Too Old To Care

The Health Secretary Andy Burnham says age discrimination in the NHS must end and there is particular concern about the treatment given to those over 65 suffering from mental health problems.

It seems that treatment or support for Mental Health problems stops at the age of 65; it also seems that for every 1 million older people with depression 850,000 receive no treatment.

“The Royal College of Psychiatrists has collected numerous examples of older people who have been left without the support they desperately need.

Such as Mr M, a 78-year-old man who attended a local hospital emergency department at 10pm on a Friday night. He had become severely depressed after the death of his wife and had suicidal thoughts.”

But because the 24-hour crisis resolution and home treatment service provided by the mental health trust will only see people younger than 65 years of age, and there is no equivalent service for older people, no support was available to Mr M until the following working week.

Then there was the case of Mrs A, a 72-year-old lady suffering from traumatic bereavement after her son killed himself.

She was willing to have psychological treatment - but the local service for psychological therapy was limited to people under the age of 65.

Her condition remains distressing and she continues to be at risk.

The Government and the NHS have had years to assess and rectify this situation, but as usual nothing has been done, as usual the Government and the NHS have ignored the impending problems that come with an ageing population; bereavement, loneliness, ill health and poverty.

In 2007, for the first time in the UK, the number of people aged 65 or over was greater than those aged under 16.

And this number is projected to increase by another 15% in the next 10 years.

“They” tell older people to keep fit, eat properly, and work until you drop which not only benefits those people but also the country through reduced NHS costs and taxes.

But when the ‘older’ person becomes depressed or suicidal there is no help available because they are ‘too old’ to deserve treatment, not worthy of money being spent on them because of their advancing years.

Eventually we will all be “older” and would you like to be consigned to the ‘Not worth it’ pile?


Angus

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Darzi-The second coming?

GPs rejoice! The lord of the polyclinic is hoping that the Tories win the next election so that he can work for them.

Ara Darzi has not ruled out working for the Conservatives after the general election, “'I have done my bit as a minister, but I'm always there to ensure the NHS's values and principles,’ he told the committee, modestly.

Lord Darzi said he had never classed himself as a political animal - a non-political GOAT - although he admitted the politics in health were ‘worse than Whitehall.’

He would it seems be quite happy to see the demolition of Darzi clinics, the demise of extended hours targets and the end of “quality care” because that is what he says he brought to the NHS.

So gird your loins GPs and wonder what “Lord” D has in mind for you under a new Government.

Second coming, or Anti Christ?


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Management Consultants-on the verge of extinction?

The health select committee has demanded that the government collect and publish details of all NHS spending on management consultants.

In a report on its 2008 public expenditure questionnaire (PEQ), published yesterday, the committee calls for the publication of full details of all consultancy contracts, including what they cover, how long they last and what they cost.

It also calls for the 10 highest rates paid by each type of NHS organisation to be published, to name and shame high spenders. It also wants regulator Monitor to do the same for foundation trusts.

This is the first time the committee has published a specific report on the PEQ. It follows apparently contradictory answers to questions given by NHS chief executive David Nicholson.

In December 2008, he told the committee that the NHS had 'started the process' of collecting information on spending on consultants.

But in a second meeting, three months later, he said that collecting detailed information would be used to 'micromanage organisations; we do not think that is the right thing to do'.

In 2007/8 the NHS spent £308.5m on management consultants. This excludes foundation trusts, which do not identify consultancy costs.

The highest spending types of trust were PCTs, which spend £132.6m.


Earlier this month an exclusive Healthcare Republic investigation found that more than half of PCTs used private firms or consultants to help commission services in 2008/9

And about bloody time, why should we pay CEOs £150,000+ pa and medical director’s £200,000 pa when they are spending millions on private consultants.

Answer-get rid of the consultants or reduce the salaries of the senior management to £20,000 which is what they are really worth.


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GMC ‘New Confidentiality guidance’ 12th October 2009

The new GMC Building in Manchester

Here is the “official” GMC guidance on confidentiality. It is in PDF format.

