Showing posts with label 'Shame on us cqc. Show all posts

Saturday 6 December 2014

GP 'disgust' at watchdog errors

By Sarah BlochHealth reporter, BBC News

GPs have told the BBC their reputations have been "tarnished by incompetence" from the health watchdog.

The Care Quality Commission has been forced to apologise to hundreds of GPs for giving incorrect patient safety risk assessments.

A BBC investigation found serious errors in the calculations used by the CQC.

The British Medical Association is calling for the whole banding system to be withdrawn.

Around 60 practices have been taken out of the highest risk categories and four low-risk surgeries need early inspection.

John Flather, a GP in Hadleigh, Suffolk, said his practice had been incorrectly banded as high risk.

He said he was "totally disgusted by the process" and that a formal complaint had been made.

He told the BBC: "Our reputation, which has been built over many years, has been tarnished by incompetence that they purport to eradicate.

"If they had only given us a chance to view their ratings we could have pointed out their errors and avoided this mess."

Dr Chris Cullen, from Ipswich, said: "My practice was rated for highest risk despite being one of the very high achieving practices in the country.

"The CQC claim we gave flu jabs to 24% of our patients, in fact it was over 96%.

"Our true rating should be for lowest risk, but the CQC aren't interested and have not returned our calls."

Bad data

Practices were judged on 38 indicators of performance, ranging from how easily patients managed to get appointments to how good doctors were at picking up conditions such as dementia.

Practices were graded in six bands, with Band 1 being the highest concern, and Band 6 the least risky.

The majority were of low concern, but 11% were rated in the highest risk band.

The BBC discovered that for one indicator, whether patients were able to get an appointment with a GP or nurse the last time they tried, the calculations were so flawed that the CQC has been forced to remove the indicator altogether.

A further four indicators had to be refined based on revisions to data provided to the CQC by NHS England.

Hundreds of practices will now be assigned a different band.

In its initial register, published two weeks ago, the health watchdog ranked 7,276 practices out of the total 7,661 in England, and placed 864 practices in the "highest concern" category.

Original rankings

As a result of the recalculations, around 60 practices will be lifted out of the two "highest concern" categories, and four that were previously deemed low-risk have been found to be in need of early inspection.

The CQC says 519 practices will move bands, but most were between the lowest risk bands.

The CQC register was set up to help target inspections, and the watchdog said it did not necessarily indicate poor GP surgery performance.

Sir Mike Richards, chief inspector of hospitals for the CQC, told the BBC: "We will make them a big apology. This only became apparent when we ran the data on the thousands of practices rather than just the hundreds that we tested them on."

He defended the publication of the risk bands in the interest of transparency.

He said: "We are using the data to help us know where we might go first. Our judgement comes from a combination of data and inspection. The main thing that is going to matter is that we are going to be inspecting every practice."

Poor data

Measures removed

Whether patients were able to get an appointment with a doctor or nurse last time they tried

Measures recalculated

Coronary heart disease incidence
Chronic obstructive pulmonary disease (COPD) incidence
Unnecessary A&E admissions
Dementia diagnosis rates

The British Medical Association said mistakes by the CQC risked "doing serious harm" to the reputation of good surgeries.

Its GP committee chair, Dr Chaand Nagpaul, said: "The banding system as a whole needs to be withdrawn.

We warned at the time that simplistic targets would fail to take into account the enormous pressures GP practices are facing, and that skewed and limited information does not tell us about the quality of care.

"These failings have the potential to seriously undermine the trust in the system and patients' confidence in their GP and it is only right that all of those practices affected are now contacted and receive a full apology."

Monday 3 November 2014

NHS screening advice 'must improve'

By James GallagherHealth editor, BBC News website

The NHS needs to get better at highlighting the dangers of screening for diseases such as cancer, say MPs.

Screening picks up diseases early to improve the odds of survival or improve quality of life.

But the practice also leads to "overdiagnosis" and people having treatment for conditions which would never have caused harm.

The Science and Technology Committee accused the NHS of "poor communication" on the issue.

Breast-cancer screening became hugely controversial in 2012. An independent review was set up to settle a fierce debate about whether the measure did more harm than good.

It showed that for every life saved, three women had treatment for a cancer that would never have proved fatal.

As a result the leaflets given to women offered a mammogram included more information to give them an "informed choice".

'Unnecessary treatment'

However, the Science and Technology Committee argues the lessons have not been learned by those overseeing other screening programmes.

Andrew Miller, the committee chairman, said: "While screening can increase the likelihood of curing, preventing or delaying the progression of disease for some patients, for others it may lead to false results, misdiagnosis and unnecessary treatment.

