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.

Antibiotic resistance- world on cusp of post antibiotic era

The world is on the cusp of a “post-antibiotic era”, scientists have warned after finding bacteria resistant to drugs used when all other treatments have failed.

The world is on the cusp of a "post-antibiotic era", scientists have warned after finding bacteria resistant to drugs used when all other treatments have failed

They identified bacteria able to shrug off the drug of last resort – colistin – in patients and livestock in China.

They said that resistance would spread around the world and raised the spectre of untreatable infections. It is likely resistance emerged after colistin was overused in farm animals.

Bacteria becoming completely resistant to treatment – also known as the antibiotic apocalypse – could plunge medicine back into the dark ages.

Common infections would kill once again, while surgery and cancer therapies, which are reliant on antibiotics, would be under threat.

Chinese scientists identified a new mutation, dubbed the MCR-1 gene, that prevented colistin from killing bacteria.

The report in the Lancet Infectious Diseases showed resistance in a fifth of animals tested, 15% of raw meat samples and in 16 patients.

And the resistance had spread between a range of bacterial strains and species, including E. coli, Klebsiella pneumoniae and Pseudomonas aeruginosa.

There is also evidence that it has spread to Laos and Malaysia.

Resistance to colistin has emerged before. However, the crucial difference this time is the mutation has arisen in a way that is very easily shared between bacteria.

The concern is that the new resistance gene will hook up with others plaguing hospitals, leading to bacteria resistant to all treatment – what is known as pan-resistance.

Early indications suggest the Chinese government is moving swiftly to address the problem.

New drugs are in development, such as teixobactin, which might delay the apocalypse, but are not yet ready for medical use.

A commentary in the Lancet concluded the “implications [of this study] are enormous” and unless something significant changes, doctors would “face increasing numbers of patients for whom we will need to say, ‘Sorry, there is nothing I can do to cure your infection.'”

Health bodies call for drugs to be decriminalised

Two leading public health organisations have called for the possession and personal use of all illegal drugs to be decriminalised in the UK.

Two leading public health organisations have called for the possession and personal use of all illegal drugs to be decriminalised in the UK.
The Royal Society for Public Health and the Faculty of Public Health said the government’s approach to drugs policy had failed.  There should be a greater focus on treatment and education, they added.

The report, called Taking A New Line On Drugs, said criminal sanctions failed to deter illegal drug use, undermined people’s life chances and could act as a barrier to addicts coming forward for help.

It called for a “sea change in approach” and said the UK should adopt the Portuguese system under which people caught using drugs were offered treatment and support rather than being punished. However, dealers and suppliers would still be prosecuted.

The report also suggested that drugs education be made mandatory, and that responsibility for drugs policy be moved from the Home Office to the Department of Health.

Royal Society for Public Health chief executive Shirley Cramer said: “For too long, UK and global drugs strategies have pursued reductions in drug use as an end in itself, failing to recognise that harsh criminal sanctions have pushed vulnerable people in need of treatment to the margins of society, driving up harm to health and wellbeing even as overall use falls.

“On many levels, in terms of the public’s health, the ‘war on drugs’ has failed.”

“The time has come for a new approach, where we recognise that drug use is a health issue, not a criminal justice issue, and that those who misuse drugs are in need of treatment and support – not criminals in need of punishment.”

Baroness Molly Meacher, speaking on behalf of the All-Party Parliamentary Group for Drug Policy Reform, welcomed the report.

She said the current system “criminalises some users of psychoactive drugs whilst very harmful psychoactive drugs including alcohol and tobacco remain legal”.

A Home Office spokesman said: “The UK’s approach on drugs remains clear – we must prevent drug use in our communities and support people dependent on drugs through treatment and recovery.

“At the same time, we have to stop the supply of illegal drugs and tackle the organised crime behind the drugs trade.”

The spokesman said there had been a drop in drug misuse over the past decade and more people were recovering from dependency now than in 2009-10.

Health Direct has for a long time noted the costly failure that is the current policy on drugs. On August 02, 2006 in Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal we reproduced the first ranking based upon scientific evidence of harm to both individuals and society.

It was devised by government advisers – then ignored by ministers because of its controversial findings. The analysis was carried out by David Nutt, the then senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council.

Sugar Tax- how will it work?

A new sugar tax on the soft drinks will be introduced in the UK the chancellor announced yesterday.

A new sugar tax on the soft drinks will be introduced in the UK the chancellor announced yesterdayThe move has been hailed by campaigners as a significant step in the fight against child obesity.

