Systematic failures by GPs lead to rise in children admitted to hospital as emergencies

A ‘systematic failure’ by GPs and hospitals has led to a 50 per cent rise in the number of under fives being admitted to wards as emergencies in the last decade.Systematic failures by GPs lead to rise in children admitted to hospital as emergenciesYoung children are increasingly being admitted to hospital beds for short periods with conditions that could be treated at home, an Oxford University study has found, as GPs are unable to determine straightforward cases and targets encourage admissions, they said.

The change to the GP contract in 2004 which allowed family doctors to opt out of providing out of hours services ‘may have played an important role’ in the rise, it was argued, along with the four-hour waiting time target that means patients are more likely to be admitted to a bed in order to get them out of A&E.

The study found there has been a steady increase in emergency admissions in children since 2003, despite a drop in child deaths and admissions due to long-term conditions such as asthma and epilepsy.

Common respiratory, urinary tract and gut infections account for much of the rise, it was found.

Admissions of children aged under one rose by 52 per cent up to 2010 and in children aged one to four by a quarter to reach around 500,000 in England by 2010.

Lead author Mr Peter Gill, of the Department of Primary Care Health Services, at University of Oxford, said: “The rise in emergency admission rates for older children has slowed in recent years, but in children under five years it continues to increase at an annual rate of three per cent.

“If the rate continues to increase at three per cent per year, population projections for England suggest that 731000 children aged under five will be admitted as emergencies in 2020, which is 230000 more than are currently admitted.

“The escalating increase after 2003 in very-short-term admission of children with conditions that are usually managed at home suggests an increasing failure of the NHS in assessing and managing children with acute self-limiting illness.”

They authors said the results ‘certainly suggests a reluctance of primary care to observe and manage sick children with self-limiting infections in the community’ and NHS Direct ‘too often’ directed parents to take their child to see the doctor or to hospital.

The way hospitals are set up also plays a part with junior docotrs working in A&E wary of legal action and becoming ‘risk averse’ as a result and short-stay units, fast diagnostics and emergency outpatients centres have meant the threshold for admission has lowered.

The authors concluded: “The continuing increase in very-short-term admission of children with common infections suggests a systematic failure, both in primary care (by general practice, out-of-hours care and NHS Direct) and in hospital (by emergency departments and paediatricians), in the assessment of children with acute illness that could be managed in the community.

“It may also reflect an increased reluctance by parents and doctors to tolerate uncertainty.

“Solving the problem of escalating hospital admissions of children is likely to require restructuring of the way acute paediatric care is delivered, particularly emergency and out-of-hours care.”

The study Increase in emergency admissions to hospital for children aged under 15 in England, 1999–2010 was published online in the Archives of Disease in Childhood.

Elderly suffer from poor home care

A quarter of home care services provided to the elderly in England are failing to meet quality and safety standards, inspectors say.Elderly suffer from poor home careMore than 700,000 people above the age of 65 rely on home help for activities such as washing, dressing and eating.

But the Care Quality Commission found evidence of rushed appointments and botched assessments during its review of 250 services.

Campaigners said it was a sign of how much pressure the system was under.

Ministers have recently announced plans for a £75,000 cap on the amount the elderly will have to pay for social care in England – only the poorest get it free.

The proposal aims to stop the elderly having to sell their homes to pay for care.

But the move will do nothing to get extra money into the system, something the sector believes is vital if the quality of services is going to be improved.

Home help services are considered essential in keeping people out of more expensive care homes.

The numbers getting help is pretty evenly split between self-funders and those who get council-funded care.

This review looked at the support being provided to both – and found too many were struggling to maintain standards.

A total of 26% failed on at least one standard. One of the most common issues identified related to late, rushed or missed visits.

The regulator also highlighted assessments that had missed vital information, such as a diagnosis of diabetes, and care records that were incomplete, meaning problems such as pressure ulcers could be missed by carers.

Concerns were also raised about the way services were monitored and complaints handled.

The regulator said home care providers, many of which are private companies, needed to work closely with local authorities to remedy the problems.

It warned the problems identified could have a “significant impact” on the elderly, many of whom did not complain because of a fear of reprisals or loyalty to their carer.

New food labelling system to start in summer

A new consistent system of front of pack food labelling will be introduced in the summer the UK government has announced.New food labelling system to start in summerThe new food labelling system is a combination of guideline daily amounts, colour coding and “high, medium or low” wording will be used to show how much fat, salt and sugar and how many calories are in each product.

The scheme will be voluntary, but ministers are confident they have the food industry on board.

