Friday, 31 October 2008

Nine out of ten preventable deaths in the NHS are never reported to officials, it has emerged.

Of the estimated 72,000 annual deaths in the NHS, just 3,200 are recorded by the National Patient Safety Agency, MPs were told.

The Commons Health Select Committee heard evidence from experts in its first evidence session on its investigation into patient safety.

The NPSA runs a system where all NHS staff can report incidents or near misses so patterns can be spotted and the wider health community warned.

Incidents can include drugs administered in the wrong way or the wrong dose, medicines mixed up, the wrong operation carried out, a patient wrongly identified and broken or malfunctioning equipment.

Howard Stoate, a practising GP and Labour MP for Dartford, said the National Patient Safety Agency's own estimates suggest there are 72,000 preventable deaths in the NHS each year.

However, the incident recording database had collected just 3,200 reports of patient deaths, in 2007/8.

He said: "That is not just under-reporting, that is an extra-ordinary figure.

"If the public realised that only between five and ten per cent of preventable deaths are being reported they would have something to say about that.

Source: Telegraph

Thursday, 30 October 2008

Baby refused NHS treatment

Baby Byron was born with a condition called plagiocephaly - also known as flat-head-syndrome - which means his skull dents and becomes mis-shapen even when just slight pressure is put on it.

Even just laying on the same part of his head can cause it to change shape.

Hi family say he was fine when he was born, but as time went by they noticed there was a dent appearing in one side of his head and a bump growing on the opposite side.

His aunt Leanne Aspinnal who lives in Eastfield described it.

"It looks like he's been hit in the head with a brick on one side, but raised up on the other."

Byron was taken to hospital to see a paediatrician and they confirmed he had the condition.

Leanne continued, "All they did was make sure he could turn his neck, as sometimes babies can get stiff necks because of it."

"We were told not to worry about it and that his hair would grow over it, but the thing is it's not just a little bit of a funny's awful."

They were also told there shouldn't be any health worries for them to worry about, but Leanne isn't so sure.

"I spoke to another mother who has a child with the same condition and he now has to have specially made glasses because his eyes don't align because of the shape. At the very least he'll get bullied and then what happens when he goes bald when he's older?"

To re-shape his head back to normal a special helmet's needed that Byron would wear for twenty-three hours a day - without NHS help it's going to cost the family £2000 which they're desperately trying to raise.

But time is of the essence because the treatment needs to be done before Byron's 1-year-old, as that's when his skull will harden permanently into whatever shape it is at the time.

Leanne doesn't see why they can't have it done on the NHS.

"It's just a lottery and depends on what postcode you live in. If you live in Leeds the hospitals will do it. In Peterborough they're not willing to."

"At the end of the day the NHS fund a whole lot of things that's caused by what people have done to themselves, but a baby's born with a condition it can do nothing about - it is going to affect the way it lives and looks - and they won't do anything about it."

When asked why the treatment couldn't be provided, Peterborough's NHS Trust released the following statement:

The use of specialist helmets for the treatment of plagiocephaly is not standard practice within the NHS and is not routinely commissioned by primary care trusts. In the absence of NHS guidelines on their application, NHS Peterborough reviews each request through its Exceptional Cases panel on an individual case by case basis.

To date NHS Peterborough has not funded an application for specialist helmets for the treatment of plagiocephaly as there has been no specialist clinical support for these individual applications. Clinical support would need to come, for example, from an NHS consultant paediatrician.

If you would like to donate anything to the family to help with Byron's treatment, please call his aunt Leanne on 01733 315 386 or 07857 346 573.

Source: Hereward FM

Wednesday, 22 October 2008

NHS Postcode Lottery: Diagnosis murder

GPs paid £1 a time not to refer patients to hospital

Family doctors are receiving cash bonuses not to send patients to hospital despite National Health Service research that suggests incentive payments can reduce the quality of care.

GPs are paid £1 per patient to spend time reviewing their decision to send someone to hospital and a further £1 for every name on their surgeries’ list if they reduce their previous year’s referral rate. An average surgery with 10,000 patients will receive up to £20,000 for taking part in the scheme.

