooms or showers that were used by the opposite sex.

Even thought most patients rate their care as good or excellent that is no excuse for the labour Government to ‘rest’ on the issue of treating patients with dignity and respect, Anna Walker chief executive of the Healthcare Commission said.

One in five patients who need help with eating do not get it and complaints from patients include basic care failures such as being left in soiled clothes, exposed in an embarrassing manner and being left in pain.

Services for patients with mental health problems are patchy and a review of care for adults with learning disabilities found ‘institutional abuse’.

Patients also want more involvement in decisions about their care and only a minority of people are being offered a choice of hospital when having a planned operation despite this being a cornerstone labour Government policy.


Alan Johnson extends nanny state as shop cigarette displays to be removed

Tobacco displays will be removed from shops and access to vending machines restricted as part of labour’s nanny state to stop children and young people from smoking.

After holding a consultation on tobacco control, the Department of Health said cigarette displays promote smoking to young people, prompt impulse purchases of cigarettes and undermine efforts to quit.

It said when similar moves had been made in other countries smoking prevalence among young people had fallen by up to 10 per cent.

Age restrictions to vending machines will also be introduced as they are thought to be the primary source of cigarettes for one in five people aged 11-15.

The moves are to be included in primary legislation in the next parliamentary session.

Protecting children

Health secretary Alan Johnson said: “Enticing multi-coloured displays encourage young people to start smoking – we must put a stop to this. Protecting children from smoking is our goal.

“My hope is that shops will use this opportunity to promote healthier goods to their customers.”


Health chiefs agree to clear £327m debts

Improvements to London’s health services will be delayed and some hospital services reshaped as the NHS tries to resolve long standing financial problems.

Under a plan agreed by the capital’s 31 primary care trust [PCT] chief executives, though not yet by their boards, about £327m ($481m) of debt would be wiped from 10 of the capital’s 38 acute trusts that are in severe financial trouble.

To get the money, the hospitals, which include four of the six big trusts in the south east of the capital and two in the north east, will have to demonstrate that they can at least break even in future, according to the London strategic health authority.

This is likely to require big changes to services – potentially even the closure of an accident and emergency department.

The decision to clear the deficits will be seen by some as rewarding failure. It also demonstrates the difficulty in allowing big hospitals with accident and emergency services to fail, in spite of the more market like mechanisms that the government is using in the NHS.

A health authority spokesman said because hospitals were paid according to the numbers of patients they took, some had found themselves “locked in a vicious circle”. If they cut back on services to pay off the accumulated deficits, they then lose money as fewer patients come through the door.

Ann Radmore, chief executive of Wandsworth PCT, who is leading the bail-out proposal, said ensuring that all the capital’s hospitals were financially stable and debt-free was “essential” for the capital’s health services.

The health authority conceded that trusts in surplus would have to put off planned improvements to fund the bail-out. But Paul Baumann, finance director for NHS London, said without action, services in London would suffer. Once the whole capital was financially stable, trusts would have greater leverage to demand better performance from their providers, he said.

Without urgent and dramatic action, the accumulated debt held by the troubled hospitals and one primary care trust was poised to rise from £327m to £579m by 2010-11, the health authority said.

To clear the debts, the PCTs have agreed to forgo 1.3 per cent of their planned 5 per cent budget increases over the next two years and a £304m surplus that was earlier taken from their allowances.

John Appleby, chief economist at the King’s Fund health think-tank, said it was vital that the root causes of the financial problems were tackled if this “once-in-a-lifetime opportunity” was to work.