Friday, 25 October 2013

Quarter of hospitals 'at raised risk of poor care'

Quarter of hospitals 'at raised risk of poor care'

Sir Mike Richards from the Care Quality Commission said the screening tool would help identify higher risk hospitals

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A quarter of hospital trusts in England are at raised risk of providing poor care, a review by the regulator shows.
The findings are based on monitoring by the Care Quality Commission (CQC) of a host of data, including death rates, serious errors and patient surveys.
It found 44 out of 161 trusts fell into the two highest risk categories.
The exercise has been carried out as part of the regulator's new hospital inspection regime, which will see inspectors go into every trust by 2015.
The first inspections got under way in September and by Christmas the first 18 will have been completed.

Analysis

This is the first time such comprehensive data has been pulled together in this way.
The work has involved the regulator poring over a mountain of data.
But what does it tell us? The Care Quality Commission is being careful to stress it is not a final rating. Instead, it is being dubbed a screening tool - and like any screening it can throw up erroneous results.
For example, the scoring system actually suggests two of the 11 trusts already placed in special measures should be in band three (medium risk) - although they have been bumped up to band one anyway.
But even taking that into account, it provides one of the clearest indications yet of how trusts are performing against each other.
Patients will undoubtedly be interested in the results until the inspection programme is completed.
It will result in every trust being given a rating of either 'outstanding', 'good', 'requires improvement' or 'inadequate' as part of a shake-up in the system ordered after the Stafford Hospital scandal.
The CQC said the latest information was not a final judgement, but would be used to prioritise which trusts to inspect earlier in the process.
Hospital chief inspector Prof Sir Mike Richards likened the risk review to a form of "screening".
He added: "Our intelligent monitoring helps to give us a good picture of risk within trusts, showing us where we need to focus our inspections."
The regulator has assessed each trust's performance against up to 150 different indicators.
Those performing worse than would be expected on each indicator get marked down as being at risk or elevated risk for that topic.
The number of risk scores they havedetermines which of the bands they are placed in.
Bands one and two - those at highest risk - include 24 trusts and 20 trusts respectively.
The trusts in band one include the 11 trusts already placed in special measures after a review of high mortality rates.
They are joined by Croydon Health Services, which was rated high risk in 12 areas for issues such as patient survey results and whistle-blowing.
Also in band one are Barking, Havering and Redbridge, which was rated high risk in 13 areas including A&E waits and patient surveys, and Aintree, rated high risk in 11 areas including an elevated risk for mortality rates.
How the highest risk trusts compare
Comparison of worst-scoring trusts
Health Foundation chief executive Dr Jennifer Dixon, who is also a CQC board member, said: "It makes sense to use the wealth of routinely available data in the NHS to try to spot patterns which might identify or predict poor quality care for patients.
"The intelligent monitoring tool can never by itself be a crystal ball, but it is a great start and will surely develop over time."
Dr Mark Porter, head of the British Medical Association, said publishing the data was an "important step" towards improving transparency across the NHS, informing and empowering patients and identifying under-performing hospitals.
Dr Mark Porter, Chair of the BMA, said the review was an "important step for the NHS"
But he added: "Hospitals are large, complex organisations so we need to avoid oversimplifying or reducing vast amounts of data to a simple band or rating."
Labour Shadow Health Minister Jamie Reed said: "David Cameron should be ashamed that he's put so many of England's hospitals in this position.
"He siphoned £3bn out of the NHS front-line to blow on a back-office re-organisation nobody voted for. Hospitals were left on a financial knife-edge and they are clearly struggling to maintain standards of patient care after more than three years of chaos."
But Health Secretary Jeremy Hunt said: "Sadly, under the last government, a lack of transparency about poor care meant problems went unchecked for too long, some times with tragic consequences for patients.
"This government is being honest with the public about the quality of care at their local hospitals, and taking tough action where standards aren't up to scratch. Patients and staff deserve nothing less."

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Thursday, 24 October 2013

“hooliganism”.

