Showing posts with label NHS: Elderly care. Show all posts

Monday 16 September 2013

NHS patients 'should not face constant moves'

By Nick TriggleHealth correspondent, BBC News

Patients often face multiple moves around hospital

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."

Wednesday 20 February 2013

Jeremy Hunt

Jeremy Hunt warns NHS trusts over 'defensive culture'

Gary Walker broke an NHS gagging clause when he spoke to the BBC

Health Secretary Jeremy Hunt has warned NHS bosses against allowing a culture that is "legalistic and defensive" in dealing with staff who raise concerns over patient care.

In a letter to all English NHS trusts, Mr Hunt highlighted fears that "gagging" clauses were being used to "frustrate" such whistleblowing.

A climate of "openness and transparency" is essential, he said.

It comes after one former NHS trust boss broke a gag to talk to the BBC.

Gary Walker, former chief executive of United Lincolnshire Hospitals Trust (ULHT), said he had been forced out of his job and gagged from speaking out about his concerns over patient safety.

'Positive move'

Analysis

Andrew HoskenBBC Today programme

The row over secret gagging clauses has focused attention on the man at the top of the English NHS, Sir David Nicholson.

His position was already being questioned in the wake of a highly critical report on the Mid Staffordshire Hospitals scandal, where hundreds of patients may have died from neglect and abuse.

However Sir David escaped personal censure from inquiry chairman, Robert Francis QC.

Following the report, another 14 NHS trusts have been placed under investigation.

What makes the gagging row potentially so toxic for Sir David is one of those trusts, the United Lincolnshire Hospitals Trust, has been trying to enforce Gary Walker's gagging clauses with the threat of legal action.

Since Mr Walker broke cover, more people are asking whether Sir David and other senior NHS civil servants can bring about the cultural change and openness Jeremy Hunt and many others consider essential.

In his letter, Mr Hunt called for the NHS to "recognise and celebrate" staff who had "the courage and professional integrity to raise concerns over care".

The health secretary insisted that "fostering a culture of openness and transparency" was essential in creating a climate "where it is easy for staff, present and former, to come forward with any concerns they have relating to patient safety".

Mr Hunt also warned NHS bosses against the "institutional self-defence that prevents honest acknowledgement of failure".

"I would ask you to pay very serious heed to the warning from Mid Staffordshire that a culture which is legalistic and defensive in responding to reasonable challenges and concerns can all too easily permit the persistence of poor and unacceptable care," he said.

Mr Walker, who was sacked in 2010 for gross professional misconduct for allegedly swearing in a meeting, told the BBC he had no choice but to sign an agreement linked to a confidentiality clause in April 2011.

He said he was gagged by the NHS from speaking out about his dismissal and his concerns over the quality of care at the trust.

After breaking the order, lawyers for the trust then warned him he would have to repay £500,000.

Speaking to BBC Radio 4's Today programme on Saturday, Mr Walker applauded Mr Hunt for "clearly taking a personal interest" in his case and the issue of gagging orders.

"I think that's a very positive move."

"I don't think it's simply about the Lincolnshire Trust," he added, calling for Mr Hunt to investigate the "chain of command" that led to the gagging, which he said included the Department of Health, the East Midlands Strategic Health Authority (SHA) and the Lincolnshire Trust.

"I don't think Mr Hunt can investigate his own department so I think he should be looking for someone exceptionally independent from all of this."

'Suppressed and bullied'

BBC Radio 4 Today programme reporter Andy Hosken said Mr Hunt's letter could spell the end of the National Health Service gag if the NHS trusts' chairmen to whom he wrote actually followed the advice and guidance contained within the letter.

Our correspondent said the letter was certainly a warning shot across the bows of the trusts. It appeared the use of these gagging clauses was widespread in the NHS, he added.

Meanwhile, Dr Phil Hammond, chief medical correspondent at Private Eye magazine joined calls for NHS chief executive Sir David Nicholson to stand down.

He told BBC News: "We need to change the culture, we have to change the people at the top. David Nicholson has to go and that's the one constructive thing that Jeremy Hunt could do.

"Unless you have accountability at the top, you won't get it at the bottom."

Health Minister Lord Howe: "It is the right and the duty of any NHS employee to raise concerns"

A spokesman for the East Midlands SHA said it had always acted "appropriately and properly" in the "interest of patients".

And ULHT has said the allegations that they had tried to stifle debate about patient safety issues were "incorrect".

ULHT is one of 14 trusts in England currently being investigated for high death rates, in the wake of the Stafford hospital scandal, where hundreds are believed to have died after receiving poor care.

It emerged on Friday that police and prosecutors are now studying a damning report into failures at Stafford to see whether any criminal charges should be brought against staff.

Sunday 10 February 2013

Staffordshire NHS Foundation Trust.

