Monthly Archives: April 2014

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.

 

Quarter of cancers diagnosed only in A&E – is this a surprise or any different from the past?

Sarah-Kate Templeton and Jon Ungoed-Thomas in The Sunday Times 27th April 2014 report: Quarter of cancers diagnosed only in A&E

The reasons for this? Well firstly the new contract for GPs has put emphasis on Chronic Disease Management, and not on early diagnosis of cancer. Secondly, we don’t know the figures historically: it may always have been a high diagnostic rate in A&E (We know the numerator but not the denominator..)! Thirdly, GPs do not have speedy access to diagnostic imaging (as they would in many other countries). It is a reflection of the underprovision of GPs, and the expectation that all their working day/time should be filled which leads to this situation. Overmanagement – and it is the same when applied to bed occupancy in Hospitals, now so high that cross infections are inevitable and endemic. Rationing by underprovision but is this a surprise or any different from the past?

ONE in four cancer cases is diagnosed in an accident and emergency department after being ignored by patients or missed by GPs, according to a new report by a leading charity.

The late recognition of the symptoms leads to thousands of patients dying unnecessarily from cancer.

The report, to be published this week by Macmillan Cancer Support, will say that half of all cases of pancreatic cancer and almost two-thirds of cases of cancer of the brain or central nervous system are diagnosed in A&E.

It will say that these patients are about twice as likely to die within a year of diagnosis as those whose cancer is discovered through an urgent referral to a specialist from a GP.

The average survival after one year is 72% for patients referred by their GP to see a specialist within two weeks, against 40% for those diagnosed after being admitted to hospital as an emergency. About 331,000 cases of cancer are diagnosed every year in Britain.

This week Macmillan will call for an end to the scandal and will begin a campaign for earlier diagnosis.

Rosie Loftus, the charity’s chief medical officer, said: “It is appalling that so many people are diagnosed in A&E.

Cutting down the capacity of General Practice by Rationing the number of approved premises

Emma Bartholomew writing in the Hackney Gazette 25th April 2014 reports: Funding cuts threaten 12 Hackney GP surgeries.

This is again covert rationing: cutting down the capacity of General Practice, means Commissioning Groups ration the number of approved premises, thereby reducing access and creating resentment. Who would be a Health Commissioner?

….Under the Health and Social Care Act 2012, any new practice created has to be put out to tender to the private sector.

Dr Brewer said: “This favours the private sector, which is used to preparing tenders. You might imply from that this is the case to deliberately bankrupt us.”

Nick Mann, a GP at the Well Street Surgery, where partners have already taken pay cuts and the blood sample collection service has been axed, said: “My impression is the government would like to see more GP surgeries run by private providers, the easiest way to achieve this might be to bankrupt general practices in a similar way they declared hospitals as failing.”

Coral Jones, honorary secretary of the City and Hackney division of the British Medical Association believes the move will lead to the “demise of general practice” and compared the model to that of health maintenance organisations in the United States.

An NHS England spokesman said: “The changes are part of a national policy to bring all practices into an equal financial position, which will ensure that all patients can expect the same high level of service from their GP where ever they live.”

“The majority of GP practices in London will receive more funding in their global sum as a result of these changes, but some will receive less.”

The Department of Health declined to comment. (On this decommissioning of service)

There is some evidence that some practices do need to close, but on the whole these are single-handed or two doctor non-teaching practices.. Here are some of the links building up to this situation…

22nd January 2013 in Pulse: CQC issues closure notices to two GP practices

26th November 2013 in The Yorkshire Evening Post: Patients oppose Leeds GP surgery closure – Yorkshire

12th December 2013, updated 24th March 2014 BC News: ‘Two practices closed’ after inspection of GP surgeries

2nd February 2014 in the Express: Closure fears for surgeries with 8,000 patients to one GP

20th February 2014 The Guardian: Funding change could force rural GP practices to close ..

21st February 2014, The Telegraph: 100 GP surgeries could close under new rules – Telegraph

11th April 2014 The Express and Star: Black Country GP surgery closes leaving 2,500 to find new

23rd April 2014, The Weston, Worle and Somerset Mercury: Government to review GP surgery (The Boulevard) closure in Weston

 

 

Commissioning groups – and decommissioning in England

Pity the leaders and members of Clinical Commissioning Groups in England. Their purpose is to organise the delivery of A map of the different groups is available here (NHS England).
The detail of the groups us here NHS England).
Patient UK (Government sponsored) description. ~
Wikipedia description.