Russia softens charges against Greenpeace activists from piracy to hooliganism

Published time: October 23, 2013 16:37
Edited time: October 23, 2013 19:02
Greenpeace ship Arctic Sunrise (RIA Novosti / Sergey Eshenko)
Greenpeace ship Arctic Sunrise (RIA Novosti / Sergey Eshenko)

Russia’s Investigative Committee has stated that the charges against the Greenpeace activists from the Arctic Sunrise have been softened from “piracy” to “hooliganism”.
"The actions of those involved in the criminal case have been reclassified to the charge of hooliganism," the spokesman for the Investigative Committee, Vladimir Markin, told the RIA Novosti news agency.  
Greenpeace has called the new Russian charge of hooliganism for its arctic protest “wildly disproportionate” and said that both the charges of piracy and hooliganism “bear no relation to reality.”

“The Arctic 30 are no more hooligans than they were pirates. This is still a wildly disproportionate charge that carries up to seven years in jail. It represents nothing less than an assault on the very principle of peaceful protest,” the organization said in a statement published on its website. “We will contest the trumped up charge of hooliganism as strongly as we contested the piracy allegations,” the group said. 
All 30 Arctic Sunrise crewmembers from 18 different countries were charged with piracy at the beginning of October, which carries a maximum penalty of 15 years in prison. The hooliganism charge carries a maximum penalty of 7 years. 
The activists were arrested following their protest at Gazprom’s Prirazlomnaya oil platform in the Barents Sea on September, 18. They are currently being held in pre-trial detention in the city of Murmansk, northern Russia. 
The prosecution insisted Greenpeace activists “posed a real threat” to employees on the rig. 
Greenpeace denies the accusations saying that it did not create any kind of threat to the safety of the platform’s personnel, as the activists had nothing but banners and ropes with them. 

Another argument against the piracy charges was that the Arctic Sunrise ship did not breach the 500-meter zone around the platform, with Greenpeace adding that satellite data proves their statement. 
On Oct. 4, the Netherlands filed a lawsuit against Russia in an international maritime court in a bid to win the release of the Dutch-registered Greenpeace vessel Arctic Sunrise and its 30 crewmembers.  

In response, Russia’s Foreign Ministry criticized the Dutch authorities for not intervening in the situation earlier, as “over the last year and a half the Russian side made repeated attempts” to draw the attention of the Dutch government to “the vessel’s illegal activities.” 
On Monday, the Dutch government asked the International Tribunal for the Law of the Sea to order Russia to free all the Greenpeace ship crewmembers, but Moscow dismissed the request sent to the Hamburg-based tribunal. It also refused to take part in the proceedings. 
However, Moscow remains “open to the settlement” of the situation around the case. 
The Greenpeace activists’ detention in Russia has sparked a massive reaction among the group’s supporters and human rights organizations. Greenpeace started the “Free the Arctic 30” campaign, over 1.5 million people across the globe have sent letters to Russian embassies demanding their release. 

Tuesday, 15 October 2013

Care inspector could use hidden cameras

Care inspector could use hidden cameras


Carer and manThe new inspections will determine whether services are caring and safe

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Hidden cameras and mystery-shopper exercises may form part of a revamped inspection regime for care homes and domiciliary care in England next year.
New adult social care chief inspector Andrea Sutcliffe said she wanted to explore the role such techniques could play in uncovering abuse and neglect.
But she admitted their use would have to be balanced against the need for privacy and dignity in such settings.
The move will be considered ahead of the launch of a new system next year.
From next autumn, services will be given an Ofsted-style rating of outstanding, good, requires improvement or inadequate to mirror the system being rolled out for hospitals.

Start Quote

Confidence in the regulation regime has been shaken, but we have turned a corner”
Norman LambCare and Support Minister
The new Care Quality Commission (CQC) inspections will determine whether services are:
  • safe
  • caring
  • effective
  • well led
  • responsive to people's needs
This replaces the current system, which relies on 16 core standards with which services are either compliant or non-compliant.
The make-up of the inspection teams are also being changed to ensure they include experts in the care sector - to date the CQC has relied on general inspectors - and members of the public with first-hand experience of the system.
The inspections will start in autumn 2014 with the aim that each of the 25,000 care homes, nursing homes and domiciliary care agencies will be inspected by March 2016.
'Fresh start'
Ms Sutcliffe - who is one of three new CQC chief inspectors following the appointments of similar posts covering GPs and hospitals - also warned she was prepared to use the powers at her disposal more than they have been to date.
The CQC can issue warning notices, fines and even close down services if they are failing.
Winterbourne ViewSecret filming by Panorama in 2011 exposed abuse at Winterbourne View
She added: "This is a fresh start for how care homes, home care and other adult social care services are inspected and regulated across the country."
She said she would be discussing the option of using hidden cameras and mystery shoppers - where people posed as individuals looking for care for a loved one - in the coming months, with providers, councils and the public.
She acknowledged the potential of secret filming had already been demonstrated by the way the BBC's Panorama programme in 2011 exposed the abuse at Winterbourne View, a care home near Bristol for people with learning disabilities.

