ESA benefit payments- retests axed for chronically ill claimants

Claimants of long term sickness benefits will no longer face repeated medical assessments to keep their payments.

Claimants of long term sickness benefits will no longer face repeated medical assessments to keep their payments.

Work and Pensions Secretary Damian Green said it was pointless to re-test recipients of Employment and Support Allowance (ESA) with severe conditions and no prospect of getting better.

More than two million people receive ESA, which is worth up to £109 a week. The move has been welcomed by charities supporting those with severe illness.

Shadow work and pensions secretary Debbie Abrahams said it was “a welcome U-turn” by the government, but “the devil was in the detail”. What about mental health conditions, conditions that are fluctuating, conditions that may not necessarily have a physical manifestation?” she said.

Applicants for ESA have to undergo a work capability assessment to find out if they are eligible and they are re-tested to ensure their condition has not changed. Some are re-tested every three months and others up to two years later.

Under the government’s change, those who are deemed unfit for work and with conditions that will not improve will no longer face re-testing.

Illnesses such as severe Huntington’s, autism or a congenital heart condition are among those that are likely to qualify for continuous payments without reassessment. The criteria will be drawn up with health professionals.

Mr Green said a “key part” of making sure those who were unable to work received “full and proper support” included “sweeping away any unnecessary stress and bureaucracy”.

Currently, those in the “work-related activity group” – deemed unable to work at the moment but capable of making some effort to find employment – receive up to £102.15 a week in ESA payments.

Those in the “support group” – deemed unable to work and not obliged to do anything to improve their chances of finding work – receive up to £109.30 a week.

From April 2017, payments will fall to £73 for new claimants in the “work-related activity” category as ministers argue that too few people in the category are moving into work.

Former Work and Pensions Secretary Iain Duncan Smith, welcomed the “progressive” reform to the re-testing regime, which he had set up when in office.

“I hope that the government will… move on to the fuller reform… where we lock together with the health department much more to be able to get a better health assessment of people, rather than a just strictly work assessment.”

Tim Nicholls, policy manager at the National Autistic Society, said ESA was a vital benefit for those unable to work, covering basic daily living costs such as food, heating and clothes.

“The flawed assessment process can be highly stressful for autistic people who can experience high levels of anxiety meeting new people or when their routine is broken, particularly when the stakes are so high,” he said. “We will be looking out for more details from the government.”

NHS trust failed to investigate hundreds of deaths

The NHS has failed to investigate the unexpected deaths of more than 1,000 people since 2011 according to a new report.

The NHS has failed to investigate the unexpected deaths of more than 1,000 people since 2011 according to a new report.

It blames a “failure of leadership” at Southern Health NHS Foundation Trust and that the deaths of mental health and learning disability patients were not properly examined.

Southern Health said it “fully accepted” the quality of processes for investigating and reporting a death needed to be better, but had improved.

The trust is one of the country’s largest mental health trusts, covering Hampshire, Dorset, Wiltshire, Oxfordshire and Buckinghamshire and providing services to about 45,000 people.

The investigation, commissioned by NHS England and carried out by Mazars, a large audit firm, looked at all deaths at the trust between April 2011 and March 2015.

During that period, it found 10,306 people had died. Most were expected. However, 1,454 did not.

Of those, 272 were treated as critical incidents, of which just 195 – 13% – were treated by the trust as a serious incident requiring investigation (SIRI).

The likelihood of an unexpected death being investigated depended hugely on the type of patient.

The most likely group to see an investigation was adults with mental health problems, where 30% were investigated. For those with learning disability the figure was 1%, and among over-65s with mental health problems it was just 0.3%.

The average age at death of those with a learning disability was 56 – over seven years younger than the national average.

Even when investigations were carried out, they were of a poor quality and often extremely late, the NHS England report says.

Repeated criticisms from coroners about the timeliness and usefulness of reports provided for inquests by Southern Health failed to improve performance, while there was often little effort to engage with the families of the deceased.

