Monday, 16 December 2013

The unions representing nurses and midwives have joined others in stating their "outright opposition" to the government's NHS plans in England.

NHS plans: Unions move to 'outright opposition'

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By Nick TriggleHealth correspondent, BBC News
Howard Catton, RCN: "We cannot move ahead with new health bill"

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The unions representing nurses and midwives have joined others in stating their "outright opposition" to the government's NHS plans in England.
The Royal College of Nursing and the Royal College of Midwives had expressed concerns in the past, but said they were willing to work with ministers.
However, now they want the entire bill covering the changes to be dropped.
Health Secretary Andrew Lansley said the unions wanted to "have a go" at government about "pay and pensions".
The colleges' stance comes after a similar move by the British Medical Association last year.
It also mirrors the stance adopted by Unison, which represents a host of administration and support staff, such as porters.
But what impact this intervention has remains to be seen.
The Health and Social Care Bill is still working its way through Parliament, and the bill is in the Lords at the moment.
In many ways it is over the worst political hurdles and it seems the only way it could be stopped would be if the Lib Dems blocked it when it returns to the Commons - but that is considered unlikely.
On the ground, changes are already being made to pave the way for the new system to kick in, in 2013.
For example, while the doctors union is against it there has still been enough GPs coming forward to pilot the new plans in 97% of the country.
Anger
Under the plans, GPs are being put in charge of much of the NHS budget, while the health service is being opened up to greater competition from the private and voluntary sector.

Analysis

The move by the two unions is unlikely to see the bill stopped in its tracks.
But it is clear the government's relationship with NHS staff is fracturing, possibly beyond repair.
Some inside government were saying the move by the royal colleges was being driven by their dissatisfaction over pensions.
That has undoubtedly played a role. So too has the drive to make £20bn of savings by 2015 - the equivalent of 4% of the budget a year.
This is putting more and more pressure on hospitals and waiting times in particular.
It means there is a toxic cocktail brewing inside the health service - and this spells trouble for the government.
It came to power saying - in private at least - that the NHS was its good news story, but all too often it is finding the headlines are negative.
In June the government announced a series of changes to the original proposals in the face of mounting opposition.
These included giving health professionals other than GPs more power over how NHS funds were spent, as well as watering down the role of competition.
The health unions initially gave the changes a cautious welcome, but they have been left disappointed by the finer details that have emerged during the parliamentary process.
One of the key developments was the news, which emerged just after Christmas, that NHS hospitals would be allowed to do 49% of their work in the private sector - something which could potentially mean eight in 10 increasing their private work 25-fold.
Peter Carter, general secretary of the RCN, which represents 410,000 nurses, midwives, support workers and students, said: "The RCN has been on record as saying that withdrawing the bill would create confusion and turmoil, however, on the ground, we believe that the turmoil of proceeding with these reforms is now greater than the turmoil of stopping them.
"The sheer scale of member concerns, which have been building over recent weeks, has led us to conclude that the consequences of the bill may be entirely different from the principles which were originally set out."
Cathy Warwick, of the RCM, said: "The government has failed to present sufficient evidence that its proposals are necessary. They have failed to present evidence that the upheaval will result in an improvement in services to the people of England.
"And they have failed to answer the concerns of the people who fear for the future of the NHS under these plans."
Savings plans
Andrew Lansley said legislation was "essential to give nurses and doctors clinical leadership"
Both unions also expressed concerns that the changes were compromising the ability of the NHS to make the £20bn of savings it has been asked to make by 2015.
Mr Lansley said that nurses had previously been "right at the heart" of the process of planning reforms to the NHS to deliver better care for patients.
"The only thing that has happened in the last few weeks that has led to this situation with the Royal College of Nursing, is that the two sides of the Royal College of Nursing have shifted," he told BBC Breakfast.
"They used to be a professional association that was working with us on professional issues, and will carry on doing that, but now the trade union aspect of the Royal College of Nursing has come to the fore.
"They want to have a go at the government - and I completely understand it - they want to have a go about things like pay and pensions."
Butr that last point was later rejected by the RCN.
Shadow health secretary Andy Burnham said it was time to scrap the bill.
"A reorganisation on this scale needs a professional consensus for it to succeed. A year since the bill was introduced, it is abundantly clear that the government's plans do have failed to build that."
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Hospital chiefs in Sheffield have said sorry after NHS figures revealed objects have been left inside patients three times so far this year.

Sheffield hospits’ apology over errors

Sheffield's Royal Hallamshire Hospital
Sheffield's Royal Hallamshire Hospital
Hospital chiefs in Sheffield have said sorry after NHS figures revealed objects have been left inside patients three times so far this year.
The blunders happened between April and September, and were included by NHS England in a list of hospital trusts’ very serious incidents, or ‘never events’ – regarded by the Government as so severe they should never happen.
One of the incidents involved a medical swab left inside a patient following a procedure. It has not been confirmed what the remaining two objects were.
Dr David Throssell, medical director at Sheffield Teaching Hospital NHS Foundation Trust, said: “We treat over one million patients every year and our priority is always to provide safe, high quality care.
“We take never events extremely seriously and always undertake a full investigation into their causes. We are very sorry these events happened.
“We are continually examining our processes and checks to try to limit the chances of never events happening.”
Last year there were seven ‘never events’ at the trust in total, up on three in 2011-12 and two the previous year.
Meanwhile, at both Rotherham Hospital and at Doncaster and Bassetlaw Hospitals, patients have had the wrong part of their body operated on or treated, the figures showed.
Nationally there were 148 very serious incidents from April to September.
Overall, there were 69 cases where foreign objects were left inside patients, including 11 cases of surgical swabs.
Other details from elsewhere in the country showed the wrong patient undergoing a heart procedure, and the incorrect person being given an invasive colonoscopy to check their bowel.
More than 20 were given the incorrect implant or prosthesis, and a woman had a fallopian tube removed instead of her appendix.
One patient had wires left inside them and another patient was left with a needle in their body. In one incident, a drill guide block was left inside a patient.
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GP surgeries exposed by inspectors

'Maggot-infested' GP surgeries exposed by inspectors

By Nick TriggleHealth correspondent, BBC News
''I might just go back to my old surgery''

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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.

