Wednesday 9 November 2011

Elderly care - 'shameful attitudes'

NHS: Elderly care dossier shows 'shameful attitudes'

Attitudes to elderly people in the NHS are shameful, says the Patients Association

A dossier containing "shameful" stories about the care elderly patients receive in NHS hospitals in England has been published by campaigners.

The Patients Association said the 16 cases include people being denied pain relief, left to sit in their own faeces and going without food and drink.

It comes after criticism from other groups and the charity said it was highlighting the tip of the iceberg.

The government said it was determined to "root out poor performance".

A programme of unannounced inspections would continue, the Department of Health added.Follow @westofmengele

Last month the Care Quality Commission attacked hospitals for what the regulator said were "alarming" levels of care.

The Health Service Ombudsman also raised concerns about the issue in February, reporting that nearly a fifth of complaints it got were related to the care of the elderly.

As well as highlighting the 16 cases, the Patients Association said the number of calls to its helpline regarding care on hospital wards had already hit 961 this year - a third more than the total made throughout the whole of 2010.

Left sitting in faeces

George Taylor was admitted to Chase Farm Hospital in London in August with a urinary tract infection and chest problem. His family said he received a shocking level of care q=while there.

On one day, he was told by a nurse to go to the toilet sitting in his chair because she did not have time to take him to a bathroom. He did and his family then found him sitting in his own faeces. His wife had to clean him up.

His family also said he was often not washed, and the smell became overpowering at times. He was also discharged too early and was soon admitted to another hospital, where doctors said he should not have been released at all.

Mr Taylor's daughter, Gaynor Marshall, said: "The nursing staff treated him as an object that they had to treat rather than a human being." A complaint has now been made about his care.

The Patients Association said the failings fell into four broad categories - communication, assistance going to the toilet, pain relief and nutrition.

And it called on NHS trusts to sign up to a pledge to ensure these four areas of care become top priorities.

It said responsibility for the problems lay with everyone from individual staff on the wards to senior managers on the board.

Among the cases highlighted are a patient who was left sitting in his own faeces for hours after a nurse told him he should empty his bowels in his chair because she did not have time to help him go to the toilet.

In another case, a family of a patient had to beg for pain relief for a dying woman before waiting for nearly two hours for help to arrive.

And one man had to wait for 15 minutes to have his call buzzer answered despite having to desperately struggle for breath.

It is the third time the Patients Association has published individual stories like this.

'Poor performance'

Katherine Murphy, the charity's chief executive, said: "We cannot ignore the fact that some trusts are not even paying lip service to the fundamentals of care.

Dying patient in 'terrible' pain

Sally Abbott-Sienkiewicz was admitted to Glenfield Hospital in Leicester in November last year. She was terminally ill with cancer and had developed pneumonia. She died within two days.

But throughout her time there, her family had to battle to get her pain relief. They said she was left in terrible pain - sometimes for more than an hour - as they argued with staff to give her sedatives. The worst problems were experienced during the night.

Her daughter Samantha White said at times her pain was "horrendous and horrific", but staff were too slow to react.

Suzanne Hinchliffe, chief nurse at the trust which runs Glenfield, said: "It is clear that we completely failed Mrs Abbott-Sienkiewicz and her family, and for that we remain very sorry." She added that measures were being taken to improve practices.

"The issues we continue to highlight are human rights issues. They show a lack of compassion and care and a shameful attitude to treatment of the elderly."

Peter Carter, general secretary of the Royal College of Nursing, said the patients had been "clearly failed" in the cases highlighted.

"Each and every nurse is personally accountable for their own actions and must act promptly to raise concerns if staffing levels or other pressures get in the way of delivering good patient care."

But he also said managers must take responsibility, pointing out that job cuts were making it more difficult to provide good care.

The publication of the Patients Association report has also coincided with an announcement by the government that it is looking to improve standards for healthcare assistants, who are providing an increasing amount of care on wards.

These staff are currently unregulated, but the Department of Health is looking to introduce new rules by 2013 to ensure that they reach a minimum training levels before being allowed to work. However, indications are that this will be a voluntary requirement, which has disappointed some.

A spokesman for the Department of Health said: "The Patients Association is right to raise these examples and issues, and we will work with them and with the NHS to sort these problems out."

Tuesday 8 November 2011

strange and curious history of lobotomy

The strange and curious history of lobotomy

Deep in the archives of London's Wellcome Collection, that great treasure trove of medical curiosities, is a small white cardboard box.It's 75 years since the first lobotomy was performed in the US, a procedure later described by one psychiatrist as "putting in a brain needle and stirring the works". So how did it come to be regarded as a miracle cure?

