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.

A&E must change or face collapse NHS warned

Urgent changes must be made to the way Accident and Emergencies (A&E) units are run – or the system could collapse, doctors and managers say.A&E must change or face collapse NHS warnedBoth the College of Emergency Medicine and Foundation Trust Network have put forward proposals to overhaul the system.

Funding and staffing have been highlighted as key issues.

Health Secretary Jeremy Hunt said it was “very tough out there” and ministers would deal with it by “better joining up” health and social care.

The warnings come as fears grow over whether the NHS can continue to cope with rising demand.

Last week both ministers and the NHS regulator admitted the problems were a cause for concern.

A&E attendances have risen by 50% in a decade and this winter the NHS in England started missing its four hour waiting time target.

The review by the College of Emergency Medicine – based on feedback from more than half the A&E units in the UK – said the scale of the challenge was the biggest for a decade.

It said there were shortages in both middle-grade and senior doctors. As well as highlighting the workforce problem, the college also said more needed to be done to reduce unnecessary attendances.

It believes between 15% and 30% of patients do not need A&E care and instead could be treated in non-emergency settings.

Meanwhile, the Foundation Trust Network (FTN) highlighted the funding system in England which penalises A&E units seeing a rise in patients.

Under rules designed to encourage the system to reduce A&E admissions, hospitals are only paid 30% of the normal fee for an emergency admission when the numbers rise above the levels that were seen in 2008-9.

But with the NHS failing to curb the rise in patients, that is costing some hospitals millions of Pounds a year.

Across the NHS more patients are being seen, but the upward trend is perhaps the greatest in A&E.

The lack of out-of-hours GP care is the cause of rising demands on A&E.

Since 2004 GPs have been able to opt out of providing night and weekend cover, leaving it to agencies to provide care.

A lack of confidence in the service has meant patients have to turn to A&E when they have not always needed emergency care.

This has been further compounded in recent months with the roll-out of the new 111 non-emergency phone line. Hospitals have reported rises in patients either because they cannot get through to 111 or have got poor advice and been told to go to their local A&E for trivial reasons.

But this does not tell the full story. The ageing population means there has been a rise in long-term conditions – about £7 in every £10 spent goes on patients with problems such as dementia and heart disease for which there is no cure.

NHS will collapse if elderly bed blocking continues claims health minister

The NHS will collapse without decisive action to get more elderly people out of hospitals, Norman Lamb, the health minister, has warned.NHS will collapse if elderly bed blocking continues claims health minister Mr Lamb, the care minister, said Britain’s system of health and social care is becoming “dysfunctional” and could “buckle under the pressure” unless radical changes are made to the way it operates.

He issued his warning amid growing concern that Accident & Emergency (A&E) departments and ambulance services are failing to cope, with rising numbers of patients forced to endure long waits.

Last week one of Britain’s most senior A&E doctors said units had begun to feel like “war zones” while the head of the NHS and social care watchdog said such services were “out of control”.

Regulators have also announced a review of the NHS funding system for which currently means that hospitals are paid to keep patients in hospital rather than discharging them to their homes or to care homes.

Mr Lamb said the NHS and social care system was under “huge pressure” from an ageing population, with high numbers suffering complex and chronic conditions and that tackling it was “the challenge of the 21st century”.

Mr Lamb said that addressing the funding system so that hospitals did not have a financial incentive to hang on to patients would be a priority.

“The hospital gets paid for a patient arriving in hospital but there is no incentive for them to leave,” he said.

Mr Lamb said the failure of health and social care to work together meant worse care for elderly people and wasted scarce resources.

The Lib Dem minister said: “At the moment the system is horribly fragmented and that means bad care – distress, crises occurring that could be avoided, massive disruption to people’s lives. If we carry on as we are the system will collapse.”

Mr Lamb’s warnings came as the government announced a review of services for elderly patients which could see elderly patients given their own personal NHS worker to oversee their care.

A single “named individual” would manage all care needs for elderly patients from arranging physiotherapy to home help and medical treatment.

The system of paying doctors by results will also be overhauled to focus on rewarding improvements in patients’ health rather than simply completing specified activities.

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.”

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 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.

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.

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”.