Monday, 30 November 2009

How obscene that NHS bosses get rich as patients needlessly die on their watch

The crisis over standards of NHS care appears to be worsening almost by the day.

Figures published in the latest Hospital Guide from the part-NHS, part-private Dr Foster organisation show that 12 hospital trusts including those with 'foundation' status are 'significantly underperforming' - including nine which had been rated good or even excellent by the NHS watchdog, the Care Quality Commission.

A further 27 are said by Dr Foster to have had unusually high mortality rates, generally considered a warning sign of care or treatment inadequacies.

True, comparative statistics like these are a minefield, and using death rates as a marker of performance can be misleading. But only a few days ago, horrific conditions were revealed at Basildon NHS Trust - which Dr Foster states has the worst mortality rates in the country.

Care Quality Commission inspectors found blood-spattered walls and filthy conditions with brown running water, mouldy bathrooms and soiled furniture and commodes.

It is hardly surprising that more and more people are beginning to fear that, far from curing their diseases, a stay in an NHS hospital might actually kill them.

Full article in Daily Mail

Saturday, 28 November 2009

Patients are paying the ultimate price for NHS targets

By Daily Mail Comment
Last updated at 9:08 PM on 27th November 2009

In the rush to clear themselves of blame for the needless deaths of more than 70 patients on the filthy, blood-splattered wards of Basildon Hospital, ministers insisted the scandal was an 'isolated case'.

Never mind the fact the Government's own Care Quality Commission inspectors had rated this supposedly elite foundation hospital as good, and awarded it 13 out of 14 for cleanliness.

Of course, it wasn't long before another 'isolated case' came along at Colchester Hospital University Foundation Trust, where the chairman was sacked for presiding over an equally alarming death rate and excessive waiting times in A&E.

Now, shockingly, it emerges that, across the NHS, there are 26 hospitals with higher than expected death rates, in which 3,000 patients may have suffered unnecessary deaths.

The sheer scale of human misery at the hands of an NHS which devours £2billion a week is deeply depressing.

Let's be clear: the Mail has huge admiration for the self-sacrificing dedication of many NHS staff.

But the hands of these professionals have been tied by a Government target and inspection regime which is stultifying individual responsibility.

Too often patients come a sorry second to Whitehall targets. And, as it emerged this week, too often hospitals are only cleaned on the handful of days when inspectors are due.

Doctors, nurses and cleaners work not as one, but as isolated, box-ticking units fulfilling ever more regulatory demands.

The dead hand of central Government control is ruining the NHS. And the patients are paying with their lives.

Wednesday, 18 November 2009

Payout over veteran neglect death

The family of a Leeds war veteran who died from horrific bed sores after a series of care failings have been paid £20,000 by a hospital trust.

Kenneth Ballinger, 86, was admitted to Leeds General Infirmary after a fall but died from multiple infected bed sores - one the size of a fist.

His daughter said she was haunted by her father's screams of agony.

Leeds Teaching Hospitals NHS Trust said mistakes were made and an out-of-court settlement was made with the family.

Mr Ballinger, a veteran of the World War II Normandy landings, was admitted to hospital in January 2006 after a fall at his home in Beeston.

He became infected with a superbug and later developed bed sores so severe that his left hip bone became exposed and he was left with no skin on his heels.

He was discharged but died five months later after the bed sores became infected and he was admitted to Pontefract General Infirmary.

His daughter Carol-Ann Knott said: "I'll be forever haunted by his screams as my father was brought up in the lift at Pontefract General Infirmary.

"The doctors were so appalled that he had been allowed to get in such a state, with a sore so big one of them could fit his fist into the open wound.

"He said that he had never seen anything like it in his life."

Full story can be read on BBC website

Saturday, 14 November 2009

'The NHS must stop killing dementia patients with drugs'

Friday, November 13, 2009

A government commissioned report has highlighted the practice of giving people with dementia antipsychotic drugs as a form of chemical restraint and says it is responsible for around 1,800 deaths a year

Up to two thirds of people with dementia who are given antipsychotic drugs as a form of chemical restraint don't need them, a new report has said. The practice of giving dementia sufferers drugs that are licensed to tackle schizophrenia is said to be "scandalous" and lead to around 1,800 deaths a year.

