Friday 23 January 2015

Treatment of whistleblowers a stain on NHS, say MPs

By Adam BrimelowHealth Correspondent, BBC News

The failure to protect whistleblowers remains a "stain" on the reputation of the NHS in England, MPs have said.

The Health Select Committee says the treatment of staff who raise concerns has undermined trust in the system.

And whistleblowers who are vindicated should receive an apology and "practical redress", its report adds.

The MPs also say the complaints system for patients is complex and confusing and there should be a "single gateway" covering health and social care.

The report says despite numerous inquiries and reports highlighting failings in complaint-handling and whistleblowing, serious shortcomings remain.

It emphasises the importance of ensuring health and care workers feel supported in raising professional concerns.

"The treatment of whistleblowers is a stain on the reputation of the NHS and has led to unwarranted, inexcusable pain for the courageous individuals affected," it says.

Open culture

The report acknowledges there have been some attempts to create an open culture, where staff are encouraged to raise concerns, and there is a proper response.

But it concludes these initiatives are "far from common", and warns other potential whistleblowers may be deterred from coming forward.

"This has undermined trust in the system's ability to treat whistleblowers with fairness. This lack of confidence about the consequences of raising concerns has implications for patient safety."

The MPs are calling for a programme to identify whistleblowers whose actions are proven to have been vindicated. They say they should receive an apology and "practical redress", which could mean financial recompense, or - in some cases - getting their job back.

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Patients and staff do not complain for financial redress but because they seek an acknowledgement and explanation, a timely apology if appropriate and for the NHS to reduce the chance of avoidable harm to others”

Dr Sarah WollastonChairwoman, Health Select Committee

'Breakdown of trust'

They also highlight continued failings in the way the NHS responds to patients' complaints. They say despite some progress, the current system remains "variable".

Too many individual cases are "mishandled", they say, sometimes leading to a "complete breakdown of trust" between patients and the NHS, and a failure to improve patient safety.

They argue the current "overly complex" system should be simplified by establishing a single complaints gateway covering health and social care. They suggest this could be modelled on the Complaints Wales service run by the Public Services Ombudsman for Wales.

Alongside this they say there is a "strong case" for the creation of a single health and social care ombudsman for England.

Health Secretary Jeremy Hunt has welcomed the report.

"We want to make the NHS the safest healthcare system in the world and we know that listening to patients and staff is absolutely vital to improve care.

"That's why we've made hospitals legally obliged to apologise to patients when mistakes do happen, introduced complaints handling as a crucial element of tougher hospital inspections and have asked Sir Robert Francis to produce an independent report on how to create a more open NHS culture," he said.

'Gold dust'

Katherine Murphy from the Patients Association said the NHS must demonstrate it is prepared to listen.

"Complaints are like gold dust - they should be welcomed, they are telling you something is not right."

Peter Walsh from the charity Action against Medical Accidents, said he valued the MPs' recommendations, but warned that progress had been too slow.

"This is just the latest in a long line of reports and we now demand action to improve what has been a failing system."

The former NHS whistleblower Dr Kim Holt, founder of the charity Patients First, said the report was a first step in making much-needed changes.

"I am really pleased that a suggestion has been made that historic whistleblower cases are looked at and practical ways found of providing redress for them. That is a really amazing step forward, but the system needs an overhaul.

"We no longer want to see people on long-term suspensions, sick leave or dismissed for speaking up. The link between bullying and raising concerns is a close one and our key issue to be addressed is the one of bullying, which creates fear and desperation."

Saturday 3 January 2015

Whooping cough proteins evolving 'unusually' fast

By Emma WilkinsonHealth reporter, BBC News

Baby having the DTP jab, which protects against whooping cough

Whooping cough may be evolving to outsmart the currently used vaccine, say researchers.

Analysis of strains from 2012 shows the parts of the pertussis bacterium that the vaccine primes the immune system to recognise are changing.

It may have "serious consequences" in future outbreaks, UK researchers state in the Journal of Infectious Diseases.

But experts stressed the vaccine remains highly effective in protecting the most vulnerable young babies.

There has been a global resurgence of whooping cough in recent years.

