Swine flu- nanny state launches mass advertising campaign as ministers step up fight

Labour ministers will blow more taxpayers’ money as a mass advertising campaign will be mounted to try to contain the growing swine flu outbreak in the UK.

Every household in the country will have a leaflet through the door from next Tuesday onwards

As five cases of swine flu were confirmed in the UK – including a 12-year-old girl – and 78 further people are being tested, labour ministers mounted a major offensive to contain the problem.

Adverts will run in newspapers, on radio and on TV from today giving information about swine flu and advising people that basic hygiene measures such as covering your nose and mouth with a tissue and washing your hands are the best ways to protect against the disease.

Every household in the country will have a leaflet through the door from next Tuesday onwards also giving information on the disease and what to do in the event of someone showing symptoms.

Health Secretary Mr Johnson said: “We are following the philosophy to hope for the best but absolutely prepare for the worst. It is inevitable there will be more cases. What is reassuring is that if you take Tamiflu early you make a full recovery. It is just like a dose of flu. It could get much worse but we are prepared.”

Sir Liam Donaldson, chief medical officer, said the last bad seasonal flu year was in the winter of 1999/2000 when 22,000 people died – ten times the norm – and he warned that a pandemic could be similar to that situation but ‘multiplied several times over’.

Mr Johnson announced a raft of new measures including boosting the stock of antiviral drugs, Tamiflu and Relenza, which reduce symptoms and severity of flu from 33m courses to 50m courses and extra antibiotics are being purchased to treat people who may develop secondary complications such as pneumonia.

Extra face masks with inbuilt filters are being bought for NHS staff and all front line health workers will receive their own course of anti-virals to take if they treat someone found to be infected with swine flu.

Health Protection Agency staff will be at all airports where flights come in from infected areas and all passengers on flights from affected areas to be given a leaflet with advice about seeking medical attention if display symptoms within seven days.

Airlines are being asked to keep passenger manifests for seven days instead of usual 24 hours to aid in contact tracing if necessary.

The public are being advised not to buy face masks as there is no evidence they prevent the spread.

Sir Liam, said: “So far all the cases in the UK have been imported cases from the main affected areas and we have not seen any ongoing transmission.”

He said the positive side of this situation is that the virus is so far not spreading easily between people and no onward transmission has been yet seen outside Mexico and the US with the only confirmed cases having caught the disease in Mexico.

He said: “The virus is giving us a bit of time. It may become fast and furious at a later stage.”

He warned that in past epidemics and pandemics children have been the ‘supercarriers’ so the school holidays, going back to school have been key factors in the spread.

This may be why health experts acted quickly to advise that the Paignton Community College be closed for a week after a 12-year-old girl there was confirmed as having contracted swine flu.

Ed Balls, the Schools Secretary egotist said: “We will put the health of children first.”


Families call for fresh police investigation into Gosport hospital death ward

Relatives of five patients who died on a hospital’s “death ward” have called for a GP to be reinvestigated after an inquest jury decided excessive doses of morphine contributed to their deaths.

Dr Jane Barton, who was the prescribing doctor in each case, was the subject of two lengthy police investigations into a total of 92 deaths which ended with the Crown Prosecution Service deciding there was insufficient evidence to charge her.

But after a 10-year campaign by families of the dead, an inquest in Portsmouth ruled that medication had been a factor in five deaths at the Gosport War Memorial Hospital between 1996 and 1999.

Relatives believed that their loved ones had, in the words of one man, been “intentionally executed” at the hospital’s Dryad and Daedalus wards.

The son of one elderly woman who died after being given an increased dose of diamorphine told the inquest that when he asked Dr Barton how long his mother was likely to be in the hospital, she replied: “Do you know your mother has come here to die?”

The inquest jury decided that Robert Wilson, 75, Elsie Devine, 88 and Geoffrey Packman, 67, were given medication which was not appropriate for their condition, and which contributed to their deaths, although it had been given for therapeutic reasons. They also ruled that medication had contributed to the deaths of Elsie Lavender, 83, and Arthur Cunningham, 79, but was appropriate for their condition.

