End Of Life care letting people down

Thousands of dying patients are being let down by poor End Of Life care provision according to the Parliamentary Health Service Ombudsman (PHSO)

End Of Life care letting people downThe health ombudsman’s report detailed “tragic” cases where people’s suffering could have been avoided or lessened.

The Parliamentary and Health Service Ombudsman has investigated 265 complaints about end-of-life care in the past four years, upholding just over half of them.

Its Dying Without Dignity report said it had found too many instances of poor communication, along with poor pain management and inadequate out-of-hours services.

One mother told the ombudsman how she had had to call an A&E doctor to come and give her son more pain relief because staff on the palliative care ward he had been on had failed to respond to their requests.

In another case, a 67-year-old man’s family learned of his terminal cancer diagnosis through a hospital note – before he knew himself. This “failed every principle of established good practice in breaking bad news”, the report said.

“There was an avoidable delay in making a diagnosis,” it added. “An earlier diagnosis would have meant opportunities for better palliative care.”

Ombudsman Julie Mellor said that the report made “very harrowing reading”.

She also urged the NHS to learn lessons from the report, adding: “Our casework shows that too many people are dying without dignity.

“Our investigations have found that patients have spent their last days in unnecessary pain, people have wrongly been denied their wish to die at home, and that poor communication between NHS staff and families has meant that people were unable to say goodbye to their loved ones.”

Macmillan Cancer Support chief executive Lynda Thomas said: “The report cites heartbreaking examples of a lack of choice at the end of life that are totally unacceptable.

“If we are to improve the current situation, we will have to see a dramatic improvement in co-ordination of care, and greater integration of health and social care.”

The chief inspector of hospitals at the Care Quality Commission, Prof Sir Mike Richards, said the organisation had seen examples of excellent end-of-life care, but also instances where it had not been given enough priority.

He said the CQC would continue to highlight those services that were failing.

Health Direct laments “These are appalling cases – everyone deserves good quality care at every stage of ones life- but at the very end of the life dignity should be paramount.”

Alcohol detox centre saves NHS millions

The NHS could save £27 million a year by changing the way it deals with alcoholic patients.

Alcohol detox centre saves NHS millionsAlcohol abuse costs the NHS £3.8 billion a year, £145 for each UK household. One in three of all A&E admissions are alcohol related- but on a weekend that can rise to 70%.

Dr Chris Daly, the lead consultant at the unit, believes the NHS is wasting money by often treating people for the effects of alcohol problems without dealing with the underlying problem.

“We were very surprised that a significant proportion, maybe as much as 50% of the patients that we see, were not open to any services and some of them had never been seen by alcohol services before, so it’s almost as if we’re dealing with a different sort of population,” he says.

“These are people who are maybe only using their A&E department as their main source of treatment for their alcohol problems.”

The Radar ward at Chapman Barker is the first of its kind in the UK. Set up three years ago it takes alcohol dependent patients directly from 11 A&E departments across Manchester.

Some 75% of the people who come through the unit do not go back to hospital for at least the next three months.

The Radar ward is split with separate eating and living spaces for both sexes. Four in 10 of the places here are taken by women, from teenagers right up to pensioners in their 80s.

Patients are treated with talking therapies, support and counselling, but also specialist medical care they would not always get in a large hospital.

Around half of all alcohol dependent patients can develop clinical symptoms when they try to quit, including seizures, fits and hallucinations.

Without the right support the most severe cases often end up back in hospital.

An independent analysis of the unit by academics at Liverpool John Moores University published in April 2015 found it saves the NHS £1.3 million a year.

If the same approach was taken across the country the researchers say it could save the NHS £27.5 million in England alone.

This unit has secured funding to operate for another year but the future is always uncertain. The people working there say ignoring these patients will cost the NHS more in the long run.

Health Direct repeats numerous research warnings that alcohol is the drug that causes the most damage to the UK population- so anything that curbs preventable crisis is to be welcomed.

Leonardo da Vinci still teaching us about the heart

After Leonardo da Vinci dissected the heart of a man he produced the first known description of coronary artery disease.

