NHS is worse than communist China say doctors

The NHS is worse than communist China in allowing bureaucrats to over-rule doctors and take decisions which harm patients, medics have said.NHS is worse than communist China say doctorsDoctors at the British Medical Association’s annual conference in Edinburgh called for a system of regulation in response to the Mid Staffordshire Foundation trust scandal, so that managers could be “struck off” for bullying doctors, or putting finances before patients.

Dr Peter Holden, a member of the BMA’s GP negotiating committee, said the lack of regulation allowed senior managers to operate in a culture of secrecy and overt bullying, while the most extreme incidents were hidden by gagging clauses.

He said: “The result is the perfect toxic professional working environment for this explosive mixture to generate disasters such as Mid Staffordshire which did so much harm to patients. Not even in Communist China did they have managers overruling doctors in the operation of hospitals and health services.”

Doctors voted overwhelmingly in favour for a system of regulation, which would mean poor managers could be barred from working.

Robert Francis QC, chairman of the public inquiry into the serious care failings at Stafford Hospital, called for a system of regulation, saying that there should be a “proper degree of accountability for senior managers and leaders”.

Ministers have promised some kind of system so that managers responsible for failures will be barred from working in the health service, though details have yet to be agreed.

Doctors also accused successive governments of a “war of attrition” on district general hospitals.

Anna Athow, a GP from London, accused the Coalition of “enthusiastically” continuing with hospital closures that began under Labour, when ministers promoted the idea of a smaller number of large hospitals serving populations of 1 million.

She said at least 32 hospitals have been closed or downgraded since the General Election while at least 20 more closures are expected.

NHS England is undertaking a review of “urgent and emergency care” which is likely to make the case for more hospitals to be redesigned, with similar networks – based around fewer larger specialist centres.

During a debate on NHS funding, hundreds of medics voted against all efficiency savings in the NHS.

Although the health service is protected from cuts, it has a savings programme to make £20 billion efficiencies by 2015 so that funding can keep up with increasing demand from an ageing population.

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.

Scottish waiting list scandal shows Nicola Sturgeon failure as Health Minister

The Scottish waiting list scandal shows Nicola Sturgeon failure as Health Minister.Scottish waiting list scandal shows Nicola Sturgeon failure as Health MinisterNicola Sturgeon must be judged a failure as Health Minister after the discovery of the shambles surrounding NHS waiting lists, Labour’s Scottish leader has said.

Johann Lamont told MSPs that Ms Sturgeon failed to “get out” of politics before her legacy in the health service was unearthed by Audit Scotland in a report this week.

She accused the former Health Minister of using “false statistics and public deceptions” to create the impression her increasingly stringent waiting times targets were being met.

The Liberal Democrats said the Scottish government had published 50 press releases boasting about NHS waiting times. Family doctors have claimed that, in reality, patient care was being sacrificed for politically-motivated targets.

But, in angry exchanges, Alex Salmond defended his deputy by arguing that Labour were more interested in attempting to “get Nicola Sturgeon” than improving standards in the NHS.

The row broke out at First Minister’s Question hours after Audit Scotland disclosed that health boards trebled the number of patients classified as unavailable for treatment as they strove to meet Ms Sturgeon’s waiting times targets.

The former Health Minister and NHS managers were criticised for failing to question how waiting lists were being cut or why the number of patients deemed unavailable was increasing so rapidly.

Ms Sturgeon stepped down in the role in September last year to take charge of the independence referendum. Mr Salmond compared her at the time to Nye Bevan, the founder of the NHS.

But Ms Lamont told MSPs: “What we have found out from Audit Scotland is that patients come second to propaganda for this government.

“Someone should tell Nicola Sturgeon false statistics and public deceptions don’t cure patients and they don’t win referendums either.”

She concluded: “It has been said that in politics there are two types of health ministers, failures and those who get out in time. Isn’t the truth laid bare today that, despite the spin, Nicola Sturgeon didn’t get out in time?”

However, the report found they could not make a judgment in the vast majority of cases as medics had failed to record why the patient had been classified unavailable.

They noted that the proportion of patients deemed unavailable only began to fall after one health board, NHS Lothian, was caught manipulating waiting lists.

Willie Rennie, the Scottish Liberal Democrat leader, asked Mr Salmond if he regretted his Government issuing “50 press releases bragging about his waiting times initiative”.