Just one or two snippets from this esteemed document:

8 Confidentiality is an important duty, but it is not absolute. You can disclose
personal information if:

(a) it is required by law (see paragraphs 17 to 23)

(b) the patient consents either implicitly for the sake of their own care
(see paragraphs 25 to 31) or expressly for other purposes
(see paragraphs 32 to 35)

(c) it is justified in the public interest (see paragraphs 36 to 56).
Confidentiality 06 General Medical Council Principles

9 When disclosing information about a patient, you must:

(a) use anonymised or coded information if practicable and if it will
serve the purpose

(b) be satisfied that the patient:

(i) has ready access to information that explains that their personal
information might be disclosed for the sake of their own care,
or for local clinical audit, and that they can object, and

(ii) has not objected

(c) get the patient's express consent if identifiable information is to be
disclosed for purposes other than their care or local clinical audit,
unless the disclosure is required by law or can be justified in the
public interest

(d) keep disclosures to the minimum necessary, and

(e) keep up to date with, and observe, all relevant legal requirements,
including the common law and data protect

And those are the sneaky bits (in bold) “Justified in the public interest”, who decides whether giving our personal medical information to any Tom Dick or Commercial Company is “justified in the public interest”?

Certainly not the patient, is it left to the doctor to decide? or maybe the accounts dept, perhaps the cleaners should be given the final decision.

This piece of GMC ‘policy’ is designed to take away our right of confidentiality, because even if we refuse to give permission; the “Powers that Be” can sell, distribute, give away or lease our medical records to anyone they like as long as they consider it to be “Justified in the public interest”

You decide.

I have tagged this with piss poor because I want the GMC to notice it, as they seem to like this blog.

Angus

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Piss Poor GMC Policy Change Invites Doctors to Break the Law

It has been a while since I had a pop at the GMC, but this cannot be ignored.

In a nutshell: Identifiable patient records will be disclosed in the name of medical research if new guidelines on patient confidentiality are passed under an ethics review by the General Medical Council in July. And the new policy seems to be in contravention of EU law, raising the possibility that sharing patients' records for research will become "ethical but illegal"

The panel that proposed the new guidelines included Sir Mark Walport, director of medical research charity the Wellcome Trust. The group decided doctors should be allowed to make identifiable patient records available to researchers, provided it can be "justified in the public interest" and that tracking down patients to ask permission would require "unreasonable effort".

Such guidance appears to run contrary to EU privacy laws. According to data security expert Professor Ross Anderson, EU law gives patients "a right to forbid their doctor to give their medical data to anyone who isn't involved in their case". From mid-September, when the new GMC guidelines are expected to be formalised, releasing named patient data will be "ethical but illegal", he says.

Such concerns might seem almost trivial when set against the possibility of scientific advances in the fight against cancer, for example. But medical histories can be valuable.

As public policy writer John Elledge points out on The First Post, everyone from potential employers to mortgage lenders would pay a lot of money to check whether you have a chronic condition or a family history of sudden death. "Many would pay enough money, in fact, for safeguards like the Data Protection Act to seem nothing more than a mild inconvenience," he writes.

The Piss Poor GMC has a remit-The General Medical Council (GMC) is an independent, statutory, UK wide body whose purpose is to protect, promote and maintain the health of the population by ensuring proper standards in the practice of medicine.

Under the Medical Act 1983 the GMC have four main responsibilities: keeping an up to date register of qualified doctors, fostering good medical practice, promoting high standards of medical education and dealing firmly and fairly with doctors whose fitness to practise is called into question.

This includes setting the standards and outcomes for basic medical education in the UK, which covers undergraduate education and the first year of training after graduation. We also run a quality assurance programme for UK medical schools to ensure those standards and outcomes are achieved. Quality assuring standards involves inspection visits and gathering information from the various bodies involved in the education and training of new doctors.

So WTF are they doing buggering about with Patient Confidentiality, the GMC “law” is clear-

6. Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality, patients may be reluctant to seek medical attention or to give doctors the information they need in order to provide good care. But appropriate information sharing is essential to the efficient provision of safe, effective care, both for the individual patient and for the wider community of patients.