"More needs to be done to ensure that both the benefits and risks are clearly, and even-handedly, communicated so that people can make an informed choice about whether screening is right for them."

Conditions screened for include:

Abdominal aortic aneurysm
Diabetic retinopathy
Breast cancer
Cervical cancer
Bowel cancer

There are also newborn screening programmes, including hearing checks, as well as Down's syndrome and foetal anomaly screens during pregnancy.

Breast-cancer screening guidelines were changed to ensure patients had an informed choice

Mr Miller continued: "Producing accurate, concise and accessible public information on screening will always be challenging, but the UK National Screening Committee must ensure there is standard process across the NHS for achieving this and facilitating informed choice."

There are hopes that screening could be extended to other diseases such as ovarian cancer and eventually prostate cancer.

However, the committee said the barriers to new screening programmes "should remain high" due to the delicate balance of risk and benefits.

'Vitally important'

Prof Kevin Fenton,, director of health and wellbeing at Public Health England, which oversees the NHS screening programmes. said: "We welcome the findings of the Science and Technology Committee's report, which has identified a number of recommendations.

"We will now consider these recommendations in full."

The British Medical Association's Dr Richard Vautrey said: "Many GPs will share the Science and Technology Committee's concerns about health screening. As the BMA has repeatedly warned, it is vitally important that people being invited for screening fully understand the pros and cons of the procedure.

"Patients must also be aware that there is a risk that false positive results could lead to unnecessary and potentially harmful further investigations."

Cancer Research UK was involved in the independent review of breast-cancer screening.

Jessica Kirby, from the charity, said: "It's vitally important that all screening programmes are based on the best possible evidence so people can be confident that screening is only offered where the benefits outweigh the harms.

"The report highlights the importance of ensuring people get the best possible information so they can make the decisions that are right for them."

Tuesday 14 October 2014

Thousands of health workers, including nurses, midwives and ambulance staff, have taken part in the first strike over pay

By Nick TriggleHealth correspondent, BBC News

The strikes were the first by NHS staff over pay in more than 30 years

for more than 30 years.

But disruption was minimised after unions agreed staff would make sure emergency care was covered.

Workers from seven trade unions took part from 07:00 to 11:00 BST in England, while two unions were involved in Northern Ireland.

The strike is being followed by four-days of work-to-rule from Tuesday.

This is expected to involve staff refusing to do overtime without extra pay and insisting on taking their breaks.

The full picture has yet to emerge about how much disruption was caused by Monday's walkout - although no major incidents have been reported.

In advance, unions and managers had met to ensure essential services were maintained.

Military personnel and police were also on hand to help ambulance services where needed.

As the walkouts progressed, reports emerged of ambulance services developing backlogs - but bosses said life-threatening cases were prioritised.

The striking unions
Name	Staff groups	Number of members
Unison	Nurses, healthcare assistants, ambulance staff and porters	250,000 in England
GMB	Nurses, healthcare assistants, ambulance staff, porters, admin workers and cleaners	22,000 in England and Northern Ireland
Unite	Nurses, healthcare assistants, ambulance staff, porters and admin	92,000 in England and Northern Ireland
Royal College of Midwives	Midwives	22,000 in England
UCATT	Maintenance staff	480 in England
British Association of Occupational Therapists	Occupational therapists	24,000 in England
Managers in Partnership (part of Unison)	Mostly middle-grade managers	4,000 in England

Meanwhile, hospital staff were seen leaving the picket lines to deal with patients in some places.

Union leaders had always said their members will be providing "life and limb" cover during the strike.

The expectation was that 999 calls would be answered and A&E units would remain open and that seems to have been the case, according to reports.

Striking NHS staff at Royal Liverpool Hospital

The picket line at Royal Liverpool Hospital was one of many across the country

A member of military driving a London ambulance

The military was drafted in to help ambulance services

Unison has the largest number of NHS members of the unions involved

However, hospital outpatient appointments, community clinics and some routine operations seem to have been affected.

The Royal College of Midwives, which is taking action for the first time in its history, said in advance services for women giving birth were going to be unaffected. Instead, its members targeted antenatal and postnatal care.

Doctors and dentists were not involved. NHS sources said about 5% of staff who were expected in work did not turn up, although unions had always maintained the numbers not working would not reflect the strength of support across the workforce.

Rehana Azam, national officer of the GMB union, said: "Reports from across the country are that the strike action was rock solid. Members are determined to get government to listen to them."

Pay dispute

Unison said the action - the first strike by NHS staff over pay in more than 30 years - would send a "clear message" to the government.

