Tuesday 31 March 2009

CARE QUALTY COMMISSION-OR COCK UP QUALITY OF CARE COMMISSION



The time has come, tomorrow the CQC will “regulate the safety and quality of health and social care services” New regulation for health and adult social care providers

Health Minister, Ben Bradshaw said:

'The way that health and adult social care services are being delivered is changing. The same person may well receive care from both health and social care providers in a range of settings including at their GP surgery, community or residential settings, hospital or from a range of public or independent providers.'

'This is the first time that one single registration framework will ensure that the health and adult social care services people receive will be safe and of a high quality regardless of which organisation is providing it.'

Cynthia Bower, Chief Executive, Care Quality Commission said:

'We are pleased that the response to the Department of Health's consultation is now published and we can take the draft regulations into our discussions with stakeholders to develop our methods for implementing the new registration system.
The new system provides a historic opportunity and we are determined to ensure that we expand on the work done to date by the Department and build a robust framework of assurance of quality across all of health and social care.'

This new system replaces the different sets of existing requirements and standards for each different provider - whether they are from the NHS, local authority, independent or voluntary sectors. The registration requirements provide flexibility for care providers, setting out what they must do, but not stipulating how they must do it.

The Department of Health has consulted widely to bring together the most appropriate regulations to enable the system to work effectively for health and adult social care, whilst also reflecting differences in the nature of services delivered by providers, for example, differences between how hospitals and residential care homes provide services.

Pulse has this to say Pulse - Threat of legal action if GPs fail to follow NICE GPs will have to prove they follow NICE guidelines or face the possibility of suspension, prosecution or the closure of their practice, the Government’s new health and social care regulator has warned.

Baroness Young, chair of the Care Quality Commission, revealed that guidance from NICE would become legally enforceable from 2009/10, with doctors to face tough annual checks on their compliance.

Pulse has also learned that the commission is determined to bring all GPs under its remit, having told the Government the ‘significant clinical risks’ justify ‘system regulation of primary care as well as professional regulation of individuals’.

Baroness Young told last week’s NICE annual conference in Manchester that policing clinical guidance was set to be a key part of the CQC’s work, and admitted the commission had been handed ‘draconian’ powers by ministers.

Take a look at the comments at the bottom of the page.

Only time will tell.


Quality in a product or service is not what the supplier puts in. It is what the customer gets out and is willing to pay for. A product is not quality because it is hard to make and costs a lot of money, as manufacturers typically believe.” Peter Drucker



Angus

Angus Dei on all and sundry

NHS Behind the headlines

Angus Dei politico

Monday 30 March 2009

TOO LITTLE TOO LATE (AS USUAL)



The Dept of half arsed ideas (DOH) has decided it’s time to instigate “NHS Health Checks, which could prevent 1600 heart attacks and strokes each year and help save 650 lives will begin from April this year, announced Health Secretary Alan Johnson today.” News Distribution Service

Everyone aged between 40-74 in England will begin to be invited for a free health check as part of a national programme to identify their risk of diseases such as coronary heart disease, stroke, diabetes and kidney disease.

The programme is an essential tool in tackling health inequalities across the country.

The health checks are part of a drive to ensure that people from this age group have the necessary information about their health in order to make important lifestyle changes and reduce their risks of developing diseases like diabetes and coronary heart disease.
These illnesses currently affect the lives of 4 million people in England and are responsible for a fifth of all hospital admissions.

The checks are part of the drive towards a more preventative NHS.
The health checks will consist of:

Straightforward questions to patients on their health and diet, exercise habits and family medical history

* Height and weight measurements taken from patients * A simple blood test for cholesterol and in some cases for glucose levels * A follow up, personal assessment setting out the individual's level of risk and what they can do to reduce this * Recommendations of what could be done to reduce risk including: weight management programmes, stop smoking, physical activity programmes


The Health Secretary also announced the start of two further groundbreaking measures - the abolition of prescription charges for cancer patients and the start of MRSA screening for elective patients.

April 1 is also the date when the abolition of NHS prescription charges for everyone undergoing treatment for cancer, the effects of cancer, or the effects of cancer treatment, will also come in to effect. Up to 150,000 patients already diagnosed with cancer are expected to benefit, saving them £100 or more each year in prescription charges.

The Jobbing Doctor explains it from a GPs point of view here, what it will mean to patients is more trips to the GP surgery, more work for GPs and not a lot of difference to the healthcare we receive.



“The trouble with always trying to preserve the health of the body is that it is so difficult to do without destroying the health of the mind.” - G.K. Chesterton

Angus

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NHS Behind the headlines

Angus Dei politico

Friday 27 March 2009

THEY STILL DON’T LISTEN


Despite all the spin from “lord” Ara Darzi his wonderful, interactive health service is still deaf to the opinions of patients.


Watchdog Calls On Healthcare Services To Do More To Act On The Views Of Patients And The Public NHS trusts are increasing their efforts to listen to patients and the public, but now must go "the next step" to ensure these views are used to bring about change and improvement, according to a Healthcare Commission study published yesterday.
The Healthcare Commission study into public and patient involvement in healthcare brings together the views of hundreds of patients and members of the public and 139 healthcare providers.
The report includes some excellent examples of healthcare providers listening and responding to patients. But many patients and service users involved in the study said they felt their views were not listened to or properly acted upon.
Few trusts involved in the study could demonstrate that they routinely took account of people's views in their decision- making. Last week in its report on the impact of regulation on healthcare, the Commission highlighted that the relevant national core standard, and the assessment of it, should be strengthened to make clear to trusts how they should involve people effectively when planning and improving services.

When the Commission asked organisations what changes they had made to services as a result of peoples views, it found people are least likely to influence areas such as quality of clinical care or choice of services provided in the local area. The study also showed that people in vulnerable circumstances or in poorest health often found it hardest to get their views and experiences heard by health services.