7. You should make sure that information is readily available to patients explaining that, unless they object, their personal information may be disclosed for the sake of their own care and for local clinical audit. Patients usually understand that information about them has to be shared within the healthcare team to provide their care. But it is not always clear to patients that others who support the provision of care might also need to have access to their personal information. And patients may not be aware of disclosures to others for purposes other than their care, such as service planning or medical research. You must inform patients about disclosures for purposes they would not reasonably expect, or check that they have already received information about such disclosures.

12. You must make sure that any personal information about patients that you hold or control is effectively protected at all times against improper disclosure.

Yes, I agree that the doctor treating me must have access to my medical records, and the nurses treating me, and the members of the Multi Discipline Team (MDT), but not some pointy head, white coated geek in a research facility, why is it necessary to know my name, my address, my phone number and my next of kin?

Do I want my medical history made available to the Wellcome Trust? No I don’t, do I want it made available to anyone who can pay for it? NO.

This piss poor policy change wanted by the GMC is a massive step backward for patients, and after all the GMC remit does not include changing the law, and inviting doctors to break it:- According to the UK General Medical Council, who are responsible for regulating the medical profession. One of the key responsibilities of a doctor is to “respect and protect confidential information” (source: GMC Standards of Practice). Other professional groups have similar rules.

For example, registered nurses and midwifes, must protect confidential information:

“You must treat information about patients and clients as confidential and use it only for the purposes for which it was given.”

“You should seek patients' and clients' wishes regarding the sharing of information with their family and others.”

It is unethical for the GMC to review this part of its ethics policy, patient records are sacrosanct, and should not be treated as an EBay auction.

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Swine Flu Vaccine- the official edict

Fresh from the Dept of Health is the H1N1 Swine Flu Vaccination programme 2009-2010, have a read; the vaccine apparently is a bit of mix and match, they don’t make it too easy for the medics.

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Is the NHS Failing?

The Beeb has this today- Watchdog vows to get tough on NHS which contains the usual ‘promises’ by the ‘new’ CQC (Care Quality Commission) to “Get Tough” on our NHS.

“One in eight NHS trusts has been told it must urgently improve the care it provides, by a new regulator publishing ratings on England's 392 trusts.

The assessments by the Care Quality Commission show a drop in the number of hospitals meeting basic standards in areas such as hygiene and safety.”

The new commission, which took over the watchdog duties of the old Healthcare Commission earlier this year, pointed out a number of successes in its report.

These included what it called the notable achievement of most patients in England receiving hospital treatment within 18 weeks.

There are the usual patitudes-‘NHS Ratings Health Minister Mike O'Brien said the report showed improving standards across the health service.

"We have transformed the waiting experience for millions of patients and now have the shortest waits on record. MRSA and C. difficile infections have been significantly reduced and over three quarters of GP surgeries are providing extended opening hours, giving patients greater choice and more convenient access to GPs."’

Great, but what is the point of getting patients into hospital faster when the care they receive is sub standard?

There are also the usual discrepancies- ‘"And it is unacceptable that the number of patients who have had their operations cancelled has risen so sharply."’

More than half of primary care trusts were rated good or excellent, with many patients reporting being able to get an appointment within two days and services such as Chlamydia screening for young people improving.

There were, however, significant regional variations, with trusts in London performing particularly poorly on patient satisfaction with appointments and opening times.

Fewer mental health trusts were rated excellent or good, and some struggled to meet new criteria on collecting data about services. Ambulance services also failed to perform as well as last year, but the CQC nonetheless praised the general response to emergency calls.

But much of the focus is on hospitals: fewer acute and specialist trusts were rated excellent, with more receiving an unimpressive fair grading.

But my main concern is the failure to meet Core standards-Based on a system of self-reporting, there was a significant drop in the number of acute trusts fully meeting basic standards such as those relating to hygiene, child protection and training: this was down to 59% of all trusts from 69% last year.

Many also failed to meet new performance targets, such as the collection of maternity data to help improve services, and stroke care.

The number of operations cancelled rose for the second year in a row - equating to 63,000 procedures called off at the last minute for non-clinical reasons.