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Health Secretary Jeremy Hunt says a 1% pay rise for all NHS staff, could lead to job losses

As well as the RCM, there were another six unions involved in the strike in England - Unison, Unite, GMB, UCATT, the British Association of Occupational Therapists and Managers in Partnership. Between them they have over 400,000 members, including porters, cleaners and administration staff.

In Northern Ireland, members of Unite and the GMB staged a walkout from 11:00 to 15:00 BST.

Ministers in England have awarded NHS staff a 1% increase, but only for those without automatic progression-in-the-job rises.

These, designed to reward professional development, are given to about half of staff, and are worth 3% a year on average.

An independent pay review board had said the 1% increase should be across the board.

It was implemented in full in Scotland. Northern Ireland has yet to make a decision on pay, while Wales did the same as England but did give extra to the lowest paid. Some unions are balloting their Welsh members about action there.

From the picket line: Dominic Hughes, BBC News

A boisterous, noisy picket outside the Edwardian facade of the old Manchester Royal Infirmary has been made up of nursing assistants, porters, paramedics and for the first time in their history midwives.

Plenty of cars are tooting their support as they pass on Manchester's busy Oxford Road.

Inside the hospital some services will be affected, and a number of midwives have already left the picket to go to staff a ward that was short on numbers.

So this is a symbolic strike but one that displays the real anger of health workers over pay.

Health Secretary Jeremy Hunt said that hospitals would be forced to lay off staff if the recommended pay award was met in full.

"We have had very clear analysis that if we did that, hospital chief executives would lay off around 4,000 nurses this year and around 10,000 nurses next year," he said.

"The NHS has just come through a terrible tragedy with Mid Staffordshire when we discovered the most appalling care happening there and indeed some other hospitals as well.

"We have turned the corner on that by recruiting in hospital wards around 5,000 extra nurses in the last year alone. We don't want to turn the clock back on that."

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Workers in Newcastle, London and Manchester support the strike

Christina McAnea, head of health at Unison, said the offer in England was a "disgrace".

"The fact that so many unions representing a range of NHS workers are taking action or preparing to join future actions should send a clear message to the government," she said.

RCM chief executive Cathy Warwick added: "At a time when MPs are set for a 10% pay hike, we're told that midwives don't deserve even a below-inflation 1% rise. And politicians wonder why the public does not afford them more respect.

"It feels to a great many people, including midwives, that there is one rule for them and another rule for everybody else."

Wednesday 25 June 2014

Right-to-die

Right-to-die Supreme Court judgement due

Paul Lamb won an earlier legal battle to join Tony Nicklinson's court challenge

Campaigners for the right to die are to receive judgement from the Supreme Court in the latest round of their legal battle.

It involves family of the late Tony Nicklinson, of Wiltshire, who had locked-in syndrome, and Paul Lamb, of Leeds, who was paralysed in a road crash.
They want the law changed to allow doctors to assist patients to die.
Judgement is likely to be issued on Wednesday.
The court has had to decide if the law prohibiting assisted suicide is incompatible with the European Convention on Human Rights because it denies Mr Lamb, and others like him, the right to choose the timing of their death.

Analysis

Clive Coleman Legal correspondent, BBC News

The Supreme Court judgement is seen as perhaps the most ambitious attempt yet to change the law on the right to die.
Paul Lamb took up the legal challenge brought by the late Tony Nicklinson, who suffered from locked-in syndrome.
At a hearing at the Supreme Court last year his lawyers argued the current prohibition on assisting suicides interfered with his right to a private and family life, because it prevented the most severely disabled from getting medical assistance to end their lives at a time of their choosing.
Any doctor who helped someone to kill themselves would be guilty of assisting a suicide, a criminal offence that carries a maximum prison sentence of 14 years.
Subject to strict safeguards, including the medical assistance being sanctioned by a court, Paul Lamb wants any doctor who does assist a suicide of someone in his position, to have a defence in law.
The defence would be that of "necessity". However, many fear any change to the law on assisted suicide which would make the position of the sick, the infirm and the elderly, more vulnerable.
The fear is that members of these groups could easily feel themselves to be, or be persuaded that they are, a burden to others and decide to end their lives as a result.
A second man, known only as Martin, wants clarification of the director of public prosecutions's guidance on the position of health professionals who assist a suicide.
The existing guidance is unclear on whether they would be prosecuted.

There are nine judges on the panel, rather than the normal five.

