Wednesday, 20 February 2013

Jeremy Hunt


Jeremy Hunt warns NHS trusts over 'defensive culture'

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

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Health Secretary Jeremy Hunt has warned NHS bosses against allowing a culture that is "legalistic and defensive" in dealing with staff who raise concerns over patient care.
In a letter to all English NHS trusts, Mr Hunt highlighted fears that "gagging" clauses were being used to "frustrate" such whistleblowing.
A climate of "openness and transparency" is essential, he said.
It comes after one former NHS trust boss broke a gag to talk to the BBC.
Gary Walker, former chief executive of United Lincolnshire Hospitals Trust (ULHT), said he had been forced out of his job and gagged from speaking out about his concerns over patient safety.
'Positive move'

Analysis

Andrew HoskenBBC Today programme
The row over secret gagging clauses has focused attention on the man at the top of the English NHS, Sir David Nicholson.
His position was already being questioned in the wake of a highly critical report on the Mid Staffordshire Hospitals scandal, where hundreds of patients may have died from neglect and abuse.
However Sir David escaped personal censure from inquiry chairman, Robert Francis QC.
Following the report, another 14 NHS trusts have been placed under investigation.
What makes the gagging row potentially so toxic for Sir David is one of those trusts, the United Lincolnshire Hospitals Trust, has been trying to enforce Gary Walker's gagging clauses with the threat of legal action.
Since Mr Walker broke cover, more people are asking whether Sir David and other senior NHS civil servants can bring about the cultural change and openness Jeremy Hunt and many others consider essential.
In his letter, Mr Hunt called for the NHS to "recognise and celebrate" staff who had "the courage and professional integrity to raise concerns over care".
The health secretary insisted that "fostering a culture of openness and transparency" was essential in creating a climate "where it is easy for staff, present and former, to come forward with any concerns they have relating to patient safety".
Mr Hunt also warned NHS bosses against the "institutional self-defence that prevents honest acknowledgement of failure".
"I would ask you to pay very serious heed to the warning from Mid Staffordshire that a culture which is legalistic and defensive in responding to reasonable challenges and concerns can all too easily permit the persistence of poor and unacceptable care," he said.
Mr Walker, who was sacked in 2010 for gross professional misconduct for allegedly swearing in a meeting, told the BBC he had no choice but to sign an agreement linked to a confidentiality clause in April 2011.
He said he was gagged by the NHS from speaking out about his dismissal and his concerns over the quality of care at the trust.
After breaking the order, lawyers for the trust then warned him he would have to repay £500,000.
Speaking to BBC Radio 4's Today programme on Saturday, Mr Walker applauded Mr Hunt for "clearly taking a personal interest" in his case and the issue of gagging orders.
"I think that's a very positive move."
"I don't think it's simply about the Lincolnshire Trust," he added, calling for Mr Hunt to investigate the "chain of command" that led to the gagging, which he said included the Department of Health, the East Midlands Strategic Health Authority (SHA) and the Lincolnshire Trust.
"I don't think Mr Hunt can investigate his own department so I think he should be looking for someone exceptionally independent from all of this."
'Suppressed and bullied'
BBC Radio 4 Today programme reporter Andy Hosken said Mr Hunt's letter could spell the end of the National Health Service gag if the NHS trusts' chairmen to whom he wrote actually followed the advice and guidance contained within the letter.
Our correspondent said the letter was certainly a warning shot across the bows of the trusts. It appeared the use of these gagging clauses was widespread in the NHS, he added.
Meanwhile, Dr Phil Hammond, chief medical correspondent at Private Eye magazine joined calls for NHS chief executive Sir David Nicholson to stand down.
He told BBC News: "We need to change the culture, we have to change the people at the top. David Nicholson has to go and that's the one constructive thing that Jeremy Hunt could do.
"Unless you have accountability at the top, you won't get it at the bottom."
Health Minister Lord Howe: "It is the right and the duty of any NHS employee to raise concerns"
A spokesman for the East Midlands SHA said it had always acted "appropriately and properly" in the "interest of patients".
And ULHT has said the allegations that they had tried to stifle debate about patient safety issues were "incorrect".
ULHT is one of 14 trusts in England currently being investigated for high death rates, in the wake of the Stafford hospital scandal, where hundreds are believed to have died after receiving poor care.
It emerged on Friday that police and prosecutors are now studying a damning report into failures at Stafford to see whether any criminal charges should be brought against staff.