Eighty out of 82 practices in the Oxfordshire Primary Care Trust area signed up for it this month. Similar incentive schemes have been set up across the country despite the NHS’s National Institute for Health Research (NIHR) giving a warning about the risks. “Financial incentives to encourage GPs to reduce referral rates can be effective, but this is a high risk,” it says. It concludes that reduction “may apply to both necessary and unnecessary referrals”.

Oxfordshire PCT introduced cash incentives after a rise of 8 per cent last year in the number of referrals to Oxford Radcliffe Hospital NHS Trust and Nuffield Orthopaedic Centre NHS Trust. Nationally, hospital referral rates increased by 16 per cent.

If doctors hit their targets, then the PCT will be left with a bill of £1.2 million. However, the trust believes that the expense is justified because the increasing amount of patients being sent to hospital is estimated to cost £6 million.

GP surgeries across London, Essex, Oxfordshire, Devon and Wiltshire are said to have signed up to incentive schemes that are at least partly based on reducing hospital referrals.

Laurence Buckman, chairman of the British Medical Association’s GP Committee, said: “I don’t think patients’ services should be treated as a commodity which is incentivised if you don’t do something. A large number of patients are referred to hospital for investigation. If you don’t know what’s wrong, you cannot know how to handle the problem.”

Martin Roland, who led the NIHR investigators, said yesterday that patients were right to be worried about payments to GPs simply for meeting quotas on reducing referrals.

“If [the payment] triggers some sort of thoughtful process, such as talking to a more experienced colleague, then that is commendable and may save unnecessary referrals,” said Professor Roland, director of the National Primary Care Research and Development Centre. “But I would be cautious about incentives simply to reduce numbers if they are not tied to some sort of clinical review. The danger is that patients who would benefit from referral to hospital would no longer be referred.”

Sue Woollacott, chairman of the Patient Support Group at Nuffield Orthopaedic Centre, said: “It seems to imply that GPs aren’t making good judgments and need financial incentives in order to do that. If I were a GP and getting payments for the practice, it would seem like some sort of bribe.”

Andrew Lansley, the Shadow Health Secretary, said that it was “inefficient and unethical” to pay GPs to refer fewer patients to hospital. “If patients find out that their local health bureaucracy is paying their GP not to refer them to hospital they will be rightly outraged,” he said.

The schemes come after the Government’s admission that the average GP now earns more than £103,000 but that two thirds of NHS patients cannot see their doctor within 48 hours.

Stephen Richards, chairman of the clinical executive for Oxfordshire PCT, said its research on 120 patients referred to hospital dermatology clinics found that at least half could have safely been seen by community-based services. “Junior, less experienced doctors do have higher referral rates than their more experienced colleagues and one of the focuses of our schemes is to encourage discussion with senior doctors with these relatively less experienced doctors,” he said. “By insisting that a senior colleague is doing a review of the decision-making progress, we are extremely unlikely not to refer someone who needs to be referred.”

A Department of Health spokesman said: “Most people prefer to be treated at home or in the community rather than in hospital if possible. GPs should base their referral decisions on what is clinically appropriate.”

Article here

29/6/08 Gordon Brown promises to end the Postcode Lottery


Friday, 17 October 2008

£30m bill for NHS negligence claims

Almost £30 million has been spent on settling NHS clinical negligence claims made in the last year.

Health Minister Ann Keen said more than £18 million had been paid out in damages, with a further £10 million on legal costs, to the end of September.

A total of £18,217,815 went on settling 2,262 cases - an average payout of just over £8,000.

But £7,878,866 was spent on claimants' legal costs, and £2,272,334 on defence legal costs.

And over half of the cases 4,593 formally claimed in 2007-08 have yet to be settled, with 2,331 outstanding.

In a written Commons answer to shadow health minister Mike Penning, Ms Keen said the claims were made against the NHS body providing the care.