Leonardo da Vinci still teaching us about the heartMore than 500 years later, coronary artery disease is one of the most common causes of death in the western world.

“He had a great mind, and he was willing to really look and see,” says Mr Francis Wells, a consultant cardiothoracic surgeon at Papworth Hospital in Cambridge, who has spent years studying Leonardo da Vinci’s anatomical drawings, which form part of the Royal Collection in Windsor.

His diagrams and sketches of the skull, skeleton, muscles and major organs fill countless notebooks while his theories on how they function fill many more pages.

But it was the heart that appeared to particularly fire his interest, from 1507 onwards, when he had reached his 50s.

In those drawings, he used his knowledge of fluids, weights, levers and engineering to try to understand how the heart functions. He also looked closely at the actions of the heart valves and the flow of blood through them.

Mr Wells’ book, ‘The Heart of Leonardo’, explores the artist’s drawings and writings on the organ, and he says his insights are “quite astonishing. The more we look, the more right we realise he was.”

Many of Leonardo’s conclusions, such as the description of how the arterial valves close and open – letting blood flow around the heart – holds true today, but is not widely known.

“Even cardiologists get this wrong now,” Mr Wells says. “Only with the use of MRI technology has knowledge of this subject been revisited.”

Many of Leonardo’s drawings were based on studies of hearts from ox and pigs. It was only later in life that he had access to human organs, and these dissections had to be carried out quickly in winter before the body began to degrade.

Contemporary dissections of the heart show he was correct on many aspects of its functioning. For example, he showed that the heart is a muscle and that it does not warm the blood.

He found that the heart had four chambers and it connected the pulse in the wrist with the contraction of the left ventricle.  He worked out that currents in the blood flow, created in the main aorta artery, help heart valves to close. And he suggested that arteries create a health risk if they fur up over a lifetime.

Mr Wells also believes that Leonardo realised that the blood was in a circulation system and may have influenced William Harvey’s discovery in 1616 that blood was pumped around the body by the heart.

Yet none of Leonardo’s theories or drawing were ever published during his lifetime. In fact, his notes were not rediscovered until the late 18th century – more than 250 years after his death.

With hindsight they may have had the potential to revolutionise surgery.

In the 16th century, for example, there was no treatment for cardiac disease, or many other diseases, and surgeons occupied a low status in society.

If people survived surgery, it was more by luck than judgement. Heart surgery has transformed in the past century, but Leonardo’s insights could have made a huge difference if they had been made public earlier.

Even now, however, there is common consensus that we have barely scratched the surface of what we know about the heart.

According to Mr Wells, Leonardo’s legacy is that we should follow the Renaissance Man’s example and continue to challenge, question and enquire rather than listen to accepted wisdom.

Overweight seen as the norm warns chief medical officer

Being overweight is increasingly seen as the norm, England’s chief medical officer warns.
Overweight seen as the norm warns chief medical officerIn her annual report on the state of health, Dame Sally Davies said this was concerning, pointing out many people did not recognise they had a problem.

Parents of overweight children were also failing to spot the signs too, she said.

Dame Sally blamed the way weight was being portrayed by the media and clothes industry.

  •     Body mass index (BMI) is used to calculate whether a person is underweight, a healthy weight, overweight or obese for their height.
  •     It is calculated by measuring weight (in kilograms) and dividing it by height (in metres) squared to give a BMI score
  •     A BMI of 25 to 29.9 is considered overweight and one of 30 or above is considered obese.

“I have long been concerned that being underweight is often portrayed as the ideal weight, particularly in the fashion industry.

“Yet I am increasingly concerned that society may be normalising being overweight.

“Larger mannequins are being introduced into clothes shops and “size inflation” means that clothes with the same size label have become larger in recent decades.

“And news stories about weight often feature pictures of severely obese people, which are unrepresentative of the majority of overweight people.”

Dame Sally also reiterated her belief that a sugar tax may be necessary to combat obesity.

At the start of March she told the Health Select Committee it may be needed, although she hoped not.

This caused some controversy as the government’s approach has been characterised by working with industry to get them to make food and drink products healthier.

In her report she says this should continue, but if it fails to deliver a tax should be “considered”.

