Hygiene worries at cancer centres

Inspectors have expressed worries at the standard of hygiene and cleaning at Scotland’s largest cancer centres.
Hygiene worries at cancer centres
On a visit to the Beatson and Gartnavel General Hospitals, they found dust and debris- and were told by staff there were not always enough cleaners.

Healthcare Improvement Scotland also found many patients had not been given information about preventing infection.

NHS Greater Glasgow and Clyde (GGC) said it had drawn up an action plan to address the inspectors’ concerns.

HIS carried out the unannounced inspection at Gartnavel, which has 558 beds, on 26 March.

The site also houses the Beatson West of Scotland Cancer Centre with 170 beds.

In its report, the inspection team stated that it “observed good compliance with standard infection control precautions” in all the wards visited.

It continued: “However, on one ward we found a large number of full sharps bins awaiting uplift.  These were restricting access to the handwash sink in the sluice.”

“The senior charge nurse confirmed that there had been no collection the previous day (Monday) and that the portering department had been contacted to arrange collection. The senior charge nurse told us that this problem was not uncommon.”

The report also noted that on the day of inspection, the hospital was “generally clean”.

It continued: “However, in four of the nine wards and departments inspected, further attention to detail was required. This included high and low level dust and debris, particularly at floor to wall junctions.  In three of these wards and departments, staff expressed concern at the inconsistent provision of adequate domestic staff to achieve the required level of cleaning.”

The inspection resulted in three requirements – covering cleaning, information availability and record keeping – being made, which HIS expected NHS GGC to address “as a matter of priority”.

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.”

Health Secretary wants to cut nurses’ paperwork by third

Jeremy Hunt the Health Secretary, wants to cut the amount of paperwork doctors and nurses have to do by a third so they can spend hours more every week with patients.Health Secretary wants to cut nurses' paperwork by third“Endless” box ticking and “burdensome regulation” mean nurses spend about a day a week on paperwork, Mr Hunt told a meeting organised by the think-tank Reform.

He has asked the NHS Confederation, which represents managers, to come up with a plan in the coming months to cut red tape.

His pledge has been welcomed by the Royal College of Nursing, which described the burden of paperwork as “excessive”.

Mr Hunt said that one of the primary lessons from the Francis report, into failings that led to hundreds of deaths at Stafford hospital, is that small things like ensuring a patient has enough water, matter more than targets.

As ministers make changes to ensure a repeat never happens, he claims “we must avoid thinking that care and compassion can be commanded from on high either by regulators or politicians”.

“Endless boxes to tick, cumbersome bureaucracy and burdensome regulations are the problem – they cannot be the solution,” he said.

Mr Hunt describes good healthcare as being “in the moment – the minute-by-minute interaction between a person in need and a person there to help”.

He continued “It is because people believe in the values of the NHS that they spend their working lives in it.

“So this is about unlocking those values that lie inside the outstanding doctors and nurses who deliver care week-in and week-out and stopping the dead hand of top-down targets crushing the goodness out of them.”

Among the cases that have come to Mt Hunt’s attention include a nurse who had to fill 10 forms – including one that was 22 pages long – to get a patient with a gunshot wound admitted to a trauma ward.

Dr Peter Carter, chief executive and general secretary of the RCN, welcomed the initiative.

He said: “Our members have been telling us for several years that they are forced to spend too much time filling in forms, ticking boxes and duplicating information.”

“While it is necessary to monitor care, record vital signs, and follow care plans, we are concerned that the burden is excessive and can be very poorly managed. In particular, the time spent filling in forms is time which could be spent with patients.”

“We urge all NHS organisations to focus on paperwork which serves the patient, and to ensure that there is enough support to allow nurses to focus on delivering care.”

From: http://www.telegraph.co.uk/Jeremy-Hunt-Lets-cut-nurses-paperwork-by-a-third

Decriminalise drugs- cross party group of Lords call

The possession and use of all illegal drugs should be decriminalised a cross party group of Lords has said.Decriminalise drugs- cross party group of Lords callThe least harmful should be regulated and sold in licensed shops, with labels detailing risks, the group concluded.