Campaigners have called for such over prescription of drugs to end and the Department of Health's plan is for prescriptions to be cut by two thirds in three years. This action follows an independent review by King's College London Professor Sube Banerjee which was commissioned by the Department of Health and showed that too many people with dementia were routinely prescribed antipsychotic drugs to treat aggression and agitation. This flies in the face of guidance from the National Institute of Health and Clinical Excellence (NICE).

The plan to tighten procedures up on drugs for people with dementia includes creating a new national clinical director for dementia, offering people with dementia and their carers access to psychological therapies to tackle the root cause of agitation and aggression, an audit to agree on definitive prescribing figures and clear local targets to cut antipsychotics use as a result of the audit.

There are also proposals for better regulation, closer collaboration with the General Medical Council (GMC) and royal colleges to make sure all health and social care staff have specialist training in dementia, and joint Department of Health /Alzheimer's Society guidance on what to do if a family member is given antipsychotics.

However, antipsychotics drugs are deemed by the medical profession to be appropriate for people with dementia in certain circumstances, such as when a person is a risk to themselves or others and where all other methods have been tried. But they should only be given them for a short time of say three months while a care plan is put in place, the report said. Banerjee estimated that about 36,000 of the 180,000 patients with dementia who are given these drugs get some benefit from them.

Care services minister Phil Hope commented: "It is unacceptable that antipsychotic drugs are routinely prescribed to people with dementia. More than half of people with dementia will experience agitation or aggression at some point, but NICE guidance is clear – antipsychotics should only be given when this is really necessary.

"Excellent examples of practice do exist, but our action plan will help make sure this is the norm, not the exception. Our new clinical director will provide strong leadership, supporting the NHS and social care to reduce antipsychotics use carefully and drive up quality."

He added: "We know there are situation where antipsychotic drug use is necessary – we're not calling for a ban, but we do want to see a significant reduction in use. We expect the findings and recommendations [of this report] to be taken into account by PCTs [Primary Care Trusts] and all other relevant organisations. Tackling the root of the problem is vital, which is why we are improving access to psychological therapies. We are also working with the Royal Colleges to ensure all health and social care professionals are able to care for people with dementia without routinely resorting to these drugs."

Banerjee said: "Antipsychotics are used too often in dementia; up to two thirds of the estimated 180,000 people with dementia receiving these are prescribed them unnecessarily. This review identifies the potential risks and benefits of these medications in dementia and presents actions that we can take to address this problem. In doing so we would provide international leadership in this complex clinical area as well as improving the quality of life and quality of care for people with dementia and their carers in England."

Neil Hunt, the chief executive of the Alzheimer's Society, called the report "long awaited" and welcome because it finally brought out into the open the scale of the problem within the NHS.

"The scandalous over prescription of antipsychotic drugs leads to an estimated 1,800 deaths a year," he said. "It must end."

Stressing that the government's action plan could not afford to fail, he went on: "Change will only be achieved with commitment from government, PCTs and health professionals and clear local targets. Today must mark a change in dementia care."

There are currently 700,000 people in the UK with dementia and this is expected to increase to a million in the next 10 years as the proportion of elderly people in the population rises.

Monday, 9 November 2009

Fears over child protection at one third of NHS trusts

More than 140 NHS trusts have been challenged over the adequacy of their child protection procedures by the Care Quality Commission in the wake of the Baby Peter scandal.

By Andrew Gilligan

Trusts are responsible for declaring whether they meet basic standards for child protection as part of the health service's annual inspection process.

This year, 363 of England's 392 trusts - over 90 per cent - declared that they met the standard.

But in a special review commissioned after Baby Peter's murder, the watchdog, the Care Quality Commission (CQC), has challenged the claims made by 112 trusts. Eighteen of them - including the main GP service in Manchester - have already been marked down by the watchdog, with other investigations "ongoing."

Internal NHS documents seen by The Sunday Telegraph show the CQC review uncovered "significant lapses" in child protection that "trust boards should have been aware of, but did not take into consideration when making [their] declarations."

The documents say that the CQC review has uncovered "clear evidence" which "conflicts with the 2008/9 declarations made by trusts."