Patients and service users involved in the study said they experienced problems when trying to make their views heard. Themes they identified included: poor communication; lack of openness; poorly designed local surveys and questionnaires; not enough opportunities to discuss views in an environment where they felt comfortable;
No sense of NHS trusts building a relationship with them over time. One in four comments from patient groups on NHS trusts' performance against the relevant core standard in the annual health check were negative. Most of these (80%) were about trusts failing to seek the views of patients and the public. About 50% were about how far, if at all, their views were taken into account.
People's views were not used routinely in planning and improving health services. Most trusts could provide some examples of using people's views, but few demonstrated they routinely took account of them when planning and improving services. In addition, few organisations described any evaluation of their work with patients to find out whether it made a difference to people or services. The Commission recommends trusts should be able to demonstrate that people are influencing their major service and commissioning decisions.


“Lord” Darzi take note.


"I like to listen. I have learned a great deal from listening carefully. Most people never listen." Ernest Hemingway


Angus

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Angus Dei politico

Thursday 26 March 2009

TIME TO SCRAP THE NHS TARGET POLICY


There have been a lot of stories lately regarding the damage to patients caused by hospitals trying to reach the Dept of Health pointy heads target policy.

I am sure you have all read the Mid Staffs horror stories, here is another “Trust” that is producing questionable target results Medical News Today “An NHS hospital has been employing staff on administrative tasks in order to artificially inflate performance against a key Government target, Pulse can reveal.
Royal Cornwall Hospitals NHS Trust has asked staff to manually upload paper referrals from GPs to boost performance against a Government target for e-booking and offering patient’s choice.
The activity means the hospital and the local primary care trust, NHS Cornwall and Isles of Scilly, appear to be closing in on a Government target for use of Choose and Book - when in reality many referrals continue to come in on paper forms.
A report to the board of NHS Cornwall and Isles of Scilly admits: 'Royal Cornwall Hospitals NHS Trust has been uploading paper referrals to the Choose and Book system to improve performance.”


This hospital is not “killing” patients because of the policy but it is encouraging the management of the hospital to produce inaccurate data that is used by the useless Monitor to “rate” the hospital.


The pointy heads brought in the target culture to enable us to establish whether we would want to be treated by hospitals based on the rating given.

It obviously isn’t working, I am not saying that all hospitals bolster the data to achieve targets but, it plants the seed of doubt in my mind that the rating system is not worth the web site it is written on.

It makes me feel that I can’t trust any of the ratings given by the useless Monitor and that the time has come for the demise of the “target culture” in our NHS.


The constant dilemma of the information age is that our ability to gather a sea of data greatly exceeds the tools and techniques available to sort extract and apply the information we've collected.” Jeff Davidson

Angus

Angus Dei on all and sundry

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Angus Dei politico

Wednesday 25 March 2009

MID STAFFORDSHIRE HOSPITAL-LESSONS TO BE LEARNT


Back in the summer of 2007 analysts working deep in the bowels of the leading London University Imperial College noticed something appeared amiss at a hospital many miles away.

The researchers, working for the private group Dr Foster, had spotted death rates at Mid Staffordshire NHS Trust were too high.

They raised the issue with the Healthcare Commission in July, and then the following month more anomalies were noted by the Imperial team.

The Healthcare Commission's own assessment system also started noticing potential problems, and within months a full investigation was launched.

It resulted in the watchdog publishing one of its most damning reports on an individual NHS trust.

The Healthcare Commission said standards of emergency care were "appalling" and would have led to unnecessary deaths.

Lessons to be learned

But what are the implications for the rest of the NHS?
Healthcare Commission chairman Sir Ian Kennedy said it was a story of one badly run hospital.

The watchdog looks into 12 alerts a month on average - the majority of which do not even result in a formal investigation.

None of these have thrown up the combination of concerns raised in the Mid Staffordshire report - namely low staffing levels, inadequate nursing, and lack of equipment, poor training, and bad management.

Things were so bad, the inspectors said, that receptionists were carrying out initial checks on patients arriving at A&E.

However, the watchdog still felt compelled to issue a number of warnings to the rest of the health service.

It said managers should not become obsessed with targets to such an extent that patient care is no longer the priority - as happened with Mid Staffordshire.

The report highlighted the use of a ward near to A&E which acted a "dumping ground" for patients so the hospital could meet the four-hour waiting time target.
It also said monitoring performance and comparing it to other NHS trusts was essential.

This is something the central command of the NHS at the Department of Health is expected to focus on in the coming weeks.
The above is part of the article on BBC NEWS Health

The real lessons to be learned are:

The Healthcare Commission is not fit for purpose; it has a policy of “a light touch to regulation.” “Gone are the days when inspectors would patrol the corridors of hospitals, and in their place is a system largely based on self-assessment and feedback.”

The problem with self assessment is just that, the hospital management tell the HC how wonderful they are performing, and the HC believes them, I have experience of both the HC and a Foundation trust, the Trust will lie and deny, the HC is completely biased towards the trusts and will believe what they are told.

The Healthcare Commission will cease to exist on April the 1st this year, what we need is to step back to “inspectors would patrol the corridors of hospitals,” and given the power to investigate “problems” and complaints.

Monitor, the institution that is supposed to ensure that the trusts are complying with the rules has failed; once again it believes what the trusts tell it.

That is the problem with self assessment, there are no checks, and the hundreds of deaths at Mid Staffs is the result layer upon layer of so called “regulators”.

“But Sir Ian rejected any suggestion that the watchdog was culpable.
He said the very fact the report had now been published was proof the watchdog's approach to inspection was working.
He said: "Everyone else was fobbed off. We alone stayed the course."
But whatever the truth, it seems the fall out from Mid Staffordshire has only just begun.”

Don’t forget that the deaths started back in 2002, and were ignored by the HC and Monitor for seven years.

If that is an example of “doing your job” then the unemployment figures should be increased by the number of pointy heads at the HC and Monitor.

When will the state of the country be sound? When its people believe that the end result of cowardice is more disastrous than that of behaving with integrity.” Naquib Mahfouz


Angus

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Angus Dei politico

Tuesday 24 March 2009

WELFARE REFORM BILL


Pointy head James Purnell the Department of Works and pensions is pressing ahead with his “you will work” ethic.

This relates to both politics and health so I will be posting it on the Politico and the NHS blog.