“He was telling us how good the system was at the same time as thousands were being sent to the waiting times equivalent of Siberia. Has he got anything humble to say to those people?” Mr Rennie asked.

Alex Neil, Ms Sturgeon’s successor as Health Minister, later announced NHS boards will be asked to review their waiting time figures within a year.

From: http://www.telegraph.co.uk/Waiting-list-scandal-shows-Nicola-Sturgeon-failure-as-Health-Minister

Childhood cancer survival improvements under threat from clinical trial red tape

Improvements in childhood cancer survival rates will stall because red tape is hindering clinical trials and the development of new drugs, British experts have warned.Childhood cancer survival improvements under threat from clinical trial red tapeNew regulations in medical research mean that is now more costly and difficult than ever before to conduct trials into new medicines and children’s cancer survival rates may be hit as a result, it was warned in the journal Lancet Oncology.

Survival rates from cancer in childhood have increased dramatically in the last 30 years, experts said, with figures showing that between 2001 and 2005, 78 per cent of children in Britain lived for more than five years after diagnosis.

This has increased from just nine per cent for some forms of cancer between 1966 and 1970.

Professor Kathy Pritchard-Jones from the Institute of Child Health, University College London, wrote: “In high-income countries, we have nearly reached optimisation of present anticancer treatments.

“New regulatory approval and research strategies are urgently needed to speed the development of new, effective, and safer treatments for children with cancer if we are to continue to improve the cure rate, reduce toxicity compared to existing treatments, and minimise side effects in later life.”

Cancer remains the leading cause of death from disease in children aged one to 15 years, and more than 5,000 children still lose their lives to cancer every year in these regions, she added.

Richard Sullivan, professor of cancer policy and global health at King’s College London and King’s Health Partners Integrated Cancer Centre, said: “An increasingly complex and strict regulatory environment for clinical research and data sharing is limiting children’s access to early-phase clinical trials and delaying the development of new drugs.

“For example, the implementation of the EU Clinical Trials Directive, in 2004, has almost quadrupled costs, led to substantial delays, and even the discontinuation of trials.”

Scientists said more collaboration was needed between drugs companies, academics, regulators, governments and patient groups.

One of the problems is that each type of cancer is very rare in individual countries so international cooperation was needed to make research viable.

Children who survive their cancer also need lifelong support, it was added, as estimates suggest that one in 1000 adults in high-income countries are survivors of childhood cancer, and 40 per cent of these survivors experience adverse effects throughout life.

Prof Sullivan said: “These are serious issues that can have a real impact on a person’s quality of life.

“It is essential that academic programmes and trial investigators ensure better follow-up of survivors to appropriately address the complications childhood cancer survivors may experience in later life.”

CQC can’t guarantee it would spot another Mid Staffs disaster

The main health regulator quango  “cannot guarantee” it will spot another scandal on the scale of Mid Staffs- its new chairman has admitted.CQC can't guarantee it would spot another Mid Staffs disasterDavid Prior said the Care Quality Commission was “going to have to change” to provide the level of inspection demanded by the Francis report.

He also said it was a “no brainer” that the CQC should have dedicated hospital inspection teams, as recommended by Robert Francis QC, who chaired the inquiry.

Mr Prior, an experienced businessman and former Conservative MP, who recently chaired Norfolk and Norwich University Hospitals NHS Foundation Trust, told The Daily Telegraph that we and his colleagues were “under no illusions” about the job ahead.

“We are going to have to change,” he said.

He continued: “At this time, we can’t give a guarantee that we would spot another problem similar to Stafford.  “We can be much better as a regulator but at the moment we can’t give that guarantee.”

He said the CQC was already changing to be better at identifying problems.

“We are going to reshape the CQC, so that we inspect on a differentiated basis,” he said, explaining that they would have teams for hospitals and teams for care homes.

Mr Prior admitted this should have happened long ago: “It’s a no brainer, I think.”

He said the CQC would also move to more of a “risk-based” regime, meaning hospitals which had shown greater problems – such as high mortality rates – would have more visits and more in-depth inspections.

Another key recommendation in the Francis report is that the CQC should take on a large chunk of the current responsibilities of Monitor.

Its duty is to check that hospital trusts are good enough to gain semi-independent Foundation Trust status.