The information was from the NHS Litigation Authority, she added, and did not include claims against self-employed contractors in primary care.

Wednesday, 15 October 2008

NHS trust to spend £400,000 on yacht for unemployed teenagers

The chief executive of NHS Hull, Chris Long, said that the yacht, which would cost £400,000, would account for just 0.1 per cent of the PCT's annual budget. "I said we would never sort out health problems in Hull until we sorted out the employment issues facing the city. There is an absolute link between good education, good employment and good health."

But Steve Brady, leader of the Labour group on the city council, said the spending plans were unacceptable. "In the current economic climate, I'm amazed our local PCT is even thinking about doing something like this."

All stories on this topic here

Breast cancer patients should be denied a life-prolonging treatment on the NHS

Women should be refused the "last-ditch" drug even though the firm which manufactures it has offered to pay for the first doses, with the NHS only paying for further courses if it is shown to work.

Trials of the drug lapatinib, also known as Tyverb, have shown it can reduce the size of a tumour by 60 per cent and extend life by an average of two months, compared to standard treatment.

But the National Institute for health and Clinical Excellence says it does not extend life by long enough to justify the extra cost.

The drug, which costs £1,068 for a four-week supply, has received its European licence, making it available on private prescription to patients in the UK.

Lapatinib works on a type of breast cancer known as HER-2 positive, so called because the tumour produces the protein HER 2 which fuels its growth.

This form of the disease accounts for around a fifth of the 45,000 cases of breast cancer each year.

The treatment is for women who have already received chemotherapy and the drug Herceptin, which is regarded as the gold standard treatment to stop the cancer returning, but whose cancer is still growing. It is thought 2,000 women each year could benefit from the drug.

The makers GlaxoSmithKline have offered to provide the treatment free for the first 12 weeks and the NHS would only pay for extra doses if it is still working after that.

But Nice has ruled in draft guidance that even with this offer the treatment is still not cost effective.

The drug is being given to patients in Austria, Denmark, Germany, Greece, Ireland, Luxembourg and Switzerland.

Jane Tomlinson, the cancer campaigner who died of the illness last year at the age of 43, was told by her NHS drug that she could not have the drug.

She was eventually given access to the drug as part of clinical trials.

Because the drug must be given in combination with another treatment and it provides only a limited extra survival, it breaches the cost effectiveness threshold set by Nice, three times over.

The row is over the fact that women in the late stages of breast cancer are receiving Herceptin even when it has stopped working for them and GlaxoSmithKline has argued it is this group who should be switched to lapatinib, which costs about the same and has been shown to work.

But because patients should not be receiving Herceptin in these circumstances anyway, Nice has argued that lapatinib cannot be compared to it in this way.

Simon Jose, General Manager for GSK UK Pharmaceuticals said: "Given our involvement, it is difficult to comment without the appearance of self interest, however we strongly believe that the wrong decision has been made for patients, doctors and the NHS.

"For patients with Her2-positive advanced breast cancer and who have few treatment options left, Tyverb (lapatinib) offers real hope of slowing the disease. We therefore remain wholly committed to working with the NHS and NICE to make this innovative medicine available."

Professor Peter Johnson, Cancer Research UK's chief clinician, said: "We are disappointed that the clinical evidence presented to Nice does not appear to be sufficient for them to recommend lapatinib on the NHS.

"Nice often has extremely difficult decisions to make, but we believe a negative decision from Nice should lead to positive action. This is an area where the Government can work closely with Nice, the pharmaceutical industry and funding bodies such as ourselves to carry out further research into the true role of lapatinib."