She said children and adults of all ages are consuming too much sugar.

Nearly two thirds of adults and a third of children are overweight or obese – classed as a body mass index of above 25. This is about double the numbers in the early 1990s.

Being born to young mothers is risk factor for early childhood death

Children born to mothers under 30 are more likely to die than those born to older mums according to a new report on child deaths in the UK.Being born to young mothers is risk factor for early childhood deathWhilst overall child mortality fell by 50% in the past 20 years having a young maternal age was found to be a risk factor for death in early childhood.

The research was led by the Institute of Child Health at UCL.  It looked at why children die in the UK using death registration data from January 1980 to December 2010. It focused on child injuries, birthweight and maternal age to assess the risk factors for child deaths.

The research found that in England, Scotland and Wales, the difference in mortality between children of mothers under 30 and those born to mothers aged 30 to 34 accounted for 11% of all deaths up to nine years old. This is equivalent to an average of 397 deaths in the UK each year, the report said.

Deaths in children born to mothers under 20 accounted for just 3.8% of all child deaths up to nine years old.

The study compared children with similar birthweight in each age category.  It reported that the biggest difference in deaths was in infants aged from one month to one year.

Among this age group, 22% of deaths in the UK were due to “unexplained causes”, the report said, “which are strongly associated with maternal alcohol use, smoking and deprivation”.

The report added that the current policy, which focuses support on teenage first-time mothers, was not wide-ranging enough because mothers aged under 30 account for 52% of all births in the UK.

Ruth Gilbert, lead researcher and professor of clinical epidemiology at UCL Institute of Child Health, said the findings were important.

“Young maternal age at birth is becoming a marker of social disadvantage as women who have been through higher education and those with career prospects are more likely to postpone pregnancy until their 30s. Universal policies are needed to address the disparities.”

The study, commissioned by the Healthcare Quality Improvement Partnership and published by the Royal College of Paediatrics and Child Health, had other key findings.

First, injuries continue to be the biggest cause of death in childhood, but they are declining,

Between 1980 and 2010, injuries accounted for 31% of deaths in one to four-year-olds and 48% of deaths in those aged 15 to 18.

England had consistently lower rates of deaths from injury than the other UK countries, particularly among older boys.

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

NHS 111 phone number raises safety concerns

Doctors are questioning the safety of a new non emergency NHS 111 phone number sparks concern.NHS 111 phone number raises safety concernsThe 111 service, replacing NHS Direct, is being piloted in some areas ahead of a nationwide launch but has proved problematic, with some callers left on hold for hours.

Dr Laurence Buckman, the British Medical Association’s GP committee chair, says rollout should be stalled.

It has already sanctioned an extension of up to six months of the original 1 April 2013 deadline for regions struggling to set up the new service.

The NHS Direct 0845 4647 service will continue to be available to callers in areas where the NHS 111 service is not yet available, Health Minister Lord Howe insists.

These include: North of Tyne and Tees, North Essex, Bedfordshire and Luton, Cambridgeshire and Peterborough, Leicestershire and Rutland, Berkshire, Cornwall and Devon.

But the British Medical Association is concerned that many of the places that are already offering the new service or that are due to launch soon are ill-prepared, putting patients’ lives at risk.

The BMA says it has been receiving widespread reports of NHS 111 failures.

Some of the pilot regions have been unable to cope with call volumes or have suffered catastrophic IT failures.

In Greater Manchester the entire system crashed, meaning calls went unanswered.

Problems led to a surge in ambulance callouts and casualty visits as callers have resorted to other measures to get seen by a healthcare professional.

Dr Buckman said: “The BMA is seriously concerned that these failures are not only having impact on other, already overstretched NHS services, but potentially putting patient safety at risk. Patients need to have their calls answered immediately and correctly and not be faced with any form of delay.

“The Department of Health needs to reconsider immediately its launch of NHS 111 which clearly is not functioning properly. They must ensure that the system is safe for patients before it is rolled out any further.”

Lord Howe said: “NHS 111 will help patients access the whole of the NHS through just one simple number.

