Monthly Archives: April 2014

City fathers should heed medical advice – Doctor Burn Out

Dr Fiona Cornish in a letter to The Times 26th April 2014 says: City fathers should heed medical advice

The medical profession is leading the way in promoting sexual equality in parental leave

Sir, The City would do well to follow the shift of culture we are seeing in medicine towards both men and women working less than full time (“Fathers with City jobs are shunning paternity leave”, Apr 23).

Diminishing numbers of men or women can take five days a week of full-on clinical work seeing patients for 12 hours a day. More and more doctors are burning out and leaving the profession early, in the same way that City workers retire in their fifties, often for health reasons.

Men should be encouraged to take leave under the new parental leave arrangements and reap the benefits of forming strong relationships with their children as well as understanding what their wives do.

Employers will realise that there is no difference between men and women in terms of potential leave for childbearing as they could well split the parental leave equally. This will help to prevent the misconception that women are seen as less desirable to employ.

Young women with university degrees are less and less inclined to play the “supporting, non-working wife” role, which is needed if jobs in the City continue to demand such long hours that participation in family life is impossible.

Medicine is well on the way to busting the myth that we are individually indispensable and must therefore be present at work for 60 plus hours a week. Doctors who work less than full time can still reach the top of their careers. Dame Fiona Caldicott revealed that her most satisfying achievement was that she was the first president of the Royal College of Psychiatrists to have trained on a less than full-time basis, while bringing up children.

Both men and women benefit from having a balance between work and family. We need to remove the stigma attached to fathers who wish to participate in their children’s lives and benefit from the new parental leave arrangements.

Let us celebrate a remarkable group of new women presidents: Jane Dacre, president-elect of the Royal College of Physicians, Clare Marx, soon to be the first woman president of the Royal College of Surgeons and Suzy Lishman, president-elect of the Royal College of Pathologists. They will join Maureen Baker, chair of the Royal College of GPs.

Mid Staffordshire NHS trust fined for ‘avoidable and tragic death’ – we may all need an advocate..

Sarah Boseley, health editor for The Guardian, reports 28th April 2014: Mid Staffordshire NHS trust fined for ‘avoidable and tragic death’

Health and Safety Executive brought case after 2007 death of Gillian Astbury, 66, because nurses failed to give her medication

The important thing to discuss from all these cases is whether we have learnt the lessons, and whether poor care, endemic in 2007, is being improved. Deliberate rationing by under capacity, and the “rules of the game” for commissioners, suggests that there will be little change. We may all need an advocate beside the bed in our Hospitals. Neglect and dehydration are real risks, and this despite the Welsh Health Service denial of Anne Clewydd’s claims. GPs and staff are cynical and know that they complain far too little – because they know the culture..

NHS contracting has been a disaster – covert rationing by contract or commissioning does not make it ethically acceptable

Ann Clwyd review of hospital complaints finds ‘shocking’ neglect

NHS ‘dismissive of neglect claims’

The cover up and denial. “Help us, doctor. We’re frightened of being ill in Cover-up General”

Not enough beds…. A story of politicial denial.

Bitter Medicine – Reforming the NHS

Patients die because of our “arrangements”. Chaos as hospitals promote all trainee doctors at once

Revisiting the death of Malcolm Green. The wrong people are likely to be criticised..

The Deterioration and Crisis to come – Whose NHS is best? It’s the wrong question

Undercapacity in Maternity – Rationing of beds

Hospital watchdog finds ‘huge variation’ in care

Private care homes: Only cameras in rooms will end patient abuse

A rare and frank diagnosis of NHS

Rationing NHS care: why we need a serious debate – NHS reality agrees – David Lock in the guardian

Hospitals ‘are covering up death rates’ – and then sack whistleblowers

Half of (our) MPs fear for future of free NHS – but have insufficient political will to change it!

Sir Bruce Keogh: “I am not interested in an NHS that aspires to mediocrity, the European average or whatever. We should set ourselves the achievable ambition of raising our cancer survival rates to match the very best in Europe.”

NHS understaffing may have effect on baby mortality rate, says top doctor

Dennis Campbell in The Guardian 27th April reports: NHS understaffing may have effect on baby mortality rate, says top doctor – ‘Legitimate to ask’ whether number of staff is contributing to death of 300 babies a year, says Dr David Richmond

Once again, we know the numerator, but not the denominator. What has been the historic rate, and ,now that mothers are older, and there are  more first babies born to older mothers, is their mortality rate proportionate to what has been happening in maternal demographics? Despite this, understaffing for adults compared to private care is the rule.. There is very little private care for children which would allow us to compare staffing rates, but as the Health Services degenerate further, I expect private care for children and babies to become more available, especially in the cities… Rationing by undercapacity..

Britain’s leading obstetrician says it is legitimate to ask whether understaffing of maternity care and labour wards is contributing to Britain’s stubbornly high rates of baby death and brain damage. Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists, has voiced alarm that nearly 300 babies a year are dying during or soon after birth with a further 1,200 ending up with brain damage or other serious health problems. The infant deaths, Richmond said, were due to a range of issues. But with maternity units struggling to cope with a baby boom over the past 10 years and a shortage of midwives and doctors, Richmond said it was “a legitimate question to ask” whether pressure on resources was contributing to the tragic toll….

