Surgeon’s data published- landmark improvement for NHS

Vascular surgeons have become the first of a new group of nine specialities to publish their operating data.
Surgeon's data published- landmark improvement for NHSThis move to publish this data is being viewed as a significant milestone as to date, individual performance data has only been published for heart surgeons.

But for years there has been debate about whether other areas of medicine should follow.

The publication of surgery-specific data was first called for in 2001 by Prof Sir Ian Kennedy, who chaired the inquiry into the excessive number of deaths of babies undergoing heart surgery in Bristol.

It is important not to view the surgeons’ performance data as a league table as surgeons all carry out a different range of procedures, even within the same specialty. They also deal with a different number of cases each year, on both high and low-risk patients.

Some surgeons will have many complex patients. Also, some procedures are inherently riskier than others.

What the tables do show are the number of times a procedure has been performed by a surgeon over a year, the mortality rate and – after adjusting for risk – if the outcomes fall within an acceptable range.

It’s acknowledged that surgeons need to perform a certain number of operations to keep their skills at a high level, but some doctors have been resistant to widening publication of data for eight surgical specialties and cardiology, as there is a fear that it may give a misleading impression.

Those doctors who take on the most difficult and complex cases may appear to be performing badly, when in fact they could be the leading specialists in their field.

The specialities taking part account for about 4,000 surgeons, more than half the workforce. Alongside mortality rates, the data includes information on other aspects such as length of stay in hospital after a procedure.

Prof Norman Williams, president of the Royal College of Surgeons, said: “This is an historic moment for surgery, and I’m enormously proud of what surgeons up and down the country have achieved.

“It has been a difficult and complex undertaking carried out in a short timescale but we see this as the beginning of a new era for openness in medicine.  It is early days, but it will change for the better the nature of the bond between patient and surgeon, which is based on both openness and trust.”

The college said that overall it looked as if more than 99% of doctors had agreed to the release of the data this summer with fewer than 30 expected to resist.

Cancers increase by 40% due to bad lifestyles

Cancers caused by smoking, drinking and excessive sunbathing have soared in the past decade- official statistics have revealed.Cancers increase by 40% due to bad lifestylesThe figures, released by the Office for National Statistics (ONS) reveal large increases in the incidence of so called “lifestyle” related cancers.

The biggest rise has been in the rate of malignant skin cancer, which has increased by 56 per cent among men and 38 per cent among women since 2002.

The ONS said the increase in skin cancer rates was probably due to changes in clothing over the last century and growing levels of sunbathing.

Oral cancers, which have been linked to smoking and poor diet, have increased by 37 per cent while kidney cancer has increased by 25 per cent in men and 36 per cent in women.

Overall new cases of cancer in England rose by almost a fifth between 2002 and 2011- when 274,233 patients were diagnosed.

Nick Ormiston-Smith, statistical information manger at Cancer Research UK, said that the figures showed how poor lifestyle choices were creating health problems for people in later life.

He said: “Forty per cent of cancers can be attributed to lifestyle factors so swapping some bad habits for healthier ones can help reduce the risk of developing the disease.

“Smoking increases the risk of at least 14 forms of cancer including lung, bowel, pancreatic and mouth.

“Cutting down on alcohol, keeping to a healthy weight, avoiding sunburn and being more active can also help reduce the risk of many cancers.

“Leading a healthy life doesn’t guarantee you won’t get cancer but it can stack the odds in your favour.”

The figures show that the number of cancers to be diagnosed in England in 2011 were 359,020, with nearly 85,000 of those being non-melanoma skin cancers.

Around 6,000 people were diagnosed with oral cancers while more than 11,000 were found to be suffering from malignant melanoma.

As skin cancer can develop decades after damage caused by ultraviolet radiation, growing numbers of people are expected to be diagnosed with the disease.

The report said: “These increases are considered to be due to changes in exposure to solar UV rays as a result of altered patterns of behaviour in recent decades, such as choice of clothing and recreational sunbathing.”