Talks will take place over the exact design of the labels. If those discussions go well it could mark the end of what has been a long-running campaign to introduce front of pack labelling.

The issue has been under discussion for the past decade with campaigners seeing it as a way of tackling the rising rates of obesity.

But the introduction of a consistent system has proved difficult, and instead a range of different labels have gradually been introduced over the years.

Despite the government’s confident announcement, this is still not quite a done deal.

Within the food industry – and particularly among manufacturers rather than the supermarkets themselves – there are still grumblings about front of pack labelling.

But after years of discussions and research and a detailed consultation over the summer, ministers are effectively sticking their necks out to force the sector over the line.

If a consistent system is not in place by the summer of next year the government will feel it can lay the blame elsewhere.

Some retailers and manufacturers have used “traffic-light” labelling, in which the least healthy foods are labelled red and the most healthy are in green, while others use guideline daily amounts – or GDAs – which give the percentage of recommended intake. Some use both.

There has also been confusion over how a system could be introduced.

To make it mandatory, regulations would have to be agreed on a European level, but agreement between countries has been hard to reach.

So the situation has meant that the UK government sought to introduce a voluntary system.

Public Health Minister Anna Soubry said: “The UK already has the largest number of products with front-of-pack labels in Europe, but research has shown that consumers get confused by the wide variety of labels used.

“By having a consistent system we will all be able to see, at a glance, what is in our food. This will help us all choose healthier options and control our calorie intake.

“Obesity and poor diet cost the NHS billions of pounds every year. Making small changes to our diet can have a big impact on our health and could stop us getting serious illnesses – such as heart disease – later in life.”


NHS spent £15 million gagging whistleblowers

Pressure has increased on Sir David Nicholson to resign after it emerged £15 million has been spent on gagging hundreds of whistleblowers.NHS spent £15 million gagging whistleblowersThe public money spent on stopping NHS staff from speaking out is almost equivalent to the salaries of around 750 nurses.

The figures were revealed after a two year battle by Conservative MP Steve Barclay, who eventually obtained them after tabling a number of Parliamentary Questions.

The figures show a total of £14.7 million of taxpayers’ money was spent on almost 600 compromise agreements, most of which included gagging clauses to silence whistleblowers.

Mr Barclay said the figures show that over three years around 90 per cent of the 598 NHS compromise agreements included the silencing clauses.

The MP for North East Cambridgeshire has requested Sir David be recalled to give evidence to the Commons public accounts committee to discuss the use of gagging clauses in the health service.

He added: “It means that hundreds of potential whistleblowers may have been prevented from speaking out for fear of legal action, at a total cost to the taxpayer of almost £15 million.

“It is now clear that a whistleblower who has reported concerns internally, but has not seen improvements take place, is induced, with taxpayers’ money, to agree to sign away their rights to not take them any further.”

It begs the question: Were NHS officials genuinely in the dark about the use of gagging clauses – in which case why were executives like Sir David Nicholson not aware it was going on? – or were they actually the ones turning off the lights when the gag went on?

“It is glaringly obvious that many NHS employees feel they are being silenced by non-disclosure clauses in their contracts.”

The Department of Health and the Treasury have previously refused to publish the costs.

Mr Barclay said he raised concerns with Sir David three times asking why whistleblowers were not being excluded from confidentiality clauses, and each time was told action had been taken.

The figures, which cover three years up to 2011, have been revealed after Health Secretary Jeremy Hunt last week warned against silencing dissent from within the NHS.

The figures have also dealt a further crippling blow to Sir David in light of the Mid Staffordshire scandal, where 1,200 patients died. South Staffordshire and Shrosphire Health Care, which borders Mid Staffordshire, made some of the highest severance payments.

Scottish waiting list scandal shows Nicola Sturgeon failure as Health Minister

The Scottish waiting list scandal shows Nicola Sturgeon failure as Health Minister.Scottish waiting list scandal shows Nicola Sturgeon failure as Health MinisterNicola Sturgeon must be judged a failure as Health Minister after the discovery of the shambles surrounding NHS waiting lists, Labour’s Scottish leader has said.

Johann Lamont told MSPs that Ms Sturgeon failed to “get out” of politics before her legacy in the health service was unearthed by Audit Scotland in a report this week.

She accused the former Health Minister of using “false statistics and public deceptions” to create the impression her increasingly stringent waiting times targets were being met.

The Liberal Democrats said the Scottish government had published 50 press releases boasting about NHS waiting times. Family doctors have claimed that, in reality, patient care was being sacrificed for politically-motivated targets.

