Monday 16 September 2013

NHS patients 'should not face constant moves'

By Nick TriggleHealth correspondent, BBC News

Patients often face multiple moves around hospital

The era of NHS patients being shunted around hospitals needs to end, an expert group says.

The Future Hospital Commission - set up by the Royal College of Physicians - said a radical revamp in structures was needed to bring care to the patient.

This was particularly true for frail people with complex needs, who often faced multiple moves once admitted to hospital, the report said.

It also recommended closer working with teams in the community.

The commission said this could involve doctors and nurses running clinics in the community and even visiting people in their own homes - as is already happening in a few places.

'Bold and refreshing'

It also called for an end to the concept of hospitals discharging patients.

Sir Mike Rawlins: "Hospital shouldn't stop at the walls of the building"

Instead, it argued that many of those seen in hospitals in the 21st Century needed ongoing care that did not end when they left hospital.

So the report recommended that planning for post-hospital care should happen as soon as someone is admitted.

Key to that will be a new hub that should be created in every hospital, called a clinical co-ordination centre, which would act as a central control room, helping to ensure information about patients is shared and their care planned properly.

Once in hospital, patients should not move beds unless their care demanded it, the report said.

That contrasts with the multiple moves many patients with complex conditions often find themselves facing as they are passed from specialism to specialism.

It said this would require a greater emphasis on general wards with specialists visiting patients rather than the other way round.

Case study

The longest Suzie Hughes, who has the auto-immune condition Lupus, has spent in hospital is 21 days.

During her stay, she was moved five times for non-clinical reasons.

"I would find myself being wheeled down the corridor with my flowers and chocolates. Nurses would be with me and I kept thinking, 'What a waste of their time.'

"And each time I arrived on a new ward I had to explain my condition again. The information does not get passed on and it results in delays."

The authors - drawn from across the NHS and social-care spectrum - also called for an end to the two-tier weekday and weekend service in many facilities.

They even said it would be preferable to work at 80% capacity across the seven days if extra resources were not available in the short-term.

Commission chairman Sir Michael Rawlins said it was about providing the care patients "deserved".

Alzheimer's Society chief executive Jeremy Hughes said too often hospitals were stressful places with patients being moved "from pillar to post".

"We need nothing less than a revolution... in order to ensure our NHS is fit for the future," he added.

Health Secretary Jeremy Hunt said the report was "bold and refreshing".

"I agree completely that we must make services more patient-centred both inside and outside hospital."

Shadow health secretary Andy Burnham said: "We must turn this system around and help support people where they want to be - at home with their family around them."

Saturday 14 September 2013

Sepsis, septicaemia and blood poisoning

Sepsis is often referred to as either blood poisoning or septicaemia, although it could be argued that both terms are not entirely accurate. Sepsis is not just limited to the blood and can affect the whole body, including the organs.

Septicaemia (another name for blood poisoning) refers to a bacterial infection of the blood, whereas sepsis can also be caused by viral or fungal infections.

Sepsis is a life-threatening illness caused by the body overreacting to an infection.

The body’s immune system goes into overdrive, setting off a series of reactions that can lead to widespread inflammation (swelling) and blood clotting.

Symptoms usually develop quickly and include:

a fever or high temperature over 38C (100.4F)
chills
a fast heartbeat
fast breathing

In severe cases you may notice:

you feel dizzy when you stand up
confusion or disorientation
nausea and vomiting

Stages of sepsis

Sepsis develops in three stages, described below.

Uncomplicated sepsis is caused by infections, such as flu or dental abscesses. It is very common and does not usually require hospital treatment.
Severe sepsis occurs when the body’s response to infection has started to interfere with the function of vital organs, such as the heart, kidneys, lungs or liver.
Septic shock occurs in severe cases of sepsis, when your blood pressure drops to a dangerously low level, preventing your vital organs from receiving enough oxygenated blood.

If it is not treated, sepsis can progress from uncomplicated sepsis to septic shock and can eventually lead to multiple organ failure and death.

If you think you have sepsis, it is important to get it diagnosed and treated as quickly as possible.

If you think that you or someone in your care has severe sepsis or septic shock, phone 999 and ask for an ambulance.

Read more information about how sepsis is diagnosed.

Treating sepsis

If sepsis is detected early and has not yet affected vital organs, it may be possible to treat the infection at home with antibiotics. Most people with uncomplicated sepsis make a full recovery.

Severe sepsis and septic shock are considered medical emergencies and normally require admission to an intensive care unit, where the body’s organs can be supported while the infection is treated.

Because of problems with vital organs, people with severe sepsis are likely to be very ill, and approximately 30-50% will die as a result of the condition.

Read more information about how sepsis is treated.

How common is it?

It is estimated that there are over 30,000 cases of severe sepsis in the UK every year, and the number seems to be rising.