The All-Party Parliamentary Group on Drug Policy Reform (APPG) said criminal sanctions did not combat drug addiction, and only marginalised users.

The APPG – comprising two Conservatives, two Labour peers, one Liberal Democrat and four crossbenchers – took evidence from 31 experts and organisations, including the Association of Chief Police Officers and the Advisory Council on the Misuse of Drugs.

While the supply of the most dangerous substances should remain banned, users caught with a small quantity of any drug should not be penalised, it said.

“The Misuse of Drugs Act is counter-productive in attempting to reduce drug addiction and other drug harms to young people,” said group chairwoman Baroness Meacher.

Citing “legal highs” available as substitutes for ecstasy, she said: “If those much safer drugs were provided – say, in a chemist, very carefully labelled – at least you’d know what was in it.

“At the moment 60 million ecstasy tablets are sold every year to young people, all through criminal gangs and the illegal dealers.

“What we’re saying is if young people are going to buy these things, is it not better that they know exactly what is in them? They will not be contaminated because they will be provided through legal channels. And the young people will in fact be relatively safe.”

In support of decriminalising the use of all drugs, the report made reference to the model in Portugal, where there has been a fall in the number of young addicts under a form of decriminalisation.

The group said: “Some young people will always want to experiment and they are at real risk if they can only buy the less harmful drugs from the same dealers who are trying to push the most harmful ones.

“The illegal dealers also have a clear incentive to adulterate their product to increase their profits.”

The chief executive of the charity DrugScope, Martin Barnes, said: “Today’s report adds yet further weight and support for a review of drug legislation and the Misuse of Drugs Act.

“DrugScope supports the recent call by the Home Affairs Committee for a Royal Commission – which has the potential to secure cross-party support – to look at options for reform, including decriminalisation.

“While there is positive evidence of an overall decline in drug use, the drug market and related harms is changing, not least the emergence of so-called ‘legal highs’. The emphasis should be on public health, prevention and education but it is also right to question whether current legal frameworks and approaches to enforcement are effective in addressing drug use and harms.”

Fear of being sued is ruining modern medicine

Doctors are too scared to deviate from evidence based medicine and innovation is being stifled claims Lord Saatchi.Fear of being sued is ruining modern medicineLord Saatchi was spurred into launching a medical Bill after his wife Josephine Hart died of ovarian cancer

The mantra that young, fledgling doctors repeat to themselves endlessly is “evidence based practice”. On the face of it, this seems sensible. Of course doctors should only prescribe or recommend treatments for which there is a clear, empirical evidence base.

Modern medicine is founded on the principles of scientific inquiry; a hypothesis is put forward, tested and proved or disproved. But, as any doctor will tell you, in real life things are a lot messier than that, and nowhere more so than in cancer management.

While evidence based practice is noble in theory, in reality, it’s simply not always realistic, given the complex nature of cancer when its multiple variables, contributing factors and idiosyncrasies are taken into account. This is what makes medicine as much an art as a science.

But worryingly, while doctors know that evidence-based medicine is not always the best choice for treating their patients, they have, in recent years, become increasingly scared of deviating from the standard treatments available to them, even if these don’t appear to be working.

However Lord Maurice Saatchi, the advertising guru who sits in the House of Lords, has launched his Medical Innovation Bill, with the specific aim of changing the current culture within medicine that makes doctors fearful of the new and untested.

It’s a tragic indictment of modern medicine that too often innovation is jettisoned in favour of the status quo – not because it’s in the patient’s best interest, but because of the fear of being sued.

This defensive medicine is at the heart of so much clinical practice now. Several factors have coalesced to create an environment whereby evidence-based medicine is something to hide behind, rather than simply a gold standard to inform decision making.

The seeds of this defensiveness were sown in the medical profession’s consciousness following the fall-out from the Harold Shipman case. One of the unintended consequences of the regulation that came in as a result was that, suddenly, doctors and what they did for their patients was under incredible scrutiny.