In 2012, there were almost 10,000 confirmed cases in England and Wales - a dramatic increase from the last "peak" of 900 cases in 2008.

The outbreak led to 14 deaths in babies under three months of age - the group who are most vulnerable to infection.

Rising figures prompted health officials to recommend vaccination of pregnant women so immunity could be passed to their newborns - a strategy that a recent study showed was working well.

Evolving strains

But there has been much debate among experts about whether the introduction of a new vaccine in 2004 has been a factor in rising rates of whooping cough.

One issue is that immunity from the newer acellular vaccine - which contains specific proteins from the surface of the bacteria - does not seem to last as long as the previous whole cell version, leaving teenagers and adults lacking protection.

In the latest study, researchers analysed the genes coding for the proteins on the surface of the pertussis bacterium responsible for the UK outbreak.

They found proteins being targeted by the vaccine were mutating at a faster rate than other surface proteins not included in the vaccine.

Potentially it means the bacteria is changing quickly to get around immune system's defences put in place with immunisation.

What is whooping cough?

It is also known as pertussis and is caused by a species of bacteria, Bordetella pertussis

It mostly affects infants, who are at highest risk of complications and even death

The earliest signs are similar to a common cold, then develop into a cough and can even result in pneumonia

Babies may turn blue while coughing due to a lack of oxygen

The cough tends to come in short bursts followed by desperate gasps for air (the whooping noise)

Adults can be infected - but the infection often goes unrecognised

But the researchers are still trying to work out what the changes mean in reality - for example do the mutations boost the ability of the bacteria to cause infection.

"We wanted to look at strains from the UK to see if there was anything sudden that had occurred that had led to these really large outbreaks," said study leader Dr Andrew Preston from the University of Bath.

Vaccine effectiveness

The "million dollar question" he said was what, if anything, could be done to improve the vaccine - which is still the best defence we have - and prevent future outbreaks.

Options to consider include adding more or different proteins to the vaccine, adding novel adjuvants - chemicals which boost the immune response, or even revisiting the old-style whole cell vaccine, he said.

"Pertussis has a cyclical nature and other big question is are we going to see another increase in late 2015," he added

Prof Adam Finn, a paediatric immunology expert at the University of Bristol said the importance - or not - of the subtle changes found in the study was as yet unclear.

"But the control of pertussis is a significant worry," he added.

Only 60% of pregnant women have had the pertussis vaccine and we should be doing more to raise awareness of its benefits, he said.

"There is very good new evidence that vaccinating pregnant women protects their babies. And the group we really want to protect is newborn babies," he said.

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Whooping cough

Whooping cough is the colloquial name for pertussis it is also called the “100 day cough” in areas of Asia. The coughing leads to loss of breath followed by a sharp intake, which creates the whooping sound that characterizes this disease. Pertussis occurs worldwide. In 2012 nearly 50 thousand cases were recorded in the United States, most occurring in infants. Whooping cough outbreaks occur cyclically with peak infection rates occurring in two to five year intervals. Transmission occurs between infected individuals through the air. The bacteria may be transmitted through breathing, talking, or coughing. Whooping cough is most severe in infants and young children; there is a 2% mortality rate in this population. In adults and older children, treatment with antibiotics usually results in a full recovery. Pertussis is easily prevented with readily available vaccines.

Whooping cough cause

Pertussis is caused by the Bordetella pertussis bacterium. The bacterium can be spread through the air as infected individuals breath, cough, or sneeze. Infected individuals are contagious for as long as three weeks after the initial onset of symptoms, and it is possible to spread whooping cough before one is aware that one is ill. Pregnant women with whooping cough may also give it to their unborn baby.

Whooping cough symptoms

The symptoms of whooping cough are initially similar to those of the common cold. An initial catarrhal stage causes a runny nose, sneezing, congestion, and/or fever. Paroxysmal or severe coughing presents one to two weeks after the catarrhal stage. The coughing is typically violent and rapid. After a cough, air is forced out of the lung and the following inspiration causes the whooping sound, which gives the illness its name. Vomiting may also occur due to the intensity of coughing, and clear sputum may be produced. In babies, the coughing may not be easily observable, but noticeable apneas or breathing pauses will occur. The paroxysmal coughing stage lasts for two to eight weeks before transitioning into the convalescent stage. The convalescent stage brings a decreased frequency and intensity of coughing as well as a reduction in vomiting. Eventually all symptoms subside. Individuals may be infected many times, the body does not develop a lifelong immunity.