Bills and Legislation - Welfare Reform Bill

The summary of the bill is:

The Bill proposes to reform the welfare and benefit system to improve support and incentives for people to move from benefits into work. It contains measures to increase personal responsibility within the welfare system. It also proposes to encourage parental responsibility by introducing a requirement for joint birth registration and by amending the law relating to child support.
Key areas:

Reforms the benefits system by abolishing Income Support and moving all claimants on to either Jobseekers’ Allowance if they are well or Employment and Support Allowance if they are sick

Aligns the contribution conditions between Employment and Support Allowance and Jobseeker’s Allowance

Introduces a regime of benefit sanctions for non-attendance at Jobcentres
Requires job search by partners of benefit claimants

Abolishes Adult Dependency Increases in the Carer’s Allowance and Maternity Allowance

Introduces work-focused interviews for over-60s

Requires work-related activity in return for receipt of Employment and Support Allowance

Introduces a requirement for births to be registered jointly by both parents
Provides additional powers for the enforcement of child maintenance arrears.


Extracts from the explanatory document are:

‗Work for your benefit schemes‘will be piloted for long-term jobseekers who have received increasingly intensive support from Jobcentre Plus and specialist back-to-work providers.
They will give jobseekers the opportunity to develop their work skills through undertaking full time work-experience.
Work for your benefit schemes will also be piloted for some jobseekers who are likely to benefit from the scheme at an earlier stage of unemployment.

The schemes will be mandatory and aim to help jobseekers find sustained work in the open labour market. Some jobseekers are likely to face particular barriers due to the length of time they have been away from employment. Work for your benefit schemes will enable them to benefit from the opportunity to develop work habits and routines that they may not have experienced for some time.

Progression to Work‘group, for whom an immediate return to work is not appropriate, but is a genuine possibility with time, encouragement and support.

18. The intention is to establish a personalised conditionality regime which is tailored to the individual‘s circumstances, so that preparation for work becomes a natural progression rather than a sudden step up. The Bill includes provision that will ensure lone parents and partners of benefit recipients in the Progression to Work group are required to undertake action planning and work-related activities. These actions and activities are broadly defined to ensure they are appropriate to the needs and circumstances of each individual. In instances where work-related activity is identified which will improve their employment prospects, for example as a result of a skills health check, individuals may be directed to carry this out.

The document is 78 pages, so if you want to red it all click on this link and then on the subject that interest you.

It seems that the Gov is determined to abolish “proper” support to the sick and disabled and move everyone onto “employment” benefits.


“Government is the great fiction, through which everybody endeavours to live at the expense of everybody else.” Frederick Bastiat


Angus

Angus Dei on all and sundry

NHS Behind the headlines

Monday 23 March 2009

Row over impact of cancer policy






The NHS cancer plan may have helped boost survival rates in England, a study suggests - but experts are split over its real impact. BBC NEWS

A comparison with Welsh data suggests "some beneficial effect" of the England cancer strategy launched in 2000.

But a leading cancer expert said the Lancet Oncology paper showed no "striking" improvement despite a huge amount of cash pumped in.

Cancer tsar Professor Mike Richards said both countries had seen benefits.
The study comes as the Office for National Statistics publishes the latest figures on cancer survival up to 2007.

For cancers of the stomach, colon, rectum, uterus, ovary and kidney, survival trends in England improved after 2001, even without screening or the widespread use of effective new treatments.

But bladder cancer, Hodgkin's lymphoma and leukaemia all showed a fall in survival, the figures showed.

The team, led by Professor Michel Coleman from the Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine in London, said the findings did not produce a "definitive verdict" and called for more detailed analysis on specific parts of the cancer plan, such as shorter waiting times and the creation of multidisciplinary teams.








As usual it doesn’t come down to money but “proper” treatment by caring medics.


"All progress occurs because people dare to be different." Harry Millner



Angus

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Friday 20 March 2009

FINALLY-A BIT OF COMMON SENSE


BBC NEWS 'Make hospitals admit error' call the system for hospitals to report errors in the care of patients should be mandatory, a patients' group says.

There is also this BBC NEWS NHS patient error deaths 'rising'

And this BBC NEWS NHS 'still failing on safe care'

So it’s not as if this were a new “thing”.


The Patients Association said that in the wake of the highly-critical report on Stafford Hospital, the time had come for the end to the voluntary system.

The National Patient Safety Agency (NPSA) reporting system depends on NHS trusts owning up to mistakes.

Regulators have already said the health service is not doing enough in reporting patient safety incidents.

The NPSA has been collecting data since 2003 in a bid to help the heath service learn from its mistakes.

In the first year, NHS trusts were only reporting just over 100 errors every three months, but that has now increased to 250,000.

However, despite the improvement the agency is still unable to compare trusts' performance because of suspicions of under-reporting.

On top of that, 32 of the 391 NHS organisations in England and Wales did not submit any incidents or enough to be included in the latest data.

The situation prompted the Healthcare Commission to call for an improvement from NHS trusts earlier this month.

And now the Patients Association says it is time to force the NHS to comply.

And about bloody time, but why has it taken the NPSA six years to reach this conclusion.

Maybe it’s because the news has exploded with horror stories this week, and they can’t ignore it any longer.

You can fool too many of the people too much of the time.” James Thurber


Angus

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Thursday 19 March 2009

Too much red meat could lead to blindness, claim scientists

From the Telegraph Researchers have shown that those who consume 10 portions or more a week are nearly 50 per cent more likely to experience deterioration of the retina in old age.

But tucking into chicken at least three times a week can have a protective effect, reducing the risk of blindness by more than half.

The findings, published in the American Journal of Epidemiology, are the latest to suggest a strong link between diet and age-related macular degeneration (AMD), Britain's leading cause of vision loss.

The macular is the central and most sensitive section of the retina. It allows us to see fine detail for reading and writing, as well as our ability to see colour.

The disease affects an estimated 500,000 people in the UK. It usually develops after the age of 50 and is caused by the growth of new blood vessels under the centre of the retina.

These blood vessels leak fluid, causing scar tissue to form and destroying vision in the centre of the eye.

For many sufferers this process can take several years. But in extreme cases, it can take place within a couple of months.

The latest evidence suggests curtailing red meat intake could help some people ward off the disease.

Researchers at the University of Melbourne, Australia, studied 6.700 people aged between 58 and 69.