Mr Francis was scathing of Monitor’s contribution to the Mid Staffs scandal, saying it essentially ignored “issues of patient safety and poor care”.

He also criticised the fact that Monitor and the CQC’s predecessor, the Healthcare Commission, barely talked to each other.

These failings meant the “the public remained exposed to an unacceptable level of risk,” he wrote.

He consequently recommended that ministers should consider handing responsibility for authorising Foundation Trusts from Monitor to the CQC. Such a move would be highly likely to see the end of Monitor.

From: http://www.telegraph.co.uk/CQC-cant-guarantee-it-would-spot-another-Mid-Staffs

NHS Stafford Hospital- Francis Report blames no one and everyone

In the aftermath of NHS Stafford Hospital report by Robert Francis QC- there seems a huge contradiction- it blames everyone and yet at the same time no one is singled out for the hundreds of needless deaths.NHS Stafford Hospital- Francis Report blames no one and everyoneJeremy Hunt, the Health Secretary, said it felt “wrong” that no one had been brought to book, while David Cameron said doctors should have been struck off.

Julie Bailey, who set up the pressure group Cure the NHS after her mother died at Stafford and was instrumental in exposing the failures, said: “We want resignations. We have lost hundreds of lives within the NHS, we want accountability.”

She said Sir David Nicholson-  the chief executive of the NHS, who was in charge of a body that had oversight of Mid Staffs for part of the time when the deaths were occurring, was “a bully” who should not be in charge of the NHS.

She also called for the resignation of Peter Carter, the general secretary of the Royal College of Nursing, which had told a whistle-blower at the hospital to “keep her head down” rather than fight for change. She added: “We want everybody who knew about this disaster to be held to account, otherwise nothing will change in the NHS.”

James Duff, whose wife Doreen died after receiving sub-standard care at Stafford Hospital, said: “Not one person has lost their job over this – instead they have been promoted and some people have been moved sideways. This has been a disaster yet nobody is accountable.”

The public sector union Unite said Sir David’s position was “untenable” as he was “not the person to lead the NHS into the world of patient-focused care as outlined by Robert Francis”.

Sir David was chief executive of Shropshire and Staffordshire Strategic Health Authority, with oversight of Mid Staffs, for a nine-month period in 2005-06 when the first instances of mistreatment and neglect are believed to have taken place.

Katherine Murphy, the chief executive of the Patients Association, said the report was a “watershed moment” for the health service.

She said: “It is clear that he [Mr Francis] has understood some of the very real failings that patients and their families face day in and day out.

“It is clear from the report that there is a lot of blame to go around for what happened in Stafford. Unfortunately too many people have escaped genuine accountability.”

Among the Francis Report’s 290 recommendations were the need for NHS hospitals to put “patients first, not numbers” and a “zero tolerance” approach to poor standards of care.

Health workers should have a “statutory duty of candour” and the obstruction of this duty should be a criminal offence, while gagging clauses preventing staff from raising concerns should be banned.

Ed Miliband, whose Labour party was in power as the Mid Staffs scandal unfolded, also apologised, but said the scandal was “not typical” of what happened in NHS hospitals up and down the country.

3,000 more patients have died needlessly in NHS hospitals

More than 3,000 people may have died unnecessarily at five NHS trusts in a crisis that could dwarf the horrors at Mid Staffordshire, which were detailed in a devastating report published yesterday.3,000 more patients have died needlessly in NHS hospitalsAn investigation began on Wednesday night into excessive mortality rates at the five trusts – the same warning sign that exposed the needless deaths of up to 1,200 patients at Mid Staffs.

The trusts in Lancashire, Essex and Greater Manchester have been “outliers” on an index of expected death rates for two successive years to 2012.

Within hours of the publication of a report which described the “disaster” at Mid Staffs as the worst scandal in the history of the NHS, the Department of Health released figures which raise the possibility that the “appalling” lack of care may still be going on at hospitals around the country.

Between July 2010 and June 2012, a total of 3,063 deaths were recorded at the five trusts, which comprise eight district general hospitals, over and above what would be expected. The worst figures were recorded at Blackpool Teaching Hospitals, where there were 879 excessive deaths. East Lancashire Hospitals NHS Trust, which has premises in Blackburn and Burnley, had 618; Colchester Hospital University Trust in Essex had 599; Basildon and Thurrock, also in Essex, had 508 and Tameside, near Manchester, 459.

