New criminal offence to stop NHS hospitals fiddling figures to be introduced

A new criminal offence to stop NHS hospitals fiddling official figures is to be introduced by ministers in the wake of the Mid Staffordshire scandal.New criminal offence to stop NHS hospitals fiddling figures to be introducedJeremy Hunt, the Health Secretary, is to announce that senior NHS managers and hospital trusts will be held criminally liable if they manipulate figures on waiting times or death rates.

Trusts could be fined millions of pounds and managers jailed if they are found to have falsified data used by patients to select where they are treated.

Several NHS hospitals have been accused recently of seeking to obscure high mortality rates by “mis-recording” the reasons for deaths. Such practices make it hard for regulators and the public to identify hospitals that have poor standards of treatment.

Nurses have also alleged privately that they have been told to “massage” waiting time figures by changing the recorded time when patients are treated or discharged.

Mr Hunt said “This is about a transparent, honest and accountable NHS. Patients and the public should be confident that they can trust information about how hospitals are performing, and a culture of honesty and accuracy will help those organisations drive up standards of care.”

“If NHS Trusts are caught deliberately manipulating that information, whether waiting times or death rates, they need to be held to account.”

Ministers believe that one of the main failings at Mid Staffs was the lack of transparency about what was going wrong.

Therefore, in future, medical staff will be under a “duty of candour” to admit mistakes, and NHS trusts will be banned from silencing former staff who wish to blow the whistle.

The criminal sanctions will be put in place to ensure that NHS hospitals publish straightforward “patient relevant data”. Board members of NHS trusts and individual senior managers responsible for the data would be held criminally liable for seeking to manipulate information.

Health regulators, the Department of Health or members of the public would be able to report NHS hospitals and managers to the police if they had concerns about the data being released.

Death rates are being closely scrutinised by regulators and ministers to highlight potentially poor care. More than a dozen hospitals are being investigated by the medical director of the NHS for having higher than expected death rates.

The Department of Health hopes that the threat of criminal prosecution will help to deter hospitals from seeking to “game” league tables.

A recent survey of nurses also uncovered evidence of even more blatant attempts to manipulate information. Four in 10 nurses said they were aware of attempts to change data, and one in 10 saying they had to change times of patient discharge to meet waiting time targets.

Police and prosecutors are due to meet to discuss the possibility of a criminal investigation. However, the current criminal law is thought to be limited and make the prosecutions of medical staff and managers unlikely.


NHS complaints system review launched

An MP who claimed her husband died “like a battery hen” in a hospital bed is to lead a review of the NHS complaints system.NHS complaints system review launchedAnn Clwyd was appointed by the Prime Minister, David Cameron, to examine how issues raised by patients and their families are listened to and acted upon.

She told MPs of the multiple anonymous examples which had been sent to her of poor care and treatment in the NHS since she spoke out about her husband’s care.

The Labour member for Cynon Valley gave a harrowing account last year of the poor treatment received by her husband, Owen Roberts, before he died from hospital-induced pneumonia in October.

He was 73 and suffering from multiple sclerosis, but nurses at the University Hospital of Wales in Cardiff treated him with “coldness, resentment, indifference and even contempt,” she said.

The review she is conducting, along with Professor Tricia Hart, the chief executive of South Tees Hospitals NHS Foundation Trust, will examine how the NHS handles concerns raised by staff and how it supports whistleblowers.

It follows the scandal at Mid Staffordshire NHS Foundation Trust, where up to 1,200 patients died needlessly.

Ms Clwyd said: “We all hope that when we go into hospital the care we receive will not give us cause to complain.

“However, when something does go wrong, it must be easy for patients and their carers to speak up, without fear.

“I am determined that the result of this review will be a system that ensures that any complaint or concern that patients or whistleblowers make will be listened to and acted upon.”

She also warned that concern over poor care was “not just something which pertains to England.”

She told the House of Commons: “It’s England, Scotland, Wales and Northern Ireland. There are similar letters from all those parts of the United Kingdom.”

The review was welcomed by doctors’ leaders.