They documented how many had early signs of AMD and matched the results up with dietary habits gleaned from food questionnaires.

The results showed those who ate an average of ten portions of red meat a week – such as roast beef, meatballs or lamb chops – were 47 per cent more likely to be suffering the early symptoms of AMD than those who ate it less than five times a week.

In contrast, those who ate chicken at least 3.5 times a week were around 57 per cent less likely to have vision loss than those who ate it 1.5 times a week.

OK, seems sensible, but tell me, how many “older” people can afford to eat red meat ten times a week?


I eat like a vulture. Unfortunately the resemblance doesn't end there.” Groucho Marx


Angus

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Wednesday 18 March 2009

HOSPITAL DEATHS


The Stafford Hospital horror BBC NEWS is I am sure being covered by bloggers more able to explain it than I can so I have decided to post this BBC NEWS Hospital death data 'misleading' from the good old BEEB.

Birmingham University have said that comparing Hospital Death rates between trusts is an “unfair” way of rating your local Hospital.

Bollocks, if I had to go into hospital and found out that my Hospital had double the death rate of a Hospital ten more miles away, guess which one I would choose?

It’s common sense, it is necessary information, we are told almost every day to rate this and rate that in the NHS, the trusts MUST be forced to publish this information, because we deserve to know our chances of being killed while under their “Care”.

The other thing is of course that the “powers that be” should pick up on these stats much, much faster than they do, because when they don’t you get the Stafford Hospital debacle.

Unfair? Not for the patients it isn’t, the management of the trusts take enormous amounts of our money home in salaries; they must also take the responsibility when things go wrong.

The ultimate priority of humanity should not be to savour the power given to us, but rather to account for the according responsibility.” Harrison Christian



Angus

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Monday 16 March 2009

SHOULD WE LISTEN TO CANCER SCARE STORIES?


BBC NEWS Giving up smoking is a good idea if you want to avoid cancer. But is it worth giving up anything else?

In the past few weeks alone we have been warned of the potentially carcinogenic qualities of coffee, alcohol, red meat and bacon.

The latest dietary 'bad boy' under the spotlight is fried food - apparently a risk for ovarian and womb cancer.

The media keeps us supplied us with a steady stream of these stories.

But among some specialist journalists there is a growing scepticism.

Michael Hanlon, the Daily Mail's science editor, said he has no intention of giving up any of the foods identified as risky - despite the fact that his own newspaper has carried plenty cancer warnings over the years.

On Radio 4's numbers programme More or Less, he challenged cancer expert Professor David Shuker to tell him how many months or years he might add to his life by following the World Cancer Research Fund's recent advice to limit red meat intake and avoid processed meats altogether.

"There are a few years to be gained by following this advice," according to Professor Shuker, an adviser to the WCRF expert panel member.

"But we cannot predict at the level of individuals what the benefit will be. We can only advise individuals how to join the group that has a lower risk."


It seems to be personal thing, do we stop eating red meat, processed meat, and anything else that is “bad” for us, and live on fruit and vegetables like a animal, or do we use the brain we have eat what we like and forfeit a couple of years at the end of our lives. With the knowledge that at least we have enjoyed ourselves?

I know which choice I would make.

The first law of dietetics seems to be if it tastes good, it’s bad for you.” Isaac Asimov

Angus

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Sunday 15 March 2009

GOOD; OR BAD NEWS FOR PATIENTS?


News Distribution Service Express LIFT framework partners announced

The list of successful bidders for the Express LIFT (Local Improvement Finance Trust) framework, which will reduce the time and cost in appointing LIFT partners for Primary Care Trusts and local authorities, has been published today by the Department of Health.

Currently around half of PCTs in England are using LIFT to update facilities and build new, modern GP surgeries, health centres and walk-in centres. LIFT enables PCTs and local authorities to develop new capital schemes faster than traditional procurement methods and provides a framework for long-term partnership between the public sector and private sector developers.

Express LIFT accelerates this process even further, offering PCTs and local authorities who have not yet conducted their own procurement, the opportunity to select a pre-approved LIFT partner more quickly and cost effectively from the list. Local procurements from the Express LIFT framework can be completed within three or four months as opposed to two years as is currently the case.

The successful framework partners have been selected on their demonstrated ability to provide expert advice and services required of a successful LIFT Company whilst providing good value for money for the taxpayer. The seven approved LIFT partners are:
Community Solutions for Primary Care * Express LIFT Investments Limited * Equity Solutions * Eric Wright Group * Fulcrum Infrastructure Group * Odyssey Healthcare * Prime Plc

For the first time ever in the LIFT process neither the bidder nor the PCT will need to engage in expensive design work prior to the establishment of a LIFT company. The list of framework partners reduces the cost of wasted bids, and will not only benefit the private sector, but ultimately the taxpayer. This new process allows both PCTs and the LIFT partners to focus on delivering through long-term strategic partnerships, some of which can last for twenty years.

Health Minister, Ben Bradshaw said:

"LIFT has proved highly successful in allowing Trusts to upgrade inadequate or ageing facilities around the country.

"The successful companies approved on the Express LIFT framework today will go one step further in cutting down on the time and cost of the procurement process and help the scheme expand rapidly. It will enable more Primary Care Trusts and local authorities to take advantage of its benefits - faster builds, improved working conditions for staff, better care environments for patients, and better overall facilities available for the local community."

Dr Ian Mitchell, a GP and Chair of NHS Cumbria's professional executive committee said:

"As Cumbria expects to be one of the first PCTs to use the new framework, this announcement is an important milestone and one that brings us a step closer to developing 21st Century healthcare facilities for the people of Cumbria.

"Cumbria's plans to revitalise our community hospitals are developing quickly, and the pre-approved Express LIFT partners will help us accelerate the process even further in a more cost effective way. By working with a LIFT Company to create purpose-built facilities, where healthcare is often on the same site as pharmacies and social care services, we can provide modern and much improved services, closer to where people live. This will bring benefits to both patients and professionals".

Providing the best potential LIFT partners with the opportunity to expand through their appointment to the framework will make the market stronger and deliver improved benefits to the NHS.