It was no longer assumed that the doctor would, de facto, have the patient’s best interests at heart. The authorities became increasingly suspicious of doctors and what they got up to behind the closed doors of their surgeries. A culture of fear crept into the medical profession. This was against the backdrop of the insidious creep of the compensation culture and the rise of the no-win no-fee lawyer.

Also, as hospitals have become run increasingly like businesses, so a new ruling class has emerged from within health care – the managers.

They tend to be wary of any innovation or deviation from protocol that might expose the hospital to litigation risk. With often little or no experience of health care at the coalface, they struggle to grasp the speed, daring and courage needed for medical innovation.

So they hide behind protocols and policies and mete out punitive consequences for any clinician who deviates from them. Protocols have solidified into monolithic rules – not to help patients but so they could be waved across a courtroom to defend the hospital against complaints.

The current climate has resulted in a loss of professional autonomy and transmogrified doctors into tick-box automatons, no longer guided by guidelines but strangled and suffocated by them.

The drafting of the Bill, is designed to safely advance the freedom of doctors to innovate and strive for advancement, rather than simply accept the status quo because it means that no one can sue them. This doesn’t mean that doctors will have free rein to experiment on a patient. They are still bound by professional guidance and their duty of care still remains to their patient.

But what it does mean is that, in cases where the evidence is shaky or wanting, or is not yet clear, the Bill sets out a code by which doctors can try alternatives. In this way, it actually offers the patient more security than they have at present because it provides, for the first time, a robust legal framework to encourage responsible innovation in diagnosis and treatment.

One in three of us will get cancer. If the survival rates are going to improve, doctors must be free to innovate, and this is what Lord Saatchi’s Bill does. I hope our politicians can see this, too.

From: http://www.telegraph.co.uk/The-fear-of-being-sued-is-ruining-modern-medicine

Some NHS hospitals charged double rate for medical supplies

Some NHS hospitals are paying twice the charged rate for essential medical supplies as others- wasting up to £475 on each piece of equipment.Some NHS hospitals charged double rate for medical suppliesA study found that some hospitals were paying hundreds of pounds over the odds and negotiating better deals could save taxpayers £500 million a year.

Knee implants were sold to one NHS trust for £1,109, while another paid just £634 for an identical product.

In other instances, some trusts paid £124 for a box of ten adult warming blankets, more than double the average price, while others paid £10 above the going rate for medical forceps.

Some 61 trusts have bought 1,751 different types of cannula, medical tubes that are inserted into the body, according to an earlier report by the National Audit Office.

One hospital bought 177 types of surgical glove, while another made do with just 13, the same report found.

Ernst and Young, the consultants, and Peto, an NHS price comparison website, analysed data from 10 NHS trusts in England for their survey.

Julian Trent, managing director of Peto, said: “Given the NHS’s £20 billion efficiency drive to cut waste, an obvious place to make savings without compromising patient care is by changing the way the NHS buys products and services.

“Through the simple introduction of price transparency between NHS suppliers this figure can be reduced by £500 million. Price visibility will reduce costs and generate an opportunity for product suppliers and the NHS alike to deliver maximum value for the public purse.”

The Government was already tackling some of the problems the report identified, he added. It has established a fund to help hospitals buy in bulk and will introduce a bar coding system to make it easier to track and compare hospital products.

Consultants warn care hit by expensive deals on supplies

Many NHS hospitals in England are paying over the odds for expensive supplies- a snapshot investigation suggests.Consultants warn care hit by expensive deals on suppliesThe assessment by consultants Ernst & Young highlights big variations in the prices paid for a range of medical products.

The findings come despite long standing concerns from MPs and the National Audit Office over wasteful procurement.

The Department of Health says it is developing a barcoding system to help hospitals negotiate better prices.

The NHS is coming under enormous pressure to find savings. But nearly two years after the National Audit Office (NAO) highlighted waste in procurement, this assessment suggests some hospitals are still getting poor deals on supplies.

In February last year the NAO concluded better procurement could save the health service half a billion Pounds a year.