Professor Norman Williams, president of the Royal College of Surgeons, said:

“Patients’ concerns and their experiences must be acted on, not ignored.

“We are pleased that the Government has announced that it will establish a review to look at how trusts currently act when concerns and issues are raised.

“In order to strengthen the system, we believe that the Government should also look at improving the representation of patient safety and dignity issues at Trust board levels.

“Patients must be put back at the centre of care.”

The review team will report back to the Health Secretary in the summer.

Meanwhile the friends and family test, a questionnaire asking patients to give feedback on the care they received, will be mandatory at all hospitals in England from next month.

Among the questions on the form is one that asks patients how likely they are to recommend the hospital to friends and family.


Social care cost caps brought forward

The government will bring forward its overhaul of social care funding by a year the chancellor has announced.
Social care cost cap brought forwardA cap on the amount the elderly pay for social care in England – which was to be £75,000 but will now be £72,000 – would start in the same year.

Mr Osborne promised in his budget to “help people who are young and people who are old”, while sticking with the government’s deficit reduction programme.

The cap on social care costs, originally planned to be set at £75,000 and introduced in 2017, will now be introduced in 2016 at a level of £72,000.

This would only cover the cost of social care and people would still have to pay for accommodation and food – although some support will be provided.

Mr Osborne said the cap would protect people from “getting a disease in later life and having to sell their house” to pay bills.

For Labour, shadow minister for care and older people Liz Kendall said: “George Osborne is still failing older people and their families. Today’s minor adjustments to the government’s plan will still leave far too many selling their homes to pay for care.”

She added that any cap above £50,000 would not “provide adequate protection” for people on low incomes.

Ms Kendall said: “We need a far bigger and bolder response to meet the needs of our ageing population: a genuinely integrated NHS and social care system which helps older people stay healthy and living independently in their own homes for as long as possible.”

Mr Osborne said: “I agree that we need to spend more on capital, which is why I had taken the decision in December to increase the spending on capital – but paid for.

“In the end this country has got to pay its way. We can’t just keep on thinking the answer to our problem is more borrowing. You can’t get out of a debt crisis by borrowing more and more.”

But the chancellor defended the ring-fenced budgets for the National Health Service and international aid.

He said the 0.7% of national income earmarked for overseas aid was a “moral commitment” and “sound foreign policy for Britain”.

London NHS wastes £13 million on public relations

The NHS in London spent almost £13 million on public relations in the last three years – enough to recruit 600 nurses.London NHS wastes £13 million on public relationsSome £9.7 million went on press officers’ salaries at hospitals and primary care trusts (PCTs), while private PR companies were paid a further £3 million.

Critics called for “medical doctors not spin doctors”, pointing to longer waiting times and cancelled operations.

The BBC sent Freedom of Information requests to all 33 London hospitals, in addition to the capital’s primary care trusts and NHS London.

The research revealed some 82 press officers on the public payroll, with an average salary of £37,278.

By contrast, in 1981 there were only eight press officers working in the entire NHS.

Katherine Murphy, chief executive of The Patients Association, said: “Far too many patients experience longer waiting times, cancelled operations and standards of care below what they deserve.”

“These figures are a concerning example of the cost of NHS PR – it is sadly patients paying the price.”

“Many will ask whether this funding would be better spent on medical doctors, rather than spin doctors.”

NHS North West London handed PR firm the London Communications Agency almost £1 million for “communications and engagement work” on a consultation programme.

The organisation said the value of the consultation was “incalculable”.

And Tower Hamlets PCT paid four different PR companies a total of £353,391 over the three year period.

£13 million could have bought:

  • 600 nurses on a minimum starting salary of £21,176
  • 3,250 hip replacements at cheapest estimated cost to NHS of £4,000
  • Potentially-life saving neuroblastoma treatment for 200 children with cancer at £65,000 each
  • A single patient staying overnight in hospital for 118 years, based on UCLH’s estimate of a £300/night cost

Many smaller spends on private PR firms were dubbed wasteful by critics too.

Chelsea Children’s Hospital paid Eureka Marketing Solutions £10,620 to design a logo and “branded merchandise”.