Key findings from the report

  • The trust could not demonstrate a comprehensive systematic approach to learning from deaths
  • Despite the trust having comprehensive data on deaths, it failed to use it effectively
  • Too few deaths among those with learning disability and over-65s with mental health problems were investigated, and some cases should have been investigated further
  • In nearly two thirds of investigations, there was no family involvement

The reasons for the failures, says the report, lie squarely with senior executives and the trust board.

There was no “effective” management of deaths or investigations or “effective focus or leadership from the board”, it says.

Even when the board did ask relevant questions, the report says, they were constantly reassured by executives that processes were robust and investigations thorough.

The culture of Southern Health, which has been led by Katrina Percy since it was created in 2011, “results in lost learning, a lack of transparency when care problems occur, as well as lack of assurance to families that a death was not avoidable and has been properly investigated,” the report says.

Over 1000 NHS ‘never events’ a disgrace says Patients Association

Over 1,000 NHS patients have suffered from medical mistakes so serious they should never have happened.

Over 1,000 NHS patients have suffered from medical mistakes so serious they should never have happenedThe so called never events included the case of a man who had a whole testicle removed rather than just a cyst. In another, a woman’s fallopian tubes were taken out instead of her appendix.

Other “never events” included the wrong legs, eyes or knees being operated on and hundreds of cases of foreign objects such as scalpels being left inside bodies after operations.

Whilst NHS England insisted that such events were rare- the Patients Association said that they were a “disgrace”.

The research by the Press Association analysis also found that patients’ lives were put in danger when feeding tubes were put into their lungs instead of their stomachs.

Patients were given the wrong type of blood during transfusions and others were given the wrong drugs or doses of drugs.

The analysis showed there were:

  • 254 never events from April 2015 to the end of December 2015
  • 306 never events from April 2014 to March 2015
  • 338 never events from April 2013 to March 2014
  • 290 never events from April 2012 to March 2013

Katherine Murphy, chief executive of the Patients Association, said: “It is a disgrace that such supposed ‘never’ incidents are still so prevalent.

“How are such basic, avoidable mistakes still happening? There is clearly a lack of learning in the NHS. It is especially unforgivable to operate on the wrong organ, and many such mistakes can never be rectified.”

NHS England insisted never events were rare – affecting one in every 20,000 procedures – and that the majority of the 4.6 million hospital operations each year were safe.

A spokeswoman said: “One never event is too many and we mustn’t underestimate the effect on the patients concerned.

“To better understand the reasons why, in 2013 we commissioned a taskforce to investigate, leading to a new set of national standards being published last year specifically to support doctors, nurses and hospitals to prevent these mistakes.

More than 400 people have suffered due to “wrong site surgery”, while more than 420 have also had “foreign objects” left inside them after operations – including gauzes, swabs, drill guides, scalpel blades and needles.

Others have been given the wrong type of implant or joint replacement, some patients have been mixed up with others, and some patients have been given the wrong type of blood during a transfusion.

Some patients have also been given far too high doses of drugs, including oral methotrexate, which is used for the treatment of severe arthritis, psoriasis and leukaemia.

Health Direct notes that the vast majority of the 4.6 million hospital operations each year are safe- but if a plane crashed after every 20,000 flights then people might stop flying.

UK end of life care- best in world

End of life care in the UK has been ranked as the best in the world with a study praising the quality and availability of services.

End of life care in the UK has been ranked as the best in the world with a study praising the quality and availability of servicesThe study of 80 countries said thanks to the NHS and hospice movement the care provided was “second to none”.

Rich nations tended to perform the best – with Australia and New Zealand ranked second and third respectively.

But the report by the Economist Intelligence Unit praised progress made in some of the poorest countries.

For example Mongolia – ranked 28th – has invested in hospice facilities, while Uganda – 35th – has managed to improve access to pain control through a public-private partnership.

The rankings were worked out following assessments for the quality of the hospitals and hospice environments, staffing numbers and skills, affordability of care and quality of care.

Just 34 out of 80 countries provided what could be classed as good end-of-life care – and these accounted for just 15% of the adult population.

The report said the quality of end-of-life care was becoming increasingly important with the ageing population, meaning people were increasingly facing “drawn-out” deaths.