Medication had not been a contributory factor in the deaths of five other patients whose deaths were examined at the inquest.

The inquest jury was not shown a report by Gary Ford, a professor of pharmacology at Newcastle University, who raised concerns that there may have been a “culture of voluntary euthanasia” on the wards.

Nor were they shown a report into allegedly abnormal death rates at the hospital written by Prof Richard Baker, who worked on the Harold Shipman inquiry, and whose findings have never been made public.

Some of the families believe there has been a “cover-up” by the NHS and demanded the CPS look again at the extensive evidence gathered by police.

Iain Wilson, whose father Robert died after telling his family doctors were “killing” him, said: “I feel absolutely ecstatic, and heartbroken at the same time, that my dad died knowing he was being killed. I will carry on now and make sure these people that are responsible for my father’s death are brought to justice.”

John White, a solicitor for three of the five families, said: “They feel vindicated by the verdicts and they believe the CPS should look again at the evidence. They don’t see this as the end of the story.”

Dr Barton is currently being investigated by the General Medical Council, which has imposed interim restrictions on her registration, including banning her from prescribing diamorphine.

The wards were nicknamed the “end of the line” locally because of its allegedly high death rates and suspicions of some families that loved ones who seemed to be in no immediate danger deteriorated rapidly after being admitted and often died within days.

Robert Wilson was admitted to Dryad ward in October 1998 after he suffered a broken arm. He also suffered from liver problems because of a long-standing drink problem and the cause of his death was given as heart and liver failure.

Iain Wilson told the inquest his father had made a good recovery at the Queen Alexandra Hospital in Portsmouth from the fall that broke his arm. But when he was transferred to Gosport, his condition deteriorated severely and he died four days later.

Mr Wilson said: “I went to give him a cuddle and he spoke his last words to me: ‘Help me son, they are killing me.’

“I said ‘No they are not Dad, they are trying to do the best for you’ and I left him there. When I went in the following day, he was in a coma.”

Prof Baker, of the University of Leicester’s department of health and science, told the hearing: “The initiation of the diamorphine was inappropriate and the starting dose too high. Mr Wilson might have left the hospital alive if he had not been started on diamorphine.”

Dr Barton, who was the main doctor in charge of the two wards, said that many relatives had “unrealistic expectations” for the health of their loved ones as they arrived at GWMH.


Swine flu confirmed in Britain

Swine flu has reached Britain it was disclosed last night, as officials confirmed that two people were being treated in a hospital isolation unit after contracting the disease on holiday in Mexico.

Cases have also been confirmed in Spain, Canada, and several states in the USA.

They were named in the Scottish press as honeymooners Iain and Dawn Askham, of Polmont, near Falkirk.

The World Health Organisation upgraded its pandemic alert level to 4 – two stages below the most serious threat – while the Foreign Office advised against all but essential travel to Mexico.

“British nationals resident in or visiting Mexico may wish to consider whether they should remain in Mexico at this time,” a statement on the Foreign Office website added.

It comes as WHO Assistant Director General Keiji Fukuda said it was “too late” to contain swine flu and countries should now focus on mitigating the effects of the virus.

Describing the significance of the level four threat, Mr Fukuda said: “What this can really be interpreted as is a significant step towards pandemic influenza. But also, it is a phase that says we are not there yet.”

It is believed twenty two other people who have been in close contact with the Scottish couple since their return who are receiving anti-viral drugs as a precaution. Seven of them are showing mild symptoms of influenza.

The seven with symptoms have been told to stay at home and will be tested to see if they have swine flu.

Fears were growing that the virus could cause a flu pandemic as a series of countries confirmed cases.

Officials in Mexico – the centre of the outbreak – said there were 1,455 probable cases and 149 confirmed deaths.

Cases have also been confirmed in Spain, Canada, and several states in the USA. More are suspected in New Zealand, Israel and Colombia. Four people in the Irish Republic were being tested for the virus.

The two British patients, from the Falkirk area of Scotland, returned from holiday last Tuesday and on Saturday developed symptoms and contacted doctors.