But, in angry exchanges, Alex Salmond defended his deputy by arguing that Labour were more interested in attempting to “get Nicola Sturgeon” than improving standards in the NHS.

The row broke out at First Minister’s Question hours after Audit Scotland disclosed that health boards trebled the number of patients classified as unavailable for treatment as they strove to meet Ms Sturgeon’s waiting times targets.

The former Health Minister and NHS managers were criticised for failing to question how waiting lists were being cut or why the number of patients deemed unavailable was increasing so rapidly.

Ms Sturgeon stepped down in the role in September last year to take charge of the independence referendum. Mr Salmond compared her at the time to Nye Bevan, the founder of the NHS.

But Ms Lamont told MSPs: “What we have found out from Audit Scotland is that patients come second to propaganda for this government.

“Someone should tell Nicola Sturgeon false statistics and public deceptions don’t cure patients and they don’t win referendums either.”

She concluded: “It has been said that in politics there are two types of health ministers, failures and those who get out in time. Isn’t the truth laid bare today that, despite the spin, Nicola Sturgeon didn’t get out in time?”

However, the report found they could not make a judgment in the vast majority of cases as medics had failed to record why the patient had been classified unavailable.

They noted that the proportion of patients deemed unavailable only began to fall after one health board, NHS Lothian, was caught manipulating waiting lists.

Willie Rennie, the Scottish Liberal Democrat leader, asked Mr Salmond if he regretted his Government issuing “50 press releases bragging about his waiting times initiative”.

“He was telling us how good the system was at the same time as thousands were being sent to the waiting times equivalent of Siberia. Has he got anything humble to say to those people?” Mr Rennie asked.

Alex Neil, Ms Sturgeon’s successor as Health Minister, later announced NHS boards will be asked to review their waiting time figures within a year.


Low vitamin D levels need preventative action

There is growing awareness about the importance of the “sunshine vitamin” – vitamin D – for you health.Low vitamin D levels need preventative actionLow vitamin D levels need preventative action, but Professor Mitch Blair, from the Royal College of Paediatrics and Child Health, says more action is needed – potentially including fortifying more foods and even cutting the cost of the vitamin to make it more easily available,

Vitamin D is an essential nutrient that contributes to healthy, strong bones and helps to control the amount of calcium in the blood.

Unlike many other vitamins, getting your recommended daily amount of vitamin D is not that easy.

The main source is sunlight; but with short days, long nights and limited sunlight even during the summer, it’s not easy to get your fix that way.

Vitamin D can be found in some foods such as oily fish, eggs and mushrooms – but only 10% of a person’s recommended daily amount is found naturally in food.

Put bluntly, eating more fish and getting out in the sun a bit more won’t make much of a difference to your vitamin D levels.

Unfortunately, there is limited national research on the true extent of vitamin D deficiency in the UK population.

But we do know that there has been a four-fold increase in admissions to hospital with rickets in the last 15 years and that some groups are more ‘at risk’ than others – namely children, pregnant women and certain ethnic minority groups.

Pilot studies and regional monitoring suggests that vitamin D deficiency is likely to affect at least half the UK’s white population, up to 90% of the multi-ethnic population and a quarter of all children living in Britain.

A recent study in Australia revealed that a third of under-25% are vitamin D deficient – perhaps surprising in a country blessed with plenty of sunshine.

Vitamin D deficiency has been linked to a range of debilitating diseases in children and adults – including diabetes, tuberculosis, multiple sclerosis and rickets, a bone disease associated with poor children in Victorian England.

Lack of vitamin D is often cited as a contributory factor in broken bones and fractures, with obvious implications for some child protection cases.

Even the National Institute of Clinical Excellence (NICE) recommends supplements for pregnant or breastfeeding women and their children from six months to four years.

The Chief Medical Officer recommends supplements for children up to the age of five and the government’s Healthy Start programme provides vitamins free for people on income support.

Currently, many brands of cereal and orange juice contain added vitamin D which helps boost daily intake.

In the USA most milk is supplemented with vitamin D, which has helped reduce deficiency, particularly in children. The Scientific Advisory Committee on Nutrition is currently looking into this.

We also need to make sure healthcare professionals – including GPs, paediatricians, doctors and nurses – know the signs and symptoms of vitamin D deficiency, but more importantly give appropriate advice to patients who are ‘at risk’ to prevent problems developing.

And it’s important that the public are aware of the implications of vitamin D deficiency, where they can get supplements and how they can boost their intake.