When coughing occurs it may be difficult to control and may interfere with the affected individual’s ability to eat, drink, or sleep. Coughing occurs more often at night. In young children and babies, the coughing may interfere with breathing, leading to red, blue, or purple faces. If the apnea is extremely severe, the baby may not receive enough oxygen, resulting in the potential for brain damage. In babies whose mothers were not vaccinated, complicating symptoms such as pneumonia or encephalopathy can occur. Other potential complications include earache and seizures. Most otherwise healthy adults and older children will make full recoveries; however, those with other conditions have an increased risk of morbidity and mortality. Due to the strenuous and severe intensity of the coughing, there is a risk of bruised or cracked ribs, abdominal hernias, and broken blood vessels in the eyes and throat.

Whooping cough in newborns is extremely dangerous as pertussis infections are fatal in 1.6% of infants under one year of age. Infants are also more prone to complications with 20% developing pneumonia, 0.3% developing encephalopathy, and 1% developing seizures.

Diagnosis

Due to the similarity between the symptoms of pertussis and the symptoms of other respiratory illnesses like flu, cold, and bronchitis, it may be difficult to accurately diagnose. A skilled clinician will diagnose pertussis by listening to the sound of the cough and inquiring about associated symptoms. Occasionally, the doctor will also check for evidence of Bordetella pertussis bacterium in nose or throat swabs.

Whooping cough vaccination

Vaccination is the main method of prevention for pertussis. The DTaP vaccine is recommended by the CDC and combines diphtheria, tetanus, and pertussis vaccines. 89 out of 100 children who receive the DTaP vaccine will have protection from pertussis. Some children will still get pertussis, but their symptoms will be greatly diminished. The DTaP vaccine loses efficacy over time and booster shots are available.

It is highly recommended that pregnant women receive a TdaP (tetanus and pertussis) vaccine near the beginning of their third trimester for every pregnancy. The vaccine causes the mothers body to produce antibodies that can help to prevent some of the complications of whooping cough.

It is also recommended that individuals who are frequently in contact with children receive the whooping cough vaccine. No repeat vaccination is required for individuals who received the TdaP vaccination before 19 years of age, and no booster is required. Adults who did not receive a TdaP vaccination as a teen should get one dose. The vaccine should be received at least two weeks before contact with children to give the body time to produce a sufficient number of antibodies.

After a baby is born he/she requires booster shots. For DTaP, five doses in total should be administered at various ages. Babies remain susceptible to pertussis until the third vaccination so those six months or younger are at very high risk of infection. Common side effects of the DTaP vaccination are redness and swelling at the site of the shot, fever, and vomiting. More rare side effects may include severe fever, crying for greater than three hours, or seizures.

The whooping cough treatment

If an individual becomes infected with pertussis, he or she will typically betreated with antibiotics. Erythromycin and azithromycin are generally the first treatments choice, but macrolides, a newer type of antibiotic, may also be preferred due its decreased risk of side effects. If the individual is allergic to first treatment antibiotics or macrolides, trimethoprim-sulfamethoxazole (TMP-SMZ) may be administered instead.

For adults and older children, appropriate rest and plenty of liquids are important parts of the recovery regimen. For babies or younger children, treatment will include isolation from others to prevent transmission between babies. Unfortunately, cough medicines are often ineffective in the face of pertussis and may not offer relief of the symptoms. All prescribed antibiotics should be taken until finished even if symptoms are diminished or gone. The doctor should be contacted immediately if seizures, troubled breathing, high fever, or hernias occur. If the infected person is unable to keep food down, an intravenous line may be used.

Learning disability GP health checks 'show results'

A GP checking a patient's blood pressure

A scheme getting GPs to offer health checks to patients with learning disabilities in England is helping to pick up problems, research suggests.

A study in Lancet Psychiatry, looking at data for more than 8,000 patients, found surgeries in the scheme were twice as likely to identify problems.