Meanwhile the Royal Free Hospital Hampstead paid a PR company £12,427 for advice on handling the UK’s first face transplant.

This was despite employing five press officers of its own – with a total wage bill of about £198,000.

Dr John Lister, of pressure group London Health Emergency, said: “I find it hard to explain this sort of spending.

“Sadly the default setting of NHS managers seems to be bringing in private consultants to do jobs staff should be doing.  It’s alarming – most people would regard it a total waste of money.”

Meanwhile the Royal Marsden Hospital paid a firm £1,500 – to “print news clippings following the visit by the Duke and Duchess of Cambridge”.

Man with no shame Sir David Nicholson is partly to blame for Mid Staffs- Jeremy Hunt

The man with no shame- Sir David Nicholson does “bear some responsibility” over the scandal at Mid Staffs hospital according to  Jeremy Hunt.Man with no shame Sir David Nicholson is partly to blame for Mid StaffsSpeaking in the Commons during a debate on NHS accountability, Mr Hunt, the Health Secretary, became the most senior Government figure to admit that Sir David, the NHS chief executive, was partly at fault for the failings that led to Mid Staffs, where up to 1,200 patients died needlessly.

It comes after it emerged that senior Government figures are considering a plan for Sir David to “pre-announce” his retirement.

Sir David would then step down later this year or early in 2014, having managed the NHS through the first months of major Coalition reforms starting next month

Sir David is under intense political pressure over the Mid Staffs hospital scandal. A public inquiry into Mid Staffs led to calls for his resignation.

David Cameron has backed him to remain in his post, and this week sent him supportive text messages, sources have disclosed.

Mr Hunt attempted to divert some of the attention away from Sir David by insisting the he does not bear “personal” for Mid Staffs and that the deaths there would have happened with or without the NHS chief overseeing the trust.

Speaking at a debate in the Commons on NHS accountability, Mr Hunt said that Sir David has “apologised” and that he has “been held to account”.

“David Nicholson has been the focus of much attention and as a manager in the system that failed to spot and rectify the appalling cases of Mid Staffs he does bear some responsibility,” Mr Hunt said.

“He said himself, ‘We lost our focus’. He’s apologised and been held to account by this House and many others.

“But I don’t believe that he bears total responsibility or indeed personal responsibility for what happened.”

Attempting to shift the focus of blame onto Labour ministers, Mr Hunt insisted that Sir David had warned figures in the last government that the “target” culture in the NHS was dangerous.

“He was at the SHA [strategic health authority] for 10 months during the period in question, overseeing 50 hospitals at a time when his main responsibility was the merger of three SHAs into one.

“And he consistently warned both ministers and managers the dangers of hitting the targets and missing the point. It is just not true that if there had been no David Nicholson at the SHA there would have been no Mid Staffs.”

Sir David is said to be resisting pressure to make some sort of concession to his critics by announcing his resignation.

However, there is a growing feeling among ministers and officials that he will have to make some sort of statement about his future.

Several ministers are known to believe that Sir David must go, and even others who sympathise with him believe his departure is inevitable.


Gagging clauses for NHS staff to be banned

Gagging orders which prevent NHS whistleblowers raising concerns about patient safety are to be banned- Jeremy Hunt, the Health Secretary has said.Gagging clauses for NHS staff to be bannedEmployees leaving their health service posts will be given a new legal right to voice their concerns about public interest issues including patient safety and death rates.

The so-called “compromise agreements” which prevent staff from discussing matters that could embarrass their employers when they move on will be outlawed from now on, Mr Hunt said.

He said the move was essential to ensure the failings seen in Mid-Staffordshire, where up to 1,200 patients died needlessly, were not repeated.

“We need a culture of openness and transparency if we are going to stop another Mid Staffs from happening. The era of gagging NHS staff from raising their real worries about patient care must come to an end,” he said.

“There has been a culture where people felt if you speak up about problems in the NHS you didn’t love the NHS. Actually it’s exactly the opposite.”