It’s no major surprise that richer countries, with stronger health systems, provide some of the world’s best palliative care. But a few poorer nations are bucking the trend, and it’s often down to the efforts of individuals campaigning for everyone to be allowed a dignified and pain-free death. Panama, Chile, Mongolia and Uganda are singled out for praise, whereas the situation in India and China is described as “worrying”.

India ranked 67th in the index, and China was in the bottom 10 at 71. Both have huge populations and have experienced rapid economic growth, but care for people at the end of their lives has not kept up. The report warns further improvements are needed across all countries to cope with the future demands of an aging population, increasingly facing drawn-out illnesses such as cancer, heart disease and dementia.

The UK received top marks for affordability – as would be expected for a service that is provided free at the point of need – but also got a perfect score for quality of care.

Overall it was given 93.9 out of 100, but the report still said there was room for improvement – as there was with all the top-performing nations.

Services in England have recently been criticised by the Parliamentary and Health Service Ombudsman.

The UK also came top the last time this report was produced in 2010. Also in the top 10 this time were the Irish Republic, France, Germany and the US.

Iraq and Bangladesh finished bottom of the ranking, while China was in the worst 10.

National Living Wage will damage care homes

The National Living Wage could result in a “catastrophic collapse” in the number of care homes, according to the five biggest providers.

 National Living Wage could result in a catastrophic collapse in the number of care homes
In a letter to the chancellor, they say staffing accounts for 60% of the cost of care. The companies said they supported the National Living Wage, but efforts would be needed to rescue the care system.

The government said social care would be considered as part of the spending review later this year.

Under plans announced in the Budget, workers aged over 25 in the UK will be paid a minimum of £7.20 an hour from April next year, rising to £9 by 2020.

Four Seasons Health Care, Bupa, HC-One, Care UK and Barchester said the measure would cost the care sector £1 billion by 2020.

They warned any shortage of care places could put huge pressure on the NHS.

Martin Green, the chief executive of Care England which represents the industry, said: “Without adequate funding to pay for the National Living Wage, the care sector is at serious risk of catastrophic collapse.”

He said there was a “grave and very real possibility” that a provider could fail within the next two years.

Mr Green added: “We want to work with the government to find a fair solution that will ensure the care sector can provide a safe and comfortable environment for older people who live in care homes.”

The UK Homecare Association made a similar warning last month, saying services to care for people in their own homes would become “unviable”.

A government spokesman said: “The National Living Wage will benefit hundreds of thousands of care workers who will see their pay increase.

“The overall costs of providing social care will be considered as part of the spending review later this year and we are working with the care sector to understand how the changes will affect them.”

New drug may delay Alzheimer’s decline

New research of how a new drug could slow the pace of brain decline for patients with early stage Alzheimer’s disease have emerged.

New research of how a new drug could slow the pace of brain decline for patients with early stage Alzheimer's diseaseData from pharmaceutical company Eli Lilly suggests its Solanezumab drug can cut the rate of the dementia’s progression by about a third.

The results, presented to a US conference, are being met with cautious optimism. A new trial is due to report next year and should provide definitive evidence.

The death of brain cells in Alzheimer’s is currently unstoppable. Solanezumab may be able to keep them alive.

Current medication, such as Aricept, can manage only the symptoms of dementia by helping the dying brain cells function.

But solanezumab attacks the deformed proteins, called amyloid, that build up in the brain during Alzheimer’s.

It is thought the formation of sticky plaques of amyloid between nerve cells leads to damage and eventually brain cell death.

Solanezumab has long been the great hope of dementia research, yet an 18-month trial of the drug seemingly ended in failure in 2012.

But when Eli Lilly looked more closely at the data, there were hints it could be working for patients in the earliest stages of the disease. It appeared to slow progression by around 34% during the study.

So the company asked just over 1,000 of the patients in the original trial with mild Alzheimer’s to take the drug for another two years.

And positive results from this extension of the original trial have now been presented at the Alzheimer’s Association International Conference.

They show those taking the drugs the longest had the most benefit.

Dr Eric Siemers, from the Lilly Research Laboratories, in Indiana, said “It’s another piece of evidence that solanezumab does have an effect on the underlying disease pathology. We think there is a chance that solanezumab will be the first disease-modifying medication to be available.”