The number of men diagnosed with lung cancer was 19,173 – a reduction of 11 per cent since 2002. However, among women, lung cancer increased by 15 per cent to 15,675.

The ONS said: “The majority of lung cancer cases occur as a result of tobacco smoking, with around one in five cases in the UK being attributable to diet and occupational exposures.

“While men remain more likely to smoke than women, the gap has narrowed.”

Breast cancer was the most prevalent diagnosis among women, with figures increasing by 5.5 per cent since 2002 to 41,523.

It is estimated that about 27 per cent of these are linked to lifestyle and environmental factors such as alcohol consumption, lack of physical activity and hormonal factors.

Prostate cancer was the most common cancer among men, with 35,567 patients being diagnosed in 2011.

Bullying creates toxic NHS culture

A culture of bullying and secrecy has created a “toxic working environment” in the NHS- doctors warn.
Bullying creates toxic NHS cultureThe British Medical Association annual conference heard how a proper system of regulation needed to be introduced for managers so they could be held to account.

This idea has already been put forward by the Francis Inquiry into the Stafford Hospital scandal- but so far ministers have resisted such a move.

Ministers in this government and the last have set out dismantle the network of district general hospitals across England, Wales and Northern Ireland, according to doctors.

Speaking at the British Medical Association, surgeon Anna Athow said this government and the previous Labour administration had become obsessed with creating super-hospitals with huge catchment areas.

She said 32 hospitals had been closed or downgraded as ministers in the coalition and past Labour government had launched a “war of attrition” stripping them of their A&Es, maternity units and paediatric departments.

Delegates at the conference in Edinburgh voted in favour of a motion critical of the way hospitals were being closed.

Addressing the meeting of doctors in Edinburgh, which voted in favour of a motion calling for a regulation system for managers, GP Dr Peter Holden criticised the way managers were operating in the health service.

He said there was a “culture of secrecy, covert bullying and gagging clauses. The result is the perfect toxic professional working environment for this explosive mixture to generate disaster such as Mid Staffordshire which did so much harm to patients.”

He added: “We all know of managers who abuse Care Quality Commission and General Medical Council procedures to bully doctors.”

Doctors also complained about the increasing pressures that were being placed on them.

NHS needs to simplify emergency urgent care

The NHS needs to provide a much simpler and co-ordinated system of 24/7 urgent and emergency care- a review of its services says.NHS needs to simplify emergency urgent careIt also warns that many patients are confused about who to turn to when they need urgent medical help, so too often they go to A&E units.

The review – led by NHS medical director Sir Bruce Keogh – says there should be a much simpler 24/7 system. He said the review offered an “excellent opportunity” to improve.

Urgent or unplanned care leads to around 100 million NHS calls or visits each year, the report says.

A growing number of frail elderly patients, more long-term illnesses, new treatments and “increased public expectations” have all contributed to increased demand.

The fragmentation and diverse nomenclature of urgent care services across England causes confusion amongst patients”

However this review looks at all kinds of urgent and emergency care – including walk-in centres, telephone advice lines and minor injury centres – and concludes there is pressure throughout the system.

A key issue is “fragmentation and variation” in services- which leads to confusion among patients who are then likely to “default” to A&E because they know where it is, that it will be open and offer a full range of care.

The report says: “The fragmentation and diverse nomenclature of urgent care services across England causes confusion amongst patients and healthcare professionals in terms of services offered. This can lead to patients presenting at services that may not best suit their needs.”

It adds that there is an increasing reliance on telephone advice, but the report warns that some patients “lack confidence” in such care and says they will often seek a second opinion anyway, leading to a “duplication of service provision”.

Other issues identified include a lack of patient-awareness about the care which community pharmacists can provide, and the need for senior staff to be on duty more of the time, such as at weekends.