Last month Health Direct posted that NHS spent £15 million gagging whistleblowers

The figures emerged after Gary Walker, the former chief executive of United Lincolnshire Hospitals Trust, broke his silence to claim he was forced out of his job in 2010 because he put patient safety ahead of Whitehall targets.

Mr Walker said he was paid £500,000 to keep quiet when he was dismissed in 2010.

In future, no compromise agreement containing a confidentiality clause that prevents employees from speaking out about issues concerning patient safety or patient care will be approved by the Department of Health or the Treasury, Mr Hunt said.

A specific clause will be added into the agreement, stipulating that nothing in it can prevent someone from voicing such concerns.

The Health Secretary said “We are just going to ban them. All these compromise agreements have to be approved by the Department of Health and the Treasury.

“We are now saying we won’t approve any with a confidentiality clause that prevents people speaking out about patient safety or patient care.”

“We need to encourage front-line NHS employees who see problems to come forward, in the first instance to tell their own institution about them but then having the ability to go beyond that if they don’t think anything is being done about their concerns.”

Big variations in NHS surgery due to postcode lottery rationing

The number of patients undergoing common NHS surgical procedures varies widely across England because of postcode lottery funding restrictions.Big variations in NHS surgery due to postcode lottery rationingLocal NHS rationing of hernia repair, hip and knee replacements, cataracts and varicose vein surgeries has led to a “postcode lottery”, say researchers.

Writing in the Lancet, they warned such policies could be “storing up problems for the future”.

The Department of Health said access to services should not be decided on cost as suitability for surgery should be judged by clinical experts on the basis of individual need, a spokesman added.

There has been much anecdotal evidence about rationing of some surgical procedures on the NHS, but this has tended to focus on the number of policies in place rather than details on how this has affected patients being operated on.

And while there had been much debate about the “clinical value” of some elective surgical procedures, there was poor consensus on which treatments should be restricted to save costs, the Imperial College London team said.

A comparison of hospital data with primary care trust (PCT) policies on rationing of surgery showed a significant difference in the number of operations being done depending on local rules.

For cataract surgery, PCTs with rationing in place were admitting about 48% fewer patients than those with no such policy in the first year restrictions were introduced, the figures showed.

And for knee replacements there was at least a 20% difference in the number of patients having the operation, depending on whether there were restrictions in place, they found.

When rationing for hernia surgery was introduced in some areas in 2006-07, there were 59% fewer patients being operated on in some PCTs, compared with those with no policy.

The researchers said this gap had since narrowed but in 2010-11 there had still been a 15% deficit, which equated to 64 fewer operations per 100,000 people per year in areas with restricted access.

Significant variations had been seen in access for almost every year looked at since rationing policies had been in place, they said.

The type and number of procedures rationed by PCTs varied considerably and only 17 of 119 respondents had no policy for all five of the procedures looked at.

Leeds heart surgery campaigners win legal challenge

Campaigners trying to keep child heart surgery in Leeds have won a key legal challenge to keep the facility open.Leeds heart surgery campaigners win legal challengeThe High Court has ruled the consultation over changes to children’s heart surgery in England and Wales was flawed.

Legal action was brought by campaigners trying to save operations at Leeds General Infirmary but the ruling could affect other units.

The team behind the NHS review said quashing its plans would be unfair.

The High Court judge backed claims by The Save our Surgery group (SOS) that the consultation process was unfair and legally flawed.

The Joint Committee of Primary Care Trusts (JCPCT) decided child heart surgery should also end at Leicester’s Glenfield Hospital and London’s Royal Brompton so care could be concentrated at fewer sites to improve standards.

The High Court ruling could also affect the future of surgery at those units.

The verdict over child heart surgery is just the latest twist in a long-running fight over the future of this complex area of care.

The debate has been raging for over a decade and has already been subject to legal challenges – a perfect illustration of why changing the NHS remains an incredibly tricky task.

The medical profession is united in the belief that expert care needs to be done at fewer sites.

Child heart surgery is the prime example of that – it is one of the most complex procedures undertaken by the NHS.

To provide a uniformly high quality and safe service operations in such fields need to be concentrated, it has been argued. Evidence shows this helps doctors improve skills and share expertise.