So how will the sugar tax work?

The levy is squarely aimed at high sugar drinks- particularly fizzy drinks, which are popular among teenagers.

Pure fruit juices and milk based drinks will currently be excluded and the smallest producers will have an exemption from the scheme.

It will be imposed on companies according to the volume of the sugar sweetened drinks they produce or import.

There will be two bands – one for total sugar content above 5g per 100 millilitres and a second, higher band for the most sugary drinks with more than 8g per 100 millilitres. Analysis by the Office for Budgetary Responsibility suggests they will be levied at 18p and 24p per litre.

Examples of drinks which would currently fall under the higher rate of the sugar tax include full strength Coca-Cola and Pepsi, Lucozade Energy and Irn-Bru, the Treasury said. The lower rate would catch drinks such as Dr Pepper, Fanta, Sprite, Schweppes Indian tonic water and alcohol free shandy.

When it comes to the sugar tax, all the emphasis has been on drinks. There are a number of reasons for this.

Firstly, unlike a chocolate bar or slice of cake, they are not automatically seen as a treat. People who drink them tend to have them every day.

Secondly, some of the drinks are incredibly high in sugar. A typical can contains enough sugar – about nine teaspoons – to take someone over their recommended sugar intake in one hit.

For teenagers they are the number one source of sugar intake while overall, children get a third of their daily sugar intake from them.

They have also been dubbed “empty calories” as they have no nutritional benefit.

Mr Osborne said the money raised – an estimated £520 million a year, will be spent on increasing the funding for sport in primary schools.

There has been pressure on ministers to increase spending in this area to build on the legacy of the 2012 Olympic Games and in light of the low numbers of children who take part in regular activity.

But while the tax applies to the whole of the UK, Mr Osborne announcement on where the money is spent applies solely to England. The devolved administrations in Scotland, Wales and Northern Ireland are free to decide how to spend their share.

The issue has been described as one of the most serious public health challenges for the 21st Century by the World Health Organization, while NHS England’s Simon Stevens has dubbed it “the new smoking”.

Health Direct applauds this new initiative and is sure that this will be just the start. Mr Osbourne has a habit of returning to existing taxes and constantly increasing them- like to tobacco and wine.

Doctors’ strike may over-crowd hospitals

Hospitals may end be over crowded tonight as they fail to discharge patients because of the junior doctor strike.

Hospitals may end be over crowded tonight as they fail to discharge patients because of the junior doctor strike.
The NHS seemed to cope well on Wednesday following the walkout from 08:00 GMT over the contract dispute. But NHS England said the second day of the 48 hour walkout in England was always going to be more difficult.

Officials said hospitals may struggle to discharge patients without junior medics on wards.

Dr Anne Rainsberry, who is in charge of planning during the strike, suggested hospitals might find it difficult to discharge patients, which could then create a backlog in hospital wards.

She said this was because they had a “valuable role” in chasing up test results and ensuring patients were ready for discharge.

“So far the NHS is holding up, but we always expected the second half of the strike will be more challenging,” she said.

She also urged patients to go to hospital only when absolutely necessary.

“If people need medical help and it’s not an emergency they should consider NHS Choices, visit their local pharmacy, or call their GP or NHS 111 for more serious matters. If their condition is an emergency or life-threatening they should call 999 as usual or go to A&E.”

Doctors are providing emergency cover during the walkout, which ends on Friday morning, and consultants, nurses and midwives are all working in hospital as normal. GP surgeries are largely unaffected.

On Wednesday just over half of junior doctors expected in work did not turn up – a figure broadly in line with the previous strikes and to be expected considering the numbers needed to provide emergency care.

The latest walkout is the third in the long running dispute, but the first to last 48 hours.

So far 19,000 operations and treatments have had to be postponed because of industrial action. The NHS carries out about 30,000 procedures a day.

Thousands of check-ups, appointments and tests have been affected as well.

Katherine Murphy, of the Patients Association, said she had “growing concern” about the dispute.

“Whatever the rights and wrongs of the arguments put forward by either side, the failure to resolve the differences by agreement is bad for doctors, bad for the taxpayer, but above all bad for patients and the NHS.”

This week’s walkout is the first of three 48 hour stoppages planned by the British Medical Association as it continues its fight against the government’s plans to force through the changes to pay and conditions. The next two are planned for April.

The union has also said it will be launching a legal challenge to oppose the imposition of the contract that was announced following last month’s strike.

But ministers have said they will be pushing ahead with imposition regardless. The new contracts are due to go out in May and will come into force from August.