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Friday, 15 February 2013

carers


More than one in 10 providing unpaid care

Elderly man

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The number of unpaid carers in England and Wales has reached 5.8 million - a rise of 600,000 since 2001, the Office for National Statistics (ONS) has said.
Figures from 2011 show that the largest increase was in unpaid carers working for 50 or more hours a week.
Wales had a higher percentage of people providing unpaid care compared with any English region.
In England, the highest percentages of unpaid carers were in the North West, North East and West Midlands.
The ONS study into unpaid care in England and Wales, 2011 found that more than 12% of the population in Wales provided some level of care in 2011.
The rise in those providing over 50 hours a week of unpaid care means that across England and Wales there are now 1.4 million people providing round-the-clock care - an increase of 270,000 people since 2001 (25%).

“Start Quote

Too often the costs and pressures of caring for older or disabled loved ones can force families to give up work.”
Helena HerklotsCarers UK
Across local authorities in England and Wales, the number of carers increased in 320 authorities and fell in just six.
In Birmingham, the number of unpaid carers increased by more than 9,000 between 2001 and 2011.
Across English regions and Wales, the provision of between one and 19 hours was the most common level of care provided.
London was the area with the lowest percentage of unpaid carers at 8.4%.
The study said London's lower level of care provision was likely to be influenced by its younger age structure, the transient nature of its population and differences in household composition.
Family pressure
The provision of unpaid care is an important statistic, the ONS says, because unpaid carers make a vital contribution to the supply of care but their role can also affect their employment opportunities as well as their social and leisure activities.
Unpaid care means care provided to family members, friends, neighbours or others who are disabled, elderly or have long-term health problems. It does not include people providing general childcare.
Heléna Herklots, chief executive of Carers UK said: "Family life is changing as a result of our ageing population and the fact that people are living longer with disability and long-term ill-health.
"Too often the costs and pressures of caring for older or disabled loved ones can force families to give up work to care and lead to debt, poor health and isolation.
"In addition, as more families need help to care, social care support and disability benefits are being cut. This risks putting even more pressure on families, many of whom are already struggling to cope."

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Sunday, 10 February 2013

Staffordshire NHS Foundation Trust.


Most of the UK media has reported on the Francis inquiry into significant failures in care at the Mid Staffordshire NHS Foundation Trust.
The report suggests a raft of radical changes to help improve patient safety. These include proposals to make serious but avoidable medical mistakes a criminal offence.
The Healthcare Commission (the hospital regulator at the time) first raised concerns about the trust in 2007, after determining it had unusually high death rates.
These concerns led to a series of reports, undertaken by different bodies, which all found widespread evidence of significant failures in care, including:
  • patients being left in soiled bedding
  • patients not given ready access to food and water
  • chronic staff shortages
  • failure in the leadership of the hospital
  • a culture in which staff members who had concerns about failures in care were discouraged from speaking out
This current inquiry was commissioned in 2010 to investigate wider issues that may have contributed towards these serious problems. The inquiry, carried out by the barrister Robert Francis QC, was asked to come up with recommendations which could help prevent similar failings from happening in the future.
The findings of the inquiry have now been published.


What is a public inquiry?

Public inquiries are wide-ranging investigations commanded by the government to look at very serious issues, particularly where there have been numerous deaths.

Due to their scale and level of detail, they are not often carried out. The most recent health-related public inquiry was the 2005 Shipman Inquiry into the case of Hyde GP Harold Shipman who was imprisoned for murdering 15 patients.

What were the main findings of the inquiry?

The findings of the inquiry can fairly be described as damning. It highlights what amounts to a ‘perfect storm’ of systematic failures of care at multiple levels, including:
  • a ‘Somebody Else's Problem’ attitude among hospital staff – perceived problems were too often assumed to be the responsibility of others
  • an institutional culture that cared more about the needs of the hospital staff than the patients
  • an unacceptable willingness to tolerate poor standards of patient care
  • a failure to accept and respond to legitimate complaints
  • a failure of different teams within the hospital, as well as in the wider community, to communicate and share their concerns
  • a failure of leadership – in particular, financial changes needed to achieve Foundation Trust status were seen, by the inquiry, to take precedence over patient care
Mr Francis concludes that, ‘The extent of the failure of the system shown in this report suggests that a fundamental culture change is needed. This does not require a root and branch reorganisation – the system has had many of those – but it requires changes which can largely be implemented within the system that has now been created by the new reforms.’