“Over the coming months this new service will replace the existing NHS Direct telephone advice line. To ensure that patients get the best care and treatment, we are giving some areas more time to go live with NHS 111 while we carry out thorough testing to ensure that those services are reliable.”

Leeds hospital suspends child heart surgery

Children’s congenital heart surgery at Leeds General Infirmary has been suspended as a review is carried out.Leeds hospital suspends child heart surgeryThere are concerns about the number of deaths at the hospital, which is at the centre of a long dispute over the future of children’s heart services.

The medical director of the NHS, Bruce Keogh, said it was “a highly responsible precautionary step”.

Leeds General Infirmary had been earmarked for closure by the NHS review to concentrate children’s heart surgery in fewer bigger centres.

Stuart Andrew, Conservative MP for Pudsey, who has led a cross-party campaign to keep the unit open, said it was a “very odd” decision coming after the jubilation that greeted the court ruling.

“We have always asked them ‘is it safe at Leeds?’ and the answer always came back ‘yes it is’.

He added he had not received one complaint about care.

Children who would have been treated in Leeds will be sent to other hospitals around England.

Affected families are being contacted directly by the trust and the review is expected to take three weeks.

Anne Keatley-Clarke, chief executive of the Children’s Heart Federation, an umbrella group for different voluntary organisations, said she had raised concerns about surgery outcomes two years ago, and more recently parents had reported difficulties in getting referrals at Leeds to other heart units.

In a statement on the federation website, she said: “My concern is that it appears that managers and clinicians in Leeds, together with the parent support group, have put their own interests ahead of the well-being of critically ill children and their very vulnerable parents.”

The chief executive of Leeds Teaching Hospitals NHS Trust said outside experts would be drafted in to help review “all aspects” of care.

In a statement, Maggie Boyle apologised to parents and families affected but assured them the trust always put the safety of patients first.

The CQC said it supported the trust’s decision and it was in close contact with the trust to ensure effective arrangements were in place to protect the safety and welfare of patients.

Sharon Cheng, from Save Our Surgery – the group which is co-ordinating the fight to keep children’s heart surgery in Leeds – said: “We’re mystified.  We don’t know of anything that could justify this step.”

Previously, an NHS review said surgery should stop at hospitals in Leeds, Leicester and London to focus care at fewer, larger sites, where medical expertise can be concentrated.

More than 600,000 people signed a petition opposing the closure plans. Many people were unhappy that children from Leeds faced journeys of up to 150 miles for care.

New NHS structure changes come into force

New Government reforms of the NHS in England have come into force and health leaders warn of a tough year ahead.New NHS structure changes come into forceApril 1st- April Fools Day- marks the first day of the new structures.

GP-led groups have taken control of local budgets and a new board, NHS England, has started overseeing the day-to-day running of services.

The NHS Confederation said the reforms represented a big opportunity but should not be seen as a “silver bullet” for the challenges ahead.

Mike Farrar, chief executive of the confederation, which represents health managers, said the squeeze on finances and the need to rebuild public confidence after the Stafford Hospital scandal meant the NHS was facing a critical period.

He said the reforms would bring clinical expertise to the fore of decision making, which would be a “huge asset”.

But he warned: “We need to recognise the huge challenges facing the health service. New structures alone won’t enable us to tackle these challenges, and we should not see them as a silver bullet.

“Those doing the day-job face major pressures in trying to keep the NHS’s head above water, while focusing on making the new world work.”

The start of the new system comes nearly three years since the changes were put forward.

The publication of the plans in the summer of 2010 sparked a long and, at times, damaging battle for the government to push through with its changes.

Ministers even had to take the unprecedented step of halting the progress of the bill through Parliament amid criticism from medical bodies, academics and unions.

In particular, concerns have been expressed about what many believe is a greater role for the private sector.

Some have also questioned whether introducing such major changes – they have been dubbed the most radical overhaul since the NHS was created – at a time when money is so tight makes sense.

But as the new bodies take up control – and the old organisations, including 152 primary care trusts, are scrapped – the government maintained the changes would put the NHS on a firm footing for the 21st century.

Health Minister Anna Soubry said: “The health service will improve, work smarter and, importantly, build an NHS that delivers high quality, compassionate care for patients.”

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”.