The BMA said it “deeply regretted” the disruption that was being caused, but the action was necessary because of the “unfair” changes being imposed on the profession.

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.

Junior doctors threaten exodus after Hunt’s ultimatum

Junior doctors are threatening an exodus from the NHS after Health Secretary Jeremy Hunt imposed a new contract.

Junior doctors are threatening an exodus from the NHS after Health Secretary Jeremy Hunt imposed a new contract.After two strikes by junior doctors, the sticking point in negotiations remained the rates of pay for working Saturdays.

Under the new contract, 7am to 5pm on Saturdays will be regarded as a normal working day. But in a final concession, the Government offered a 30 per cent boost for any doctor working one or more Saturday a month.

Dr Johann Malawana, BMA junior doctor committee chairman said the union was now considering “all options open to us” warning of a “real risk that some will vote with their feet”.

This could mean further strikes – with an option of a full walkout by junior doctors, an attempt legal action by the union, or moves towards mass resignations.

On social media, junior doctors said they were considering emigrating, while others staged angry protests outside the Department of Health headquarters in Whitehall.

Labour accused Mr Hunt of “behaving like a recruiting agent for Australian hospitals” while the Labour Welsh health minister tried to lure medics over the border.

In a statement to the Commons, Mr Hunt said the BMA had proved “unwilling” to show flexibility and compromise.

He announced junior doctors would recieve a basic salary increase of 13.5 per cent – higher than the 11 per cent offered in November and insisted that no trainee working within contracted hours will have their pay cut.

The first new contracts would be imposed in August, on all new doctors graduating from medical school, and those changing contracts, during their training.

Some estimates suggest this means the majority of the 55,000 workforce would be on new contracts within a year.

Some doctors on longer contracts would not be affected, along with those who have completed their training, but not become a consultant.

In response, Dr Malawana had repeated the BMA’s offer of reducing basic pay in return for more unsociable hours payments.

Dr Malawana said: “The decision to impose a contract is a sign of total failure on the Government’s part.”

He accused Health Secretary Jeremy Hunt of “ploughing ahead with proposals that are fundamentally unfair” and warned that it had no plans just to accept the contract.

He said: “The Government’s shambolic handling of this process from start to finish has totally alienated a generation of junior doctors – the hospital doctors and GPs of the future, and there is a real risk that some will vote with their feet.

“Our message to the Government is clear – junior doctors cannot and will not accept a contract that is bad for the future of patient care, the profession and the NHS as a whole, and we will consider all options open to us.”

Health Direct echos BMA council chairman Mark Porter views: “Nurses and other clinical staff who work in the NHS will know now that essentially the Government is coming for them. If the Government is prepared to impose a contract on junior doctors, it’ll be them next.”

Fraud could be costing NHS in England £5.7 billion a year

The NHS in England could be losing up to £5.7 billion a year to fraud from its £100bn budget, a new report suggests.

The NHS in England could be losing up to £5.7 billion a year to fraud from its £100bn budget, a new report suggests.A review – led by former NHS anti-fraud boss Jim Gee – highlighted fraud by pharmacists, dentists, GPs and patients.

Among the areas it found to be affected were procurement, prescriptions, registration of patients and payroll.

To work out how much fraud is being committed, the review had to rely on estimates as well as detected fraud. It said the level of fraud was likely to be between £3.7 billion and £5.7 billion a year- out of a budget of more than £110 billion.

Among the scams highlighted were dentists claiming money for NHS care they did not carry out and GPs falsifying records for extra payments.

To illustrate the scale of some of these cases, it highlighted the jailing of a Birmingham dentist in 2012 after she stole £1.4m from the NHS.
The biggest sources of fraud in the NHS
Area                                                     Scams used                                                          Estimated value per year
Payroll                  False allowance claims and incorrect qualifications used                   £555m – £1.49bn
Procurement          Overcharging for goods and services or under-delivery                      £1bn – £1.27bn
General practice     Claims for services not provided and for ghost patients                          £348m
Patients       Claim for free prescriptions, dental care and optician services they are not entitled to     £304m
Dentistry                 Claims for dental work not carried out                                                        £121m – £137m
Pharmacy     Staff claiming for more drugs than actually dispensed or for services not provided     £83m – £96m

Patient fraud identified included wrongful claims for free prescriptions, dental and optician care.

But the biggest area of fraud was estimated to be payroll, at between £555m and £1.49bn – although the report said this mainly consisted of lots of small-scale cases.