Most of the UK media has reported on the Francis inquiry into significant failures in care at the Mid Staffordshire NHS Foundation Trust.
The report suggests a raft of radical changes to help improve patient safety. These include proposals to make serious but avoidable medical mistakes a criminal offence.
The Healthcare Commission (the hospital regulator at the time) first raised concerns about the trust in 2007, after determining it had unusually high death rates.
These concerns led to a series of reports, undertaken by different bodies, which all found widespread evidence of significant failures in care, including:

patients being left in soiled bedding
patients not given ready access to food and water
chronic staff shortages
failure in the leadership of the hospital
a culture in which staff members who had concerns about failures in care were discouraged from speaking out

This current inquiry was commissioned in 2010 to investigate wider issues that may have contributed towards these serious problems. The inquiry, carried out by the barrister Robert Francis QC, was asked to come up with recommendations which could help prevent similar failings from happening in the future.
The findings of the inquiry have now been published.

What were the main findings of the inquiry?

The findings of the inquiry can fairly be described as damning. It highlights what amounts to a ‘perfect storm’ of systematic failures of care at multiple levels, including:

a ‘Somebody Else's Problem’ attitude among hospital staff – perceived problems were too often assumed to be the responsibility of others
an institutional culture that cared more about the needs of the hospital staff than the patients
an unacceptable willingness to tolerate poor standards of patient care
a failure to accept and respond to legitimate complaints
a failure of different teams within the hospital, as well as in the wider community, to communicate and share their concerns
a failure of leadership – in particular, financial changes needed to achieve Foundation Trust status were seen, by the inquiry, to take precedence over patient care

Mr Francis concludes that, ‘The extent of the failure of the system shown in this report suggests that a fundamental culture change is needed. This does not require a root and branch reorganisation – the system has had many of those – but it requires changes which can largely be implemented within the system that has now been created by the new reforms.’

What recommendations does the inquiry make?

The inquiry makes a total of 290 individual recommendations. These include:

causing harm or death to a patient due to avoidable failures in care should be a dealt with as a criminal offence (rather than a regulatory or civil matter)
NHS staff, including doctors and nurses, should have a legal ‘duty of candour’ – so they are obliged to be honest, open and truthful in all their dealings with patients and the public
a single regulator of both quality of care and financial matters should be created
non-disclosure agreements (‘gagging orders’) – where NHS staff agree not to discuss certain matters – should be banned
there should be a ‘fit and proper’ test for hospital directors, similar to those set for football club directors
a clear line of leadership needs to be established, so it is always clear who is ultimately ‘in charge’ when it comes to a particular patient
uniforms and titles of healthcare support workers should be clearly distinguished from those of registered nurses

What happens next?

The final report of the public inquiry has now been published, and the government has said it will respond to the recommendations of the inquiry in March 2013. Changes required by earlier reports into the failings at Mid Staffs are already underway.
The Prime Minister David Cameron has said that “quality of care” should be on a par with “quality of treatment”.
He said: “We have set this out explicitly in the Mandate to the NHS Commissioning Board, together with a new vision for compassionate nursing.
“We have introduced a tough new programme for tracking and eliminating falls, pressure sores and hospital infections.
“And we have demanded nursing rounds every hour, in every ward of every hospital.”
Edited by NHS Choices. Follow Behind the Headlines on twitter.

Links to the headlines

Stafford Hospital: Hiding mistakes 'should be criminal offence'. BBC News, February 6 2013
Mid Staffordshire NHS trust inquiry report published. The Guardian, February 6 2013
David Cameron apologises for Mid Staffs scandal after damning report. The Daily Telegraph, February 6 2013
Medical staff must face criminal charges for failures, says care scandal report. The Independent, February 6 2013

Thursday 13 September 2012

Hospitals 'on brink of collapse'

By Nick Triggle

Health correspondent, BBC News

Hospital beds are being closed, but demands are increasing

Hospitals in England could be on the brink of collapse because of rising demand and the increasing complexity of patients' conditions, doctors warn.

The Royal College of Physicians' report said the number of beds had been cut by a third over the past 25 years.

It said at the same time emergency admissions had started rising and hospitals were seeing older patients with a wider variety of conditions

The college said this process now meant urgent care was being compromised.

And it warned the problems could lead to another scandal like that surrounding the Mid Staffordshire NHS Trust, which became the subject of a public inquiry after regulators said poor standards had led to needless deaths.

The Royal College of Physicians (RCP) said standards were slipping in hospitals throughout England.

It cited the way older patients were repeatedly moved around wards, the lack of continuity of care while in hospital and tests being done during the night as some of the examples of how care was suffering.

The college also highlighted the results of feedback from its members, which showed concern about discharge arrangements and workload.