But the push for change is not just confined to child heart surgery. Similar debates are going on over everything from A&E units to stroke care as the problem is that change comes at a price: the loss of services from much loved local hospitals.

The strength of feeling in Leeds – and in other places that face losing services for that matter – is testament to that.

These are difficult decisions and with money getting ever tighter in the health service expect more disputes in the future.

Olympian lifespan is possible for everyone

The longevity lifespan that Olympians enjoy is within the reach of everyone, doctors say.Olympian lifespan is possible for everyoneA research report- Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era is published by the British Medical Journal (BMJ) suggests athletes live 2.8 years longer on average than the average lifespan.

The research indicated those who took part in non-contact sports such as cycling, rowing and tennis enjoyed the longest life of all.

But the general population could have a similar “survival advantage” by doing a little more exercise, experts said.

The conclusion by two public health professors came after they reviewed two studies of Olympic athletes published by the BMJ website.

The studies looked at the lifespan and health of 25,000 athletes who competed in Games dating back to 1896.

Those taking part in contact sports such as boxing had the least advantage, while cyclists and rowers enjoyed the best health.

But the researchers also found those who played lower intensity sports such as golf enjoyed a boost.

Possible explanations put forward for the finding included genetic and lifestyle factors and the wealth and status that comes with sporting success.

The recommended level of physical activity for adults is 150 minutes of moderate to vigorous exercise each week.

Studies suggest people who manage that amount or more live for up to several years longer than those that do not.

Writing for the BMJ website, the professors said: “Although the evidence points to a small survival effect of being an Olympian, careful reflection suggests that similar health benefits and longevity could be achieved by all of us through regular physical activity.

“We could and should all award ourselves that personal gold medal.”

But they said governments were still not doing enough to promote the benefits of physical activity, calling it a “public health failure”.


UK ranks badly in European health league table

The UK is lagging behind progress by similar countries on many indicators for ill health, research suggests.UK ranks badly in European health league tableHealth data over 20 years was compared with figures from 18 other countries in the research published in the Lancet.

Although average life expectancy has risen by four years since 1990, it says the UK needs to increase its strategies for tackling preventable problems such as heart disease and stroke.

The team of experts from the UK and the University of Washington in Seattle said the UK had a high burden of smoking-related illnesses, and greater priority should be given to reducing lung disease.

There was also a large rise in the number of recorded deaths related to Alzheimer’s Disease.

The big five avoidable killers:

  1.     Heart disease
  2.     Cancer
  3.     Stroke
  4.     Lung disease
  5.     Liver disease

In the 20 years from 1990 to 2010 that The Lancet study examined, average life expectancy increased by 4.2 years in the UK to 79.9 years.

But the premature death rate had hardly changed in the UK for both men and women aged 20-54.

These are linked to avoidable risk factors such as smoking, high blood pressure and obesity, which are still all too common in the UK, say Chris Murray, from the Institute for Health Metrics and Evaluation, University of Washington, USA, and colleagues who carried out the analysis of global data.

But progress is being made on conditions like diabetes, where the UK appears to be ahead of many of its European neighbours and other high-income countries like the US and Canada.

Prof Murray says the UK also faces fresh challenges, like its growing burden of disability from alcohol use and a 137% rise in deaths linked to Alzheimer’s disease.

He and his team also acknowledged that making firm conclusions based on data from different countries was inherently problematic – not all record the same information and each has its own unique issues and policies that made interpretation and comparison difficult.

Recent figures from the Office for National Statistics suggested people in the UK were living in good health for longer.

But the UK still measures up poorly compared with other countries – it ranked 12 out of the 19 countries in the Lancet study.

Britons have 68.6 years of healthy life, whereas people in top-ranked country, Spain, have 70.9 years of healthy life on average.

In an accompanying editorial in The Lancet, Edmund Jessop from the UK Faculty of Public Health in London said the UK had done very well in many areas of public health – it had stronger tobacco control than any other country in Europe, for example – but there was still “plenty of room for bold action by politicians”.