Inside is a pair of medical devices. They are simple. Each consists of an eight-centimetre steel spike, attached to a wooden handle.

"These two gruesome things are lobotomy instruments. Nothing sophisticated," says senior archivist Lesley Hall. "It's not rocket science is it?"

These spikes once represented the leading edge of psychiatric science. They were the operative tools in lobotomy, also known as leucotomy, an operation which was seen as a miracle cure for a range of mental illnesses.

For millennia, mankind had practised trepanning, drilling holes into skulls to release evil spirits.

“

The idea behind lobotomy was different. The Portuguese neurologist, Egas Moniz, believed that patients with obsessive behaviour were suffering from fixed circuits in the brain.

In 1935, in a Lisbon hospital, he believed he had found a solution. "I decided to sever the connecting fibres of the neurons in activity," he wrote in a monograph titled "How I came to perform frontal leucotomy".

His original technique was adapted by others, but the basic idea remained the same.

Surgeons would drill a pair of holes into the skull, either at the side or top, and push a sharp instrument - a leucotome - into the brain.

The surgeon would sweep this from side to side, to cut the connections between the frontal lobes and the rest of the brain.

Moniz reported dramatic improvements for his first 20 patients. The operation was seized on with enthusiasm by the American neurologist Walter Freeman who became an evangelist for the procedure, performing the first lobotomy in the US in 1936, then spreading it across the globe.

The hyperactive McMurphy, played by Nicholson, is lobotomised in One Flew Over the Cuckoo's Nest

From the early 1940s, it began to be seen as a miracle cure here in the UK, where surgeons performed proportionately more lobotomies than even in the US.

Despite opposition from some doctors - especially psychoanalysts - it became a mainstream part of psychiatry with more than 1,000 operations a year in the UK at its peak. It was used to treat a range of illnesses, from schizophrenia to depression and compulsive disorders.

The reason for its popularity was simple - the alternative was worse.

"When I visited mental hospitals… you saw straitjackets, padded cells, and it was patently apparent that some of the patients were, I'm sorry to say, subjected to physical violence," recalls retired neurosurgeon Jason Brice.

Find out more

The Lobotomists was broadcast on Radio 4 on Monday 7 November
Listen again using the link below

The Lobotomists

The chance of a cure through lobotomy seemed preferable to the life sentence of incarceration in an institution.

"We hoped it would offer a way out," says Mr Brice. "We hoped it would help."

There were centres for lobotomy across the UK, in Dundee, North Wales and Bristol. But by far the most prolific lobotomist in the country, and indeed the world, was the neurosurgeon Sir Wylie McKissock, based at the Atkinson Morley hospital in Wimbledon.

"He was one of the great men of medicine of the 20th Century," says Terry Gould, who worked as McKissock's anaesthetist.

Freeman (left) built on Moniz's discovery

He believes his former boss performed around 3,000 lobotomies, as part of his famously speedy approach to surgery. "It was a five-minute procedure. Very quickly done," says Dr Gould.

As well as operating at Atkinson Morley, McKissock would travel across the south of England at weekends, performing extra leucotomies at smaller hospitals.

"He was quite prepared to travel down to whatever the hospital was on a Saturday morning and do three or four leucotomies and then drive away again," says Mr Brice.

He says the operation could have dramatic benefits for some patients, including one who was terrified of fire. "Funnily enough she finished up after I had done the operation very much better, but she went and bought herself a fish and chip shop with grossly hot oil in it."

The reality was very different. "She was irreversibly damaged," he said. Eileen became apathetic and listless. "I've cracked, haven't I?" as she put it. Several years later, she was told that the first operation had failed and she agreed to a second round of psychosurgery.

"I still felt that these were very eminent gentlemen and if were confident would be a success, it would be a success. They did it and it was a disaster," said Sid. Instead of curing her, she became more apathetic and had severe incontinence problems.

However, he had increasing doubts about lobotomy, especially for patients with schizophrenia.

Psychiatrist Dr John Pippard followed up several hundred of McKissock's patients. He found that around a third benefited, a third were unaffected and a third were worse off afterwards.

Although he himself had authorised lobotomies, he later turned against the practice.

"I got increasingly conservative about it because I don't think any of us were ever really happy about putting in a brain needle and stirring the works," he says. "Not a nice thought."
But from the mid-1950s, it rapidly fell out of favour, partly because of poor results and partly because of the introduction of the first wave of effective

psychiatric drugs.

n 1949, Egas Moniz won the Nobel Prize for inventing lobotomy, and the operation
peaked in popularity around the same time.

