Sunday, 28 April 2013

The NHS must share patient data more effectively

Data-sharing 'good for patients'

Who can access medical records is a key question for the NHS

The NHS must share patient data more effectively to ensure that people undergoing treatment receive the optimum care, Health Secretary Jeremy Hunt has said.

He was responding to the publication of the Caldicott review, an analysis of how the NHS in England treats data.

It calls for the NHS to share information more effectively, but also for patient confidentiality to be respected,

Doctors' leaders welcomed the report.

'Opt-out'

Mr Hunt said: "Most NHS users would be astonished that information doesn't flow around the system.

"In many hospitals the IT systems aren't even linked within a hospital, let alone between hospitals and other parts of the health economy."

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Confidentiality is the cornerstone of the doctor/patient partnership and we must do all we can to safeguard it”

Dr Tony Calland,BMA

The Caldicott Review cited a "culture of anxiety" in the health and social care sector about sharing data, meaning health professionals do not pass on information that could improve someone's care.

But it said sharing appropriately should be "the rule, not the exception".

However the review also suggests there should be better monitoring and control of who has access to records, and that what people see should be limited to what is necessary for them to provide good care.

And while the NHS uses patient data to plan care at local and national levels, Mr Hunt said patients could opt out of their GP records being shared with the Health and Social Care Information Centre, which collates statistics for the NHS.

Controls

The review says patients should be able to see any records held on them, the review adds, whether that is in hospitals or the community.

Dame Fiona said she had heard "great frustration" from patients who had experienced problems accessing their own records.

The report applies to the NHS in England, but she said many of its recommendations would apply to the whole of the UK.

Dr Tony Calland, head of the BMA's ethics committee, said: "Confidentiality is the cornerstone of the doctor/patient partnership and we must do all we can to safeguard it."

He said that when patient data was used for research there had to be "strict controls" which were "scrupulously adhered to and regularly audited by an independent body".

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

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."

'Cosmetic crisis' waiting to happen

By James GallagherHealth and science reporter, BBC News

Injections to plump up the skin are a "crisis waiting to happen" and should be available only on prescription, a UK review of cosmetic procedures has said.

It warned that dermal fillers, covered by only the same level of regulation as toothbrushes, could cause lasting harm.

The independent review added cosmetic surgery had been "trivialised". It also attacked "distasteful" companies for putting profit ahead of care.

The review has recommended a series of measures to better protect patients.

It was commissioned by the Department of Health in England, but the findings will be passed to health ministers throughout the UK.

From fillers to breast implants - the cosmetic procedures industry is booming. It was worth £750m in the UK in 2005, £2.3bn in 2010 and is forecast to reach £3.6bn by 2015.

But there is considerable concern that regulations have failed to keep pace - leaving patients vulnerable.

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Anybody, anywhere, anytime can give a filler to anybody else, and that is bizarre”

Sir Bruce KeoghNHS Medical Director

The biggest growth is in non-surgical procedures such as fillers to tackle wrinkles, Botox and laser hair removal - the area the report describes as "almost entirely unregulated".

The advisory panel said the procedures, which could go horribly wrong, were being treated as casually as having highlights done at a lunchtime hairdresser's appointment and had become commonplace at "beauty parties".

Former beauty clinic manager Sarah Payne recalls how a dermal filler treatment went badly wrong

Sir Bruce Keogh, the NHS medical director for England who led the review, said: "The most striking thing is that anybody, anywhere, anytime can give a filler to anybody else, and that is bizarre."

At a European level, both medical devices such as breast implants and Botox, which is classed as a medicine, are regulated.

Fillers are deemed to have no medical purpose so are regulated in the same way as toothbrushes and ball-point pens. There are 190 different fillers available in Europe compared with just 14 in the US.

Bad practice

Analysis

James GallagherHealth and science reporter, BBC News

When you go for cosmetic surgery, you expect the same standard of care as for any other operation. The review makes it clear that this is not the case.

There have been widespread calls for reform since a health scare caused by faulty breast implants, made by the French firm Poly Implant Prothese (PIP).

Data on which women had been given PIP implants, let alone what had happened to them, was not kept. It was described as a "data-free zone".

And the problems are wider. Botox should be available only on prescription, but is far more readily available.

Calf and buttock implants are barely regulated at all. The same goes for dermal fillers.

The European Union is making moves to tighten the rules. However, changes are not expected for five more years.