But many patients who are entitled to the checks are still missing out.

The Down's Syndrome Association said there was a lack of awareness that the health checks were available.

Learning disability health checks were introduced in 2008 through GPs surgeries as a way of monitoring the health of this vulnerable group of people.

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We found that surgeries who did health checks did much better - they offered blood tests, reviewed the patients' medication, and drew up health action plans for the next year”

Andre StrydomUniversity College London

NHS England decided to pay GPs as part of an incentive scheme for carrying out the health checks.

People with learning or intellectual disabilities, such as Down's syndrome, are known to have significantly poorer health than other people.

This is because they find it more difficult to talk about symptoms and are less likely to make appointments to talk about their health problems.

'Barriers'

Lead researcher Andre Strydom, reader in intellectual disabilities at University College London, said there was good evidence that health checks for people with learning disabilities could help identify previously unrecognised health problems.

His study, comparing the results of health checks performed by GP surgeries who signed up to the scheme and those surgeries who did not, found that health concerns were picked up twice as often when surgeries got involved.

"We found that surgeries who did health checks did much better - they offered blood tests, reviewed the patients' medication, and drew up health action plans for the next year."

But even with six out of 10 surgeries signed up to the scheme in England, 40% of patients with learning disabilities did not receive a health check.

Dr Strydom said this may be owing to the fact that a large number of people with these disabilities were not on the list to receive a health check.

Either they were not known to local social services or their GP, or they were known but had been given the wrong patient code which meant they missed out when the list was collated, he said.

Stuart Mills, information officer at the Down's Syndrome Association, said there could be many reasons why this group of people were not being offered the health checks.

"It's a relatively complicated picture. It's down to a lack of awareness, not being on the disability register, and the fact there are more barriers for people with Down's syndrome."

He said the Association wanted to increase awareness that people with Down's syndrome were entitled to a health check.

The charity has also produced information booklets for GPs about potential health problems, which can include hearing and sight problems, thyroid conditions and muscular-skeletal problems. Depression is also a common health issue.

Although there was evidence some people were being given good health checks, others reported that their health checks were poor and lasted only 15 minutes, however.

Tuesday 30 December 2014

A health worker who was diagnosed with Ebola

Ebola healthcare worker transferred to London unit

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The BBC's Nick Quraishi says the patient was whisked past reporters in an RAF ambulance

Ebola outbreak

A health worker who was diagnosed with Ebola after returning to Scotland from Sierra Leone has arrived at a specialist treatment centre in London.

The woman, who travelled to Glasgow via Casablanca and London Heathrow, was taken to the Royal Free Hospital.

She is understood to have been flown to RAF Northolt in a military plane after leaving Glasgow in a convoy.

Passengers on flights she took to the UK are being traced, but officials say the risk to the public is very low.

The woman left Gartnavel Hospital in Glasgow just after 03:00 GMT on Tuesday.

Six police cars accompanied two ambulances as she was taken to Glasgow Airport. She has been taken to an isolation unit at the north London hospital from the RAF base in west London.

The patient being transferred from hospital in Glasgow

The female patient left hospital in Glasgow in the early hours of Tuesday

The ambulance arriving at the Royal Free Hospital

The woman arrived at the Royal Free Hospital in north London just before 08:00 GMT

UK Health Secretary Jeremy Hunt said NHS safety measures in place were working well.

Mr Hunt, who chaired an emergency Cobra meeting on Monday evening, said the government was doing "absolutely everything it needs to" to keep the public safe.

"We are also reviewing our procedures and protocols for all the other NHS workers who are working at the moment in Sierra Leone," he added.

The patient, who had been working with Save the Children in Sierra Leone, arrived in Glasgow on a British Airways flight on Sunday but was placed in an isolation unit at Gartnavel Hospital on Monday morning after becoming feverish.

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Dr Stephen Mepham explains how the isolation unit works

Under UK and Scottish protocol, she was moved to the high-level isolation unit at the Royal Free Hospital.

UK nurse William Pooley - who contracted Ebola in Sierra Leone earlier this year - was successfully treated at the same facility.

Scottish First Minister Nicola Sturgeon, who chaired a meeting of the Scottish Government Resilience Committee on Monday, said the risk to the public was "extremely low to the point of negligible".