Direct Health NHS 111 debacle- inquiry needed

An independent inquiry is needed into the direct health NHS non-emergency 111 phone line “debacle” in England GPs say.
Direct Health NHS 111 debacle- inquiry neededDoctors at the British Medical Association’s GPs conference in London said lessons had to be learned after the “disastrous” roll-out of the service in recent months.

The phone line – which has replaced NHS Direct – has been dogged by reports of calls going unanswered and poor advice.

GPs said they had seen their workloads increase because of the problems.

There are actually 46 different services across the country, run by a variety of organisations including private firms and ambulance crews.

Some places have seen the service suspended, while others are relying on the support of old NHS Direct teams to deal with calls.

GPs at the conference in London voted unanimously in favour of a motion calling for an independent inquiry over debacle.

John Hughes, a GP from Manchester, which saw its 111 system suspended soon after its launch, said the whole system was an “absolute mess”.  He said he had been told on the night it crashed in the north west the service had just 31 call handlers instead of the 100 GPs had been told it would.

Others complained they had been deluged with paperwork from 111 and visits from confused patients who had not got the right advice from the phone line.

South London GP Lilian Awere said: “It has been successful in some places, but in most places it has been disastrous.  The workload in A&E and for GPs has increased.”

NHS England has admitted the failings have been “inadequate”, but has said the service is now improving. It is carrying out its own review into what went wrong.

The call comes as the BMA’s GP chairman Dr Laurence Buckman launched an attack on Health Secretary Jeremy Hunt.

He accused Mr Hunt of being more interested in bashing doctors and spouting “rubbish” after the health secretary blamed the rise in A&E waits on changes to the GP contract in 2004 which allowed GPs to stop providing out-of-hours care.

Dr Buckman said there was no evidence that the changes, which led to agencies taking on responsibility for care, have been a major factor.

Friday is worst day of the week for surviving surgery

Health Direct wishes you good luck if you are going under the knife today- you have a 44% gerater chance of dying than if you had your operation on a Monday.
Friday is worst day of the week for surviving surgeryPeople who have surgery towards the end of the week are more likely to die than those who have procedures earlier on, researchers say.

A British Medical Journal report into non-emergency operations in England, suggests the overall risk of death from such planned procedures remains low, but it shows “unacceptable” variation in survival rates through the week, a leading body of UK surgeons says.

Researchers from Imperial College London gathered data from all non-emergency surgery undertaken by the NHS in England in 2008-11.

Looking at some 4 million operations they found more than 27,000 deaths within a month of surgery, putting the average risk of death at 0.67%.

The researchers say they are concerned about the significant variation over the week, with the risk lowest for surgery carried out on Monday and then increasing with each subsequent day to peak at the weekend.

The paper shows people who have their operations on Friday are 44% more likely to die than those who have a procedure on Monday.

The researchers say the findings may be due to a poorer quality of aftercare at the weekend, when people who have their surgery later in the week need it most.

Dr Paul Aylin, lead author of the study said: “The first 48 hours following a procedure is most critical and when things can go wrong, such as bleeding and infections. If you don’t have the right staff, this is likely to contribute to things being missed.

“If I were a patient I would take comfort from the fact the overall death rate is low, but if I were to have an operation towards the end of the week I would be interested in whether the hospital had the appropriate services to look after me throughout my recovery, including at the weekend.”

He says the higher risk of death could be due to fewer doctors, nurses and many non-clinical staff being available on Saturdays and Sundays.

And the study suggests the risk of dying was higher still for surgery conducted over the weekend – 82% greater than on Monday – though the researchers caution only a minority of planned operations currently take place on Saturdays and Sundays.

Previous research looking at emergency procedures shows people are at greater risk of death if admitted during the weekend, but this is the first large study to look at planned operations, ranging from high-risk procedures such as heart bypass grafts to routine hernia repairs.

Katherine Murphy, chief executive of the Patients Association, said: “Whilst this research once again highlights the NHS’s weekend malaise and makes for concerning reading, it unfortunately doesn’t identify a new problem, but rather a failure to address an issue that has repeatedly been highlighted in the past…

“It is a shame that, despite the publication of hundreds of pages worth of reports and recommendations, so little action has been taken to actually address the problems identified.”

