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

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

Monday 16 December 2013

GP surgeries exposed by inspectors

'Maggot-infested' GP surgeries exposed by inspectors

''I might just go back to my old surgery''

Related Stories

The first national inspection of more than 900 GP surgeries in England has found one in three is failing to meet basic standards.
The Care Quality Commission unearthed failings in some practices, many of which had been selected after concerns.
It said it had found examples of poor standards in the handling of medicines and cleanliness, with maggots found at two surgeries.
Overall, concerns were expressed about a third of practices.
In nine cases the failings were so serious that they could "potentially affect thousands of people", the CQC said.
These practices have been ordered to improve, although in one case new GP management has been brought in.
No door
The checks were targeted mainly at those practices deemed to be high risk ahead of next year's rollout of the first national GP inspection regime.
Among the problems identified across the board were concerns about the way medicines were managed.

GP practices with serious concerns

  • Dr Harira Syed's practice (Rochdale, Greater Manchester) - No equipment available, such as oxygen, to use in the case of a patient emergency. Not enough staff or adequate training in areas such as basic life support.
  • Norris Road Surgery (Sale, Greater Manchester) - Staff not undergone criminal record checks and practice did not gather feedback from patients. No up-to-date training or infection-control policy. Consulting rooms dusty and cluttered.
  • Wolds Practice (Tetford, Lincolnshire) - Errors in the supply of medicines to patients. Problems relating to the management of controlled drugs.
  • Lincoln Road Surgery (Peterborough, Cambridgeshire) - Practice visibly dusty, poorly maintained and inadequate infection control.
  • Northfield Surgery (Doncaster, South Yorkshire) - Prescribing problems, including evidence of patients getting the wrong medicines, and shortfalls in monitoring quality of care.
  • Dr Satish Patel's ( Reading, Berkshire) - Infection control guidance not followed.
  • Long Street Surgery (Wigston, Leicestershire)- Personal information not kept securely and concerns over staff safety. Could not demonstrate reasonable steps to protect children and vulnerable adults from abuse were being taken.
  • King Street Surgery (Burton upon Trent, Staffordshire) -No systems in place to ensure patients were cared for by suitably-trained staff, which meant there was a lack of awareness about child protection issues. Compliant on follow up inspection.
Source: Care Quality Commission
The CQC said it had found examples of emergency drugs being out of date and vaccines not kept in properly regulated fridges - something which could damage the effectiveness of the jab and cause outbreaks of disease.
The regulator said some practices were "visibly dirty", and in one of the better-performing practices, Dale Surgery in Sneinton, Nottinghamshire, inspectors found maggots. The details of a second practice where maggots were found have not yet been released.
Dale Surgery said it took action to deal with a "small number of insect larvae" in a hallway, adding that a pest control company confirmed there was no evidence of wider infestation.
"We are responding to the actions we have been asked to take," it said in a statement.
In another case, a practice was found to be carrying out patient consultations in a room with no door.
It also said practices were not always doing the necessary employment checks, and access to routine appointments was also a "constant theme", with some patients reporting they were unable to get one for weeks.
The checks were carried out to help test how the GP inspection regime will work when it is launched next April as well as to inspect practices where concerns had been flagged up to the regulator.
Of the 910 inspected, 80% were targeted because of known concerns. The remainder were chosen at random.
The CQC is aiming to inspect all 8,000 practices over the following two years and give them one of four ratings - "outstanding", "good", "requires improvement" and "inadequate" - as is happening with hospitals.
The move will mark the first national independent inspection of practices - to date GPs have faced only local audits at most.
Prof Steve Field, the CQC's new chief inspector of GPs, said it would herald the end of an era where poor care was tolerated in general practice.
'Inexcusable'
He said the problems highlighted in the checks had sometimes been known about locally for years.
"We are hearing about problems that people are very worried about but no-one has tackled in the past.
"We need to make sure that everyone, from the most well-off to the most disadvantaged, can get access to really good care."
Dr Chaand Nagpaul from the BMA: "It's important not be alarmist about these figures"
He told BBC Radio 4's Today programme: "Of the really poor practices we're talking nine or ten out of that 900, so very tiny numbers. But, if you have a problem with, for example, storage of vaccinations for children, the impact could be on hundreds of patients. So the numbers are small, but the impact is large."
Roger Goss, of the campaign group Patient Concern, said: "The failings are inexcusable. The standards the CQC wants met are the basic minimum for protecting patients' safety, let alone improving their health."
Health Secretary Jeremy Hunt added: "Patients have a right to expect the best care from their GP practice."
Dr Maureen Baker, who chairs the Royal College of GPs, said: "Breaches of procedure cannot be condoned - even if they are isolated incidents."
But she added: "Patients should expect high quality and consistent care from their GP practice, and the vast majority of practices do an excellent job of delivering quality care while maintaining the highest possible standards."
• The practices which were ordered to improve were: Dr Harira Syed's practice, Rochdale, Lancashire; Norris Road Surgery, Sale, Cheshire; Wolds Practice, Horncastle, Lincolnshire; Kingshurst Medical, Birmingham; Lincoln Road Surgery, Peterborough, Cambridgeshire; Northfield Surgery, Doncaster, South Yorkshire; Dr Satish Patel's, Reading, Berkshire; Long Street Surgery, Wigston, Leicestershire; King Street Surgery, Burton upon Trent, Staffordshire.