Lynsey Hanley  in The Guardian reports 27th April: At last, a doctor who respects older mothers

David Richmond recognises why women are having babies later – they want to take control of their lives

Chris Woodhead: “Britain lacks courage to help me die”

Chris Woodhead is quoted by Sian Griffiths in The Sunday Times 27th April 2014: Britain lacks courage to help me die.

This reflects a lack of political will to lead, and their denial that patients should have autonomy when they so choose. I wonder which CCG (LHB in Wales) will first have the courage to commission Dignitas in Switzerland?

1/5 of Hospitals are under standard – in England and that’s not counting the rest of the UK

Tim Shipman in The Sunday Times 27th April 2014 reports: Patients suffer as one in five hospitals fail to meet care standards

So 1/5 of Hospitals are under standard – in England and that’s not counting the rest of the UK. We know the numerator but not the denominator.. How many would have been under standard at this level 10 and 20 years ago?

ONE in five hospitals failed inspections as a result of poor care last year, leaving patients to endure a catalogue of neglect, new figures have revealed.

Inspectors from the Care Quality Commission (CQC) watchdog found that 45 hospitals were not meeting acceptable standards of safe care, following 215 inspections in the year to March — a failure rate of nearly 21%. In the same period, 32 hospitals, about one in six of those inspected, did not have an adequate number of staff.

The inspectors’ reports reveal extensive failings, including a trebling of bed sores….

An excuse to ration by decommissioning?

The cover up and denial. “Help us, doctor. We’re frightened of being ill in Cover-up General”

Camilla Cavendish in The Sunday Times 27th April 2014 opines: Help us, doctor. We’re frightened of being ill in Cover-up General

Another important article that I am printing in full – with apologies to The Times and CC. Fear and denial are stopping cultural change.. and the fear and denial is in both patients and politicians.

When the Labour MP Ann Clwyd spoke movingly about her husband’s shocking treatment in a Welsh hospital two years ago, I thought it heralded a new era of glasnost. Thousands of patients, relatives and staff started writing to Clwyd with similar stories and to journalists such as me. As the Francis inquiry painstakingly unravelled the tragedies at the Mid Staffordshire Foundation NHS Trust, there was a feeling within the health service that the system would regain its pride and stature if problems were dealt with openly, not behind closed doors.

How naive I was. On Thursday, 18 months after Clwyd’s husband died in the University Hospital of Wales, Cardiff, UHW published a report dismissing most of her complaints (BBC News 23rd April 2014: Most of MP Ann Clwyd’s claims over late husband’s care rejected). The trust found there was “insufficient evidence to uphold” her claims that Owen Roberts had been treated “like a battery hen” by “cold” nurses. It did, however, admit that he died of “hospital-induced pneumonia”. That speaks for itself, really. As does the tone of the report. Clwyd has said that when she rang in for updates, she was told she could not speak to her husband because there was no bedside phone. The hospital’s response? “There is a lack of evidence to uphold the concern that a bedside facility telephone wasn’t available.”

What kind of organisation uses such language to rebuff a grieving widow? What land of doublespeak are we in here? The published report is only a summary of an internal one. But the bald rejection of Clwyd’s claims, line by line, can be read only one way. It is an attempt to imply that this brave woman, who was the first MP to highlight the plight of the Kurds, who campaigned successfully to ban female circumcision, who served on the NHS royal commission, decided for some unfathomable reason to lie about the treatment of the man she loved.

The report reads like a parody of legalistic paranoia. It is probably impossible to prove conclusively whether, for example, nurses “ignored” Clwyd and her husband. What managers should care about is that this is how she felt — and they should ask themselves why. All organisations make mistakes. The best, including NHS hospital trusts, acknowledge problems and take action. The worst try to smear their critics and cover up.

Clwyd used her profile to attack UHW very publicly. It is not entirely surprising that the hospital wanted to hit back. But it should never have come to this. The hospital has now agreed to appoint a properly independent investigator. It should have sat down with the MP two years ago, taken her seriously and got to the truth.

It would be easy to feel sorry for Clwyd, but also to assume that perhaps her husband was a tragic victim of an unusually busy A&E department on a bad day. Sadly, that seems unlikely.

Last week I spoke to a doctor from a different hospital whose mother recently died at UHW. He says he was appalled by errors that resulted in her succumbing to a common, treatable condition. This man loves the NHS. But a month after raising his concerns he has heard nothing.

The impression of an organisation on the defensive is reinforced by UHW’s treatment of Peter O’Keefe, a heart surgeon who raised concerns about a patient who suffered a serious brain injury after a ventilator was disconnected. Since 2012 O’Keefe has been suspended on full pay, ostensibly for bullying staff. But most of the bullying seems to be coming from the trust.

If MPs and doctors can be treated with so little respect by one of Wales’s pre-eminent hospitals, what hope is there for ordinary patients?