CQC to reveal NHS cover up names

England’s NHS regulator will name some officials accused of covering up a failure to investigate deaths of babies at a Cumbria hospital.CQC to reveal NHS cover up namesPressure is mounting on the Care Quality Commission to name managers who apparently blocked publication of a critical report.

The Information Commissioner said the Data Protection Act does not overide public interest in releasing the names.

The CQC said no decision had yet been formally reached. However it has said it is exploring all legal means possible to see if names can be made public.

However, Health Minister Lord Howe said those involved will be named.

Speaking in the House of Lords, he said his “understanding” was that the CQC would reveal the identities of some of the officials involved later today.

However, the CQC said no official decision has yet been made.  Before the meeting, CQC chief executive David Behan confirmed he was reviewing legal advice not to reveal the names of those involved.

It follows growing pressure to publicly name those involved.

Information Commissioner Christopher Graham in the meantime has told the BBC that senior managers could not “hide behind the Data Protection Act”.

More than 30 families have taken legal action against the hospital in relation to baby and maternal deaths and injuries from 2008.

Consultants Grant Thornton were asked by the health regulator to investigate its own failure to spot the problems: in 2010, Morecambe Bay NHS Trust, which ran the hospital, had been given a clean bill of health.

Grant Thornton found that, a year after this, with more concerns emerging, an internal review had been ordered into how the problems had gone unnoticed.

In March 2012 it was decided the findings should not be made public because the review was highly critical of the regulator.

That order is said to have come from a senior manager who has not been named and who denies the allegations.

The latest report said this “might well have constituted a deliberate cover-up”.

Information Commissioner Mr Graham told BBC Breakfast: “What appeared to be going on yesterday was a sort of general duck-out saying ‘oh, data protection, sorry can’t help you’ – that’s all too common and in this case it certainly looked as if data protection really wasn’t the issue.”

He said he could not order the CQC to reverse its decision but said he was glad it was looking at the issue.

“So far as the Data Protection Act is concerned, we all have a right to the protection of our personal privacy but if you are a senior official then there are issues about the point at which your privacy is set aside because of over-riding public interest. That’s really the issue at stake here,” he said.

The 1998 Data Protection Act details how personal information is used by organisations, businesses and government. It demands that information is used fairly and legally, is accurate, used for specifically stated purposes and is kept secure.

There have been numerous occasions where data protection has been wrongly cited as a reason something should not happen.

In 2010 the Information Commissioner was forced to warn schools that they could not use it to ban parents from taking pictures of their children in nativity plays.

NHS cover up is unacceptable wanrs Health Secretary

A cover up by England’s NHS regulatory body after a series of baby deaths at a Cumbria hospital is unacceptable warns the Health Secretary.NHS cover up is unacceptable wanrs Health SecretaryJeremy Hunt was speaking after a review of the Care Quality Commission’s (CQC) response to complaints about several deaths at Furness General Hospital.

The review has shown a senior manager may have ordered the deletion of a report critical of the CQC last year.

Mr Hunt promised there would be “no hiding place” for those responsible.

In a statement to the House of Commons, he said the CQC was already introducing a tougher inspection regime and had just appointed a chief inspector of hospitals.

Meanwhile, he said the government was introducing measures to make the NHS more transparent, including a duty of candour to compel the health service to be open and honest about mistakes.

But Mr Hunt said the attempt to cover up as described in the report was “completely unacceptable” and the truth must come out.

“There should be no anonymity, no hiding place, no opportunity to get off Scot-free for anyone at all who was responsible for this. What happened at Morecambe Bay is above all a terrible personal tragedy for all the families involved. I want to apologise on behalf of the government and the NHS for all the appalling suffering they have endured.”

The CQC asked consultants Grant Thornton to investigate its failure to spot the problems – Morecambe Bay NHS Trust, which ran the hospital, had been given a clean bill of health in 2010.