The report said in some ways the NHS had been a victim of its own success. Advancements in medicine had led to people living longer, but this meant they were increasingly developing complex long-term conditions such as dementia as a result.

Doctor Andrew Goddard of the Royal College of Physicians: ''The winter pressure is an all-year pressure''

Prof Tim Evans, of the RCP, said: "This evidence is very distressing. All hospital patients deserve to receive safe, high-quality sustainable care centred around their needs.

"Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population who increasingly present to our hospitals with multiple, complex diseases.

"We must act now to make the drastic changes required to provide the care they deserve."

The report said the solution lay in concentrating hospital services in fewer, larger sites that were able to provide excellent care round-the-clock, seven days a week.

But it also said this would require improvements in community services as there were many patients who ended up in hospital because of a lack of help close to home.

Jeremy Hughes, chief executive of the Alzheimer's Society, said: "These latest findings are alarming but, unfortunately, not surprising.

"It is painfully evident that the healthcare system stands on the brink of crisis.

"People with dementia are going into hospital unnecessarily, staying in too long and coming out worse."

Health minister Dr Dan Poulter said: "It is completely wrong to suggest that the NHS cannot cope - the NHS only uses approximately 85% of the beds it has available, and more and more patients are being treated out of hospital, in the community or at home.

"But it is true that the NHS needs fundamental reform to cope with the challenges of the future.

"To truly provide dignity in care for older people, we need to see even more care out of hospitals. That's why we are modernising the NHS and putting the people who best understand patient's needs, doctors and nurses, in charge."

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Wednesday 12 September 2012

Trust chief executive Lyn Hill-Tout said she welcomed working with Monitor

Rescue package for troubled Mid Staffordshire NHS Trust

A rescue package is being drawn up for a hospital trust accused of "appalling standards of care" three years ago.

Independent experts will look at a long-term solution for patients using Mid Staffordshire NHS Foundation Trust, health service watchdog Monitor said.

The watchdog, which oversees finance and management, said clinical care has improved but needs to be made sustainable.

Experts will look at how services can be made viable.

Financial advisors, accountants, administrative and legal service firms will form part of the team recommending how services should be run.

'Deeply dysfunctional'

Monitor said the body had an "open mind" about what solutions would be reached but suggested a solvent restructuring of the trust or possibly putting it in special administration could be options.

A final report will be delivered to Monitor in spring 2013.

The trust looks after Stafford and Cannock Chase Hospitals.

A 2009 Healthcare Commission report revealed a higher than expected number of deaths at Stafford Hospital.

Analysis

Nick TriggleHealth correspondent, BBC News

After the placing of South London Healthcare into administration in July, this is another significant step for the NHS.

The decision by the health secretary two months ago was a first for the health service and could lead to that trust being broken up and services closed.

Mid Staffordshire is a foundation trust so this option is not open to ministers or regulators - yet.

But come April Monitor will have the powers to take the same step and so by announcing troubleshooters will be brought in Monitor has paved the way for that to happen.

It will not be the first time that outside experts have been asked to assess the governance and finances of an NHS trust.

But it is the first time they will have the remit to recommend administration for a foundation trust.

It is another sign that in the current financial climate tough action will be taken against struggling trusts.

A public inquiry into the role of regulators in the lead up to the critical report is set to report later this year.

The A&E unit is also temporarily shut at night and earlier this month an NHS report criticised the standard of breast cancer care, describing the set-up as "deeply dysfunctional".

A contingency planning team will work with local commissioners and clinicians, Monitor said.

Dr David Bennett, chair and interim chief executive of Monitor, said: "We have been working closely with Mid Staffordshire NHS Foundation Trust to improve its performance.

"It has made significant improvements in the clinical care provided for patients, but we need to make sure these services can be secured in the long-term.

"It is therefore time for us as the sector regulator to step in and look for a solution that ensures services are provided for local patients on a sustainable basis.

"We have an open mind about the form that solution might take, but it should be the best one for patients in the long term."

Lyn Hill-Tout, the trust's chief executive, said she welcomed working with Monitor so "clear decisions" could be made.

She said: "Reviews of the trust over the last few years and the changes to the way healthcare has begun to be provided nationally have led to a growing feeling of uncertainty about the future of the two hospitals."

Dr David Bennett: "We are open minded about what is the right answer"

In July a new medical director took over at the trust replacing Manjit Obhrai, who was brought in three years ago to improve standards.

At the same time, the Care Quality Commission lifted all of its previous concerns regarding the hospital, saying all "essential standards" were being met.

A Department of Health spokeswoman said the hospitals trust was "still facing serious financial challenges".

She added: "This puts at risk its work on improving services for patients.

"It is important that valued local services are sustainable and able to continue providing high quality treatment and advice for patients."

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Monday 16 September 2013

NHS patients 'should not face constant moves'

NHS patients 'should not face constant moves'

Case study