I don’t pofess to know much about this, but the bit that concerns me is the “public/private” statement, yes it will provide much needed facilities, but will it be like my own local “Centre for Health” which is not owned by the NHS but is rented to them by the private sector, in my view the money spent on rent should be used for patients, not lining the pockets of companies who are not really interested in health but profit.

Or is this the way our NHS is headed, public treatment in private buildings, with the capital cost recouped many times over by the private sector?

"Progress lies not in enhancing what is, but in advancing toward what will be." Kahlil Gibran

Angus

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Saturday 14 March 2009

TRAFFIC IS BAD FOR YOUR HEART


I seem to be making a series of “bad for your” posts, but the Telegraph has this:

Researchers found that people were three times more likely to have an attack if they had recently spent time on the roads, possibly because of the exhaust fumes and other pollution they inhaled.

Women were more at risk than men - five times more likely than normal to suffer a heart attack if they had been exposed to traffic within the preceeding hour.

The “experts” seem to think that it’s the “the exhaust and air pollution coming from other cars, but we can't exclude the synergy between stress and air pollution that could tip the balance".

As well as women, elderly men and patients with a history of heart problems were most at risk, according to the findings.

My take on this-STRESS, most new cars have micro filters which remove the pollutants, unless you have the windows open of course.

It’s STRESS, spending bloody hours in traffic jams because the plonkers can’t get the roadworks done at night when there is less traffic, crawling along at stupid speed limts on open roads, having to keep watching the speedometer, getting caught in the “school run” every firkin day because the parents have lost the use of their legs and can’t walk anymore, stopping at traffic lights every two hundred yards because the plonkers at the council think it “helps traffic flow”, getting dizzy negaotiating five or six roundabouts in a half mile stretch of road in towns, one way systems where you have to travel four bloody miles to get to your destination which was only half a mile away at the start of the one-way system.

The pillocks that don’t indicate, undertake, cut in, cross three lanes on the motorway to make the exit, stick their bonnets up your exhaust and try to intimidate you into getting out of their way, the arseholes who still insist on using their mobiles while driving, the lorries that seem to thimk you can fly into the air when they pull out on a dual carriageway while you are alongside them.

The tosspots who are in “charge” of our roads don’t have the faintest idea of what they do to drivers, it’s no bloody wonder people drop dead from heart attacks after driving, the STRESS is killing them.

Rant over.


“If you think you’re under pressure, you’re probably not, because when you really are, you don’t even have time to think about it.” Ron De Jonge

Angus

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Friday 13 March 2009

DARZI’S “NEW” NHS


More misery, still it is the thirteenth.

This tale concerns an old mate of mine-El Cleef (don’t ask), anyway he went into hospital to have a shiny new hip fitted, it was done at a local private establishment, because his sons who live on the other side of the world decided to pay the medical insurance for him.

The operation went fine and he was recovering, he was due out on Tuesday in the morning, this was delayed until the afternoon because on the Monday night he had a horrendous nose bleed during the night.

So, I picked him up at four in the afternoon, took him home and his partner settled him in.

That night he had another horrendous nose bleed, the Ambulance was called and unfortunately he was taken to our local Foundation Trust (grimly dark as it is known to the wise), he arrived at the A&E dept at about 2am, and apparently the place was heaving with patients, by 2pm he was still in the A&E dept still in his blood soaked pyjamas and still waiting, he had been seen but there was some confusion as to his diagnosis.

I would like to point out here that two days before the hip op his leg gave way and he fell, head-butting the washing machine and suffered a nose bleed.

Anyway, his partner visited him at 4.30 pm and yes, he was still in A&E, still in his blood soaked pyjamas and still waiting for a bed, apparently after a “word” or two with the powers that be, he was moved to a temporary male ward where he was given clean pyjamas and a proper bed.

My old mate El Cleef (don’t ask) is 75, he was a few days post op for his shiny new hip and was left in A&E for 14 hours or so.

So I would like to thank “Lord” Darzi for the wonderful work he is doing in making OUR NHS better, for all the our money he has spent “improving” treatment and making our hospitals better.

I would also like to thank “Grimly Dark” for their caring attitude and treatment of my 75 year old mate, for living up to the “excellent” rating they have received from the Healthcare Commission, and for treating my mate as a piece of meat, and leaving him in pain and confusion for over half a day.

The people I distrust most are those who want to improve our lives but have only one course of action.” Frank Herbert


Angus

Angus Dei on all and sundry

NHS Behind the headlines

Angus Dei politico

Thursday 12 March 2009

THE EU IS BAD FOR YOUR HEALTH


The Telegraph has this today, “Patients face a significant increase in waiting times for operations as 'insane' European rules mean doctors' hours are cut so much medics will not be able to cope, surgeons have warned.”

Labour has been boasting, as have the trusts about reducing waiting times about the majority of patients are treated within the target of 18 weeks from seeing their GP.

However this will be reversed as junior doctors will be limited to working a 48-hour week, from their current 56 hours, it is claimed.

“The extension of the European Working Time Directive will effectively result in the loss of thousands of doctor shifts, John Black, President of the Royal College of Surgeons said.
And the Government fears there will be a lack of locum doctors available to step in and help fill the gaps, following changes in doctors' recruitment.

It means patients will have to wait months for routine operations as surgeons prioritise emergencies rather than scheduled cases.

The Royal College of Surgeons wants trainee surgeons on a 65-hour working week in order to produce safe, properly trained doctors and cover the workload required by hospitals.

Mr Black said: "If the 48 hour limit is enforced, surgeons will have to make a hard choice
between caring for emergency cases and dealing with elective cases as there will not be the time available to do both. Surgeons will put patient safety first and focus on looking after emergency patients.”

The shake-up of doctors' training, which caused a fiasco in 2007, means more trainees are in longer-term posts so there are now fewer candidates looking for locum posts and temporary jobs.

Remedy UK, the junior doctors pressure group, has calculated that switching all juniors from a 56 hour to a 48 hour working week is the equivalent of losing one working day per doctor per week, or up to 70,000 doctor days per week across the UK.

Dr Matt Jameson Evans, co-founder of Remedy UK, said: "In many key specialties the system is already massively overstretched.