The guidance from NICE is still in the draft stages and is open for consultation.

article here

Tuesday, 14 October 2008

Dentists 'giving patients pointless check-ups to exploit NHS payouts'

Dentists are 'exploiting' the NHS by inviting healthy patients for needless check-ups to maximise their profits, the Government has said.
Chief dental officer Dr Barry Cockroft accused dentists of advising patients to return every six months when official guidance says check-ups are only required every two years.
He also said some were routinely splitting up treatment that could be given in one session, in order to receive the NHS appointment payment more times.
Dr Cockcroft said unnecessary check-ups were unfairly inflating dentists' salaries - already pushing £100,000 - and were clogging up waiting lists.
Officials have ordered a crackdown on the practice, which they say could free up 800,000 appointments a year and hundreds of thousands of pounds for the NHS.
Dentists' pay shot up after a new contract was introduced in 2006, but over the time since then the number of people seeing an NHS dentist has fallen by a million.
The average dentist's salary in 2006-07 was £96,135 - an 11 per cent increase on the last year of the old contract. Guidance from NICE, the National Institute for Health and Clinical Excellence, recommends patients have a check-up every two years, unless they are at risk of a life-threatening illness.
A Department of Health spokesman said: 'It is a contractual requirement for dentists to apply the NICE guidance.

'However, it is clear from new data available to primary care trusts that many patients are being seen every six months or so, effectively preventing new patients from getting access to NHS dentistry.
'PCTs now have contract based data to enable them to address this.' Some invitations to check-ups have come in the form of ' threatening' letters, warning that failure to attend could cost a patient their NHS place.
Dr Anthony Halperin, a dentist and a trustee of the Patients' Association, said: 'There is no doubt that some dentists are abusing the system. It is entirely inappropriate to see healthy patients so often.'
But Peter Ward, chief executive of the British Dental Association, said there was no evidence to back up the Government claims.
'The interval between patients being recalled by their NHS dentist is, according to NICE guidelines, a matter for the practitioner's clinical judgment in consultation with the patient,' he said.
'The BDA supports this guideline, as we do not believe a one-size-fits-all approach is clinically appropriate.
'Dentists develop treatment plans in conjunction with the patient, ensuring they are clinically appropriate and fit with the individual's wishes.'

article here

Sunday, 12 October 2008

'It's like having a death sentence hanging over me'

Sam Khan, 42, from London, has suffered from pulmonary hypertension – high blood pressure in the lungs – since the age of 25. This potentially fatal condition causes extreme breathlessness in around 1,500 people in the UK. In March 2008, Nice ruled against a whole class of existing drugs called prostacyclins, leaving Sam with a two-month supply of hers, which cost £37,000 per year.

Ms Khan said: "My condition has reached the stage that the tablets alone are not enough. I need the inhaler six times a day, but then I can work and contribute to society. Without it, I can barely walk three or four steps. When Nice decided the drug wasn't cost effective, I was devastated. The fact it could be taken away is like having a death sentence hanging over me. I know I won't be able to work any more if Nice doesn't reverse the decision as my PCT [primary care trust] has refused to pay for it. I understand the reality behind what Nice has to do, but when you're in the middle of it, it is difficult. I don't want to live for ever, or even to 75 with this illness, but I want to be an active member of society while I reasonably can."

Article in The Independent: The price of life – it was £20,000. Now NHS drugs body recalculates here

Tuesday, 7 October 2008

NHS child loses out as surgeon gives liver transplant to private patient from the Gulf

A senior surgeon broke NHS guidelines by transplanting part of a donated liver into a private overseas patient instead of saving it for someone on Britain’s waiting list.

Professor Nigel Heaton, head of the transplant unit at King’s College Hospital in London, transplanted part of the liver into a boy from one of the Gulf states.

The surgeon was the subject of a formal investigation after other doctors said that a child on the NHS organ waiting list should have been given priority. National guidelines state that, because of the acute shortage of donor organs in Britain, livers must be offered to all other NHS centres before they can be given to a patient from outside the EU.

There are about 400 NHS patients on the liver transplant waiting list – 20 per cent of whom will die before a suitable organ can be found.

The incident sparked fury among surgeons at St James’s University Hospital in Leeds, which first received the liver from a 40-year-old donor. After instructions from UK Transplant, which co-ordinates NHS transplant services, the Leeds surgeons sent the liver to King’s for a ‘super-urgent’ adult NHS patient on the understanding that it was to be used solely for that person.

Complete article here