Childhood cancer survival improvements under threat from clinical trial red tape

Improvements in childhood cancer survival rates will stall because red tape is hindering clinical trials and the development of new drugs, British experts have warned.Childhood cancer survival improvements under threat from clinical trial red tapeNew regulations in medical research mean that is now more costly and difficult than ever before to conduct trials into new medicines and children’s cancer survival rates may be hit as a result, it was warned in the journal Lancet Oncology.

Survival rates from cancer in childhood have increased dramatically in the last 30 years, experts said, with figures showing that between 2001 and 2005, 78 per cent of children in Britain lived for more than five years after diagnosis.

This has increased from just nine per cent for some forms of cancer between 1966 and 1970.

Professor Kathy Pritchard-Jones from the Institute of Child Health, University College London, wrote: “In high-income countries, we have nearly reached optimisation of present anticancer treatments.

“New regulatory approval and research strategies are urgently needed to speed the development of new, effective, and safer treatments for children with cancer if we are to continue to improve the cure rate, reduce toxicity compared to existing treatments, and minimise side effects in later life.”

Cancer remains the leading cause of death from disease in children aged one to 15 years, and more than 5,000 children still lose their lives to cancer every year in these regions, she added.

Richard Sullivan, professor of cancer policy and global health at King’s College London and King’s Health Partners Integrated Cancer Centre, said: “An increasingly complex and strict regulatory environment for clinical research and data sharing is limiting children’s access to early-phase clinical trials and delaying the development of new drugs.

“For example, the implementation of the EU Clinical Trials Directive, in 2004, has almost quadrupled costs, led to substantial delays, and even the discontinuation of trials.”

Scientists said more collaboration was needed between drugs companies, academics, regulators, governments and patient groups.

One of the problems is that each type of cancer is very rare in individual countries so international cooperation was needed to make research viable.

Children who survive their cancer also need lifelong support, it was added, as estimates suggest that one in 1000 adults in high-income countries are survivors of childhood cancer, and 40 per cent of these survivors experience adverse effects throughout life.

Prof Sullivan said: “These are serious issues that can have a real impact on a person’s quality of life.

“It is essential that academic programmes and trial investigators ensure better follow-up of survivors to appropriately address the complications childhood cancer survivors may experience in later life.”

Tax fizzy drinks and ban junk food ads say doctors

Fizzy drinks should be heavily taxed and junk food adverts banished until after the watershed, doctors have said, in a call for action over obesity.Tax fizzy drinks and ban junk food ads say doctorsThe Academy of Medical Royal Colleges, which represents nearly every doctor in the UK, said ballooning waistlines already constituted a “huge crisis”.

Its report said current measures were failing and called for unhealthy foods to be treated more like cigarettes.

The UK is one of the most obese nations in the world with about a quarter of adults classed as obese. That figure is predicted to double by 2050 – a third of primary school leavers are already overweight.

Doctors fear that a rising tide of obesity will pose dire health consequences for the nation.

The Academy of Medical Royal Colleges is a “united front” of the medical profession from surgeons to GPs and psychiatrists to paediatricians. It says its doctors are seeing the consequences of unhealthy diets every day and that it has never come together on such an issue before.

Its recommendations include:

  • A ban on advertising foods high in saturated fat, sugar and salt before 9pm
  • Further taxes on sugary drinks to increase prices by at least 20%
  • A reduction in fast food outlets near schools and leisure centres
  • A £100 million budget for interventions such as weight-loss surgery
  • No junk food or vending machines in hospitals, where all food must meet the same nutritional standards as in schools
  • Food labels to include calorie information for children

Prof Terence Stephenson, the chair of the Academy, evoked parallels with the campaign against smoking.

“That required things like a ban on advertising and a reduction in marketing and the association of smoking with sporting activities – that helped people move away from smoking.”

He said there was no “silver-bullet” for tackling obesity, instead the entire culture around eating needed to change to make it easier to make healthy decisions.

“I choose what I eat or whether I smoke, what people have told us is they want help to swim with the tide rather than against the current to make the healthy choice the easy one,” he said.

While the report makes a raft of recommendations, Prof Stephenson attacked sugary drinks for being “just water and sugar” and lambasted a culture where it was deemed acceptable to drink a litre of fizzy drink at the cinema.

A tax was needed to help “encourage people to drink more healthy drinks,” he said.

“Doctors are often accused of playing the nanny state, we didn’t hear from a single person who said they liked being overweight, everybody we met wanted help from the state and society.

“If we didn’t have things like this we wouldn’t have speed limits that save lives, we wouldn’t have drink-driving limits that save lives, there’s a host of things that society and state does to help us live long, healthy fulfilling lives and we’re just suggesting something similar.”