The Department of Health wants to delay the introduction of a 48-hour week for some specialities and is expecting an answer from the European Commission by the end of May. However this would only mean some doctors could remain on 56 hours until 2012 and will not solve the problem in the long-run, experts have said.

A spokesman for the Department of Health said: "Most UK doctors in training already comply with the Working Time Directive, and the overwhelming majority will do so by 1st August this year. However, we have notified the European Commission that we intend to operate a derogation for a small number of services involved in delivering urgent and emergency patient care."

Come on Gov grow some balls and tell the EU where it can poke its “working time directive”

“Government is the great fiction, through which everybody endeavours to live at the expense of everybody else.” Frederic Bastiat

Angus
Angus Dei on all and sundry

NHS Behind the headlines

Angus Dei politico

Wednesday 11 March 2009

RECESSION STOPPING HEALTHY EATING


BBC NEWS it seems that the credit crunch is making a quarter of us put healthy eating to the back of our minds.

Which found 24% of UK adults feel healthier eating is now less important, with 56% saying price has overtaken as a priority when choosing food.

And the poll of 2,102 showed 76% think the government needs to take action to make choosing healthier options easier.

Although most of us want to eat more healthily, the current economic climate is a barrier to our good intentions, says Which.

Nearly three in five said they would buy more fruit and vegetables if they were cheaper.


Rates of obesity and diet-related disease continue to rise, with around a quarter of the UK population now obese.

Based on current trends, almost 60% of the UK population will be obese by 2050.

In the meantime, there are things people can do to help themselves through these hard financial times, such as making meals from scratch and buy fruits and vegetables that are in season - things that should make food shopping bills more affordable.

The other side of the coin: - The British Retail Consortium said Which? was wrong to say price was a barrier to eating well.

Spokesman Andrew Opie said: "Which? is actually discouraging customers from exploring healthy eating choices by pushing the myth that fresh fruit and vegetables are expensive.
Customers should look beyond scare headlines, get into supermarkets and see just how affordable good fresh food is."

He said retailers and manufacturers had worked hard to make food more healthy and affordable.

So why is the rate of inflation 12% on food?

“Spaghetti can be eaten most successfully if you inhale it like a vacuum cleaner.” Sophia Loren

Angus

Angus Dei on all and sundry

NHS Behind the headlines

Angus Dei politico

Tuesday 10 March 2009

DUCK! IT MAY MAKE YOU LIVE LONGER


BBC NEWS People with quick reactions are likely to live longer than those less quick off the mark, a study suggests.

The joint Edinburgh University and Medical Research Council team looked at the response rates of more than 7,400 people, the journal Intelligence said.

Researchers found those with the slowest reactions were 2.6 times more likely to die prematurely.

They said quick reactions may be a sign of intelligence, which in turn was linked to healthier lifestyles.

Dr Geoff Der, one of the authors of the report, said: "Research has shown that there is a correlation between reaction times and intelligence. "

"People with greater intelligence tend to have been better educated and worked in jobs where resources and workplaces practices are better."

"They also look after their health better in regards to smoking, exercise and eating."
Researchers also said the implications could go back to birth with quicker reactions being a marker for a healthy body."

Dr Der added: "There is tentative evidence which suggests the body is just better wired."

"In all probability, it is probably a combination of all of these reasons."



Makes sense to me, especially if you are a javelin catcher at the Olympics.

"The people who say they don’t have time to take care of themselves will soon discover they’re spending all their time being sick." Patricia Alexander

Angus


Angus Dei on all and sundry

NHS Behind the headlines

Angus Dei politico

Monday 9 March 2009

MORE PRIVATE PATIENTS OR NO TOP UPS


BBC NEWS Leading hospitals in England say they may be forced to refuse patients who want to top up their care because they fear they could be breaching NHS rules.
Elite hospitals with foundation trust status have a cap on the number of patients they can treat privately.

And NHS managers have warned that unless the limit is scrapped they will have to send top-up patients elsewhere.

The House of Lords is due to debate scrapping the cap, but unions have said such a move could harm NHS care.

It was only in November that the government agreed to allow top-ups - where patients pay privately for care not available on the health service while continuing to receive their basic package of NHS treatment.

But now foundation trusts have said the policy could unravel because of the long-standing rule on private patient income.

Sue Slipman, director of the Foundation Trust Network, said: "Hospitals are worried that because they are close to the cap they will have to send patients to other centres.
"Top-ups are still bedding in, but in the future it could be a serious problem."

However, Unison is opposed to scrapping the cap.
A spokeswoman said: "Our fear is that it will allow these hospitals, with all their freedoms, to effectively become private facilities. That is not in the interests of NHS patients."

The Department of Health said the government would respond to the amendment through the parliamentary process in due course.

But a spokeswoman also added that officials were carrying out a national audit of demand for unfunded drugs "to help inform our consideration of policy on the private patient cap in the future".

The usual half arsed policies from the Dept of Half arsed ideas, the answer is quite simple, supply the drugs under the NHS, then the “Prima-Donna” Foundation trusts can treat the patients.

There is a simplicity that exists on the far side of complexity, and there is a communication of sentiment and attitude not to be discovered by careful exegesis of a text.” Patrick J Buchanan


Angus




Angus Dei on all and sundry

NHS Behind the headlines

Angus Dei politico







Sunday 8 March 2009

END OF LIFE ADVICE FOR MEDICS

BBC NEWS The medical regulator is to issue updated guidance to doctors on making treatment decisions at the end of life.

Doctors must consider any harm caused by going against patient wishes in withdrawing artificial nutrition, the General Medical Council says.

The draft recommendations also advise on holding early discussions with patients about end of life decisions.

Doctors at the British Medical Association said any "additional clarification" is welcome.

The guidance, which will be put out for consultation, builds on a raft of previous reports on how doctors should approach end of life care.

It has long been the case that patients have a legal right to refuse treatment.

But in recent years there has been controversy about the right of patients to be tube fed or hydrated right up until the point of death.

In 2005, Leslie Burke, 45, who has a degenerative brain condition, lost his legal case to prevent doctors withdrawing artificial nutrition against his wishes.

The GMC guidance states that in some cases providing nutrition or hydration at the end of life may cause unnecessary suffering.