In addition to the 112 trusts whose claims have been questioned, a further 29 trusts admitted that they fell below the standard. They include hospitals, mental health trusts and primary care trusts, which run GP services and health centres.

Cynthia Bower, chief executive of the Care Quality Commission, said: "We make no apologies for coming down hard on trusts not meeting the standard on safeguarding children. Baby Peter was a wake-up call for the NHS. Some trusts have realised they've got more to do than they previously thought. In other cases we needed to bring shortfalls to their attention."

Baby Peter, now named as Peter Connolly, died of multiple injuries in August 2007. He was a patient at a child abuse clinic at St Ann's Hospital, Haringey, north London, and had been seen eight times by NHS staff in the month before his death.

At his last visit to the clinic, two days before he died, the paediatrician examining him sent him home after failing to notice that he had a broken back. The 17-month-old was found dead in his blood-stained cot with eight broken ribs, severe lacerations to his head, a tip of a finger missing, broken teeth, missing nails, and scores of bruises, cuts and abrasions, including a deep tear to his left earlobe, which had been pulled away from his head.

Full article in the Telegraph

Monday, 2 November 2009

'3,000 a year die’ in cancer shambles

THREE thousand Britons a year die because of a lack of lung cancer treatment, it emerged yesterday.

Vital areas of care are "woefully inadequate" and there are shortages of key surgical staff, according to new research.

A review has revealed a shambolic postcode lottery where treatment varies from one part of Britain to another.

In some areas, fewer than one in TEN patients get any kind of treatment at all and there are "huge variations and vast inequalities" in others, the UK Lung Cancer Coalition reported after a review of services.

There are only 44 thoracic surgeons - specialists in chest problems including lung conditions - spread thinly over 240 cancer teams.

The NHS is failing to fast-track thousands of patients to consultants every year or prescribe them life-prolonging drugs.

And a third of people stricken by lung cancer never have biopsies carried out.

Dr Mick Peake, head of the UKLCC's clinical advisory group, said: "Alarmingly, patients who are fit for surgery are being turned down.

"We are calling for a 70 per cent active treatment rate across the board, which would mean a massive reduction in the number of deaths. Up to 3,000 lives could potentially be saved each year."

Lung cancer is the second most common cancer in the UK with around 39,000 diagnosed each year.

The UKLCC's chairman Dame Gill Oliver said: "We are still letting down lung cancer patients."
Source: The Sun

NHS is paying millions to gag whistleblowers

Patients' lives put at risk by tactics used against those who highlight safety fears

By Nina Lakhani

Sunday, 1 November 2009

NHS whistleblowers are routinely gagged in order to cover up dangerous and even dishonest practices that could attract bad publicity and damage a hospital's reputation.

Some local NHS bodies are spending millions of taxpayers' money to pay off and silence whistleblowers with "super gags" to stop them going public with patient safety incidents. Experts warn that patients' lives are being endangered by the use of intimidatory tactics to force out whistleblowers and deter other professionals from coming forward.

The IoS has learnt of children in Stoke-on-Trent needlessly losing organs after safety issues highlighted by a senior surgeon – who was suspended after coming forward to voice concerns – were ignored. In one of more than 20 serious incidents, a newborn baby girl needed an ovary removed after a standard procedure to remove a cyst was delayed because of staff shortages.

According to Public Concern at Work (PCaW), two-thirds of doctors, nurses and other careworkers are accepting non-disclosure clauses built into severance agreements, in order to avoid years of suspension, financial ruin, incriminations and distress before a case reaches court. The details of these claims, including allegations of dangerous practice, dishonesty and misconduct, are never disclosed to the public.

However, judges are also failing the public by agreeing to NHS gagging orders when presiding over whistleblower cases in court. Such orders leave future patients exposed to poor practice, while past ones remain unaware that they may have been a victim, says Dr Peter Wilmshurst, consultant cardiologist at Royal Shrewsbury Hospital.

This evidence of widespread gagging comes amid government insistence that whistleblowers are fully protected under the 1998 Public Interest Disclosure Act, which made it illegal for NHS trusts and other public bodies to include confidentiality clauses preventing the disclosure of information that is in the public interest.