More on This Story

Related Stories

Friday 15 November 2013

GPs take on extra role for frailest patients

GPs take on extra role for frailest patients

Jeremy Hunt said he hoped this would be part of a "much bigger change"

Related Stories

The 100,000 most frail patients in England will be identified and given a named GP to co-ordinate their care.
The move has been agreed by the British Medical Association and NHS England in talks over next year's GP contract.
Ministers had been pushing for doctors to take greater responsibility for the most vulnerable patients in society to relieve pressure on hospitals.
An analysis by NHS England showed many of the winter pressures on A&E came from frail elderly patients.
Contrary to common perception, it found that summer was the busiest time for A&E units in terms of numbers, but winter was when the difficulties arose because of the rise in the numbers of elderly patients needing care.
A third of emergency admissions are among the over-75s - many of which could be avoided if they received earlier and better care in the community.
This is where the agreement with GPs - which will kick in next April - will help, ministers say.
'Old-fashioned' approach
Under the terms of the deal, doctors have agreed to carry out a trawl of their registers to identify the frailest 2% of patients.
Dr Richard Vautrey from the BMA: "This will mean GPs will spend less time focusing on box ticking... and more time on the needs of their patients"
This is likely to include people at the end of life, in care homes and those who are frequently in and out of hospital.
They will then take responsibility for overseeing their care across the NHS and social care sectors.

Start Quote

This will free up GPs to spend more time focusing on treating patients”
Dr Chaand NagpaulBritish Medical Associaton
The aim is to create a much more proactive services whereby their needs - from home adaptations to intensive nursing support - are met much more quickly.
They will also need to offer these patients same-day telephone consultations as well as checking up on them after discharge from hospital.
This contrasts with what the government and doctors' leaders agree is the more reactive service many patients are currently getting.
A further four million people over the age of 75 will be given a named GP - at the moment patients are registered to a practice rather than individual doctor. It is hoped this will lead to greater continuity of care for those patients who visit GPs the most.
'Phone frustration'
Health Secretary Jeremy Hunt hailed as the return of the "old-fashioned family doctor" and an end to the current "box-ticking" culture.
"We are bringing back the named GPs for the vulnerable elderly. This means proper family doctors able to focus on giving elderly people the care they need and prevent unnecessary trips to hospital."

GP FUNDING

GP practices are small businesses - and contracts are held by the practice, rather than individual GPs.
Funding comes from a number of different sources and is weighted so a practice with, say, lots of elderly people on its books will receive more than one which looks after a relatively young and healthy population.
The main source of income, accounting for around half the funding a practice receives, is the 'global sum'. This is a payment based on the estimated workload from the patients registered.
Next comes QOF - the Quality and Outcomes Framework which is at the centre of these latest contract changes.
This is in effect a points system where practices accumulate a score from meeting requirements such as monitoring how many of their patients have a certain condition or ensuring checks such as blood pressure readings are carried out on a regular basis.
These contract changes would cut QOF - and move funding of around £290m into the global pot.
Other funding streams include extras services such as flu and childhood jabs, which are not part of the contract but which most offer, are funded separately.
Seniority payments for long-serving GPs, and funding for premises make up the rest of a practice's income.
Out of this pot, a practice has to pay staff costs and other bills - as well as GPs' pay.
Those GPs who have responsibilities for practice management earned on average across the UK £103,000 in 2011/12.
Salaried GPs, who do not, could this year earn a maximum of £81,969.
In return, doctors have been freed from what they considered some of the most burdensome aspects of the form-filling they had to do for their performance-related pay.
This means requirements such as having to annually ask men with diabetes if they experienced erectile dysfunction at their check-ups will be removed, as will the need to ask those with high blood pressure in detail about their activity levels, with what doctors say were often irrelevant questions.
But Labour's Shadow Health Secretary Andy Burnham told BBC Radio 4's Today programme: "The bottom line is under this government, it has got harder to get a GP appointment. And nothing in today's announcement will correct that.
"People will still face the frustration of phoning the surgery at nine o'clock in the morning, being told there's nothing available for days and then some having to turn to A & E."
He added: "David Cameron cut Labour's scheme of evening and weekend opening and the guarantee of seeing a doctor within 48 hours," Mr Burnham added.
"This announcement will not put an end to patients phoning the surgery at 9am and finding it impossible to get an appointment - many of whom, not happy with a phone consultation, will still turn to A&E.
"People will fail to see how this package delivers the public commitment David Cameron gave last month to keep GP surgeries open from 8am to 8pm."
Dr Richard Vautrey of the British Medical Association's GPs committee, told the BBC: "It will help to a degree. It certainly won't be a panacea but it will start to focus on the needs of the most vulnerable and those patients who do go into hospital more frequently.
"And it will give GPs that bit more time to be able to spend with their patients to try and meet their needs."