'Unanimously dismissed' Paul Lamb, 57, has been almost completely paralysed from the neck down since a car accident more than 20 years ago and says he is in constant pain.
He has called for the law to be changed so any doctor who helped him die would have a defence against the charge of murder.
Tony Nicklinson was paralysed from the neck down after suffering a stroke while on a business trip to Athens in 2005.
After losing his High Court battle last year, he refused food and died naturally, aged 58, a week later at his home in Wiltshire. His widow, Jane, is continuing his legal battle.
Earlier last year, Mr Lamb joined forces with Mr Nicklinson's family to fight a joint legal case.
In their Appeal Court case, the decision centred on whether the High Court was right to rule Parliament, not judges, should decide whether the law on assisted dying should change.
The three Court of Appeal judges unanimously dismissed the Nicklinson and Lamb challenge.
In the judgement, the Lord Chief Justice Lord Judge said Parliament represented "the conscience of the nation" when it came to addressing life and death issues, such as abortions and the death penalty.
"Judges, however eminent, do not - our responsibility is to discover the relevant legal principles, and apply the law as we find it," he said.
At the same hearing a third paralysed man won his case seeking clearer prosecution guidance from the director of public prosecutions (DPP) for health workers who help others die.

Tony Nicklinson suffered from locked-in syndrome

The man, known only as Martin, wants it to be lawful for a doctor or nurse to help him travel abroad to die with the help of a suicide organisation in Switzerland. His wife and other family want no involvement in his suicide.
The Supreme Court will also deal with the DPP's appeal against the Court of Appeal's ruling in Martin's favour.

Thursday 22 May 2014

people in A&E lying in corridors

Hundreds of thousands of patients are being sent home from hospital in the middle of the night despite a promise to limit the practice.
During the past two years at least 300,000 people, many of them elderly, have been discharged between 11pm and 6am to relieve pressure on wards.
An investigation by The Times in 2012 revealed that patients were being woken and removed from their beds, even if they had no way of getting home. Some were left in night clothes, with no medication or paperwork, and in vulnerable or dangerous situations.
At the time, health chiefs promised that patients would be moved at night only in exceptional circumstances, but new figures obtained under a freedom of information request show that the practice remains just as widespread.
More than half of the NHS trusts that responded reported that the number of patients sent home at night had increased during the past three years. Almost 60,000 of the patients were over 75. The true number of patients discharged overnight is likely to be much higher because less than half of England’s 160 NHS trusts responded to the data request by Sky News.
Katherine Murphy, of the Patients Association, said: “These figures are truly shocking. It is simply unacceptable that patients are being discharged from hospital late at night.
“We are particularly concerned that tens of thousands of these patients are aged over 75. For older people, spending time in hospital can be extremely distressing and disorientating.
“Patients need to be treated with care, compassion and dignity. For the many older people who live alone, being discharged after early evening shows not only a lack of care and thought, but can actually be dangerous.”
Nadra Ahmed, chairwoman of the National Care Association, said that elderly patients were returning home or arriving at care homes in disarray.
“They come out very often without the appropriate papers that would give information and the history of what has happened to them. Often they will come out without the appropriate medication, because the hospital pharmacy has closed, and there is no cross-referencing to what medication they’re already on.
“You’re also discharging them into the hands of night staff at care homes, when the manager or owner may not be there, so it’s creating an unplanned and chaotic atmosphere. They may find it disorientating and very distressing. We keep hearing these platitudes that things are so much better now. But I’ve heard of people being discharged with no clothes on, just a blanket around them, or wearing soiled incontinence pads that haven’t been changed. We’re not a third world nation.”
Two years ago, Professor Sir Bruce Keogh, medical director of the NHS, demanded that all hospitals review how they discharged patients, describing the practice of sending elderly people home in the middle of the night as unacceptable.
He said: “By and large the NHS is coping reasonably well, but there are times of peak admissions where there are real, significant pressure on beds. But the answer to that is not chucking people out in the middle of the night.”
Two months ago, he added that moving patients within hospitals at night struck at the heart of NHS efforts to “treat all patients with respect and compassion”. He ordered hospitals to review night-time ward transfers and stop all but the essential.
Dr Mike Smith, chairman of the Patients Association, said: “They have got people in A&E lying in corridors, they have got to be admitted and they have no beds. It’s for the convenience of staff and the person they are admitting but at the gross detriment to the person they are chucking out.”
NHS England said: “Discharging patients at night without appropriate support is unacceptable. The decision to do this should always be based on what is best for the patient

Friday 8 November 2013

NHS spends £700 on negligence cover for every birth

By Adam Brimelow

Health Correspondent, BBC News

There are wide unexplained variations between trusts, the report says

The NHS spends nearly £700 on clinical negligence cover for every live birth in England, a report says.