What recommendations does the inquiry make?

The inquiry makes a total of 290 individual recommendations. These include:
  • causing harm or death to a patient due to avoidable failures in care should be a dealt with as a criminal offence (rather than a regulatory or civil matter)
  • NHS staff, including doctors and nurses, should have a legal ‘duty of candour’ – so they are obliged to be honest, open and truthful in all their dealings with patients and the public
  • a single regulator of both quality of care and financial matters should be created
  • non-disclosure agreements (‘gagging orders’) – where NHS staff agree not to discuss certain matters – should be banned
  • there should be a ‘fit and proper’ test for hospital directors, similar to those set for football club directors
  • a clear line of leadership needs to be established, so it is always clear who is ultimately ‘in charge’ when it comes to a particular patient
  • uniforms and titles of healthcare support workers should be clearly distinguished from those of registered nurses

What happens next?

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

Links to the headlines

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

Further reading

Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Executive summary (PDF, 839Kb). Published 
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Saturday, 9 February 2013

Stafford Hospital scandal: Jeremy Hunt calls for police inquiry


Stafford Hospital scandal: Jeremy Hunt calls for police inquiry

Jeremy HuntJeremy Hunt said the police and the General Medical Council should review the evidence

Staffordshire NHS scandal

The deaths of patients at Stafford Hospital should be investigated by the police, the Health Secretary has said.
In an interview with the Daily Telegraph, Jeremy Hunt said it was "absolutely outrageous" that nobody had been "brought to book".
Staffordshire Police said it was currently "studying the report's full contents."
It said it had previously investigated two cases at the hospital but found no evidence to bring prosecutions.
"This was a public inquiry that was designed to help us understand why the system didn't pick up what went wrong but I think it is absolutely disgraceful with all those things happening, whether it is doctors, nurses or managers, nobody has been held to account," Mr Hunt told the newspaper.
'Duty of care'
He said that it was not for politicians to decide whether people should be prosecuted but that evidence should be reviewed.
The findings of the public inquiry into failings at Stafford Hospital were published on Wednesday.
Helene DonnellyNurse Helene Donnelly left the hospital trust in 2008
The 12-month inquiry, which cost £13m, came after a higher-than-expected number of deaths at Stafford hospital between 2005 and 2008.
The report by Robert Francis QC strongly criticised hospital managers and the Department of Health.
Helene Donnelly worked as a staff nurse in the casualty department at Stafford Hospital and raised concerns about patient care about 100 times in six years.
She said there had been a culture of neglect at the hospital and that she was in favour of the evidence being looked at.
"As a nurse who went through it and saw some terrible things, I think there does need to be some accountability certainly with some of the nurses I spoke out against," she said.
Staffordshire Police said two cases of misdiagnosis had been formally investigated following patient deaths but no evidence was found to suggest the hospital had been negligent in its care.

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FEBRUARY 25TH, 2010

Why Burnham Didn’t Want An Inquiry

Guido understands that Andy Burnham is about to be in some deep trouble. Yesterday he said he“did not believe that a lengthy, adversarial inquiry would be in the best interests of health care in Staffordshire.” Today it has emerged that in 2007, as a Junior Health Minister, he signed offon one of four stages of the Mid-Stafford Hospital’s elevation to Labour’s coveted Foundation Trust status. This was despite four formal alerts about the hospital’s dangerous practises. The rest they say is history.
No wonder Dave was asking about this at PMQs yesterday. Guido just got off the phone with Julie Bailey of Cure the NHS, a local group campaigning for a full inquiry into the case, who said she had to go because “we’re just about to start filming” as Andrew Lansley was on the way.
After Burnham’s “tired and emotional” outburst at Lansley last week for the death tax posters, Guido senses he may be dodging Nokias by the end of the tea time news…
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Friday, 8 February 2013


Stafford Hospital: Does NHS boss have case to answer?