Start Quote

Confidence in the regulation regime has been shaken, but we have turned a corner”
Norman LambCare and support minister
But she added: "We have to consider the privacy and dignity and how we can balance these."
Simon Wood, who installed his own CCTV cameras to check on the care his mother-in-law was getting, told the BBC what filming uncovered.
"Mum getting sworn act, threatened, hit, medication being poured down the sink, not being given to Mum, it was quite upsetting and quite horrendous to see what she was going through," he said.
"The final thing was when the two carers... dragged her out of a chair and threw her on the bed and threatened to smash her face in."
Care and Support Minister Norman Lamb said there were "serious flaws" in the current system that needed addressing.
"Confidence in the regulation regime has been shaken, but we have turned a corner. I welcome the chief inspector's new commitment to protecting people vulnerable to abuse and neglect," he added.
But Steve Sollars, the parent of a former resident at Winterbourne View, said he was worried the move was too little, too late.
"It's too slow to what's happening," he said.
"Winterbourne View happened two-and-a-half to three years ago. Things should be happening now."

Friday, 11 October 2013

Vitamin D pills' effect on healthy bones queried

Vitamin D pills' effect on healthy bones queried

Supplements

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Healthy adults do not need to take vitamin D supplements, suggests a study in The Lancet which found they had no beneficial effect on bone density, a sign of osteoporosis.
But experts say many other factors could be at play and people should not stop taking supplements.
University of Auckland researchers analysed 23 studies involving more than 4,000 healthy people.
The UK government recommends children and over-65s take a daily supplement.
The New Zealand research team conducted a meta-analysis of all randomised trials examining the effects of vitamin D supplementation on bone mineral density in healthy adults up to July 2012.
The supplements were taken for an average of two years by the study participants.

Start Quote

I'm not surprised they didn't find any evidence of the effects of vitamin D on bone density because there are so many other factors involved...”
Dr Laura TripkovicUniversity of Surrey
Bone mineral density is a measure of bone strength and measures the amount of bone mineral present at different sites in the body. It is often seen as an indicator for the risk of osteoporosis, which can lead to an increased risk of fracture.
The trials took place in a number of different countries including the UK, the US, Australia, Holland, Finland and Norway.
Although the results did not identify any benefits for people who took vitamin D, they did find a small but statistically significant increase in bone density at the neck of the femur near the hip joint.
According to the authors, this effect is unlikely to be clinically significant.
Free up resources
Prof Ian Reid, lead study author, from the University of Auckland, said the findings showed that healthy adults did not need to take vitamin D supplements.
"Our data suggest that the targeting of low-dose vitamin D supplements only to individuals who are likely to be deficient could free up substantial resources that could be better used elsewhere in healthcare."
Writing about the study in The Lancet, Clifford J Rosen from the Maine Medical Research Institute agrees that science's understanding of vitamin D supports the findings for healthy adults, but not for everyone.
"Supplementation to prevent osteoporosis in healthy adults is not warranted. However, maintenance of vitamin D stores in the elderly combined with sufficient dietary calcium intake remains an effective approach for prevention of hip fractures."
The Department of Health currently recommends that a daily supplement of vitamin D of 10 micrograms (0.01mg) should be taken by pregnant and breastfeeding women and people over 65, while babies aged six months to five years should take vitamin drops containing 7 to 8.5 micrograms (0.007-0.0085mg) per day.
Additional factors
Dr Laura Tripkovic, research fellow in the department of nutritional sciences at the University of Surrey, said the study was important but very specific.
"I'm not surprised they didn't find any evidence of the effects of vitamin D on bone density because there are so many other factors involved in osteoporosis, like genes, diet and environment.
"To pin it all on vitamin D... it's difficult to do that."
Dr Tripkovic said it was no good taking vitamin D supplements if people didn't also maintain a healthy, balanced diet containing calcium and take plenty of exercise.
She said most healthy people should be able to absorb enough vitamin D naturally, through sunshine and diet.
"But if people are worried about their vitamin D levels then a multi-vitamin tablet would do. If you have bone pain and muscle aches then you should go and see your GP and discuss it."
We get most of our vitamin D from sunlight on our skin, but it is also found in certain foods like oily fish, eggs and breakfast cereals.
However, taking too much vitamin D in the form of supplements can be harmful because calcium can build up and damage the kidneys.
Experts advise taking no more than 25 micrograms (0.025mg) a day.
The UK guidance is currently being reviewed.

