Missed hospital appointments cost east of England NHS £42 million

Patients who missed hospital appointments cost the NHS in the eastern region more than £42 million in the past year alone.Missed hospital appointments cost east of England NHS £42 millionThere were nearly five million appointments in the east’s 24 NHS hospital and foundation trusts in 2012.

But in about 418,000 cases- nearly ten per cent, the patients failed to turn up.

Automated reminders are cutting the number of wasted appointments but hospitals say patients must do their bit by not wasting resources.

The figures have come from a mix of Freedom of Information requests lodged with the various hospitals and data from the Department of Health.

Although the cost of missed appointments varies widely, a number of hospitals apply a rough figure of £100 – and this has been used to arrive at the £42 million overall cost amount.

A spokesman for Colchester Hospital University Trust said: “It is important that members of the public appreciate that they too have responsibilities, like not wasting precious NHS resources.”

One hospital to see a significant drop in the number of ”did not attends’ (DNAs) was the East and North Hertfordshire NHS Trust.

In April 2011, 4,173 DNAs cost it £417,000. By November 2012, the bill had fallen to £284,670 for 2,847 DNAs.

Dr Tim Walker, a consultant anaesthetist at East and North Hertfordshire, said: “It has been a significant issue because we have a limited capacity to see patients in clinics. If people then don’t turn up we have wasted capacity.

Cambridge University Hospitals had the highest number of DNAs last year with 35,225- it is also one of the region’s largest hospitals.

The cost of appointments varies widely. At James Paget University Hospitals, for example, first appointments tend to cost about £160 and follow-ups about £80

“We can be saving up to £1.5 million a year to the outpatient service without having to lose services or staff.”

Jason Foster, deputy general manager for the hospital’s outpatient service, said simply reminding patients had played a key role in reducing missed appointments.

While hospitals say they are making efforts to reduce the number of DNAs, not all hospital staff regard them as a problem.

One hospital spokesman, who asked not to be identified, said: “Some doctors actually like DNAs because it means they can spend more time with the patients who do show up.

“In terms of the patient experience it can be a good thing – it is not uncommon for consultants to complain about clinics being overbooked, which is one of the reasons why they overrun.”

Dementia care patchy- quango finds

The standard of care provided for people with dementia is “patchy”, the National Institute for Curbing Expenditure (NICE) has said. Dementia care patchy- quango findsSome people with the condition were not getting even basic levels of care, it added.

The warning came as NICE unveiled new standards for dementia care in England, covering issues such as housing and access to leisure services.

Care services were playing “catch-up” on dementia, it said.

The guidance is the first to be produced by NICE under its new extended remit.

To date, the organisation has focused on issuing recommendations about NHS treatments and encouraging healthy lifestyles.

But under the shake-up of the NHS, it now has responsibility for providing guidance on care and support provided by the likes of councils and care homes.

NICE’s dementia guidance includes 10 standards it wants the care sector to follow.

One calls for people with dementia to live in housing that meets their needs, while another says they should be given the support they need to access leisure activities.

Others focus on keeping patients involved in community life and ensuring they get access to services such as dentists and opticians.

NICE deputy chief executive Prof Gillian Leng said: “The general picture is that care is patchy.  We know that it is really good in places but it’s not consistent.  My personal view is that we are all playing catch-up because the number of people with dementia has been increasing so dramatically.”

Currently about 670,000 people in England are living with dementia but one in three over the age of 65 are expected to develop the condition.

George McNamara, of the Alzheimer’s Society, said people with the condition were being denied the quality of life they deserved.

“These standards will be a useful tool for the care sector and show what people with dementia and carers should be able to expect,” he said.  “But, as they are not mandatory, it’s a case of ‘wait and see’ as to whether this guidance will drive real change or just sit on the shelf.”

NHS satisfaction ratings stabilising after record fall

Public satisfaction ratings with the NHS appears to have stabilised following a record fall- according to the British Social Attitudes Survey.NHS satisfaction ratings stabilising after record fallThe poll of more than 1,100 people in England, Wales and Scotland last year found satisfaction with the way the NHS was run stood at 61%.