She added the patient was thought to have had direct contact with only one other person between arriving in Glasgow and attending hospital on Monday.

A second health worker who returned from West Africa recently is being tested in Aberdeen for Ebola, it has emerged.

But Ms Sturgeon said there was only a "low probability" the woman also had the disease as she has not had direct contact with anyone infected with Ebola.

Analysis: BBC health editor Hugh Pym

This latest incident will raise questions about the screening process in place for passengers leaving West Africa and arriving at Heathrow.

Public health officials say the woman was taken aside on arrival in the UK and her temperature was taken - the procedure followed for all incoming health staff who say they have been in contact with Ebola patients.

Her temperature was found to be normal and she was not feeling unwell, so she continued her journey to Glasgow.

Someone with Ebola only becomes infectious once they develop symptoms. In this case, that only became apparent after she arrived in Scotland.

The task of contacting the passengers and crew on the flights she took is now under way. That will be complicated, but officials are insisting the risk to those people is extremely low.

Efforts are being made to trace the 71 other passengers who travelled on the same flight from London to Glasgow.

A British Airways spokesman said: "The safety and security of our customers and crew is always our top priority and the risk to people on board that individual flight is extremely low."

A telephone helpline has been set up for anyone who was on the BA 1478 flight which left Heathrow Airport on Sunday evening. The number is 08000 858531.

Glasgow Ebola case

Patient flight details - 28 December

Flight AT596 from Freetown, Sierra Leone, to Casablanca, arriving 06:10 GMT
Flight AT800 from Casablanca to London Heathrow, arriving 15:50 GMT
Flight BA1478 from London Heathrow to Glasgow, arriving 22:20 GMT

Reuters

Tom Solomon, director of Liverpool's Institute of Infection and Global Health, said of the reaction to the woman's diagnosis: "We've had training exercises up and down the country and that's why you've seen that the response has been very calm and very controlled.

"It's very important that despite this case we have healthcare workers continue to go out to west Africa to help bring this disease under control."

Paul Cosford, medical director for Public Health England described the woman as a "very brave person", telling BBC Breakfast she had "put herself in the front line of care for people with Ebola".

He also said that about 150 people in the UK had been tested for Ebola recently - with all except Mr Pooley and the female patient being taken from Glasgow returning a negative result.

The patient had travelled from Freetown in Sierra Leone via Casablanca

Professor Dame Sally Davies, Chief Medical Officer for England, said: "We have robust, well-developed and well-tested NHS systems for managing unusual infectious diseases when they arise, supported by a wide range of experts.

"The UK system was prepared, and reacted as planned, when this case of Ebola was identified."

Ebola is transmitted by direct contact with the bodily fluids - such as blood, vomit or faeces - of an infected person.

The virus has killed more than 7,800 people, mostly in West Africa, since it broke out a year ago.

The World Health Organization says the number of people infected by the disease in Sierra Leone, Liberia and Guinea has now passed 20,000.

What are the symptoms?

The Ebola virus causes a range of painful and debilitating symptoms

The early symptoms are a sudden fever, muscle pain, fatigue, headache and sore throat.

This is followed by vomiting, diarrhoea, a rash and bleeding - both internal and external - which can be seen in the gums, eyes, nose and in the stools.

Patients tend to die from dehydration and multiple organ failure.

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Friday 23 January 2015

Treatment of whistleblowers a stain on NHS, say MPs

Treatment of whistleblowers a stain on NHS, say MPs

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Saturday 3 January 2015

Whooping cough proteins evolving 'unusually' fast

Whooping cough proteins evolving 'unusually' fast

Learning disability GP health checks 'show results'

Learning disability GP health checks 'show results'

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Tuesday 30 December 2014

A health worker who was diagnosed with Ebola

Ebola healthcare worker transferred to London unit

Ebola outbreak

Glasgow Ebola case

Patient flight details - 28 December

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Friday 23 January 2015

Treatment of whistleblowers a stain on NHS, say MPs

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Saturday 3 January 2015

Whooping cough proteins evolving 'unusually' fast

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Tuesday 30 December 2014

Ebola healthcare worker transferred to London unit

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