For example, if a patient's kidneys were not functioning or fluid was collecting in their lungs then to continue a saline drip might cause a more unpleasant death.

Doctors can still withdraw treatment in the best interests of the patient but the new guidance says they "must consider any harm that might be caused" in going against the patient's interests.

The recommendations also provide clarification on when attempts at resuscitation with CPR may or may not be in a patient's best interests.

It does not cover assisted suicide, which is illegal in the UK.

The GMCs arrogance is exposed-“Jane O'Brien, GMC assistant director of standards and fitness to practise, said: "Clinicians still have the final say on 'best interests', but we are asking them to give greater weight to patients' wishes in a more formal sense than we have before.

"Those who have strong feelings about how they want themselves or their loved ones to be treated should expect those feelings to be considered."

Wrong! The patient has the final say on best interests, and until the GMC realise that they will remain the piss poor institution that they are.
“The public good is in nothing more essentially interested than in the protection of every individual's private rights.” William Blackstone

Angus

Angus Dei on all and sundry

NHS Behind the headlines

Angus Dei politico

Saturday 7 March 2009

Lost prescription data


Almost 46,000 NHS prescriptions containing patient details were lost or stolen in one year, figures obtained by the Tories show.

About 130 prescription forms per day went missing in 2007/08, a rise of 49% on the previous year, when almost 31,000 were lost or stolen.

The forms went missing in transit between pharmacies in England and the arm of the NHS which reimburses the costs.

The Government reacted to the figures by saying that more than 99.9% of prescriptions are processed securely.

Almost 46,000 forms were lost between April and November 2008, which suggests the total figure for the year 2008/09 is likely to rise even further.

Overall, between April 2007 and November 2008, there were 241 separate incidents where batches of the forms were lost or stolen, health minister Dawn Primarolo said in response to a request from the Tories.

The forms contain a patient's name, address, NHS number, date of birth and details of the drugs they are prescribed.

If a patient fills in the reverse of their prescription form to claim exemption from paying, there is also space for a National Insurance number to be written.

The Conservatives said the Government was still sending prescriptions by courier rather than electronically, despite a pledge to do so by 2004.

Shadow health secretary Andrew Lansley said: "The Labour Government has showed time and again that it is utterly incapable of protecting people's most private details which have been entrusted to them."

"There is nothing more frightful than ignorance in action." Johann Von Goethe

Angus

Angus Dei on all and sundry

NHS Behind the headlines

Angus Dei politico






Friday 6 March 2009

Prescription,Dental charges and Optical vouchers

I have posted the entire letter, basically it all goes up on the 1st of April.

CHANGES TO PRESCRIPTION AND DENTAL CHARGES AND OPTICAL VOUCHERS

From 1st April changes will be made to prescription charges and some dental treatments in England. The value of optical vouchers will also increase by an overall 2 per cent.

The prescription charge exemption for people being treated for cancer, the effects of cancer, or the effects of cancer treatment also comes into force from 1st April. This new scheme will benefit up to 150,000 people already diagnosed with cancer, who might otherwise pay around £100 a year in prescription charges.

The following changes will come into effect on 1st April:

Optical
Optical vouchers will increase in value by an overall 2 per cent.

Vouchers help with the cost of spectacles and contact lenses for children, people on low incomes and people with complex sight problems.

Dental
The maximum charge for complex NHS dental treatments, such as the fitting of crowns, bridges or dentures will be frozen at the existing rate of £198.

For the simplest and most common visits to the dentist, involving an examination, advice and any necessary X-rays or scale and polish, the charge will go up by 30 pence from £16.20 to £16.50.

The charge for intermediate treatments such as fillings or extractions will increase by £1 from £44.60 to £45.60.

Prescriptions
Prescription charges will increase by 10 pence from £7.10 to £7.20

Health Minister Dawn Primarolo said:

“In England, 89 per cent of prescription items are dispensed for free, the remainder provide valuable income to the NHS.

“From April 1 cancer patients will be eligible for free prescriptions. A review of how this exemption can also be extended to patients with long-term conditions is currently underway and recommendations will be made to me in the Summer”





Dental charges will change as shown:
Course of treatment
Current Charges
Charge from 1 April 2009
Band 1
£16.20
£16.50
Band 2
£44.60
£45.60
Band 3
£198.00
£198.00

NHS Prescriptions and Appliances charges will change as shown:
Item
Current Charges
Charge from 1 April 2009
Prescription
£7.10
£7.20
12-month PPC
£102.50
£104.00
3-month PPC
£27.85
£28.25
Surgical brassiere
£24.00
£24.35
Abdominal or spinal support
£36.30
£36. 80
Stock modacrylic wig
£59.20
£60.00
Partial human hair wig
£156.60
£158.90
Full bespoke human hair wig
£229.05
£232.45

People in receipt of working tax credit with child tax credit or with a disability (or severe) disability element or child tax credit on its own, are entitled to free prescriptions, free NHS dental treatment, and NHS sight tests and optical vouchers if their annual income for tax credits is below a specified level. This is currently £15,050 and will increase to £15,276 from 6 April 2009.

Prescription Prepayment Certificates offer savings for those needing 4 or more items in three months or more than 14 in one year.

Cancer patients with an exemption certificate will be entitled to free prescriptions from April this year.

The Government has established a review of prescription charges, led by Professor Ian Gilmore, President of the Royal College of Physicians. In drawing its conclusions, the review will take into account the views of patients, the public, patient representative bodies, clinicians and healthcare organisations in considering how to exempt patients with long-term conditions from prescription charges

NHS charges and optical voucher values in Scotland, Wales and Northern Ireland are a matter for the Devolved Administrations.

So we know who to blame!

Angus

Thursday 5 March 2009

A MATTER OF PERSPECTIVE

The almost defunct Healthcare Commission has issued one of its last documents, this one is entitled:

“Report highlights that patients remain concerned about how trusts deal with their complaints, as well as the same basic aspects of healthcare” ” Healthcare Commission
And contains the usual stats:

The way trusts handle complaints is still the number one issue raised by complainants, accounting for 19% of cases reviewed, up from 16% last year.

In almost half of complaints reviewed, the Commission either upheld the complaint or sent it back to the trust for further work because the trust's initial response to the complainant was not good enough.