They have a few options in each service area. Their duty is to respond to patient need, and not necessarily to the evidence, and they have only four options in their approach:

1. Keep the current service – and the expenditure which goes with it.

2. Reconfigure the service, changing the paradigm, and hopefully saving money by decreasing  demand and increasing patient autonomy

3. Simply cut and slice the service down, so that there are less and less staff covering more and more people.

4. A fourth option is to decommission the service.

They even have their own bulletin.
It seems they are actually decommissioning some GP services.
This type of action is impossible in the rural areas where travelling is time-consuming and expensive: the rural handicap..

24th April 2014 David Goldberg in The Guardian: Are clinical commissioning groups coping with the changes in the NHS?

With CCGs just over a year old, do they have the ability to provide the bold leadership needed to make the necessary changes to local healthcare?

Unfortunately the answer seems “No”.

The Welsh Governement (Assembly) is a parasite. It is sucking the life out of Health and Education

The structures around the funding of the Welsh Government mean that money for Health and Education is top-sliced. Yes, we voted for this (by a small majority) but there are no plans for a second vote, or for re-designing the funding rules.

This means Wales will suffer as a “competitor” with English and other UK regions, to recruit professionals, to teach to the same standards, and to aspire to highest standards in Health and Social Care.

The state of Wales: we should all rage against it’s dying.

Wales government compares GDP with Europe and others..

Welsh Waiting longer

Persistently high death rates in Wales:

Persistently high death rates in Welsh hospitals should be investigated: Listen to Sir Bruce Keogh. Bring back the Welsh Office.

Education, Education, Education – our politicians have failed us all

All education is divisive – We must all aspire to excellence, and speak out.

The Welsh Government (Assembly) is a parasite. It is sucking the life out of Health and Education

 

Wales NHS emergency care suffers uncertainty, AMs say

BBC News reports 24th April 2014: ‘End uncertainty’ over A&E units”

Recruitment difficulties existed in the rural areas of Wales before the recent (rationing without agreement -Similar to Shadwell) pressures on A&E. Political cowardice in not discussing philosophy and rationing  is making it worse

The threat of closure is making it difficult for hospitals to recruit and keep key staff, according to a report by the Public Accounts Committee.

Their inquiry followed an auditor general’s report last year which said A&E services were deteriorating.

The Welsh government said it would respond to the report in due course.

The state of the NHS in Wales has been the subject of much debate over waiting times, along with plans to downgrade A&E units at Prince Philip Hospital in Llanelli, Carmarthenshire, and the Royal Glamorgan Hospital in Llantrisant which have met public opposition.

Committee chairman Darren Millar said: “The pressures facing the delivery of unscheduled care services in Wales are complex.

“While there has been an effort by those working within NHS Wales to drive forward improvement, we are yet to see the major step change in performance that the people of Wales need.

Challenges

“The committee concludes that radical solutions are required to address the challenges faced by our health services.

“We also want to see an end to the uncertainty surrounding the provision of emergency health departments – especially given the challenge that this is presenting to recruitment in our hospitals.”

Elderly care demand to ‘outstrip’ family supply – The system is imploding

Update 1st Feb 2015. Jon Ungoed-Thomas reports: Elderly get just five minutes of care

The BBC News reports 24th April 2014: Elderly care demand to ‘outstrip’ family supply More evidence that without being honest about what we can and cannot have, the system is imploding..

The number of older people in England needing care will “outstrip” the number of family members able to provide it by 2017, a think tank has warned.

An Institute for Public Policy Research (IPPR) report estimates that by 2030 there will be more than two million people aged 65 and over with no child living nearby to give care if needed.

The IPPR said the country must “build new community institutions” to cope.

The government said it was working to make sure more people got care at home.

The IPPR report estimates that, of the two million people it says will have no child living nearby to care for them in England in 2030, 230,000 will need more than 20 hours of care per week.

‘Left to cope’

Care chart

Clare McNeil, senior research fellow at the centre-left think tank, told the BBC: “There won’t be the family members needed to provide the types care that people see at the moment. That will mean there is more pressure on social services, and stretched services like the NHS.

“We need to have a fundamental rethink about the way that we how we look after each other later in life.”…..