Sepsis lives can be saved, says ombudsman

Bacterial infection of the blood causing sepsis

Sepsis is a potentially fatal condition caused by the body's immune system overreacting to infection

More must be done to save the lives of patients with sepsis, says a report from the Health Service Ombudsman.

It found significant failings in treatment of the condition, which is caused when the body's immune system overreacts to infection.

It focused on 10 patients who were not treated urgently enough and died.

The National Institute for Health and Care Excellence will produce guidance for GPs and clinicians to help them recognise sepsis at an early stage.

Around 37,000 people are estimated to die of sepsis each year, accounting for 100,000 hospital admissions.

The Ombudsman, who investigates complaints from people who have received poor service from the NHS in England, said diagnosing and treatment presented some real problems because the condition was hard to spot and treat.

'Sepsis was taking over his body'

Jem Abbotts was 37 years old and recovering from a routine operation when he became ill.

He started vomiting and feeling feverish so the GP prescribed antibiotics and he went to bed to recover.

But a few days later he woke up vomiting and was rushed to hospital in a coma, as his organs began to fail.

He had contracted a bacterial infection which had entered his bloodstream, causing a condition known as sepsis.

'My husband thought he had flu - it was sepsis'

Sepsis can lead to swelling and blood clotting - and cause internal organs to stop working.

The most common causes of severe sepsis are pneumonia, bowel perforation, urinary infection, and severe skin infections.

Julie Mellor, the Health Service Ombudsman, said it was time for the NHS to act.

"In the cases in our report, sadly, all patients died. In some of these cases, with better care and treatment, they may have survived.

"We have worked closely with NHS England, NICE, UK Sepsis Trust and Royal Colleges to find solutions to the issues identified in our report. NICE and NHS England have already agreed to take forward the recommendations of our report.

“Start Quote

We know it is not easy to spot the early signs of sepsis, but if we learn from these complaints... then lives can be saved ”

Julie MellorHealth Service Ombudsman

"We know it is not easy to spot the early signs of sepsis, but if we learn from these complaints and work to improve diagnosis and provide rapid treatment, then lives can be saved."

The report recommended improving the recognition and treatment of sepsis by providing medical staff with clear clinical guidance.

She also recommended that NHS England launch a public awareness campaign which targets vulnerable groups of patients, such as those who are weak or in hospital.

Clinical staff should attach more importance to listening to the relatives of patients since they can be the first to recognise the patient's deterioration, she said, and more senior doctors should be involved in patient care.

Charles Turton, clinical advisor with the Health Service Ombudsman: "Patients in the early stages can look quite well"

Simple life-savers

Dr Ron Daniels, chairman of the UK Sepsis Trust, said there was a straightforward solution.

Facts about sepsis

Sepsis is a more common reason for hospital admission than heart attack - and has a higher mortality.
The most common causes of severe sepsis are pneumonia, bowel perforation, urinary infection, and severe skin infections.
The most common signs of sepsis are a high fever, violent shivering, fainting, cold and pale hands, rapid breathing, confusion or delirium.
37,000 people are estimated to die of sepsis each year in the UK.
From the time sepsis first takes hold, healthcare workers have just hours to deliver the right care.

UK Sepsis Trust

"The best hospitals have achieved better outcomes from sepsis by adopting a simple set of life-saving measures, collectively known as the Sepsis 6, and ensuring that a culture of awareness around sepsis has been created.

"We now need to spread this awareness to other health professionals and to the public, and to underpin this with guidance from NHS England and the National Institute for Health and Care Excellence."

He said the recommendations would potentially save 12,500 more lives every year.

Dr Mike Durkin, NHS England's director of patient safety, said the NHS would use the findings to work with GPs and hospitals to reduce deaths from sepsis.

"This report and guidance will help us to build on the work that is already in place to emphasise the importance of education, early detection and prompt treatment.

"We all need in every setting to understand the importance of identifying deterioration in both adults and children, in reducing the admission of full-term babies to neonatal care and identifying problems in vulnerable older people in the first 48 hours of acute illness."

Dr Peter Carter, chief executive of the Royal College of Nursing, said the report showed the tragic consequences of sepsis.

"It is vital that all staff are provided with training and support to enable them to recognise the signs and symptoms of sepsis, and crucially to know how to act quickly when sepsis is diagnosed."

Wednesday 21 August 2013

Measles jab claims by Children's Immunisation Centre 'irresponsible

Measles jab claims by Children's Immunisation Centre 'irresponsible'

Some 75,868 unscheduled vaccinations were given to people in Wales to control the measles epidemic

A clinic selling separate measles, mumps and rubella vaccines has been told to remove "misleading" claims from its website implying a link between the MMR jab and autism.

Complaints were made about the Cheshire-based Children's Immunisation Centre during the measles outbreak centred on Swansea.