So I checked out my “local” Foundation Trust Frimley Park, or Grimly Dark as it is known locally-Frimley Park Hospital NHS Foundation Trust, and according to the stats it is a wonderful place to be ill in, it has excellent scores in Financial management and Quality of Services (whatever that is) but it failed to meet the Core Standard Target, and was rated as “almost met” which to my mind is a fail.

Some four years ago the Health Care Commission decided in its wisdom that Grimly Dark was failing to meet the core standards and it seems that things have not changed despite the astronomical salaries of the senior management, and the hundreds of millions poured into it.

So I compared them to other Trusts- Survey of patients and surprise, despite all the “excellent” ratings Grimly Dark is according to patient ratings (the people that matter) “about the same” as other trusts.

Which makes me think that something is awry, and that all the numbers and stats in the world will not make treatment any better, because as a potential patient I don’t care about “Financial management” or the collection of maternity data when the hospital can’t provide a clean environment which is staffed with trained professionals, where I will be safe and leave fitter than I was when I went in without spending weeks in ICU because of poor surgical procedure and infection control.

The CQC can wave as many flags as it likes but until personal responsibility is accepted by the senior management and medical staff, until they are held to book for the outcome of poor treatment the NHS will continue to stagger on, top heavy with management and “consultants”, failing to meet even the most basic levels of health care.


Angus

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What happened to the right to live?

From the Telegraph:

Terminally ill grandmother 'left to starve' by doctors

Hazel Fenton, an 80-year-old grandmother who was placed under a controversial care plan and left to “starve to death” after doctors identified her as being terminally ill, only recovered after the intervention of her daughter.

Mrs Fenton, from East Sussex, is still alive and “happy” nine months after doctors declared she would only survive for days, withdrew her antibiotics and denied her artificial feeding, her daughter, Christine Ball, said.

“Without my persistence and pressure I know my mother would be dead now,” she added.

Mrs Fenton, a former private school house mother, had been placed on the Liverpool Care Pathway (LCP) scheme, which was originally developed as a way to care for cancer patients towards the end of their lives.

However, there has been recent criticism that not only cancer patients but others with terminal illnesses are being made to die prematurely under the NHS scheme.

Last month six prominent British doctors and health care professionals wrote to The Daily Telegraph, expressing concern that some patients were being wrongly judged as close to death.

Under NHS guidance introduced in England, medical staff can withdraw fluid and drugs from dying patents and many are put on continuous sedation until they pass away. But this approach can also mask signs of improvement, it has been argued.

Miss Ball, who had been looking after her mother before she was admitted to the Conquest hospital, Hastings, East Sussex, on Jan 11, said she had to fight hospital staff for weeks before her mother was taken off the plan and given artificial feeding.

Miss Ball, 42, a carer, from Robertsbridge, East Sussex, said: “My mother was going to be left to starve and dehydrate to death. It really is a subterfuge for legalised euthanasia of the elderly on the NHS. ”

Mrs Fenton was admitted to hospital suffering from pneumonia. Although Mrs Ball acknowledged that her mother was very ill she was “astonished” when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days.

On Jan 19, Mrs Fenton’s 80th birthday, Mrs Ball said her mother had lost “an awful lot of weight” but was feeling better, and told her she “didn’t want to die”.

But it took another four days to persuade doctors to give her artificial feeding, Miss Ball said.

Mrs Ball said the fight to save her mother had been made harder by the Mental Capacity Act. “I was told that we had no rights, and food and hydration were classed as treatment, which meant they had the right to withhold feeding. It gave a doctor the power to play god with my mother’s life,” she said.

Mrs Fenton is now being looked after in a nursing home near her daughter’s home.

A spokesman for East Sussex Hospitals NHS Trust said: “Patients’ needs are assessed before they are placed on the [plan]. Daily reviews are undertaken by clinicians whenever possible.”

Having been the “victim” of doctors giving up on a relative I cam sympathise wholeheartedly with Mrs Fenton’s Grand Daughter, some doctors do not listen to patients or their relatives, the arrogance pervading certain trusts is killing people.