The review by the National Audit Office said last year this cost nearly £500m - almost a fifth of all spending on maternity.

Public Accounts Committee chairwoman Margaret Hodge said the figure was "absolutely scandalous".

The Department of Health said the NHS is one of the safest places in the world to have a baby.

Having a baby is the most common reason for admission to hospital in England.

The number of births has increased by almost a quarter in the last decade, reaching nearly 700,000 live births.

The public spending watchdog said maternity services were generally good for women and babies, but there was still a lot of scope for improvement.

Its report highlighted "wide unexplained variations" between trusts in rates of complications such as readmissions, injuries and infections.

Laura Blackwell, director of health value for money studies at the National Audit Office, told the BBC the number of maternity claims had risen significantly in recent years.

Speaking to BBC Radio 4's Today programme, she said: "There has been an increase in claims and we don't cover exactly why. It is the same across the NHS.

"I think it's a complicated picture... further complicated by the fact it takes an average of four years for a claim to be settled... so it's quite hard to draw conclusions about the current state of care."

Clinical negligence

The NAO also pointed to a shortage of midwives and consultants on labour wards. The report concluded that a further 2,300 midwives are required, though their distribution across England varies substantially.

And although it said the level of consultant presence has improved, more than half of units are not meeting the standard recommended by the Royal College of Obstetricians and Gynaecologists.

The report noted that between April and September last year more than a quarter of maternity units were closed to admissions for at least half a day because demand outstripped capacity.

Clinical negligence claims for maternity have risen by 80% in the last five years. The cost of cover last year was £482m, and the average payment per claim was £277,000.

Figures from the NHS Litigation Authority released last year showed the health service in England paid out more than £3bn in compensation claims linked to maternity care between 2000 and 2010.

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We are many thousands of midwives short of the number needed to deliver safe, high quality care”

Cathy WarwickRoyal College of Midwives

Ms Hodge said: "I find it absolutely scandalous that one fifth of all funding for maternity services, equivalent to around £700 per birth, is spent on clinical negligence cover."

She said the NAO report had shown an urgent need to improve maternity services.

"The department needs to buck up and take responsibility for this. It needs to review its monitoring and reporting process to ensure that all relevant bodies can work effectively together to deliver maternity services that are value for money and fit for purpose."

James (not his real name), a recipient of medical negligence money, told the Today programme the money had helped give his son a better quality of life.

He and his wife did not claim for negligence until six months after the birth of their son, when they realised the costs involved in his care. Their son had been starved of oxygen during birth and now suffers from quadriplegic cerebral palsy, severe brain damage, visual impairment and epilepsy.

Health Minister Dr Dan Poulter said the health service should always learn from any mistakes to improve patient care in the future.

"The NHS remains one of the safest places in the world to have a baby, but on rare occasions care falls below acceptable standards and unsafe care should never be tolerated."

Jacque Gerrard, Royal College of Midwives: "The system is creaking"

He said the service was making progress.

"This report shows that most women have good outcomes and positive experiences of maternity care. We know 84% of women now say they have good care, which has gone up from 75% six years ago. But we are determined to improve further."

Royal College of Midwives chief executive Cathy Warwick said the report backed up what the college had been saying for a long time.

"We are many thousands of midwives short of the number needed to deliver safe, high quality care. Births are at a 40-year high and other figures out this week show that this is set to continue. As the report states, births are also becoming increasingly complex putting even more demands on midwives and maternity services."

Royal College of Obstetricians and Gynaecologists president Dr David Richmond said the NAO report raised valid concerns.

"Although the UK is generally a safe place for women to give birth, we have known for some time that pressure on maternity services is growing in some areas, particularly inner city conurbations, placing stress on clinicians, managers and patients alike."

mengele plus

Saturday 6 December 2014

GP 'disgust' at watchdog errors

GP 'disgust' at watchdog errors

Monday 3 November 2014

NHS screening advice 'must improve'

NHS screening advice 'must improve'

Tuesday 14 October 2014

Thousands of health workers, including nurses, midwives and ambulance staff, have taken part in the first strike over pay

The striking unions

Wednesday 25 June 2014

Right-to-die

Right-to-die Supreme Court judgement due

Analysis

Thursday 22 May 2014

people in A&E lying in corridors

Friday 8 November 2013

NHS spends £700 on negligence cover for every birth

NHS spends £700 on negligence cover for every birth

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Saturday 6 December 2014

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Monday 3 November 2014

NHS screening advice 'must improve'

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The striking unions

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Right-to-die Supreme Court judgement due

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NHS spends £700 on negligence cover for every birth

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