They are being kept in isolation at a hospital in Airdrie. They are being treated with anti-viral drugs and are said to be ‘‘recovering well’’.

Senior civil servants met in an emergency session in Whitehall to discuss the threat posed by the disease.

Nicola Sturgeon, the Scottish Health Minister, said every precaution was being taken to prevent further spread of the virus.

She said: “The seven displaying, and I stress, very mild symptoms will now be given anti-virals as treatment. The 22 that are not symptomatic will be given very extensive advice about minimising the spread.

“The focus is on the immediate contacts. Effectively, what we are trying to do is put a ring around this. We are trying to contain this as effectively as we can.”

Sir Liam Donaldson, the Government’s Chief Medical Officer, had earlier said that it was “inevitable” that the infection would reach Britain. “Hopefully, if we identify those early and treat people and their contacts, we might be able to reduce the spread,” he said.

Alan Johnson, the Health Secretary, told MPs there had been 25 suspected cases so far in Britain. Eight of them had subsequently tested negative for the disease.

A Canadian woman was taken to hospital in Manchester showing symptoms of flu, but officials said it was highly unlikely she had swine flu.

Mr Johnson added that Britain was – with France – one of the two best-prepared countries in the world to deal with a potential flu pandemic.

The Government had imposed “enhanced” port health checks in an attempt to identify passengers arriving in Britain with symptoms of the illness, he said, and measures were in place to allow the swift nationwide distribution of the drug Tamiflu, which can reduce the severity and length of flu illnesses.

In the Government’s pandemic plan the worst case scenario suggests that if half the population contracted pandemic flu there could be around 709,000 deaths.

Schools, sports events and concerts could be shut down to limit the spread of the illness. Doctors who come into contact with suspected cases should wear face masks, gloves and aprons, under protocols issued by the Health Protection Agency.

The World Health Organisation (WHO) has said the disease has ‘‘pandemic potential’’ and work has already begun on a vaccine against the potentially lethal virus – a variation of H1N1 swine flu – although this is likely to take months before it is ready for use.

Mr Johnson said: “Everywhere outside Mexico the symptoms have been mild and all the victims have made a full recovery.”

People who suspect they may have been infected should stay at home and seek medical advice over the telephone, he added.

The WHO increased the pandemic alert level from level three, where experts have identified little or no human to human transmission to level four indicating that it was spreading much more easily between people across large areas. A pandemic is declared at level six.

Since the alerts were introduced in 2005 it has never been higher than level three.

The Department of Health pandemic plan says that a likely scenario during a pandemic is that businesses should expect repeated waves of one in four employees being off work.

Stephen Alambritis, of the Federation of Small Businesses, said that this could be disastrous during a recession.


Relatives win 10 year battle to prove NHS culture of euthanasia

Three patients who died at a hospital in Hampshire in the late 1990s were given inappropriate medication, an inquest jury has ruled.

The panel of five women and three men also found that two patients were given the correct medication but in doses which contributed to their deaths.

The patients’ families are now calling for a criminal investigation.

Some of the relatives had long believed morphine was being over-prescribed.

Police carried out investigations into 92 patients’ treatment at the hospital, but no prosecutions were brought.

The jury at Portsmouth Coroner’s Court decided that in the cases of Robert Wilson, 74, Geoffrey Packman, 66, and Elsie Devine, 88, the use of painkillers was inappropriate for their condition.

Arthur Cunningham, 79, and Elsie Lavender, 83, were prescribed medication appropriate for their condition but in doses which contributed to their deaths, jurors found.

In the cases of Leslie Pittock, Helena Service, Ruby Lake, Enid Spurgin and Sheila Gregory, the jury decided that the prescription of painkillers had not contributed to their deaths.

The jury heard evidence from members of the patients’ families, medical experts and staff at the hospital, including Dr Jane Barton.

She was investigated by police in connection with deaths at the hospital but she was not charged with any offence.

She said in a statement: “I can say that I have always acted with care, concern and compassion towards my patients.

“I am pleased the jury recognised that in all of these cases, drugs were only given for therapeutic purposes.”