The British government is about to create a duty of candour, which will force all hospitals to be open and honest with patients and relatives about incidents of significant harm. The duty is known as “Robbie’s law” in honour of the Powell family in Powys, who have campaigned heroically to end cover-ups in the NHS since losing their son 20 years ago.

The duty of candour is probably the greatest single advance in patient rights since the NHS was founded. But it will apply only to England. Wales is a separate fiefdom. There, any attempt to raise concerns about patient safety is seen as an English plot.

Last November Sir Bruce Keogh, the medical director of NHS England, sent an email to his Welsh counterpart. Keogh was in the process of investigating 14 English hospital trusts with worryingly high mortality rates. He suggested there were six trusts in Wales that should also be investigated and he offered to help.

Keogh is an amiable cardiac surgeon who wants the best for patients. From the response he received you would have thought he was a rampant imperialist. The British Medical Association in Wales described his comments as “wicked slander”. The Welsh government said there was no need for an inquiry: Welsh and English data were not comparable.

It is quite true that mortality data is calculated differently on either side of the border. But other data is comparable: on, for example, waiting times for diagnostic tests. The latest figures suggest that 42% of people in Wales wait more than six weeks for scans and other diagnostic tests, compared with 1.8% in England and 3.8% in Scotland. This is not a blip; it is a gulf that directly affects individual chances of survival.

Given this backdrop, the complacency of the Welsh government is bewildering. Last week I spoke to Gareth Williams, who is campaigning with 100 other patients for a public inquiry into hospitals in Bridgend, Swansea and Neath Port Talbot. He believes there has been “a major cover-up” and the Welsh watchdog is “dysfunctional”. He claims his own mother was badly treated. “I’m not political,” he says, “but we’ve had one party in charge for 14 years. They don’t want an inquiry because too many skeletons will be exposed.”

With Labour holding a slim majority in the Welsh assembly, opposing parties are bound to make political capital out of the situation. Ministers complain that opponents are exaggerating the problems, and perhaps they are. But that does not justify ignoring patients.

Personally, it sticks in my craw to be told that those of us on the wrong side of the border have nothing to say. I am part-Welsh. My in-laws are Welsh. Wales is not another country to us; it is a place where some of our nearest and dearest are in the hands of hospitals that may be failing.

No one should be afraid of the NHS. Yet too many people are scared to become ill. Too many people, staff and patients, are afraid to complain. As Clwyd said to me last week: “How many people will go down this road [challenging a hospital] if they know how emotionally exhausting and financially draining it is?” A system that has treated her and her late husband with such contempt is a system that needs a very bright light shone down every single corridor.

camilla.cavendish@sunday-times.co.uk

Parents want end to ban on testing of newborns for fatal (genetic) diseases

Lois Rogers reports in The Sunday Times 27th April 2014: Parents want end to ban on testing of newborns for fatal diseases.

Of course it’s a good idea to be able to plan to avoid these conditions. Cystic Fibrosis, Huntington’s Disease and many others could be diagnosed at birth – surely it should be a choice for parents? It will be expensive… Will the commissioners approve? Will the service be rationed by Post Code and Region, or Universal?

HEALTH officials will be urged this week to lift a ban on the testing of newborn babies for fatal diseases.

 

A report to be presented to the National Screening Committee (NSC) on Wednesday says parents should be told about children’s disabilities as soon as possible to allow the babies to have life-prolonging treatment and make parents aware of the risk of having more affected children.

 

The call for change is being led by the Muscular Dystrophy Campaign and is backed by MPs, scientists, Genetic Alliance UK and the Patients’ Alliance for Newborn Screening.

 

The report comes after three children who suffered from spinal muscular atrophy were found dead at their home in south London last week. All three were tube-fed and needed hourly medication.

 

The children’s mother, Tania Clarence, 42, has been charged with the murders of Olivia, 4, and three-year-old twin boys Max and Ben. Clarence is believed to have discovered Olivia had the condition only when she was pregnant with the twins.

 

The ban on testing newborns for fatal diseases was imposed because the results could prevent parents bonding with their babies and it was deemed better to allow parents to find out gradually about children’s disabilities.

 

The two-year study to be presented to the NSC found, however, that parents want an early diagnosis.

 

It also highlights the availability of new drugs for Duchenne muscular dystrophy (DMD), which affects 100 babies a year.

 

More than 3m families in Britain have children struggling with life-limiting congenital defects, according to Genetic Alliance UK.

 

Britain currently screens for just five of 700 known genes for such defects, including cystic fibrosis.

 

The campaign is being backed by thousands of affected families. Jane Field 55, from Worcester, had IVF to have a second child, Fenella, now seven, when she discovered her son Murray, now 16, had DMD and would not survive into adulthood.

 

“There is never a good time to have the diagnosis, but I would have had another child straight away if I had known this was going to happen,” she said.

 

By contrast, Sharran Price, from Milton Keynes, who has two sons with DMD, James, aged 11, and Toby, 6, said she would never have had another child if she had known James had the illness.

 

“People should be given the information, so they can choose what to do,” she said.

 

The NSC, part of Public Health England, said screening would be recommended only if the benefits clearly outweigh any possible harm.

 

The pressure group Human Genetics Alert said the predictive value of gene tests was questionable.