The consultants found a year after this, with more concerns emerging, an internal review had been ordered into how the problems had gone unnoticed.

But in March 2012 it was decided the findings should not be made public as the review was so critical of the CQC. The order is said to have come from a senior manager who has not been named for data protection reasons. The individual denies the allegations.

Half of UK population will get cancer

The number of people in the UK who will get cancer during their lifetime will increase to nearly half the population by 2020 a report has forecast.Half of UK population will get cancerMacmillan Cancer Support said the projected figure of 47%, up from the current 44%, would put huge pressure on the NHS.

People living longer is thought to be a major reason for the increase, but the charity said that more people were surviving cancer compared to 20 years ago.

In 1992, the proportion of people in the UK who got cancer during their life was 32%. This increased to 44% in 2010, an increase of more than a third.

Macmillan said this figure would continue rising over the next decade, levelling off at around 47% between 2020 and 2030.

The charity said this was likely to be an underestimate of the true risk facing people alive in 2020, as life expectancy increased and more people developed cancer.

To produce their figures, Macmillan used data on cancer incidence, cancer mortality and deaths from all causes from across the UK.

They collected figures on cancer survival rates too.

In 1992, 45,000 people, or 21% of those who had cancer, did not die from the disease.

This increased to around 90,000 (35%) in 2010 and is predicted to rise to four in 10 people (38%) surviving cancer and dying from another cause by 2020.

Other causes of death are most commonly heart disease, respiratory disease or stroke.

Macmillan puts the increased survival rates from cancer down to a greater focus on early diagnosis, advances in cancer treatments and better cancer care.

Although the charity said the survival trend was “encouraging”, it said there was growing evidence that many cancer patients did not return to full health after gruelling treatments and the serious side effects of the disease.

Prof Jane Maher, chief medical officer at Macmillan Cancer Support, said: “Many patients can be left with physical health and emotional problems long after treatment has ended. People struggle with fatigue, pain, immobility, or an array of other troublesome side-effects.”

“We need to manage these consequences for the sake of the patient, but also for the sake of the taxpayer. We should plan to have more services to help people stay well at home, rather than waiting until they need hospital treatment.”

Health Secretary to name and shame surgeons’ data

Surgeons who refuse to publish their performance data including mortality rates should be publicly named, the health secretary says.Health Secretary to name and shame surgeons' dataJeremy Hunt promised to take tough action after it emerged doctors could block the release of the information under the Data Protection Act.

League tables for 10 specialities are due to be published in England from next month.

The league tables on the NHS Choices website will cover about 4,000 surgeons- more than half of the workforce.

The move is being seen by ministers as a critical step in making the NHS more transparent.

The publication of surgery-specific data was first called for in 2001 by Prof Sir Ian Kennedy, who chaired the inquiry into the excessive number of deaths of babies undergoing heart surgery in Bristol.

Since then, only heart surgeons have published data down to an individual level.

Some doctors have been resistant to widening publication of data for nine surgical specialties and cardiology, as there is a fear that it may give a misleading impression.

Those doctors that take on the most difficult and complex cases may look to be performing worse, when in fact they could be the leading specialists in their field.

But while doctors can block the publication of the data to the public it does not mean the details, including mortality rates, are hidden from regulators.

Mr Hunt said: “Subject to proper risk adjustment of the data there can be no valid reason why it should not be published.  In an era of public concern over patient safety issues this will be a major step forward in restoring public confidence.”

Royal College of Surgeons president Professor Norman Williams urged doctors not to block publication of the data.

“Patients have a right to know of doctors who are not meeting the standards expected of them.”

But he warned that naming surgeons who refuse to co-operate could prove problematic.

In particular he drew attention to the fact that as not every doctor was involved in the publication programme it could be difficult to identify which doctors were not co-operating.

The college says some surgeons have delayed giving their consent until they know the data is robust and say that patients would not want unreliable measurements published.