In a statement after the verdicts, the families said: “This has been a 10 year emotional journey for the families, not just those families directly involved in the inquest but also the relatives of the 92 victims investigated by the police who are also still waiting for answers.

“We did not expect this inquest to be transparent, honest or fair and our expectations have been met in full.”

“Extreme drug overdoses were given without justification or logic that rendered our families comatose in a matter of hours and dead soon after, giving relatives no warning or opportunity to speak with them.

“The families’ journeys are not over. Once we have all the evidence as denied by this coroner, we will reflect on the last few weeks and decide our next steps.”

The families also said that a fresh criminal investigation by Hampshire police was needed. But in response to their call the force has said it will not reinvestigate any of the deaths.

Meanwhile, the patient safety charity Action against Medical Accidents (AvMA) called for a public inquiry.

AvMA chief executive Peter Walsh said: “It is now quite clear the refusal to hold a public inquiry was wrong.

“There were other deaths at Gosport which should have been looked into as well as the role played by various agencies, which may have prevented the poor practice at Gosport or it being investigated promptly and appropriately.”


Hospital death rates to be published on NHS Choices website

NHS medical director Sir Bruce Keogh has instructed the website NHS Choices to publish each hospital trust’s overall death rate.

Sir Bruce’s move follows concern that failures at Mid Staffordshire foundation trust may have been spotted sooner had more attention been paid to its hospital standardised mortality ratio (HSMR).

The ratios are one way of measuring whether a hospital’s death rate is within expected limits given the mix of patients it treats. The method is disputed by some academics, including those commissioned by West Midlands Strategic Health Authority, where Mid Staffordshire sits.

Sir Bruce said: “It would be irresponsible of trust boards not to investigate high mortality ratios. The HSMR is one of many measures that will help them do this, but it is not enough on its own. [It is] a rather blunt, but useful, indicator of trouble.”

“Given the controversy around them on both sides of the Atlantic I have instructed NHS Choices to publish HSMRs with reliable information to help the public and boards understand their strengths and weaknesses.”

He said he had also asked NHS Choices to develop plans to publish a set of 250 more sophisticated measures of quality, which have been approved by the new National Quality Board for Health and Social Care.

A spokesman for the Department of Health said there was as yet no time scale for the publication of the HSMRs or 250 additional indicators.


Health Direct congratulates Sir Bruce Keogh on learning from a dozen years of labour spin- announce a new initiative but don’t bother to promise when it might actually be delivered.

If the NHS medical director really wants to know what state hospitals are in- why not do what the real world does and just ask the staff?

Labour stops asking the uncomfortable question- is your hospital OK?
Tue, 14 Apr, 2009- National Health Service staff are no longer being asked whether they would be happy to be treated in their own hospitals, because the answers don’t match labour’s spin.

NHS and healthcare to bear the brunt of 2009 budget cuts

The NHS and the Department of Health took the biggest hit yesterday as the labour government allocated its £5bn cut in public spending for next year, which it claims will be made up by efficiency savings.

The NHS has to make virtually half the savings – £2.3bn – on top of the 3 per cent a year savings with which it was already charged. Next year’s budget has been cut from a planned £104.6bn to £102.3bn, but that will still represent £4bn in growth over this year.

The reduction in health allocations was greeted with equanimity by Alan Johnson, the health secretary, who said the NHS was making the savings “in response to the current economic conditions” and already had plans in hand through shorter length of stay, better commissioning and better procurement.

The already announced allocations to primary care trusts for next year will not be affected, he said, and the department is sufficiently sure of its financial position to have released back to the Treasury an £500m contingency reserve.

The NHS Confederation, which represents health authorities and trusts, said it was “disappointed but not surprised” by a savings target larger than its share of public spending.

“The much bigger issue is the cut in planned public spending growth after next year,” Nigel Edwards, the confederation’s policy director, said. “Our fear is that 0.7 per cent growth in total spending is not going to translate into anything like 0.7 per cent for the NHS. If we are lucky it might be zero.”

The confederation said that would require “difficult decisions about priorities and change” if patient care were not to suffer through budgets being merely “salami sliced”.