Sir Bruce Keogh says: "I don't think we can wait, keeping our citizens at risk."

Sir Bruce also said cosmetic surgery deals, such as buy-one-get-one-free offers and handing out free breast surgery as prizes in raffles, were a "particularly distasteful" way of incentivising people to go under the knife.

There were also questions of safety. The review said there were no checks on surgeons' qualifications in some parts of the private sector, an issue made worse by more than half of cosmetic surgery being performed by "fly in, fly out" doctors - surgeons based abroad who fly into the UK to perform operations and then fly back out again.

The review recommends:

Legislation to classify fillers as prescription only
Formal qualifications for anyone who injects fillers or Botox
Register of everyone who performs surgical or non-surgical cosmetic interventions
Ban on special financial offers for surgery
Formal certificate of competence for cosmetic surgeons
A breast implant register to monitor patients
Patients' procedures must be approved by a surgeon not a salesperson
Compulsory insurance in case things go wrong
A pooled fund to help patients when companies go bust - similar to the travel industry

Dan Poulter, Health Minister for England, said he agreed "entirely" with the principles of the recommendations and there would be a full response in the summer.

"There is a significant risk of people falling into the hands of cowboy firms or individuals whose only aim is to make a quick profit. These people simply don't care about the welfare of the people they are taking money from.

"It is clear that it is time for the government to step in to ensure the public are properly protected."

Common sense

The review was started after a global health scare caused by breast implants made by the French firm Poly Implant Prothese (PIP).

A breast implant made by Poly Implant Prothese

The implants were filled with industrial grade silicone and had double the rupture rate of other implants.

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Profits before patients, that's what happens. Surgery is sold like double glazing and it's totally wrong”

Michael SaulTJL solicitors

Catherine Kydd, 40, from Dartford in Kent, had ruptured PIP breast implants.

She said: "Why is it acceptable that I have to live with industrial silicone in my lymph nodes for the rest of my life due to this industry that is not properly regulated?"

Her story is far from unusual. Michael Saul, from TJL solicitors, represents the victims of botched cosmetic procedures, including one patient who went blind in one eye immediately after being injected with a dermal filler.

"Profits before patients, that's what happens. Surgery is sold like double glazing and it's totally wrong.

"I think it is very difficult for there to be any rational and reasonable opposition to [the recommendations], they're really sensible common sense suggestions."

Sally Taber, director of the Independent Healthcare Advisory Services, which represents the cosmetic surgery industry, praised the review.

"There has been so much bad practice out there, it's very welcome," she said. But she remained "concerned" at a lack of extra protection for people having laser procedures.

Ms Taber added: "Surgeons being on a specialist register will be an issue because we have got a lot of surgeons who fly in, fly out, as such, so that will be an issue that will be controversial."

The British Association of Aesthetic Plastic Surgeons welcomed the report saying it was "thoroughly relieved" with the findings and that there was an "urgent need" for dermal fillers to be classed as prescription medicines.

The British Association of Plastic, Reconstructive and Aesthetic Surgeons said there had been an exponential increase in the number of cosmetic interventions and that it hoped "they achieve parliamentary approval and support quickly".

Tuesday, 16 April 2013

Stafford Hospital trust to go into administration

The administrators have 145 days to to produce a plan for the future of hospital trust services

The trust which runs Stafford Hospital is to be put into administration by the health regulator Monitor.

Mid Staffordshire NHS Foundation Trust will be run by two specially appointed administrators to "safeguard the future of health services" currently provided.

Dr Hugo Mascie-Taylor and Alan Bloom of Ernst and Young will take over the running of the trust on Tuesday.

It will become the first foundation trust to go into administration.

A report for Monitor, written by a panel including Dr Mascie-Taylor in February, said services at the trust were "unsustainable".

It recommended the closure of its maternity unit, intensive care unit and accident and emergency department.

It said services could instead be provided at neighbouring trusts including the University Hospital of North Staffordshire, the Royal Wolverhampton or Walsall Healthcare NHS Trust.

Monitor said the administrators were appointed after it was concluded the trust, which also runs Cannock Chase hospital, was "neither clinically nor financially sustainable in its current form".

The trust "was likely to become unable to pay its debts", it said.

Last year, the trust reported a drop in annual income of about £4m and received a £20m bailout from the government.