This followed a record fall from 70%, in 2010, to 58% in 2011.

The drop coincided with the first year of the spending squeeze and controversy over reforms in England.

The 2012 survey, conducted by NatCen Social Research, found that 74% were satisfied with GPs while just 30% were satisfied with social care.  A total of 59% said they were satisfied with A&E units and 56% were satisfied with dentists, it found.

Prof John Appleby, of the King’s Fund think tank, said the poll was an “important barometer”.

“With no real change in satisfaction with the NHS in 2012, this suggests the fall in 2011 was not a blip and that the ground lost may take some time to recover,” he said.

Patients Association chief executive Katherine Murphy said it was important to “look beyond statistics and properly assess patient experience”.

“People are still contacting our helpline every day to tell us that they or a loved one is receiving the most appalling care in hospital.

“These serious issues need to be tackled and the government needs to monitor closely the impact of its reforms.”

A spokesman for NHS England, the new national board which oversees the health service, said: “The changes which have been implemented put patients at the centre of everything the NHS does.

“We are committed to providing the best services possible for patients in England.”

Food allergies may be linked to chemicals in tap water

 The huge rise in food allergies may be linked to chemicals in tap water according to new research.Food allergies may be linked to chemicals in tap waterFood allergies have risen sharply over the past 20 years, with 1-2 per cent of adults and 4-6 per cent of children thought to be affected.

The number of children admitted to hospital for food-related anaphylaxis (a life-threatening allergic reaction) has risen seven-fold since 1990 – but no one quite knows why.

The latest theory Food Allergies? Pesticides in Tap Water Might be to Blame, published in the Annals of Allergy, Asthma and Immunology, suggests that chemicals called dichlorophenols could be to blame.

US researchers who looked at food allergies in more than 2,000 people found that those with the highest levels of dichlorophenols in their urine had an 80 per cent higher risk of having a food allergy.

Their theory is that dichlorophenols, which they say are found in purified tap water and in pesticides and disinfectants, have anti-bacterial properties that could affect the microflora in the gut that are thought to protect against food allergies.

Dichlorophenols are also by-products of a common antibacterial and antifungal agent called triclosan (used in many consumer products, including toothpaste) and in the UK are more likely to be found in household cleaning products, kitchen utensils and containers and pesticide residues than in water.

Although little research has been done on UK exposure levels, the Chemicals Regulation Directorate says dichlorophenols “have not been identified as a cause of concern”.

The reason behind the rise in food and other allergies remains a mystery.

One well-known theory is the hygiene hypothesis – that as we become increasingly obsessed with cleanliness, our children are not exposed to the bugs that help the immune system develop properly.

Another unproven theory is that the rise in allergies may be due to basic changes in Western diets, with processed foods becoming more common and fresh fruit and veg less so.

Some experts now think that government guidelines introduced in the Nineties may have contributed to the explosion in food allergies.

“Parents were advised to avoid giving peanuts to young infants on the grounds that early consumption of potential allergens could affect underdeveloped immune systems, resulting in allergy – when the opposite seems to be the case,” says Prof Brostoff.

The guidelines were quietly withdrawn in 2009 after a large study the previous year showed that Jewish children living in the UK were almost 10 times more likely to develop a peanut allergy than those living in Israel, where peanut protein – often in the form of Bamba, a popular snack – is commonly given to infants in the first year of life.

Prof Brostoff says the best thing parents can do to reduce the risk of food allergy in their children is to gradually introduce potential allergens – not just peanuts, but cow’s milk, eggs and fish – at an early age.

“The lining of the gut membrane is the most powerful immune organ in the body,” he says. “The advice I always give is that it is better to introduce foods when the gut is more plastic and able to adapt. Giving a food early in a baby’s life can help make the gut more tolerant, and numerically this effect is more important than the presence in the environment of any chemicals.”

NHS could charge fees to call out a doctor

Calling out a doctor to your home could cost £8.50 under radical proposals to shore up the finances of the NHS.NHS could charge fees to call out a doctorThe proposals are being outlined as a way of tackling the financial hole in the accounts of the Health Service.