Other sectors that bear a significant part of the £5bn cut are schools and families, which must find £650m, and work and pensions, which must find £120m even as its budget for the unemployed is boosted by £1.7bn.

Although health takes the biggest cash hit, analysis by the Institute for Fiscal Studies shows transport, the Home Office and environment facing the largest savings requirement as a percentage of budget.

From the Financial Times:

Acute overspending raises questions over PCT plans

Primary care trusts have overspent against acute contracts by hundreds of millions of pounds, raising questions over the success of efforts to deliver care more cheaply in the community.

The average overspend figure for PCTs contacted by HSJ this week was £7.6m, suggesting that nationally the total could be as much as £1.2bn.

HSJ asked a cross-section of 20 PCTs across all strategic health authority areas in England how they had performed against what they had planned in their 2008-09 acute contracts.

Commissioners have been warning of pressure on acute contracts since a spike in referrals by GPs began to drive up hospital activity last year.

PCTs are covering the extra costs using their surpluses or by dipping into next year’s funds.

At the start of March, Warrington PCT predicted in its board papers that its surplus would be half what it had envisaged at the beginning of 2008-09. The acute overspend is listed as a contributing factor.

Some have taken money earmarked in development plans for other areas of care to cover the shortfalls.

PCT leaders attributed the overspend to pressure to achieve the 18-week referral to treatment target, the increase in GP referrals and the bad winter weather increasing hospital activity.

But they also acknowledged that some commissioners had been optimistic when predicting how much money they could save from acute contracts by moving services into community settings.

Shifting treatment out of hospitals in order to provide care more economically was a cornerstone of the 2006 Our Health, Our Care, Our Say white paper.

PCT Network director David Stout said: “Therne has been a history of slightly optimistic demand management assumptions. PCTs need to avoid making optimistic assumptions about demand and capacity, unless they’ve got very worked-through plans about how they are going to [manage demand] that they are confident are deliverable.”

Mr Stout said PCTs needed to understand why the overspend was so high this year, including assessing whether assumptions that demand would go down in certain specialties had been too optimistic.

Birmingham East and North PCT chief operating officer Andrew Donald said shifting more services into primary care would bring returns, but PCTs must monitor activity “forensically” to make sure they were achieving the savings they had planned for.

He said: “You’ve got to have done the detailed business case and understand the consequences in terms of what you’re trying to do in primary care and model cause and effect.

“If it’s not delivering, you’ve got to be brave enough to stop it and say let’s do something else.

“It relies on PCTs measuring outcomes and the impact of what they are doing, which hasn’t been a strong point.”

Mr Donald predicted pressure to stay on top of spending would increase as budgets were squeezed in coming years.

King’s Fund deputy policy director Candace Imison suggested that shorter waiting times could have introduced an element of “supply induced demand”.

The “painfully” slow progress of practice based commissioning was also likely to be a factor in delays in providing more community based services, she said.

PCTs should be more proactive in tracking patients as they moved through the health service and in assessing the effectiveness of treatment.

She urged PCTs to study choose and book data to find out who was using alternative services and what was happening to them afterwards – for instance whether they were ending up in hospital following treatment in the community.

She said: “Maybe they have created services outside of hospital but they haven’t reduced acute activity and have supplemented acute care rather than replacing it.”


Overworked healthcare professionals blamed for medical errors

Patient safety is being put at risk by overworked medical staff who made 4,000 avoidable errors last year, it has been disclosed.

More than half of the blunders – 2,221 – were considered serious, resulting in deaths, injuries and patients being left in severe pain, according to new figures.

They included surgeons operating on the wrong person or part of the body, doctors making wrong diagnoses and prescribing dangerous doses of medication.

The newspaper submitted Freedom of Information requests to all 172 NHS trusts to obtain details of Serious Untoward Incidents (SUIs).

Of the 97 that responded, most refused to give details and just listed fatal errors as “unexplained deaths”, it said.

The Patients’ Association described all the mistakes as “avoidable”.

In one case in the North West a patient under the care of the Aintree University Hospitals NHS Foundation Trust underwent the wrong urological procedure in May.