Dr Richard Taylor, Independent MP for Wyre Forest and a member of the Health Select Committee which condemned the lack of support for whistleblowers in its recent patient safety inquiry, will this week call for an adjournment debate on the issue. Two "terrified" local doctors have recently approached Dr Taylor after their concerns about patient safety in the out-of-hours GP service were not taken seriously.

Francesca West, a policy officer at PCaW, which provides legal advice to whistleblowers, said: "Bad employers are using super gags to hush up problems rather than sort them out, and many people feel scared and pushed into accepting these terms. That's why we are pushing for these settlement claims to be made public so we can identify problems and hold employers accountable. But why are judges allowing gagging orders through their courts anyway?"

The introduction of the 1998 Act was hailed as a huge step forward. Yet whistleblowers still risk facing "trumped up" allegations of misconduct, improper behaviour or mental illness if they feel compelled to voice concern. Margaret Haywood, for example, a nurse who filmed undercover to expose shocking care of elderly patients in Sussex, was struck off for breaching patient confidentiality, even though no patient or relative complained. She was reinstated by the High Court last month after widespread public outrage at her dismissal.

According to Peter Gooderham, lecturer in law and bioethics at the University of Manchester Law School, there are too many legal hurdles to jump over for a whistleblower to ensure their full protection. "The legal protection for whistleblowers does not work. The NHS is littered with whistleblowers whose lives have been damaged or destroyed. For protection, the whistleblower must have a reasonable belief in their accuracy, and the disclosure must be made in good faith. A whistleblower may not understand what 'reasonable belief' and 'good faith' mean, and indeed may not wish to run the risk that a court or tribunal might find against them on these points. I question whether these legal hurdles are necessary where patient care is threatened. A lot of tactics used are too subtle for the law; threats and bullying work for trusts, so they continue to be used."

The British Medical Association has opened 15 new whistleblowing cases in the past three months, and more than 200 doctors have rung its helpline since July 2009. Around a third of 1,700 Public Interest Disclosure Act claims each year involve workers in health and social care, many of which take years to resolve.

According to Dr Wilmshurst, one doctor was recently vindicated by a court, five years after raising the alarm about the misconduct of a more senior colleague. The trust agreed to pay compensation and the five years of lost salary on condition the doctor agreed to a gagging clause. The doctor, now broke, exhausted, career in tatters, had no option but to accept the terms, even though it means the public will never find out what happened.

In another case, the IoS has learnt of more than 20 senior doctors and nurses being warned against supporting the claims of a whistleblowing colleague, as this would place them in breach of their employment contract.

Mr Shiban Ahmed (see below), a paediatric surgeon employed by University Hospital of North Staffordshire NHS Trust, has been suspended on full pay since March after raising the alarm about botched operations on children and unnecessary delays in treatment. A senior colleague has told the IoS about a relentless "campaign" by the trust managers to discredit Mr Ahmed among his colleagues.

The trust said it would always encourage staff to raise issues internally first, but has not and would not prevent staff talking to the media or external parties about patient safety concerns or governance issues.

Peter Bousfield: Gagged and pushed out

In 2007 Dr Peter Bousfield, a consultant gynaecologist and former medical director at Aintree Hospitals Trust in Liverpool, felt forced to accept early retirement, with a gagging clause attached, after his concerns about insufficient staffing levels and patient safety at Liverpool Women's NHS Foundation Trust were ignored for years.

Dr Bousfield repeatedly reported delayed operations, overcrowded clinics and inadequate staffing levels to the medical director and chief executive from 2002. He was pushed towards early retirement in 2006, as an allegation of bullying was made against him – though it was not formally investigated.

He was subsequently threatened with a court injunction by lawyers acting for the trust if he ever took his concerns about patient safety to his MP or the media.

His story came to light when his son, Andrew Bousfield, a non-practising barrister, was referred to the Bar Standards Board by the trust after he tried to represent his father in correspondence.

The trust last night said it was satisfied the terms of the compromise agreement, which included the confidentiality agreement, have not stopped Dr Bousfield raising concerns with the appropriate regulatory bodies.

Nina Lakhani
Full article in The Independent