Thursday 3 October 2013

'Serious errors' caused patient's death

David Sellu trial: 'Serious errors' caused patient's death

David SelluDavid Sellu has been a surgeon for four decades
A patient died because of "serious errors in judgment" by a senior doctor at a private hospital in north-west London, the Old Bailey has heard.
James Hughes received "exceptionally bad" care from David Sellu after routine knee surgery at the Clementine Churchill Hospital, jurors were told.
The operation, in 2010, went well but afterwards his bowel ruptured.
Mr Sellu, who denies gross negligence manslaughter, "simply ignored" the urgency of the case, the court heard.
After the initial operation on 5 February at the hospital in Harrow, Mr Hughes, a 66-year-old retired builder from County Armagh, developed abdominal pain and was transferred to the care of Mr Sellu.
The surgeon, of Croft Close in Hillingdon, west London, has been a surgeon for four decades and specialises in colorectal surgery.
Death 'avoidable'
Prosecutors told the court Mr Sellu suspected there had been a rupture, which is a potentially life-threatening condition that requires surgery.
But instead of immediately performing surgery he ordered a CT scan for the next day.

Start Quote

Had (Mr Sellu) operated earlier Mr Hughes would have had a very good chance of survival”
Bobbie Cheema QCProsecutor
The scan confirmed the medic's suspicions but he "failed" to carry out the surgery immediately and instead carried on with his own clinic, prosecutor Bobbie Cheema QC said.
Mr Hughes was sent to the operating theatre at 9pm on 12 February after being in pain for 40 hours, however, by this point, his condition had deteriorated so badly that intensive care specialists had to work to stabilise him, the court heard.
Ms Cheema told the jury that Mr Hughes was transferred to the intensive care unit after surgery but died the following day.
"That death was avoidable," she said.
"Had (Mr Sellu) operated the night before, or even earlier on February 12, Mr Hughes would have had a very good chance of survival."
Perjury charge
She added: "There was a series of missed opportunities and serious errors in judgment in the care of this patient and they combined to cause Mr Hughes' death.
"The standard of care was exceptionally bad."
Ms Cheema told the court that Mr Hughes felt he was not getting sufficient help from hospital staff and phoned a doctor friend who told him to call the surgeon who had operated on his knee.
That surgeon, John Hollingdale, visited Mr Hughes and examined him.
"He was concerned something was wrong... unrelated to his knee surgery and asked for an X-ray to be completed urgently," Ms Cheema said.
Mr Hollingdale was "surprised" to learn the test was to be delayed until the next day as the hospital had the facilities to perform the tests around the clock, Ms Cheema told jurors.
Mr Sellu is also accused of perjury in relation to allegations he lied at under oath Mr Hughes's inquest, which he also denies.
The trial continues.