The company also started a completely separate trial in mild patients in 2012, and these results could prove to be the definitive moment for the drug.

At the moment there is no medication that can slow down dementia. If such a drug was developed it could transform how the disease is managed.

People would still get worse, but they would spend more time in the milder phase of the degenerative disease rather than needing constant care.

In a field that has been plagued by repeated disappointment, even a hint of such a drug is an exciting moment.

Next year, when further trial results are due, we will know for certain whether solanezumab is the breakthrough everyone hopes it could be.

Dr Eric Karran, the director of research at Alzheimer’s Research UK, said “If this gets replicated, then I think this is a real breakthrough in Alzheimer’s research. Then, for the first time, the medical community can say we can slow Alzheimer’s, which is an incredible step forward.”

“These data need replicating, this is not proof, but what you can say is it is entirely consistent with a disease-modifying effect. We’ve never ever had evidence that we can affect the disease process.”

Elderly being trapped in hospital warns Age UK

Elderly people are being “trapped” in English hospitals in ever greater numbers as there is nowhere else for them to go.

Elderly people are being Age UK said it was bad for patients’ health, a waste of NHS resources and a huge cost to taxpayers. Its analysis shows patients spent a total of nearly 2.5 million days stuck in a hospital over the past five years.

Age UK says there is a crisis in social care ranging from a shortage of care home places to a lack of district nurses to help people in their own home.

It says the situation has got worse and the number of people being kept in hospital in 2014-15 increased by 19% on the previous year.

The charity’s analysis of NHS England data for the last financial year showed the days spent stuck in hospital included:

  • 174,000 waiting for a residential home place
  • 216,000 waiting for a nursing home place
  • 206,000 waiting for help from social care workers or district nurses to get people back into their own home
  • 41,400 waiting for ramps or stairlifts to be installed into patients’ homes.

Caroline Abrahams, from Age UK, said: “These figures show that year on year, older people are being trapped in hospital in ever greater numbers because of a delayed assessment, care home place, home care package or home adaptation.

“Without decent social care when discharged, whether to their own home or to a care home, hospital stays are often much longer than they need to be and older people are more likely to be readmitted because their recovery stalls.”

She said this was a waste of NHS resources because it cost nearly £2,000 per week for an NHS bed in comparison to around £560 per week in residential care.

“Everyone agrees the way to go is to integrate social care and health much more effectively, but unfortunately our report shows we’ve got a long way to go before really the reality lives up to the rhetoric,” she said .

“And if we can’t get it right for such an important group of people, older people stuck in hospital waiting to get out, really we have to redouble our efforts and do much better.”

NHS failing to direct patients to dentists

NHS patients are still facing problems finding an NHS dentist in England, research suggests.

NHS patients are still facing problems finding an NHS dentist in EnglandA survey found some patients were confused by charges for dental treatment as access to dentistry within the NHS has been a long running problem.

To help patients navigate their way round the system, NHS Choices now provides details of which dentists accept new NHS patients.

But researchers from consumer group Which? found three in 10 advertising availability could not actually take on new patients.

There are 7,500 dental practices that provide NHS services, but only 4,500 of them were advertising as being able to see NHS patients.

Undercover Which? researchers contacted 500 of those, choosing them randomly across the country.

As well as some not having availability, 29% of those that could take on new NHS patients had waits of at least two weeks for an appointment – with one saying it would be eight to nine months before the patient could be seen.

Some practices also made people “jump through unnecessary hoops” such as visiting the surgery to fill out forms or asking patients to pay deposits.

The Which? report said the problems needed to be investigated.

Which? executive director Richard Lloyd said: “We found it frustratingly difficult to get an appointment with a dentist, as information about availability doesn’t reflect reality.

“This is a kick in the teeth for patients and yet more evidence of poor communication from the dental sector.

“We want the Competition and Markets Authority to step in and ensure that dentists put the existing rules into practice so that people can easily find out where they can get NHS dentistry.”

The research comes after an investigation by Which?, published in January, indicated half of patients who had visited a dentist in the past six months had not seen a price list and a fifth had been unsure about the costs ahead of treatment.