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Monday, 7 October 2013

'Disgraceful" short care visits on rise, says charity

'Disgraceful" short care visits on rise, says charity

Richard Stapely, who has Multiple Sclerosis, says his 30-minute visits are not long enough

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Short care visits to elderly and disabled people are "disgraceful" and on the rise, a charity has claimed.
In England, 60% of councils use 15-minute visits, which are not long enough to provide adequate care, Leonard Cheshire Disability says.
The charity says such visits can "force disabled people to choose whether to go thirsty or to go to the toilet".
The government said the Care Bill would prevent "inappropriate" short visits but would not outlaw 15-minute visits.
Leonard Cheshire wants a ban on what it calls the "scandal of flying 15-minute visits", lobbying the government to prevent the practice in England.

Case study

Tracey Currey, from Swindon, was a care worker for two years but left because her employer would not let her do more than the "bare minimum" for clients.
She said: "I was forever in trouble with my company because I always went over my time.
"There was usually a care plan in place telling you what was needed at each visit but there was always more to do. I would stay and do everything that was needed.
"What is a carer to do on arriving for a 15-minute call to find the client soiled, confused and extremely distraught?
"What would the priorities be? To administer the medication as instructed, or to clean and change the client, or to make a hot drink and try to calm and reassure the client? All three in my book, but the present times do not allow for this.
"It is simply atrocious how this has gone on for so long. Care companies, agencies and councils getting away with this, money having become top priority and the compassion, love and care that should be shown to each and every elderly person has long gone, been thrown out of the window."
'Ridiculous split'
Care minister Norman Lamb said the government "can't ban these short visits completely" because they are useful in some circumstances, such as when a carer visits to give someone medicine.
But he told the BBC a 15-minute visit was "completely inappropriate" when people needed things like feeding or bathing.
"We're actually introducing an amendment to the Care Bill this week which will require councils to focus on an individual's wellbeing when they're organising care on their behalf, and so this sort of very short visit for personal care would not meet that standard," he said.
He also said the government plans to "force" the NHS and local government to work better together and end the "ridiculous split" between health and social care.
A report published by Leonard Cheshiresaid short visits "simply do not allow enough time to deliver good-quality care".
It said data from 63 local authorities pointed to a 15% rise in such visits in the last five years, and said some in councils more than 75% of care visits were carried out in less than 15 minutes.
The charity's latest research looks at England alone, but in August Unison accused many councils in Scotland of providing "care on the cheap" by arranging 15-minute home visits, and in June the union said 83% of Welsh councils were doing the same.
Research by the UK Homecare Association published last year suggested 87% of home visits in Northern Ireland lasted 30 minutes or less, the highest proportion in the UK (73% in England and 42% in both Scotland and Wales).
Separate care bills are currently going through the Scottish Parliament and the Welsh Assembly.
Sandie Keene from the Association of Directors of Adult Social Services: "We're all committed to making sure that we all continue to get it right"
Chief executive Clare Pelham said visits should be at least 30 minutes long.
"It is disgraceful to force disabled people to choose whether to go thirsty or to go to the toilet by providing care visits as short as 15 minutes long," she said.
Ms Pelham said most people need 40 minutes to get up, washed, dressed and have breakfast.
"We are treating disabled and older people as if they are robots to be serviced, rather than real people who deserve to be treated with kindness and consideration," she added.
But the Association of Directors of Adult Social Services (Adass), which represents care managers, argued it was "totally wrong" to suggest all caring tasks require more than 15 minutes.
Sandie Keene, the association's president, said some short visits were "fully justified and fully adequate".
It was "frankly naive to believe that simply by abolishing 15-minute slots a magic wand will have been waved, and improvements automatically achieved in our care services," she added.
Ms Keene said social workers and their managers had to make "horrendously difficult choices" every day to give the best possible care with limited resources.
Leonard Cheshire wants peers to back a ban on short visits by amendingthe government's Care Bill when it is debated in the House of Lords on Wednesday.
Care manager Tina Blake: "It's very difficult, it's very stressful for the person, and it's certainly stressful for the care worker as well"
Time pressure
Speaking to BBC Radio 5 live, Rosaleen, a Thames Valley care worker who gave only her first name, said 15-minute visits usually overrun.
But she said the short time available still forced carers to make choices such as whether to leave someone alone with a hot drink which they might spill on themselves, or sit with them while they drink but fail to get them ready for bed.
Asked if people's safety was being compromised by visits being too short, she replied: "Their safety, their independence, their dignity."
Another care worker told the BBC that travel time was not included in her pay, so she would work unpaid time every day travelling between appointments.
Sally Lubanov, 83, who is house-bound, said even in 30-minute visits "nothing got done" because carers would take some time booking in, checking what the previous visitor had done and preparing for whatever tasks needed doing.
She said 15-minute visits might be fine for giving someone medicine, but for people living alone it was "wonderful to see someone" and short visits allowed no time for conversation.
The Local Government Association (LGA), said social care was "substantially underfunded" and councils were under increasing pressure.
"Significant cuts to council funding mean local authorities are struggling to meet the rising demand for home care visits," said Katie Hall, chairwoman of the LGA's community and wellbeing board.
She said 15-minute visits "should never be the sole basis for care", but added: "In some circumstances such as administering medication they can be appropriate, but only as part of a wider comprehensive care plan involving longer one-to-one visits."
Leonard Cheshire Disability said a survey of 2,025 people found 93% of those who expressed an opinion agreed 15 minutes was "not long enough to support a disabled or older person to do everyday things like wash, dress and get out of bed in the morning"