More on This Story

The BBC is not responsible for the content of external Internet sites

Monday 16 September 2013

NHS patients 'should not face constant moves'

NHS patients 'should not face constant moves'

Hospital wardPatients often face multiple moves around hospital

Related Stories

The era of NHS patients being shunted around hospitals needs to end, an expert group says.
The Future Hospital Commission - set up by the Royal College of Physicians - said a radical revamp in structures was needed to bring care to the patient.
This was particularly true for frail people with complex needs, who often faced multiple moves once admitted to hospital, the report said.
It also recommended closer working with teams in the community.
The commission said this could involve doctors and nurses running clinics in the community and even visiting people in their own homes - as is already happening in a few places.
'Bold and refreshing'
It also called for an end to the concept of hospitals discharging patients.
Sir Mike Rawlins: "Hospital shouldn't stop at the walls of the building"
Instead, it argued that many of those seen in hospitals in the 21st Century needed ongoing care that did not end when they left hospital.
So the report recommended that planning for post-hospital care should happen as soon as someone is admitted.
Key to that will be a new hub that should be created in every hospital, called a clinical co-ordination centre, which would act as a central control room, helping to ensure information about patients is shared and their care planned properly.
Once in hospital, patients should not move beds unless their care demanded it, the report said.
That contrasts with the multiple moves many patients with complex conditions often find themselves facing as they are passed from specialism to specialism.
It said this would require a greater emphasis on general wards with specialists visiting patients rather than the other way round.

Case study

The longest Suzie Hughes, who has the auto-immune condition Lupus, has spent in hospital is 21 days.
During her stay, she was moved five times for non-clinical reasons.
"I would find myself being wheeled down the corridor with my flowers and chocolates. Nurses would be with me and I kept thinking, 'What a waste of their time.'
"And each time I arrived on a new ward I had to explain my condition again. The information does not get passed on and it results in delays."
The authors - drawn from across the NHS and social-care spectrum - also called for an end to the two-tier weekday and weekend service in many facilities.
They even said it would be preferable to work at 80% capacity across the seven days if extra resources were not available in the short-term.
Commission chairman Sir Michael Rawlins said it was about providing the care patients "deserved".
Alzheimer's Society chief executive Jeremy Hughes said too often hospitals were stressful places with patients being moved "from pillar to post".
"We need nothing less than a revolution... in order to ensure our NHS is fit for the future," he added.
Health Secretary Jeremy Hunt said the report was "bold and refreshing".
"I agree completely that we must make services more patient-centred both inside and outside hospital."
Shadow health secretary Andy Burnham said: "We must turn this system around and help support people where they want to be - at home with their family around them."

More on This Story

Related Stories

Wednesday 24 April 2013


Party leaders in Commons clash over Stafford Hospital scandal

David Cameron and Ed Miliband clash on NHS spending figures and casualty waiting times

Related Stories

David Cameron has said the Stafford Hospital scandal shows Labour cannot be trusted over the NHS as he clashed with Ed Miliband in the Commons.
The prime minister said the failings at Stafford, which led to the death of hundreds of people 2005 and 2008, would be "repeated again" under Labour.
Mr Miliband said that case was terrible but accused the PM of a "disgraceful slur" on Labour's record on the NHS.
And he said A&E services were "in crisis" under the current government.
At the first Prime Minister's Questions for more than a month, the two men clashed over which party was better placed to run the health service, exchanging views on their parties' respective records while in power.
Mr Cameron suggested that if Labour was returned to power at the next election, there was a risk of further tragedies like that at Stafford - which took place while the last Labour government was in power.
"If anyone wants a memory of Labour's record in the NHS, they only have to read the report into the Stafford Hospital," he told MPs.
Under Labour, he suggested, there would be "cuts to the NHS, longer waiting lists and all the problems we saw at Stafford Hospital will be repeated over again".
Mr Miliband said what had happened in Stafford was "terrible" but accused the prime minister of misrepresenting the "transformation" that took place in the health service under the last government and a "disgraceful slur on the doctors and nurses that made that happen".
The Francis report into the Stafford scandal earlier this year criticised the culture of care at the hospital and the proliferation of central targets but did not blame ministers or specific managers for what went wrong.
'In distress'
The Labour leader said accident and emergency services in hospitals were now in crisis, with the number of people waiting for four hours - a government target - rising from 340,000 in 2009-2010 to 888,000 last year.
"Accident and emergency is the barometer of the NHS," Mr Miliband told MPs during heated exchanges.
"This barometer is telling us that it is a system in distress."
The coalition had also presided over a fall in the number of nurses while the NHS helpline was in chaos, he added.
But Mr Cameron said a million more people were being seen at A&E departments now than when Labour was in power while the number of day cases had increased by 500,000 over the past three years.
Waiting times for inpatient operations had fallen since 2010 while waiting times for outpatients were stable, he added.
"The NHS is performing better under this government than it ever did under Labour."

More on This Story

Related Stories

Featured post

More patients in Scotland given antidepressants

More patients in Scotland given antidepressants 13 October 2015   From the section Scotland Image copyright Thinkstock Image ca...