The moves sparked outrage with claims they amount to a patients’ tax and undermine the “free at point of use” principle of the NHS.

There are also fears that ill patients will be discouraged from seeking treatment.

The NHS Confederation, which represents all Health Service trusts, outlined the proposals as a way of generating extra funds and as one option in dealing with the hole in the NHS budget.

The group gave an example of a pilot scheme in Germany where 10 euros was charged for a call out by a doctor.

The federation said there was no plans to suggest charging but frank discussions were needed.

The chief executive Mike Farrar said: “We need to talk openly and honestly about why our Health Service needs to change.  We cannot risk the wheels coming off and patient care suffering.”

The report claims the radical proposals may be needed as the NHS faces soaring costs of caring for an ageing population and increasing levels of obesity.

Katherine Murphy, chief executive of the Patients Association, said the proposals undermine a fundamental tenet of the NHS.

“Some of these proposals amount to what would effectively be a “patients’ tax”, she said.  “It would be absolutely unacceptable for patients to foot bill for reform through new charges.”

Surveys have found 27 per cent of patients would delay calling out a doctor and 18 per cent would avoid it altogether if they had to pay.

However, some trusts are already considering imposing a £10-a-day fee to watch TV.

Last year, an NHS trust went into administration for the first time and officials estimate there are around 20 more in severe crisis, with combined debts of about £130 million.

The costs of propping up Private Finance Initiative (PFI) under Labour’s deal will worsen the position even more in the next decade.

Ambulance service boss warns bed shortages are harming patients

Steve Wheaton of West Midlands Ambulance Service has said nearly 2,000 ambulances had waited more than an hour in March.Ambulance service boss warns bed shortages are harming patientsPatients in the West Midlands are suffering as hospital bed and staff shortages mean ambulances cannot unload patients, a senior ambulance boss says.

He said the situation was the worst he had known in his 20 year career.

The service covers Shropshire, Herefordshire, Worcestershire, Warwickshire, Staffordshire and the West Midlands conurbation.

The ambulance service is regularly leaving paramedics with patients in corridors – called cohorting.

Occasionally, vehicles are answering emergencies without a stretcher because the patient is still lying on it in hospital.

“Patient safety is our number one priority and we do our best to make sure that we look after patients, but it is becoming increasingly hard to maintain a 999 service and a service to patients in a corridor,” Mr Wheaton said.

“Corridors are not the best place for patients to be nursed.”

Mr Wheaton said hospital delays were impacting on 999 response times.

The West Midlands has consistently had among the best response times in the country.

But calls are literally stacking up, with patients who dialled 999 having to wait more than an hour because there are no vehicles available.

Mr Wheaton said: “I am sure that if you looked through some of the cases, that we have seen patients where their chances of survival would have improved, or the outcome of their care could have been better, had we got there faster.”

This year, ambulance activity has increased by 6%, but the trust said it had recruited 60 extra paramedics to cope.

Documents reveal the worst turn-around times are at Heart of England NHS Foundation Trust, University Hospitals Coventry and Warwickshire and Russells Hall Hospital, Dudley.

He said A&Es at the trust’s three sites received “the highest volumes of ambulances” by far across the region and he urged people to only use A&Es in emergencies to help cope with “unprecedented” demand in the region.

From April, hospitals will start being fined for not releasing ambulances quickly enough.

Mr Wheaton said, on present levels, the fines would cost Heart of England £17 million a year.

Documents also show that this week six hospitals across the region declared an internal emergency due to a shortage of beds.

NHS Doctors put lower value on lives of the disabled research finds

NHS doctors are more likely to allow patients to die if they suffer from a mental disability according to a damning Government-backed research finds.NHS Doctors put lower value on lives of the disabled research findsIn some cases doctors may even be making orders not to resuscitate “because” patients have learning difficulties, the three year study concludes.

In other cases, it found evidence of doctors making more “rapid” and “premature” life-and-death decisions in cases involving the disabled than other people.

People with special needs are also less likely to be diagnosed quickly with conditions such as cancer and “all aspects” of medical care were “significantly” worse for them than for the wider population, it concluded.