'Starting again'

Monitor said the administrators would have 145 days to work with commissioners and other local healthcare organisations to produce a plan for patients that was "sustainable in the long term".

The plan would be subject to a public consultation, it said.

Analysis

Adam BrimelowHealth Correspondent, BBC News

Monitor says the decision to put Mid Staffs into special administration had nothing to do with the recent public inquiry - which highlighted appalling neglect, abuse and incompetence in the four years up to 2009.

But although standards of care have improved, the trust remains clinically and financially unsustainable.

It is now on a fast track to reorganisation, with a strong likelihood that some services will be relocated to bigger hospitals in Stoke-on-Trent, Walsall and Wolverhampton.

Monitor insists they will remain accessible within "reasonable journey times", and local people will be consulted.

Despite Stafford Hospital's notoriety, it commands deep loyalty among many in the town, and for them, the fight starts now.

David Bennett, from Monitor, said the current management at the trust would report to the administrators but patients would not see changes to services over the next 145 days.

He said: "It is important that people in Mid Staffordshire know that they can still access services as usual at Stafford and Cannock hospitals while the Trust Special Administration process is on-going."

"We have taken this decision to make sure that patients in the Mid Staffordshire area have the services they need in the future."

Administrator Hugo Mascie-Taylor said recommendations to downgrade some services were not "set in stone" and would be looked at again.

He said: "We will derive a lot of information from the report but we arrive here starting again, looking at the whole health economy, looking at what other hospitals could do, maybe what other services like community trusts could do.

"It's about taking all that into account and asking what could we do in Stafford and Cannock that's safe and sustainable."

'Put patients first'

The Support Stafford campaign group said it would be holding a march in the town centre on Saturday against the current proposals.

Cheryl Porter from the group said: "We haven't been listened to yet, and these plans are unacceptable.

"I do hope that the administrators listen to what the people need for safety reasons because to take all our acute services away is leaving us very vulnerable in a very dangerous position."

She said more than 15,000 people had signed a petition against the proposals.

The Conservative MP for Stafford, Jeremy Lefroy said he hoped the administrators would "put patients first".

He said: "There is a vital need to retain acute services in Stafford and Cannock because the capacity elsewhere is simply not there.

"They also need to consider the huge disadvantage to local people who would have to travel much longer distances for their treatment but also for hospital visitors who would have to do the same."

The trust's chief executive, Lyn Hill-Tout, said: "We would like to reassure local people and GPs that we are continuing to provide all our usual services at both hospitals and patients should turn up as usual for any appointments they have."

"We would like to thank our local community for their continued support, which means a great deal to staff."

The Mid Staffordshire trust was at the centre of a three-year public inquiry into "appalling standards" of care at Stafford Hospital, following concerns over high death rates.

The concluding Francis Report, published in February, highlighted the "unnecessary suffering of hundreds of people" between 2005 and 2009.

Tuesday, 2 April 2013

Health correspondent

Doctor's equipment, a sphygmomanometer and stethoscope

The changes have proved extremely controversial

Government reforms of the NHS in England have come into force and health leaders warn of a tough year ahead.

Monday marks the first day of the new structures.

GP-led groups have taken control of local budgets and a new board, NHS England, has started overseeing the day-to-day running of services.

The NHS Confederation said the reforms represented a big opportunity but should not be seen as a "silver bullet" for the challenges ahead.

Mike Farrar, chief executive of the confederation, which represents health managers, said the squeeze on finances and the need to rebuild public confidence after the Stafford Hospital scandal meant the NHS was facing a critical period.

He said the reforms would bring clinical expertise to the fore of decision making, which would be a "huge asset".

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Because GPs have face-to-face contact with patients every day... they are really well-placed to be able to make decisions about how healthcare should be delivered best”

GP Catherine Briggs

But he warned: "We need to recognise the huge challenges facing the health service. New structures alone won't enable us to tackle these challenges, and we should not see them as a silver bullet.

"Those doing the day-job face major pressures in trying to keep the NHS's head above water, while focusing on making the new world work."

The start of the new system comes nearly three years since the changes were put forward.

The publication of the plans in the summer of 2010 sparked a long and, at times, damaging battle for the government to push through with its changes.

Ministers even had to take the unprecedented step of halting the progress of the bill through Parliament amid criticism from medical bodies, academics and unions.

In particular, concerns have been expressed about what many believe is a greater role for the private sector.