Prostate cancer gene targeted by drugs

Scientists have published a comprehensive genetic map of advanced prostate cancer.

Scientists have published a comprehensive genetic map of advanced prostate cancer- which suggests nearly nine in 10 patients with advanced prostate cancer could benefit from targeted treatments
The study, published in the journal Cell, shows that nearly nine in 10 men had gene mutations that could be targeted with drugs.

The study was led in the UK by scientists at the Institute of Cancer Research (ICR) London in collaboration with several teams in the United States.

Researchers analysed the genetic codes of tumours from 150 patients with metastatic – or advanced – prostate cancer, whose disease had spread to other parts of the body.

They found that 89% had genetic aberrations for which there were existing drugs or treatments undergoing clinical trials.

Prof Johann de Bono, of the ICR and Royal Marsden NHS Foundation Trust “This is truly a gamechanger. We are calling this prostate cancer’s Rosetta Stone, because we can now decode the disease for the first time.”

“In the past, we used to treat lethal prostate cancer as a single illness but this shows that it is a group of diseases, each driven by their own set of mutations.”

Prof de Bono said it meant that, using genetic testing, it would be possible to individualise patient care, heralding the arrival of personalised treatment for advanced prostate cancer.

More than 40,000 men are diagnosed with prostate cancer and nearly 11,000 die in the UK each year.

Nearly all men with advanced disease develop resistance to hormone therapy, which is used to prevent prostate cancer cells from growing.

In the study, nearly two thirds of the patients had mutations in a molecule that interacts with the male hormone androgen, which is targeted in current treatments.

Scientists at the ICR believe this could open up new avenues for hormone therapy.

Mutations in BRCA1 and BRCA2 genes were found in nearly one in five patients.

Trials at the Royal Marsden/ICR have already shown prostate cancer patients with BRCA mutations can benefit from drugs called Parp inhibitors which disrupt cancer cells’ DNA repair mechanism.

One of these drugs, called olaparib, is now licensed by the EU to treat women with ovarian cancer, who carry BRCA mutations.

The research is part of a move towards treating cancer – not just by its site of origin – such as breast, lung or prostate – but with medicines which target the individual genetic mutations driving the disease which can be common across several cancers.

Prof Paul Workman, ICR chief executive said: “This major new study opens up the black box of metastatic cancer, and has found inside a wealth of genetic information that I believe will change the way we think about and treat advanced disease.”

Younger people having more strokes

There has been a big rise in the number of working age men and women having stroke.

big rise in the number of working age men and women having stroke.In England in 2014 there were 6,221 hospital admissions for men aged 40-54 – a rise of 1,961 on 14 years earlier according to reserach by the Stroke Association.

Experts said unhealthy lifestyles were partly to blame for the rise, though the growing population and changes to hospital practice also played a part.

Researchers say based on their findings strokes should not be considered as a disease of the old.

Strokes are caused by blood clots or bleeds to the brain and can lead to long lasting disability.

The majority occur in people aged over 65, and though rates are decreasing in this group, this report suggests growing numbers of younger people are at risk.

Experts analysed national hospital admission data spanning 2000 to 2014.

These findings highlight the importance of ensuring your blood pressure and cholesterol are under control, as well as having a health check at the age of 40.

Trends for people in their 40s and early 50s appeared to be getting worse. In women aged 40-54, there were an extra 1,075 strokes recorded in 2014, compared with 2000.

Experts said growing obesity levels, sedentary lives and unhealthy diets – which raise the risks of dangerous blood clots – all played a part.

And they argued strokes among this age group had long lasting personal and financial impacts on individuals and their families, as well as on the economy.

Recovering patients can find it difficult to return to work and should have more support from employers, the report suggests.

Jon Barrick, of the Stroke Association, said: “These figures show stroke can no longer be seen as a disease of older people.”

“There is an alarming increase in the numbers of people having a stroke in working age. This comes at a huge cost, not only to the individual, but also to their families and to health and social care services.”

The Stroke Association said that even younger people should be aware of the warning signs such as dizziness, difficulties with speech and changes in the face.