But from the mid-1950s, it rapidly fell out of favour, partly because of poor results and partly because of the introduction of the first wave of effective psychiatric drugs.

What's the modern equivalent?

"I'm not criticising chemotherapy because it's effective but compared to other treatments, in decades to come it will seem to be overly destructive and something that needed to be changed and will be changed.

"It's a very similar judgement, that the pluses outweigh the minuses."

Jack El-Hai, author of The
LobomotistDecades later, when working as a psychiatric nurse in a long-stay institution, Henry Marsh used to see former lobotomy patients.

"They had been lobectimised 30-40 years ago, they were chronic schizophrenics and they were often the ones were some of the most apathetic, slow, knocked-off patients," he says.

Mr Marsh, who is now one of Britain's most eminent neurosurgeons, says the operation was simply bad science. "It reflected very bad medicine, bad science, because it was clear the patients who were subjected to this procedure were never followed up properly."

"If you saw the patient after the operation they'd seem alright, they'd walk and talk and say thank you doctor," he observes. "The fact they were totally ruined as social human beings probably didn't count."

'I wish I'd never had it'

British housewife Eileen Davie suffered depression after the birth of her second son in 1948. Conventional treatment failed to help her, so her doctor recommended a leucotomy.

Speaking in a BBC documentary in 1976, her husband Sid, who signed the consent forms, said: "I got the impression that it was no more serious than having a tooth extracted."

Start Quote"I still felt that these were very eminent gentlemen and if were confident would be a success, it would be a success. They did it and it was a disaster," said Sid. Instead of curing her, she became more apathetic and had severe incontinence problems.

These two gruesome things are lobotomy instruments”

Lesley HallWellcome Collection, London

Walter Jackson Freeman II
Walter Freeman (right) and James Wattsperforming a lobotomy.
Born	November 14, 1895 Philadelphia, Pennsylvania, United States
Died	May 31, 1972 (aged 76)
Education	Yale University University of Pennsylvania Medical School
Known for	Popularizing the lobotomy Invention of the "ice pick" lobotomy
Children	Walter Jackson Freeman III
Parents	Walter Jackson Freeman I
Relatives	William Williams Keen, grandfather

Painkillers cost the NHS in England £442m a year

By Dominic HughesHealth correspondent, BBC News

The amount spent each year on painkillers - also known as analgesics - has been growing

The NHS in England spent more than £440m last year on painkillers.

Figures also show that some doctors spent thousands of pounds prescribing over-the-counter painkillers and flu medication like Anadin and Lemsip.

On average, health trusts in England spent £8.80 per head of population on analgesics.

But in some northern towns and cities the figure was as high as £15, while in parts of the south it was as low as £3.26 per head.

Using figures from the NHS Information Centre and the Office for National Statistics, data analysis firm SSentif found some large differences between the average amount spent on painkillers.

The biggest spenders were Middlesbrough, Hartlepool, Rochdale and Blackpool, where painkiller prescription bills in primary care trusts (PCTs) averaged £2.3m.

That is more than double the amount spent in Richmond and Twickenham, Camden and Westminster.

Deprivation link

Drug tariff

Top five spenders per head of population in 2010/11:

PCT Middlesbrough: £15.39
PCT Hartlepool: £15.01
PCT Heywood, Middleton & Rochdale: £14.80
PCT Blackpool: £14.29
PCT Great Yarmouth & Waveney: £14.25

The lowest five spenders per head of population in 2010/11:

PCT Richmond & Twickenham: £3.26
PCT Camden: £3.84
PCT Westminster: £3.85
PCT Sutton & Merton: £3.86
PCT Kingston: £3.86

The analysis also showed that across England just over £3,000 was spent on prescriptions for cold and flu remedies like Lemsip and Beechams Powders.

More than £59,000 was spent on over-the-counter painkillers like Anadin and Panadol.

Researchers looked for a link between painkiller prescribing, deprivation and old age.

In the south they found a strong link between prescribing painkillers and age, but almost no link with deprivation.

In the north the link with deprivation was stronger but there was no link to age.

'Good of patients'

Judy Aldred, managing director of SSentif, said that spending on painkillers in the NHS had grown steadily.

"At the moment, the responsibility for the prescribing budget lies with primary care trusts but this is about to change. PCTs are phasing out and GPs are being given greater responsibility, including the management of their own prescribing budgets.

"Although the figures involved were comparatively low, it was concerning to see products such as Lemsip and even Alka-Seltzer XS offered on prescription.

"When GPs begin shouldering the responsibility for prescribing costs, it will be interesting to see if this continues."

But the chair of the Royal College of General Practitioners, Dr Clare Gerada, said GPs were not prescribing painkillers without cause.