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"horrendous stories" about the NHS were reported every day,

Ex-Cardiff hospital boss Russell Hopkins says NHS a 'mess'

Russell Hopkins is a former hospital manager, surgeon and BMA Wales chairman

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A former general manager of Wales' largest hospital has condemned the state of the NHS, claiming politicians and managers have "messed it up".
Russell Hopkins, who used to manage the University Hospital of Wales, Cardiff, was left with bladder and nerve damage after an operation in the area in 2011.
He chose to speak out because he claims patients' lives are "endangered".
Cardiff and Vale health board offered "unreserved apologies once again" to Mr Hopkins for his distress.
Mr Hopkins, now living in Newport, Pembrokeshire, is a former consultant oral maxillofacial surgeon at the University Hospital of Wales, and a former chair of the British Medical Association in Wales.

“Start Quote

I'm angry for what has happened to the profession and I'm angry for the patients”
Russell HopkinsFormer surgeon
He underwent hip surgery at Llandough Hospital near Cardiff in 2011, during which he said a spinal anaesthetic caused a bleed in his spinal column.
"When you get things like that you have got to be decompressed within eight to 12 hours at best - certainly within 24 hours - to relieve the pressure," he told BBC Wales.
"I didn't see a senior doctor despite me telling the nurses there were things wrong.
"Nobody paid any attention until my daughter - who's a hospital consultant - rang up from London and said 'what's wrong with my father'?"
Mr Hopkins said it was four days before he was seen by a consultant.
By the time he was investigated, he said a spinal surgeon told him: "There's no point in doing it."
As a result, Mr Hopkins said he suffered urinary problems which meant "I have been disabled in my plumbing."
He says problems are occurring throughout the NHS "fundamentally because some consultants" - not all - "are no longer looking after their patients in the way they used to do because there's a timetable system in place - the management will pay for that, but nothing else".
He added: "You cannot timetable a doctor to see how Mr Bloggs is doing because that's not on the timetable. It would have to be done in their own time.
"An increasing amount have stopped going to see their patients post-operation, and are leaving it to juniors."
Mr Hopkins said he was seen by a junior doctor after his operation and "the junior doctor didn't spot it".

“Start Quote

We are working very hard with our staff and surgical teams to put in place systems which mean there are always experienced colleagues available”
Cardiff and Vale University Health Board
"I'm not embittered, because I'm not that sort of chap," he added.
"But I have been angry with the health service for some time. The politicians have messed it up."
He said he wanted members of the public to know about his experience because he felt as someone with his experience could be affected so could others.
A spokesperson for Cardiff and Vale University Health Board said: "As a health board, we understand how frustrating and upsetting it is for patients when things don't go right, because we share that frustration.
"We are working very hard with our staff and surgical teams to put in place systems which mean there are always experienced colleagues available.
"While we can't comment in detail on the case of Mr Hopkins, we are aware of his concerns and have been in communication with him on the issues he raises.
"We would like to take this opportunity to offer our unreserved apologies once again to Mr Hopkins for the distress he and his family have experienced."
Mr Hopkins said "horrendous stories" about the NHS were reported every day, adding: "The damage done in the last 20 years in the profession has endangered patients.
"I'm angry for what has happened to the profession and I'm angry for the patients."
The three solutions, he says, are firstly to train undergraduates on the wards, shadowing doctors, as well as nurses, who he says "don't do any active clinical work during their three years of training".
Working time directives also have to be addressed, he says, because "if you do shift work you get a scenario where people might say 'it's not my problem, I'm off'."
Russell HopkinsMr Hopkins' experience was raised by surgeons in a letter to the Daily Telegraph
Finally, he says something needs to be done to improve the professionalism of consultants because "the politicians and managers are destroying the professional values. It's about checking boxes, targets and numbers".
Mr Hopkins is one of the doctors and surgeons who wrote a joint letter to the Telegraph.
Referring to Mr Hopkins's case, the letter says: "The after-care of a hip operation failed him catastrophically, the NHS repaying a lifetime of service with negligence and long-term disability."
It adds: "We, the other signatories, are experienced consultants who share his analysis of how the system failed him and why it fails so many others."
The Welsh government said in a statement: "Every year, the NHS in Wales cares for thousands of patients safely and effectively, and the vast majority are entirely satisfied with their care.
"Cardiff and Vale University Health Board has already responded to Mr Hopkins' specific claims."
The letter from surgeons came as proposals are unveiled which mean hospitals in England would have to ensure senior doctors and key diagnostic tests are available seven days a week under new plans.
The measures form part of a vision unveiled by NHS England to tackle the higher death rates at weekends.
The changes, proposed by medical director Prof Sir Bruce Keogh, will be applied to urgent and emergency services over the next three years.
It comes after a year-long inquiry into NHS care in England following concerns over higher death rates on Saturdays and Sundays.
The Welsh government said health boards and council social services have produced joint plans for the first time this year to manage winter pressures, while an government official did not rule out seven day working as part of an overhaul.
Dr Grant Robinson, the Welsh government's clinical lead for unscheduled care, said radical changes were needed to the system.
"Sometimes there are some big game changers - seven day working is a radical change that as the potential to help," he said.

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