Friday, 4 October 2013

CQC official Anna Jefferson cleared over 'cover-up'

CQC official Anna Jefferson cleared over 'cover-up'

Furness General HospitalInvestigations had focused on maternal and infant deaths at Furness General Hospital in Barrow

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One of the officials at England's health regulator accused of a cover-up has been cleared of wrong-doing in an internal inquiry.
The Care Quality Commission said media manager Anna Jefferson had not supported an alleged decision to delete a critical report.
It had been suggested the CQC tried to conceal failings in its investigation at Furness General hospital in Cumbria.
Ms-Jefferson said she was "relieved that her name has now been cleared".
She added that it had been "an extremely difficult time".
Baby deaths
The spotlight fell on the CQC when it published a review in June by consultants Grant Thornton which looked at how the organisation had investigated Furness General Hospital in Cumbria.
This review had been ordered by the CQC's new chief executive, David Behan, after he took over the regulator in 2012.
The CQC had given Morecambe Bay NHS Trust, which runs the hospital, a clean bill of health in 2010 despite problems emerging in relation to its maternity unit - since then more than 30 families have taken legal action against the hospital in relation to baby and maternal deaths and injuries from 2008.
In 2011 - with more concerns arising - the CQC ordered an internal review into how those problems had been missed.
But when this report was finished, officials decided not to make the findings public and the author was allegedly been told to "delete" it, the Grant Thornton review said.
The officials alleged to have been involved in this decision were initially not named by the CQC.
No disciplinary action
The organisation came under immediate pressure from ministers and the information commissioner, who accused them of hiding behind the Data Protection Act.
Within a day the identities of the three - former chief executive Cynthia Bower, her deputy Jill Finney and media manager Anna Jefferson - had been revealed.
All three strongly disputed the allegations made against them.
Ms Jefferson is the only one of the three to still work for the CQC - she is now its head of media - and therefore the only one subject to an internal investigation.
The CQC says no disciplinary action will be taken.
In a statement, it added Anna Jefferson had "not used 'any inappropriate phrases' as attributed to her by one witness quoted in the Grant Thornton report" and "had not supported any instruction to delete an internal report prepared by a colleague."
It added: "The CQC regrets any distress Anna Jefferson has suffered as a consequence of this matter and is pleased to welcome Anna back to the organisation following a period of maternity leave."
The independent report had suggested that Ms Jefferson had said of the critical internal review: "Are you kidding me? This can never be in the public domain."
A spokesman for Grant Thornton said it fully supported and stood by its findings.

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