In July, a chest drain that had been wrongly inserted punctured a patient’s heart and in another case in October a tube was dislodged from the windpipe of a patient who later had a heart attack and died.

In the South East, where a total of 66 SUIs were reported, the wrong unit of blood was administered in January and a mother died of meningitis after giving birth in August.

Katherine Murphy, director of the Patients’ Association, told the newspaper: “These are all avoidable accidents. Patient safety must be paramount in every hospital. Saving money must not be put before patients’ lives.”

Dr Peter Carter, general secretary of the Royal College of Nursing, said staff shortages led to more errors.

“It is always deeply concerning to learn of any mistakes which have endangered the life of a patient,” he said. “But the fewer staff there are the more mistakes are made.”

According to the newspaper, the NHS paid out £264 million in compensation claims in 2008, plus £134 million costs.

The Department of Health said it was working with regulators to monitor improvements in patient safety.

“Unfortunately, as in any health service, unforeseen incidents occasionally happen.

“The independent National Patient Safety Agency, responsible for monitoring and reporting incidents, and the new independent regulator, the Care Quality Commission, with increased inspection and intervention powers, will help ensure we sustain improvements in safety and quality of care.”

The revelations come after the head of the former Healthcare Commission said in December that the NHS was only just out of the “starting blocks” when it came to ensuring patient care was as safe as it could be.

Sir Ian Kennedy said reporting mistakes and learning from them needed to be “internalised in the DNA” of NHS trust boards.

He added that there was a “black hole” in the information available about mistakes made in GP surgeries.

His remarks were made as the commission published a report calling for more coherent systems for reporting mistakes, saying the priority given to safe care varied among NHS trusts.

But the report said estimates suggested that one in 10 patients admitted to hospital would suffer harm as a result of an error.

In primary care, the report referred to a study carried out in 2001 which found that medical errors occur between five and 80 times per 100,000 consultations, “mainly related to the processes involved in diagnosis and treatment”.

The Healthcare Commission ceased to exist at the beginning of this month when a new regulator, the Care Quality Commission, took over its role and also adopted the work of the Commission for Social Care Inspection (CSCI) and the Mental Health Act Commission.


Mid Staffordshire redundancies under scrutiny

Mid Staffordshire hospital trust paid out £1.3m in redundancy payments between 2006 and 2009, figures disclosed under the Freedom of Information Act have revealed.

The request was made by the Liberal Democrats. The party’s health spokesman Norman Lamb said the figures were “absolutely shocking” as the lay offs coincided with at least 400 unnecessary deaths at the trust and levels of care that the Healthcare Commission last month described as “appalling”.

Mr Lamb said the payout figures “demonstrate how much money was being wasted getting rid of staff who were desperately needed, at a time when hundreds of people were dying because of the inadequate care”.

Over the three year period the trust paid out an average of £433,000 a year in redundancy pay offs. Over the same period, payouts across the entire NHS totalled around £438m – so the Mid Staffordshire payouts represented 0.3 per cent of this.

The trust made its biggest payouts in 2007-08 when it spent £878,000 on redundancies, representing 0.5 per cent of the total £183m paid out on the 2,223 NHS redundancies that year.


Flaws exposed in NHS winter planning

The NHS must improve the way it deals with the increased demand for hospital care in winter months, director general of NHS finance, performance and operations David Flory has said.

Mr Flory said in the quarterly update on performance that he was “disappointed” that the NHS as a whole had missed its target to see 98 per cent of patients in accident and emergency departments within four hours.

He said: “We have had one of the coldest winters for over a decade, placing greater demand on services. Ambulance services experience elevated demand in winter and it is critical that the NHS maintains high levels of service and ensure the timely handover of patient care from ambulance to hospital.”

Mr Flory told HSJ that he expected most hospitals to recover their position over the remaining months of the year and so, overall, the NHS would still meet the 98 per cent target for the full year. However, he underlined the importance of better winter planning.

The forecast surplus remains £1.74bn, with only seven organisations forecasting real terms deficits – down from 11 in September.