As a result they can expect to die an average of 16 years earlier than those without a disability, it found. The gap rises to as much as 20 years among women.

Charities said the study, a three-year investigation by Bristol University academics into hundreds of deaths, proved that the lives of disabled people are “valued less” than those of others.

A parallel paper, commissioned by Mencap using the same data, calculated that there are more than 1,200 avoidable deaths of people with mental disabilities every year across the country – the equivalent of a Mid-Staffordshire hospital deaths scandal every year.

Its author, Dr Pauline Heslop of Bristol University’s Norah Fry Research Centre, said the findings were “shocking” and a “wake-up call”.

“We have, over the past few years, been rightly horrified by the abuse of people with learning disabilities at Winterbourne View hospital and of vulnerable patients at Mid-Staffordshire,” she said.

“The findings of the confidential inquiry into the deaths of people with learning disabilities should be of no less a concern.”

The Government-sponsored Confidential Inquiry into Premature Deaths of People with Learning Disabilities looked in detail into the circumstances of all deaths involving people with learning difficulties in South West England over a two-year period – almost 250 in total. They also compared them with a sample of deaths involving non-disabled people.

It found that 42 per cent of deaths of people with learning disabilities were “premature” and 37 per cent might have been avoided with better or quicker treatment.

While early deaths among non-disabled people was often associated with factors such as smoking and drinking – for those with learning difficulties the most common factors were delays or problems with diagnosis, referral and treatment as well as a wider failure to take make allowances for special needs.

About a third of those with special needs who died had had trouble communicating pain and a similar proportion had not had an annual health check in the previous year.

The most common age for men with learning disabilities to die was just 65 – 13 years before other men. For women with learning disabilities the median age at death was 63 – two decades earlier than other women in the same area.

NHS whistleblower Gary Walker faced bullying culture

Former NHS trust executive Gary Walker claimed he was put under pressure to meet non emergency targets.NHS whistleblower Gary Walker faced bullying cultureThe former boss of a hospital which is being investigated over high death rates has told MPs there was a culture of “sheer bullying” in the NHS.

Gary Walker, former United Lincolnshire Hospitals Trust chief, said he was sacked because of a row over an 18-week non emergency waiting list target.

He said he was threatened by the East Midlands Strategic Health Authority when he flagged up capacity problems.

The NHS said he was sacked for allegedly swearing in a meeting and denied Mr Walker’s claims he was “gagged” by a compromise agreement for raising concerns about patient safety.

Gary Walker described in vivid detail the pressures facing Lincolnshire’s hospitals back in 2008 and 2009.

Mr Walker said he personally witnessed hospital trolleys lined up together in an assessment ward – such was the demand for beds.

He claimed that when he tried to raise concerns he was “bullied”, threatened with his position and told that “everyone else is coping”.

Speaking for the first time in public, Mr Walker told the health select committee staff had been forced to cancel 700 operations when hospitals were full of emergency cases in 2009.

He said he had to put Lincoln County Hospital on an emergency footing, or red alert, but felt pressurised by health executives.

He said the response from the health authority was “this is your problem – you need to meet the targets whatever the demand”.

“It is a very dangerous thing to be trying to push through targets when hospitals are dangerously overfull,” he said.

Mr Walker told the committee: “I got a phone call from Dame Barbara Hakin former chief executive of the East Midlands Strategic Health Authority saying ‘we’re about to approve £11 million of funding for your trust and that’s going to be very difficult while you’re on red alert’.

“I don’t personally see the link between £11 million of largely capital funding to build facilities and being on red alert, the two are separate.

“One is about operationally running a hospital safely and the other one is about longer term plans.”

Mr Walker said he prepared a presentation for the Department of Health about problems with hitting targets but was ordered to remove any reference to him calling for a capacity review.

Mr Walker, who was sacked in 2010 for “gross professional misconduct” over alleged swearing at a meeting, said he was forced to quit after refusing to meet Whitehall targets for non-emergency patients and was gagged from speaking out as part of a settlement deal.