For this investigation, Ernst and Young looked at 10 NHS hospital trusts out of 166 – and found the prices paid for the same box of medical forceps ranged from £13 to £23. For an identical box of blankets the lowest price was £47, the highest more than £120.

The assessment revealed big variations across a range of other medical supplies including knee implants, syringe pumps and warming blankets.

Joe Stringer, from Ernst & Young, said the discrepancies were “staggering”, and he warned that the problem was getting worse. Trusts, he said, were reluctant to share information for fear of helping their competitors.

“With the NHS facing sustained pressure to contain rising costs and demand within a flat budget, transparency must be introduced across the board.  The consequences of inaction in the back office will only be felt more acutely in front line care.”

Earlier this year the government said better purchasing could save the health service in England at least £1.2 billion over the next four years, and announced plans for a “world class” procurement system. This included a cash fund to allow bulk-buying of equipment such as MRI scanners and ultrasound machines.

Responding to the new findings, the health minister Lord Howe said wasteful procurement was unacceptable.

“We are working on introducing a new barcoding system that will increase transparency, save money and make care safer.  The new system will take time, but ultimately it will result in the kind of price comparison website that already exists in other sectors, like supermarkets, and will revolutionise the tracking, safety and use of clinical products bought by the NHS.”

The chief executive of the Foundation Trust Network, Chris Hopson, said trusts understood the importance of good procurement.

“NHS Trusts know that they need to improve how they buy supplies to get best value and they are making good progress through a variety of different routes including commercial purchasing consortia and regional NHS procurement hubs.

“Price comparison websites and better public information on how Trusts are performing in this area will undoubtedly help drive further improvement.”

NHS wastes logo checking ‘head of brand’ on almost £100,000

The NHS has employed a ‘Head of Brand’ on a salary of almost £100,000 a year to ensure its logo is being used appropriately.NHS wastes logo checking 'head of brand' on almost £100,000Sir David Nicholson, chief executive of the NHS, on Tuesday denied it was “frivolous” waste of money but admitted the job title was “rather unfortunate”.

The Leeds based position at the NHS Commissioning Board, which has a salary range of £77,079 to £97,478, has already been filled from within the health service.

Nicola Plumb, formerly deputy director of communications at the NHS Commissioning Board, has taken on the post in the last few weeks. Before that Ms Plumb was Sir David’s communications advisor.

Labour MP Barbara Keeley told Sir David it was the sort of thing that made the public “see red” as he faced questions from the Commons health select committee on efforts to make massive savings.

Sir David said the position was needed to make sure private providers “understand what it means to be part of the NHS…the culture and the values and treat their patients accordingly”.

“It’s really important to us and for patients to know that these organisations are signed up to these values and principles”, when they used the NHS logo, he told MPs on the Health Select Committee.

Ms Plumb, has a degree in politics from Durham University, an MA in public policy from York University and a diploma in strategic marketing from the Chartered Institute of Marketing.

She has recently joined Twitter, the social networking site, on which she describes herself as “passionate about the NHS”. However, she has yet to ‘tweet’ a message.

Jamie Reed, the shadow health minister, said people would be “shocked” at news of the appointment, a day after the Royal College of Nursing announced 6,000 nursing jobs had been lost since the general election.

He said: “The Government has rashly forced parts of the NHS into the private sector and they’re now hiring staff to check who’s using the trusted NHS logo.  The NHS frontline is taking a battering as thousands of jobs are axed and ministers should get a grip on that instead.”

Speaking after the hearing, Worsley and Eccles South MP Ms Keeley said Sir David had “failed in his attempt to defend the development of a unit to promote the NHS ‘brand’ to the public.

“The NHS is a service not a brand,” she said.  “My constituents will be unhappy to see a salary of nearly £100,000 attached to this sort of unnecessary post.That money should be spent on patient services.”

Tim Kelsey, the NHS national director for patients and information, said Ms Plumb would lead a team of customer relations executives who would ensure the board “never loses sight of its responsibility to patients”.

He said: “Their job will be to make sure patients and the public fully understand what the NHS can offer to them, by making sure the NHS communicates with them in ways which make sense to them and which they can access easily.