Sir David NicholsonSir David Nicholson has been chief executive of the NHS for the past six years

Staffordshire NHS scandal

For a man who is so renowned for keeping a tight control on the health service, the past few days have been undoubtedly uncomfortable for NHS chief executive Sir David Nicholson.
Campaigners have been calling for his resignation from his £270,000 post following the public inquiry into the failings at Stafford Hospital.
And on Thursday he found his picture splashed on the front pages of two national newspapers.
Both included critical articles about his role in the scandal.
But what is the evidence against Sir David?
Anybody in charge of an organisation that has just had its culture criticised in the way the public inquiry did with the NHS would find themselves being asked questions.
But what makes Sir David even more vulnerable is the fact he had contact with Stafford Hospital when he was a regional NHS boss - as has been documented in the the 1,700-page report.
In fact he was on the panel that appointed a new chief executive for the hospital in the second half of 2005. The panel chose Martin Yeates, the man who would subsequently order a deep round of cost-cutting at the trust that contributed to the "appalling" levels of care.
Sir David actually became interim chief executive of the health authority that oversaw Stafford Hospital in August 2005. At the time, a number of health authorities were being merged and Sir David had been leading a neighbouring once since 2003.
The inquiry report makes clear that even at this time it was apparent that the Mid-Staffordshire Trust, which ran the hospital, had problems with finances and management structures.
Plain Mr Nicholson, as he was then, met with Mr Yeates and the chairwoman of the trust, Toni Brisby, soon after he took charge, to discuss what was being done.
Documents from the time show he was concerned about the performance of the trust and wrote to the trust to say so.
A letter back to him from Ms Brisby convinced him that new leadership at the trust was engaged with tackling the problems. The inquiry questioned this, suggesting the letter could be interpreted as the trust being in denial.
Top job
But Mid-Staffordshire was soon someone else's problem, as Sir David left the West Midlands in June 2006 to take up the reins of the NHS in London.
Within months he was on the move again after being appointed to the top job, chief executive of the whole health service in England,
The next time Stafford Hospital loomed large on his horizon was in the summer of 2007.

“Start Quote

What has been found to be wrong here cannot be cured by finding scapegoats”
Robert FrancisInquiry chairman
It had been put forward for foundation trust (FT) status - elite status that gives hospitals freedom from government control.
A Department of Health committee recommended the trust was in a fit state to be put forward for FT status.
Without any objections forthcoming, it was left to Andy Burnham, then a junior health minister, to sign off the relevant paper work and pass the application off to Monitor, the body that makes the final decision on FT status.
The following summer Sir David again found himself discussing Mid-Staffordshire in a meeting with the Healthcare Commission, the NHS regulator, which had just started an investigation into the trust following concerns about high death rates.
He is reported to have told officials from the regulator to beware of the Cure the NHS campaign, the group set up by local patients upset about the care provided by Stafford Hospital, suggesting they were "simply lobbying" as opposed to representing widespread concern among patients using the hospital.
Sir David denied using the phrase, leaving the inquiry to conclude that it was not possible to determine exactly what was said after all this time.
But the inquiry report did warn that care needed to be taken in these sort of situations to "avoid the impression that the Department of Health was seeking to influence an independent regulator".
'Cultural leader'
By March 2009 the Healthcare Commission published its findings on Mid-Staffordshire. They were devastating, lifting the lid for the first time on what had been happening.
A year later an independent inquiry was adding more harrowing detail to the picture. According to those who were close to him at the time, both reports are said to have shaken and upset Sir David.
The public inquiry also raised questions about the power the Department of Health wielded over the health service.
Of course, this will be influenced by ministers as well as senior officials such as Sir David.
The inquiry report described the department as a "cultural leader" but said the evidence did not suggest it was an organisation that bullied.
Instead, it concluded that "well-intentioned decisions and directives... have either been interpreted further down the hierarchy as bullying, or resulted in them being applied locally in an oppressive manner".
None of this was enough to convince inquiry chairman Robert Francis QC that Sir David - or anyone else for that matter - should go.
Mr Francis stressed in his statement to the media immediately after publication of the report that the blame game should be avoided, saying: "What has been found to be wrong here cannot be cured by finding scapegoats."
But this is not enough for Julie Bailey, the woman who set up Cure the NHS after losing her mother at Stafford Hospital.
She is adamant Sir David, who has apologised for what happened, should lose his job.
Ministers though are sticking by him.
As well as being chief executive of the NHS, he is also the head of the new NHS Commissioning Board, which will take charge of the health service from April.
As one government adviser put it: "Even if there was an appetite to get rid of him we couldn't afford to. We have a major restructuring on our hands and growing financial problems.
"He is the man who has a grip on the system. Without him we would be in real trouble."
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