'Compassionate care'

Some have also questioned whether introducing such major changes - they have been dubbed the most radical overhaul since the NHS was created - at a time when money is so tight makes sense.

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Far from letting 'doctors decide', ministers are forcing the medical profession to open up all NHS services to the market”

Andy BurnhamShadow health secretary

But as the new bodies take up control - and the old organisations, including 152 primary care trusts, are scrapped - the government maintained the changes would put the NHS on a firm footing for the 21st century.

Health Minister Anna Soubry said: "The health service will improve, work smarter and, importantly, build an NHS that delivers high quality, compassionate care for patients."

But shadow health secretary Andy Burnham predicted the changes would have the opposite effect.

"Far from letting 'doctors decide', ministers are forcing the medical profession to open up all NHS services to the market.

"Hundreds of new private companies now risk fragmenting patient care when more integration is needed."

GP Catherine Briggs said she would welcome more control over how budgets are spent.

"Because GPs have face-to-face contact with patients every day and because they know their patients and their communities really well," she said.

"That means they are really well-placed to be able to make decisions about how healthcare should be delivered best."

But GP John Hughes said he had reservations.

"The GPs aren't really free to do what they like with the money as a lot of people seem to think," he said.

"Most of the directions as to what happens to that money and what should be bought or commissioned locally is coming from the Department of Health.

Friday, 29 March 2013

the ageist BBC says

Are the patients the problem?

COMMENTS (126)

Two thirds of hospital admissions are people over the age of 65

More from Nick

On unveiling the package of measures in the government's response to the Stafford Hospital public inquiry, Health Secretary Jeremy Hunt said he was confident the changes would ensure problems on such a scale would not slip under the radar again.

A clearer system of rating hospitals and better regulation of managers and healthcare assistants, he argued, would ensure greater accountability, while better training for nurses could create a culture of compassionate care.

But in some ways the changes ignored the elephant in the room: the changing nature of the patient population.

It is an open secret that hospitals in the 21st Century are full of patients that should not be there.

A combination of the ageing population and advances in medicine have meant that there is a growing number of frail, elderly people who need intensive care and support.

But all too often that is not available in the community, and so they end up in hospital as an emergency case.

Two-thirds of hospital admissions are people over the age of 65. Many have multiple chronic conditions, such as heart disease and dementia.

In fact, the change in the patient population has been so acute that aKing's Fund study has put the average age of a patient at over 80.

That is presenting problems for staff that no amount of training and resources can counter.

'Wrong place'

As one nurse, who has worked in the NHS for over 30 years, told me: "The patients we are seeing in hospital are completely different from the ones that were being admitted when I started out.

"These patients need a complex package of care and support.

"They need help washing, dressing and eating round-the-clock. It requires a lot more personal care than the hospital environment is designed for."

However, it need not be like this. The evidence suggests as many as a third of hospital admissions could be prevented with better systems in place in the community.

But instead of going down the numbers being admitted as emergencies is actually on the rise - it is up by nearly 40% in the past decade - and that is having a damaging impact on hospital wards.

The Royal College of Physicians has warned hospitals are "on the brink" with a mindset developing among staff that many patients are simply in the "wrong place".

Its report, Hospitals on the edge?, cautioned staff against such defeatism, but it was also clear for that to change there needed to be progress on keeping people out of hospital.

To be fair, it was a point acknowledged on Tuesday by Care Services Minister Norman Lamb.

During the government press conference to announce the response to the public inquiry, he said it had to be a "top priority", conceding "a lot of hospitals have large numbers of frail elderly that perhaps with better care would not have ended up there".

Improving the culture, accountability and transparency is clearly important, but the defining challenge for the health service over the next decade and beyond could prove to be something completely different

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Sunday, 28 April 2013

The NHS must share patient data more effectively

Data-sharing 'good for patients'

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Wednesday, 24 April 2013

Party leaders in Commons clash over Stafford Hospital scandal

'Cosmetic crisis' waiting to happen

'Cosmetic crisis' waiting to happen

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Analysis

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Tuesday, 16 April 2013

Stafford Hospital trust to go into administration

Stafford Hospital trust to go into administration

Analysis

Tuesday, 2 April 2013

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Friday, 29 March 2013

the ageist BBC says

Are the patients the problem?

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The NHS must share patient data more effectively

Data-sharing 'good for patients'

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Tuesday, 16 April 2013

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Tuesday, 2 April 2013

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