Sir Bruce Keogh, the medical director of the NHS Commissioning Board, will be in charge of the investigation in the five areas, where patients and their families have been warning for years that care was inadequate.

The figures piled more pressure on Sir David Nicholson, the chief executive of the NHS, who was already facing demands to resign over his failure to root out the problems at Mid Staffs.

Professor Sir Brian Jarman, an international authority on hospital performance, said he warned the Government in early 2010 about high death rates at four of the hospitals now under investigation. Sir Brian, a former president of the British Medical Association, said problems in the NHS have been ignored for too long and called for Sir David to step down.

“I think he should go,” he said. “The Francis Report [into Mid Staffs] is very good but the difficulty is the same people are running the NHS and the mechanism of denial is continuing.” Earlier, Robert Francis QC published his findings following a 31-month public inquiry into deaths at Mid Staffordshire NHS Foundation Trust, in which he catalogued the “harrowing” experiences of patients at Stafford Hospital.

The report says there was “a failure of the NHS system at every level” to detect problems and take action. Despite between 400 and 1,200 people dying needlessly, and despite five investigations including Mr Francis’s £13  million public inquiry, not one person has been sacked or struck off.

Mr Francis said conditions of “appalling care” flourished because managers “put corporate self-interest and cost control ahead of patients and their safety”. He said patients were “let down” by a “lack of care, compassion, humanity and leadership”, with patients having to relieve themselves in their beds because no one would take them to the lavatory, others drinking water from vases because they were not given drinks and “callous indifference” to their suffering by ward staff. Staff who tried to raise concerns were ignored, bullied or intimidated, and watchdog bodies failed to react to repeated warnings.

Stafford Hospital- hiding mistakes should be criminal offence- Francis inquiry

NHS staff should face prosecution if they are not open and honest about mistakes, according to a public inquiry into failings at Stafford Hospital.Stafford Hospital- hiding mistakes should be criminal offence- Francis inquiry Years of abuse and neglect at the hospital led to the unnecessary deaths of hundreds of patients.

The “appalling” levels of care that led to needless deaths have already been well documented by a 2009 report by the Healthcare Commission and an independent inquiry in 2010, which was also chaired by Mr Francis.

They both criticised the cost-cutting and target-chasing culture that had developed at the Mid Staffordshire Trust, which ran the hospital.

But inquiry chairman, Robert Francis QC, said the failings went right to the top of the health service.

He made 290 recommendations, saying “fundamental change” was needed to prevent the public losing confidence.

His report comes after the families of victims have voiced anger that no-one has been sufficiently punished for their roles.

Senior managers were able to leave the trust with little sanction, while most doctors and nurses involved have escaped censure from their professional regulators.

Responding in the House of Commons, Prime Minister David Cameron apologised to the families of patients.

He said he was “truly sorry” for what happened at Stafford Hospital, which was “not just wrong, it was truly dreadful” and the government needed to “purge” a culture of complacency.

Mr Cameron said a full response to the inquiry would follow next month, but he did immediately announce that a new post of chief inspector of hospitals would be created in the autumn.

The final report contains 290 recommendations over nearly 1,800 pages. In particular, it recommended:

  •     The merger of the regulation of care into one body – two are currently involved
  •     Senior managers to be given a code of conduct and the ability to disqualify them if they are not fit to hold such positions
  •     Hiding information about poor care to become a criminal offence as would failing to adhere to basic standards that lead to death or serious harm
  •     A statutory obligation on doctors and nurses for a duty of candour so they are open with patients about mistakes
  •     An increased focus on compassion in the recruitment, training and education of nurses, including an aptitude test for new recruits and regular checks of competence as is being rolled out for doctors

While it is well-known the trust management ignored patients’ complaints, local GPs and MPs also failed to speak up for them, the inquiry said.

The local primary care trust and regional health authority were too quick to trust the hospital’s management and national regulators were not challenging enough.

Meanwhile, the Royal College of Nursing was highlighted for not doing enough to support its members who were trying to raise concerns.

The Department of Health was also criticised for being too “remote” and embarking on “counterproductive” reorganisations.

Instead, it urged everyone from “porters and cleaners to the secretary of state” to work together to shift the culture and adopt a “zero tolerance” approach to poor care.