Mr Gee, who carried out his work for PFK Littlejohn accountants, said: “There is a vast, honest majority who find fraud against the NHS to be completely unacceptable. However, there is also a dishonest minority who can cause significant financial damage.

“The best way of stopping this is not to wait for fraud to happen and then act after losses have been incurred, but to proactively deter and prevent them. Fraud is a cost to be measured, managed and minimised like any other.”

There is nothing new about fraud in the NHS. The scams are all too familiar – whether it’s health service managers purchasing hospital supplies and taking backhanders or corrupt GPs claiming they have patients who don’t actually exist.

But the report’s authors argue that, even though the NHS’s fraud problem is no worse than in other healthcare systems, the need for a crackdown is as urgent as ever because of the intense financial pressure on the NHS and the need to make efficiency savings.

They accuse the government of failing to carry out a detailed audit of the extent of health service fraud. The Department of Health said it didn’t recognise the figures, but there has been no official denial that there is a problem that needs fixing.

Fraud officers work in each local area while at a national level, fraud work is co-ordinated by NHS Protect.

NHS negligence bill tops £1 billion

The NHS in England paid out over £1.1 billion in 2014/15 to lawyers and to patients who suffered harm.

The NHS in England paid out over £1.1 billion in 2014/15 to lawyers and to patients who suffered harmThis coming year it will be £1.4 billion, said the NHS Litigation Authority. The body said it would work with other parts of the NHS to reduce costs and improve safety and learning.

Chief executive officer Helen Vernon said: ”Negligence claims place increasing pressure on the health service, frontline staff, our members and ultimately patients.

“It is one area of the NHS where no one would argue against a reduction.”

The NHS in England has seen an increase in costs associated with clinical negligence claims in recent years, although the figure last year was slightly higher at £1.192 billion.

The authority said in its annual report that several factors were involved, including an increase in the number of patients being treated on the NHS.

It also said there was an increase in the number of reported incidents, although this could be due in part to a positive reporting culture.

The Medical Defence Union, which provides medical indemnity to doctors, said the money paid out by the NHS to compensate patients could have funded over eight million MRI scans.

Dr Michael Devlin, head of professional standards and liaison, said: “The cost of care is the main reason for the staggering negligence bill.”

“The money paid is no reflection on clinical standards, which remain high, but it reflects the unsustainable cost of private sector health and social care packages.”

“We have to stop money haemorrhaging out of the NHS in compensation awards. Today’s figures only accentuate the need for a complete rethink of personal injury law.”

Last month, the government said it intended to put strict limits on the “excessive fees” some lawyers claim in medical negligence cases against the NHS in England.

Officials have called for a defined limit on legal costs in cases where the claims are below £100,000, saying that some lawyers submit bills that charge more than patients receive in compensation.

Solicitors have warned the move could deny patients access to justice.

Female lung cancer cases top 20,000

Cases of lung cancer in women have reached 20,000 a year in the UK for the first time since records began.

Female lung cancer cases top 20,000The figure for 2012 represents a rise from 14,000 in 1993, according to the data compiled by Cancer Research UK.

It means the rate of lung cancer in the female population has risen by 22% to 65 cases per 100,000 people.

The trend is the opposite of what is happening with men and is linked to smoking-  which peaked in men in the 1940s but in women peaked in the 1970s.

About 24,000 men are diagnosed with lung cancer each year, which means it is the second most common cancer for both sexes.

Prof Caroline Dive, from Cancer Research UK, said: “It really is devastating to see that the number of women diagnosed with lung cancer continues to climb.”

“We also know survival remains poor and one of the problems is that lung cancer tends to be diagnosed at a late stage when it has already spread.”

That makes it hard to treat and as a result lung cancer claims the lives of 35,000 people each year.

Just 10% of people live for five years after diagnosis – compared with more than 80% for breast and prostate cancer.

Prof Dive said efforts were being made to tackle this with lung cancer one of its key priorities of its research strategy.

The work focuses on a new technique to carry out a biopsy using magnets to capture rogue cancer cells in the blood of patients – potentially providing vital information on the biology of the disease, which could help improve treatment.

But as well as investing in new treatment techniques, Nell Barrie, senior science communication manager at Cancer Research UK, said: “It’s vital that we keep on fighting against lung cancer.”

“It’s the biggest cancer killer in the UK so the government and health service must work to help smokers quit by providing more stop smoking services to help people give up this deadly addiction.”

Health Direct laments the sad increase in female lung cancers as these deaths are wholly preventable.