"There are very many reasons why GPs prescribe painkillers, including - but not limited to - the changing and increased needs of our ageing population, and the improved use of painkillers themselves, for example in alleviating the symptoms of osteoporosis and osteoarthritis.

"GPs understand the importance of responsible prescribing, and do so in accordance with the standards laid out by the British National Formulary. GPs do not prescribe just for the sake of it; they do it for the good of their patients."

A spokesman for the Department of Health added: "It is important that those living with pain should be able to obtain adequate relief. However the decision to prescribe pain relief must be clinically based on the assessment of the patient's needs.

"There are many factors that affect the number of prescriptions for painkillers dispensed in one particular area and no one factor can be looked at in isolation."

Sunday 6 November 2011

The worrying news that drilling for shale gas

Home » WWF news

Fracking, earthquakes and the positive answer to shale gas

2 November 2011

The worrying news that drilling for shale gas probably did cause earthquakes near Blackpool is only part of our problem with ‘fracking’. The other big environmental elephant in the room is that shale gas is simply another greenhouse gas-pumping fossil fuel, and far from the ‘wonder gas’ it’s hyped as.

The report into this year’s unusual seismic activity in Lancashire - released today by Cuadrilla Resources, the British company exploring for natural shale gas in the Bowland Basin – concludes that: “It is highly probable that the hydraulic fracturing … did trigger a number of minor seismic events.”

It just serves to confirm one of our many fears about shale gas. As well as the earth tremors, and concerns over ground and surface water contamination attributed to shale gas drilling, there are of course also the greenhouse gas emissions associated with its extraction and the consequent burning of what is yet another carbon-emitting fossil fuel.

That’s why we’re calling in the first instance for a moratorium on shale gas extraction in the UK until the potential environmental risks around shale gas drilling have been properly researched and the right regulations have been put in place.

But we’re also reiterating that a new ‘dash for gas’ risks taking the world towards dangerous levels of climate change - increasing temperatures by at least 3.5°C according to a recent report by the International Energy Agency.

As Nick Molho, our head of energy policy, says: “We’re extremely concerned by the way shale gas is being painted as a ‘wonder gas’ that will slash energy bills in Britain and somehow help tackle climate change.

“Shale gas is still a fossil fuel, and a new dash for gas could see global temperatures skyrocket. There’s also no evidence that it will have a big impact on energy bills, which have in fact been driven up in recent years by a rising gas price.”

Our research - seen most recently in our Positive Energy report, which demonstrates how renewable sources of energy could meet between 60% and 90% of the UK’s electricity demand by 2030 - makes it clear that prioritising energy efficiency and renewables like wind, wave and tidal power, not shale gas, are the best way of reducing our disproportionate vulnerability to the gas price, and of genuinely tackling climate change, in the long term.

The government has to listen to the clear and sensible evidence and steer a straight course to a low-carbon future - resisting the siren calls of the fossil fuel industry

mengele plus

Wednesday 9 November 2011

Elderly care - 'shameful attitudes'

NHS: Elderly care dossier shows 'shameful attitudes'

Left sitting in faeces

Dying patient in 'terrible' pain

Tuesday 8 November 2011

strange and curious history of lobotomy

“

Find out more

What's the modern equivalent?

'I wish I'd never had it'

Start Quote"I still felt that these were very eminent gentlemen and if were confident would be a success, it would be a success. They did it and it was a disaster," said Sid. Instead of curing her, she became more apathetic and had severe incontinence problems.

Painkillers cost the NHS in England £442m a year

Painkillers cost the NHS in England £442m a year

Drug tariff

Sunday 6 November 2011

The worrying news that drilling for shale gas

Featured post

More patients in Scotland given antidepressants

Wednesday 9 November 2011

Elderly care - 'shameful attitudes'

NHS: Elderly care dossier shows 'shameful attitudes'

Related Stories

Left sitting in faeces

Dying patient in 'terrible' pain

More on This Story

Related Stories

Related Internet links

Tuesday 8 November 2011

strange and curious history of lobotomy

“

Find out more

What's the modern equivalent?

'I wish I'd never had it'

Start Quote"I still felt that these were very eminent gentlemen and if were confident would be a success, it would be a success. They did it and it was a disaster," said Sid. Instead of curing her, she became more apathetic and had severe incontinence problems.

Painkillers cost the NHS in England £442m a year

Painkillers cost the NHS in England £442m a year

Related Stories

Drug tariff

More on This Story

Related Stories

Related Internet links

Share this page

Sunday 6 November 2011

The worrying news that drilling for shale gas

Featured post

More patients in Scotland given antidepressants