Patients and the public also continue to raise issues about the same basic aspects of healthcare such as: poor communication (12% of cases, down from 17% in 2006/07), standard of treatment (11% up from 6% in 2006/07), delay or failure to diagnosis a condition (9%), and delays in accessing care (8% up from 4% in 2006/07).

The Commission upheld 30% of the cases reviewed in this period, up from almost 20% last year. In a further 17% of cases (down from 26% in 2006/07), the Commission found the trust's response to the complainant was not sufficient and it was sent back to the trust for further work. This means almost half of complaints reviewed required further work by the trust.

Twenty-seven percent were out of the Commission's jurisdiction, mostly because the complainant had not raised their concerns locally first. This is up from 24% last year, suggesting that some trusts are not making the complaints procedure clear enough for patients and the public or that people do not have faith in the independence of the local procedure.

Eighteen percent of cases were found in favour of the trust as it was found that the NHS had handled them appropriately. Most of the remaining cases were either withdrawn by the complainant or referred on to the Parliamentary and Health Service Ombudsman.

The report shows there were an equal number of complaints reviewed by the Commission about both primary and hospital care (both 43%). The remainder were about mental health trusts (10%), strategic health authorities (1%), ambulance trusts (0.9%), prisons (0.8%) and other trusts (2%).

Yawn, yawn.

Here is the Analysis of the complaints reviewed by the Commission which reveals the following themes:

Hospitals (43% of total)The majority of complaints about hospitals were concerning nursing care. Of these, 43.5% were about general care, highlighting issues such as nutrition, falls and observation of patients.

GP practices (11% of total)Complaints about GPs were the most common type of complaint about the primary care sector. Twenty-five percent of complaints about GPs were in relation to a delay or failure to diagnose a condition or illness.

Dental surgeries (4% of total)The majority of complaints about dental services related to treatment (36%). This included issues such as delays in accessing services and incorrect or unsuccessful treatment.

Accident and emergency care (3% of total)The main issues complained about were related to treatment (24%). There were concerns about ambulance response times and incorrect treatment.

Maternity services (2% of total)Thirty-one percent of complaints about maternity services were about treatment. These include complainants' concerns about the standard and timeliness of treatment they received.

Mental health services (5% of total)The main concerns were in relation to general care (47%), such as the appropriateness of treatment, care review meetings and the use of control and restraint.

Learning disabilities (0.3% of total)These were not primarily complaints made about learning disability services, but healthcare services for those with learning disabilities. Recommendations to the trust were made in over half of cases.

No stats on Hospital doctors I see.

This is where the different perspectives come in:- Anna Walker, the Commission's Chief Executive, said: "Considering that millions of treatments are delivered by the NHS each year it is perhaps encouraging that we only receive around 8,000 complaints a year. However, it is concerning that around half of complainants received an inadequate response from the trust when they first complained and we required further work to be done on the complaint.

“Each year the NHS delivers 380 million treatments and receives around 135,000 complaints.”

The Commission reviews cases where the patient is unhappy with the response from the trust. The report, the third of its kind, covers the 8,949 complaints reviewed in the year to 31 July 2008.”

The healthcre Commission’s perspective is that 135,000 complaints, 8949 which were not resolved at local level by the Health Trusts is “encouraging”.

My perspective is that 135,000 complaints is a damning indictment of the NHS management, this is not about percentages, if we were talking about cars, and only 135,000 out of 380 million were defective then OK.

But we Are talking about 135,000 people that were unhappy with their own or their loved ones’ treatment, that is the population of South Cambridgeshire or more than the population of Colchester, which is “enouraging” to the Healthcare Commission.


I accept that we are all human (well most of us anyway), and that mistakes happen, and we have the right to complain, which we did 135,000 times to July 2008, what I don’t think acceptable is the scrotum twisting way the firkin NHS managers deal with our righteous complaints.

These complaints all 8,949 of them were bollocksed up by the management, by ineptitiude, lack of care and worst of all not listening.

Somewhere out there in NHS neverland there are thousands of piss poor top Knobs causing people stress and anguish because they can’t get their act together to resolve complaints made by people who have been hurt, emotionally and physically by their lack of care.

And what happens to these so called “managers” ?

Bugger all, once the initial comnplaint is received and acknowlegded they are allowed to take as long as they like to deal with these 8,949 cases, yes there are guidelines on how long to take in replying, and the supposedly full and complete reply, but they are treated as a license to delay, deny and dither about with the minutia of the complaint rather than the core problems.

The healthcare Commission send back the complaint to the Trust, sometimes they uphold the complaint, sometimes they do nothing, but have you ever heard of any action taken against the people responsible, the CEOs, the Medical Directors, or the boards of these trusts being sacked or fined?

No, because the HcC is only interested in stats and “learning”, we all want the NHS to learn from mistakes, but they don’t seem to, the same old complaints keep coming up, year after year, the Trusts give the same old answers, the complaints move to the HcC and they do the same old thing-send it back to the Trust who………..ad infinitum.

The CEOs of trusts are like a rat up a drainpipe when it comes to blaming “system failures” to excuse their poor treatment, and that is the problem: the system, the complaints procedure to be exact, we hear about the “new” system for complaints, with the demise of the Healthcare Commission the complaint will be dealt with by the Trust first, then if you are not happy it will go to the Health Ombudsman, who will either uphold the complaint or refer it back to the Trust.

So where have we gained?

It may be marginally faster to bounce the complaint back but it will still be in the hands if the CEOs, what is the outcome of the Ombudsman upholding a complaint? Will there be any punitive action taken against those Really responsible? Of course there won’t.

The real problem of the complaints procedure still hasn’t been addressed, the Hospital CEO and complaints dept, until the complaints procedure is taken away from “in house” and a truly independent body is given the powers to investigate, put forward solutions and take action against the management, the lack of justice for complainants will continue.

“The habit of analysis, the ability to get under the surface of things and at the vital essentials, gives a man a tremendous advantage.” Anon


Angus

Angus Dei on all and sundry

NHS Behind the headlines

Angus Dei politico

Stll Under Construction

As yet there are no posts, but soon!


Angus