Hunt criticises health trust for bullying whistleblower

The Health Secretary Jeremy Hunt, has criticised a hospital trust’s actions after a gagging order was broken to raise concerns about patient safety.Hunt criticises health trust for bullying whistleblowerGary Walker, a former chief executive at United Lincolnshire Hospitals Trust, broke the order when he was interviewed by the BBC.

Lawyers for the trust then warned him he would have to repay £500,000.

Mr Hunt said the trust should have been concentrating on the concerns raised, not heading straight for the lawyers.

“I have written to the chairman of the United Lincolnshire Hospitals Trust to ask him why their first reaction when faced with this was to get their lawyers to send a letter rather than to get to the bottom of the patient safety issues that were raised.”

He told the World at One on BBC Radio 4 that: “I don’t think it’s acceptable, I think it was the wrong thing to do.”

He attacked a culture of “institutional self-preservation” in parts of the NHS.

Gary Walker said he had no choice but to sign an agreement linked to a confidentiality clause in April 2011. He was sacked in 2010 for gross professional misconduct for allegedly swearing in a meeting.

He said he was gagged by the NHS from speaking out about his dismissal and his concerns over patient safety.

Mr Walker told the BBC that demand for emergency hospital beds in 2008 and 2009 became so acute that he felt he had no other choice than to abandon the 18-week Whitehall target for non-emergency cases.

ULHT is one of 14 hospital trusts in England currently being investigated for high death rates, in the wake of the Stafford hospital scandal, where hundreds are believed to have died after receiving poor care.

He said: “It’s a simple decision: you have emergency care or you have care that could wait.”

“It’s not nice to wait but it could wait and therefore we chose as a board – it was not just me – that we should take priority, that emergency care should take priority.”

He said the message from the East Midlands Strategic Health Authority was to hit the targets “whatever the demand” and that he was ordered to resign when he refused to back down.

After the BBC interview, Mr Walker was threatened with legal action for breaching the terms of a package reported to be worth £500,000.

A note from lawyers DAC Beachcroft said: “Having seen an outline of the issues, we have advised our client that if you have provided an interview, or should this interview proceed, you will be in clear breach of the agreement.”

It said that, as a result, “the Trust would be entitled to recover from you the payments made under the agreement and any costs including its legal costs”.

The health secretary said he did not want to make a judgement about Mr Walker’s claims but there were “a lot of very serious allegations that we need to get to the bottom of”.

He said this could become a test case for other “gagged” NHS employees, but said he did not know how many of these orders were in place.


A paperless NHS would save billions

Further to the Health Direct post of yesterday: Health Secretary wants to cut nurses’ paperwork by third the Health Secretary Jeremy Hunt wants the NHS to be paperless by 2018 – a move which a report says could help save the National Health Service billions of pounds a year.A paperless NHS would save billionsIn a speech, Mr Hunt said that the first step is to give people online access to their health records by March 2015.

And by April 2018- most controversially, any crucial health information should be available to staff at the touch of a button.

This information technology revolution has been long in the offing.

It was Mr Hunt’s predecessor Andrew Lansley who first pledged in 2010 to start an information revolution to ensure patients could use the web to report their experiences, rate NHS organisations and access their records so there would be “no decision about me, without me”.

A couple of years on and progress has been patchy, with some parts of the NHS offering a big digital presence and others lagging.

Previous attempts to transform NHS information technology have run into trouble.

Labour’s white elephant scheme, Connecting for Health, ballooned in costs to £12 billion only allowed X-rays and scans to be stored and sent electronically.

But other parts of the programme – launched in 2002 – became mired in technical problems and contractual wrangling and the national programme has effectively been disbanded and local parts of the health service asked to proceed with upgrading IT systems.

In a speech to think tank Policy Exchange, Mr Hunt said “We need to learn those lessons – and in particular avoid the pitfalls of a hugely complex, centrally specified approach. Only with world-class information systems will the NHS deliver world-class care,” he will say.

Mr Hunts comments come as a report by PwC suggests a potential £4.4bn could be put back into the NHS by using better use of information and technology.

Using electronic prescribing and electronic patient records would also give staff more time to spend with patients, for example the John Taylor Hospice near Birmingham found that using laptops more than doubled the amount of time clinicians could spend with patients.

The reason that the City got so worked up during the “DotCom Bubble” was that they foresaw the benefits of digitising business processes. Whenever one sees a TV interview with staff or patients in a NHS hospital one always sees huge files of paperwork for every patient.

Common sense cries out for a paperless NHS. The main issue though is patient data security- which has yet to be properly addressed. Until it is then more disappointment and more wasted tax payers’ money will be expected.