Bikini waxes and Brazilians- causes rise in STI warts

Bikini waxes and shaves are the cause for the explosion in the number of cases of a type of sexually transmitted infection that causes unsightly warts, doctors are warning.Bikini waxes and Brazilians- causes rise in STI wartsShaving the pubic region causes ‘micro-trauma’ of the skin, boosting the chance of a pox virus called Molluscum contagiosum, say the medical experts.

The virus causes water warts, small pink bubbles which can break out over the body. These warts are relatively common in children as the virus can be spread by normal skin-on-skin contact.

However, it is also passed on during sexual activity, and over the last decade the incidence of this type of infection has been on the rise.

Doctors wanted to know if this rise was linked to the growing fashion for ‘Brazilians’ and other forms of pubic hair removal.

They looked through records of visits to a private skin clinic from January 2011 to March 2012, and identified 30 cases of water warts infection. All but two of the 30 patients had undergone pubic hair removal. Twenty of the 28 had been shaved, five clipped and three waxed.

In four cases the warts had spread to the abdomen and in one they had spread to the thighs.

Their research Pubic hair removal: a risk factor for ‘minor’ STI such as molluscum contagiosum which was published in the journal Sexually Transmitted Infections, they warned: “Hair removal (especially shaving) could favour its acquisition, propagation and transmission by micro-traumatisms.”

They said the reason for opting for pubic hair removal remained “unclear”, “but may be linked with internet based pornography”.

“Another reason cited is an increased sexual sensation. There may also be psychological reasons, as an unconscious desire to simulate an infantile look or a desire to distance ourselves from our animal nature.”

The trend, they noted, was “also growing among men”. In fact, 24 of the 30 cases were in men.

Man with no shame- Sir David Nicholson- calls to resign after misleading MPs

Calls for the resignation of Sir David Nicholson- the chief executive of the NHS, were growing after it emerged he misled MPs over how he dealt with a ‘whistleblower’.Man with no shame- Sir David Nicholson- calls to resign after misleading MPsSir David was forced to issue a correction over evidence he gave to the Public Accounts Committee (PAC), after part of it was revealed to be untrue.

He had claimed that Gary Walker, former head of United Lincolnshire NHS Trust, had not identified himself as a whistleblower in a July 2009 letter to him. Sir David also told MPs that Mr Walker had not raised concerns about patient safety in the letter.

However, Mr Walker produced the letter in his own evidence to the Health Select Committee, which flatly contradicted Sir David’s account.

He told the MPs that he had “asked for protection as a whistleblower” in the letter, which also warned that patient safety could be compromised because he was “being forced to comply with targets”.

The letter, seen by the Telegraph, concludes: “I assume the Department of Health has a policy on whistle-blowing and would therefore like this letter to be considered in that context and not freely copied to the SHA [strategic health authority] or the local PCT [primary care trust].”

Mr Walker was sacked from his post in February 2010, for allegedly swearing in meetings.

He has always maintained the real reason was his refusal to bend to pressure from East Midlands Strategic Health Authority (SHA) to prioritise hitting waiting list targets. Mr Walker argued this would have endangered the safety of emergency patients.

He eventually received a £325,000 pay-off from the trust, on the condition he never talked about the dispute. Last month he broke the terms of that ‘gagging order’, resulting in him being invited to the Health Select Committee.

In the letter to Sir David, Mr Walker also claimed that he and David Bowles, the former chairman of the trust, had been the subject of “bullying and harassment” by the SHA.

Referring to the scandal at Mid Staffordshire NHS Foundation Trust, which at the time was just unfolding, he added: “This is the behaviour that gave this country a mid-Staffordshire.”

The matter is important because Sir David is fighting to maintain his reputation in the fallout of the Stafford hospital scandal, in which up to 1,200 people died due to appalling care.

A culture of bullying, not admitting mistakes and slavish adherence to targets is now widely accepted to have led to the tragedy.

Mr Walker argues he was trying to bring to Sir David’s attention similar problems at United Lincolnshire and East Midlands Strategic Health Authority ( SHA), which oversaw it. At the time the SHA was run by Dame Barbara Hakin, who Sir David has just appointed as his deputy.

From: http://www.telegraph.co.uk/Sir-David-Nicholson-calls-to-resign-after-misleading-MPs