Angus

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More General Medical Council Loony Tunes

The GMC has struck off Dr Pushpa Kaushal for the irresponsible treatment of 15 patients at two care homes she ran, deemed as “nothing short of scandalous”.

The overseeing body felt the doctor’s actions between January and October, 2006, had shown a reckless disregard for patient safety, did serious harm to others, violated patients’ rights, was dishonest, had a lack of insight into consequences and put her own interests before those of the patients.

Along with providing below-par care and poor record-keeping, mistakes included taking on seven extra patients she was unable to provide proper care for, putting them in danger. Dr Kaushal, from Kidderminster, also broke the law by providing medical service at Areley House and made basic errors with prescriptions.

A GMC spokeswoman said: “The recurrent theme in this case has been the failure in Dr Kaushal’s duty to discharge her responsibilities with regard to two care homes. In relation to Areley House, the panel found that she had failed 13 patients in a number of respects and for Shenstone House, Dr Kaushal blatantly disregarded the regulations, broke the law, and two patients came to harm. A failure to make the necessary improvements at Shenstone House affected patient care and eventually led to the closure of the home. The panel concurs with the submission that these failings were ‘nothing short of scandalous’.”

The GMC have allowed “Dr” Jane Barton to continue to practise after oversubscribing drugs to patients at Gosport War memorial Hospital.

The doctor at the centre of almost 100 suspicious deaths at a Hampshire hospital said last week she routinely prescribed large doses of painkillers and sedatives because she "didn't want any of her patients to suffer unnecessarily".

Spot the difference.A case of who you know?

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Pick a number

Well maybe not a number but a surgeon according to the Tories.Patients will be allowed to decide which doctor or surgeon treats them in hospital after consulting "performance" tables, under plans to be announced by the shadow Health Secretary.

Every doctor will be assessed on the basis of their performance and their success in treating patients. People will then be able to study the doctors' performance online and select who they would like to treat them, under the Conservative proposals.

Conservative aides warn that patients may have to wait longer to see the country's top-performing doctors but will be able to see less successful medics or surgeons more quickly.

Under the Conservative plans, doctors will also be paid on the basis of how many patients they treat. Therefore, the more successful doctors will also be paid more.

The scheme is likely to prove controversial as it may be difficult to accurately gauge a doctor's "success". Wealthier, better-informed patients may also monopolise the country's top doctors.

The proposals will be outlined today by Andrew Lansley, the Shadow Health Secretary, in a speech which will confirm that the Conservatives will continue to increase NHS spending while other public services face cutbacks.



Oh look! A flock of flying pigs!


Angus

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Too little too late....again

The pointy heads at the DoH (Dept of Half arsed ideas) have come up with a spiffing plan to give free parking to inpatients.

Andy Burnham the health Secretary reckons that if labour win the next election the minority of people going to hospitals will gain from “free” parking.

He said patients would get a permit to cover the length of their stay which visitors could use to park for free.

But campaigners said the move did not go far enough as in-patients, who tend to require the most complex care, only represent a fraction of total patients.

Wales and Scotland are both scrapping fees for everyone.

This has already happened in most instances, although under the terms of contracts signed with private firms to fund the building of new hospitals it will take several years to ensure parking is free across the board.

NHS trusts have always maintained that some level of parking charges were necessary to ensure core health funds were not diverted towards managing and maintaining car parks.

But the variation in procedures across the UK has caused controversy among patient groups.

And even though the health secretary has now intervened, many NHS trusts will still not be compelled to act because they have foundation trust status which gives them autonomy from central government.

New legislation would be required if ministers wanted to force this through.

Mr Burnham said the move would make a big difference.

"When people are coming into hospital the last thing they want to worry about is keeping the car park ticket machine up to date.

"It's not right if some people don't get visitors every day because their families can't afford the parking fees."

Got it in one Andy, the solution is simple, do away with all parking charges, or put a cap on them say £1 for all day, then both sides win.

Blatant electioneering isn’t the way to encourage the electorate to vote for a Government that allowed the parking charges to spiral out of control in the first place.

Go and borrow some of Bennie’s (Ben Bradshaw) Lego and play with that instead.

Angus

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