Mr Francis said: “This is a story of appalling and unnecessary suffering of hundreds of people.  They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety.”

He said the public’s trust in the NHS had been “betrayed” and a change of culture was needed to “make sure that patients come first”.

Number of mothers aged over 45 treble in a decade

The number of women having babies over the age of 45 has more than trebled in just over a decade as couples delay having children for career and financial reasons, according to official figures.The number of mothers aged over 45 treble in a decadeWhile the prevalence of teenage mothers has dropped dramatically since the 1990s, older mothers have reached the highest level seen in recent times.

A new analysis of birth records for 2011 published by the Office for National Statistics (ONS) confirms a major shift towards women having babies later in life, with even mothers in their early 20s becoming increasingly rare.

They show that less a quarter of births England and Wales in 2011 involved mothers under the age of 25 – half the proportion seen in 1970 and the lowest level since records began in 1938.

At the same time women over the age of 35 accounted for a fifth of the total in maternity wards, almost four times as many as in 1977, while those having babies over the age of 45 dramatically higher than a generation ago.

The ONS said the shift reflected a greater emphasis by women on building a career before having children couples with the impact of fertility treatment as well greater instability in relationships.

The figures also show the number of children born outside of marriage reaching a record high of 47.2 per cent.

Four out of 10 mothers over the age of 45 were also unmarried. Only 25 years earlier, almost eight out of 10 children were born to parents who had tied the knot.

But, significantly, the figures also hinted at major changes in the attitudes of fathers.

Birth registration records show that over the same period the number of men signalling a desire to play a part in the lives of children when they are not in a relationship with the mother has more than doubled.

Overall there were 723,913 live births in England and Wales in 2011, the most recent year for which figures are available.

A total of 1,832 babies were born to mothers over the age of 45 in 2011, almost three times the number as recently as the year 2000.

The figures bear witness to the impact of IVF, indicated by a marked rise in the number of women in their late 40s having twins or triplets.

In 1989, just three women in England and Wales had a multiple birth, a figure which was to increase more than thirty-fold in 20 years.

An analysis of birth registrations showed that almost a third of births were registered to couples living together but not married, up from only 10 per cent in 1986.

But more than one in 10 births were registered to parents who lived at separate addresses but were prepared to share responsibility.

That is three and a half time the level seen in the mid 1980s.

New Meningitis B vaccine for killer strain of meningitis is licensed

A meningitis B vaccine that could save thousands of lives has been licensed for the first time, in a move hailed as the most important breakthrough in 30 years.New Meningitis B vaccine for killer strain of meningitis is licensedThe vaccine could soon be available privately and Government advisers are deciding if it should be introduced into the free NHS childhood vaccination programme.

The jab, called Bexsero, has been licensed for use in babies from the age of two months and offers protection against the majority of meningitis B strains that occur in the UK.

Up to 2,000 people are infected with meningitis B each year in the UK and one in ten will die despite receiving prompt medical treatment.

A further one in four will suffer lifelong disability as a result of the brain disease.

Meningitis is commonly cited as the most feared disease by parents because it strikes otherwise healthy children who can deteriorate and die within hours.

Campaigners urged the Government to introduce the vaccine routinely as soon as possible after previous jabs against the disease took five years from licensing to reach the general population.

Steve Dayman, founder of the charity Meningitis UK, who lost his 14 month old son Spencer to meningitis and septicaemia, said: “This ground-breaking vaccine is the most important development since I lost my son to meningitis 30 years ago.

“The news is the most significant step forward in the fight I have ever heard.

“The Government must introduce the Meningitis B vaccine into the immunisation schedule as soon as possible – it will save thousands of lives and spare families so much suffering.

“Any delay means lives will be lost.  The last major meningitis vaccine took five years to be introduced – we cannot wait that long again.  Cost shouldn’t be a barrier for this vaccine either – you cannot put a price on life.”

“Please support our Beat it Now campaign. Together we can end the heartache caused by Meningitis B.”

There are already vaccines against the other major causes of meningitis, Hib and meningitis C, which saw substantial reductions in deaths and disability from the disease.

The Health Protection Agency estimates that since 2000, the MenC vaccination programme has prevented over 9000 cases of serious disease and more than 1000 deaths. Uptake rates of the vaccines, given to babies, has remained consistently high.