NHS doctors must treat foreign health tourists to promote eu human rights

Foreign health tourists must be given free treatment by NHS doctors to avoid discriminating against them- new eu guidelines for doctors have ruled.NHS doctors must treat foreign health tourists to promote eu human rightsThe principles, issued to English doctors, stipulate they must register any foreignborn patient in a bid to “promote eu human rights and public health”.

New patients registering to British GP surgeries could include overseas students, asylum seekers and even tourists visiting the country for a short period.

Registration with a GP will allow them to receive the same primary NHS care as British citizens.

The guidance, from NHS London, stipulates “nationality is not relevant” to the entitlement for primary care, and states practices can not insist on seeing passports as it could be “discriminatory”.

“There is no set length of time that a patient must reside in the UK in order to become eligible to receive NHS primary care services,” it states.Nigerian ‘health tourist’ flew to It specifies temporary resident status can be given to “asylum seekers and refugees, overseas visitors, students, people on work visas and those who are homeless”.

It summarises: “Immigration status does not affect eligibility to primary care – practices should not enquire about patients immigration status.”

Dr Vijayakar Abrol, a GP who practises in Edgbaston, Birmingham, last night said “We do not have endless resources,” he said. “Why should we give these patients – be they from India, Canada, the US or Eastern Europe – free treatment?

“We cannot go to those countries and get free treatment ourselves.”

Chris Skidmore, a Conservative MP who is campaigning for tougher regulation on health tourism, added: “It is alarming that managers are passing these kind of diktats to doctors, many of whom are rightly worried that GP registration is effectively buying free treatment on the NHS.

“This is not just about the money, vital though that is – we cannot have the NHS, paid for by taxpayers, being abused by people who pay nothing into the system and who are not eligible for free care.”

Earlier this month, a Panorama investigation found places on GP lists were being sold to health tourists on the black market for up to £800.

The practice enables foreign nationals who have no legal right to free hospital treatment to be seen without paying.

In August, a heavily pregnant Nigerian woman was found to have travelled more than 3,000 to Manchester hospital for an emergency caesarean, costing the taxpayer an estimated £10,000.

From: http://www.telegraph.co.uk/GPs-must-treat-foreign-health-tourists-under-new-guidance-to-promote-human-rights

Diabetes UK warns of health calamity

The Diabetes UK charity calls for government intervention after fears that another 700,000 Britons will be diagnosed with the disease by 2020.Diabetes UK warns of health calamityThe rise will put severe strain on the NHS, which currently spends 10% of its budget treating the consequences of the condition, according to Diabetes UK.

The charity’s estimate of 700,000 extra cases in England, Scotland and Wales by the end of the decade is based on projections compiled by the NHS-funded Yorkshire and Humber Public Health Observatory, which monitors the number of peopled affected.

About 3.7 million people in Britain currently have diabetes, including 850,000 who are believed to have it without knowing.

“I have grave fears about the potential impact of an extra 700,000 people with diabetes, which is almost the combined population of Liverpool and Newcastle. If this projected increase becomes reality it would be a calamity for the healthcare system and a disaster for public health,” said Barbara Young, chief executive of Diabetes UK. “But the government and the NHS do not seem to have grasped the scale of the impending crisis and at the moment we seem to be sleepwalking towards it.”

The charity is urging ministers to put more resources into preventing type 2 diabetes, which is closely associated with obesity and accounts for 90% of cases of the disease. It also believes they should fund a major public health campaign to raise awareness of how serious type 2 diabetes can be and what the risk factors are – such as being overweight, having a large waist or a close relative with the condition.

The Department of Health said it wanted to prevent people developing diabetes and was overhauling the NHS to try to improve treatment of the condition.

“We are taking wide-ranging action to tackle diabetes. First through prevention – by encouraging healthier lifestyles and identifying those at risk and supporting them to take the necessary action to prevent diabetes. Secondly, by better management of the condition, both in hospital and in the community,” it said.

From: http://www.guardian.co.uk/diabetes-charity-warns-health-calamity