The Advertising Standards Authority (ASA) decided the clinic's language "could have caused fear and distress".

The centre said it had now complied.

One person died and a total of 1,219 measles cases were diagnosed during the Swansea area measles epidemic, which was officially declared over in July.

As part of the response from public health officials, almost 76,000 unscheduled MMR vaccinations were given to people around Wales who had not been immunised in a bid to bring the epidemic under control.

The Children's Immunisation Centre offered single vaccines to parents, running a clinic in Swansea and others in England.

“Start Quote

We told Children's Immunisation Centre not to promote prescription-only medicines and to remove claims not supported by objective scientific evidence”

ASA report

In its response to the ASA, the centre said it offered a safe alternative for parents who needed to have their children protected from childhood diseases but did not wish to undergo government or NHS programmes such as the MMR vaccine.

It also argued its website information did not constitute advertising.

But the ASA said because the centre "promoted non-government recommended vaccination and because the overall context of the website focused on their claim that a single MMR vaccination was linked with autism, we considered the language used could have caused fear and distress without justifiable reason and we concluded the website was irresponsible".

Three complainants, including a GP, challenged whether the centre's 100% safety claim could be substantiated, while two said the advert was irresponsible and could cause fear and distress because it appeared during the measles outbreak in south Wales.

The ASA ruled that the website breached regulations because it advertised prescription-only medicines.

The centre told the ASA each of its 20,000 patients had a record card and not one had been hospitalised or had regression, autism or other health issues after vaccination.

SWANSEA MEASLES OUTBREAK

Began in November 2012
There have been no laboratory-confirmed cases in the affected area since May and the outbreak was cleared over in July
Some 75,868 unscheduled vaccinations were given to people around Wales who had not been immunised to control the epidemic
In the outbreak area more than 30,000 doses of the MMR vaccine were given
GP surgeries administered 16,500 and drop-in clinics have given more than 8,500
School and occupational health clinics administered more than 5,300 jabs

But the ASA noted that a sample complaint log supplied by the centre confirmed some children had developed minor and major complications as a result of receiving a vaccination ranging from a rash and high temperature to emergency hospital admission.

The ASA said: "Because Children's Immunisation Centre did not have a 100% safety record, we concluded the claim was misleading."

It added: "We considered the website had probably been live for some time before the outbreak of measles in Wales, during April and May 2013.

"However, we noted two links referenced the Welsh measles outbreak."

The ASA said it had not seen robust evidence that linked a single MMR vaccine with autism, concluding that that website was misleading.

It ruled: "The ad must not appear again in its current form.

"We told Children's Immunisation Centre not to promote prescription-only medicines and to remove claims not supported by objective scientific evidence."

Dr Andrew Wakefield's research linking the MMR jab to autism was published in 1998 has since been entirely discredited.

In a statement to BBC Wales, Zoe Miller from the Children's Immunisation Centre said: "We're now fully ASA compliant, everything that was requested has been taken off the website."

Saturday 17 August 2013

Basic rights of mentally ill

Basic rights of mentally ill 'violated'

By Adam Brimelow

Health Correspondent, BBC News

The cross-party group of MPs is urging Parliament to take action

The basic rights of some mental health patients in England are being "violated" because of a shortage of beds in psychiatric units, MPs say.

The Health Select Committee said there was evidence some people are being sectioned unnecessarily to secure hospital treatment.

It also warned safeguards to protect patients who lack capacity are often ignored.

The charity Rethink said the findings were "shocking".

Changes to mental health laws in 2007 were supposed to ease pressure on psychiatric units by extending the treatment available out of hospital.

Legislation provided for Community Treatment Orders so some people previously detained in hospital could be treated - under supervision - in the community.

But compulsory detention has continued to increase.

“Start Quote

It's absolutely shocking that people are being sectioned unnecessarily, just so they can get access to the treatment they are entitled to”

Paul JenkinsRethink

The report said in 2008-09 there were 42,208 detentions in England. By 2011-12 the figure had risen to 44,894.

'Ticket to a bed'

Many wards are at over-capacity. The MPs were told it has become hard to be admitted voluntarily.

One witness said "being detained is the ticket to getting a bed".

Their report said compulsory detention when it was not clinically necessary would be a "serious violation" of civil rights.

It called for an urgent investigation by the Department of Health to establish the prevalence of the practice.

The inquiry also examined safeguards to protect people detained under the Mental Capacity Act. These are often patients in care homes with dementia or severe learning difficulties.

The safeguards include provisions to provide a representative, to offer a right of challenge, and for a regular review of their deprivation of liberty.

The MPs concluded there was "extreme variation in their use" - a situation they describe as "profoundly depressing".

They called for an urgent review of Deprivation of Liberty Safeguards (DOLS) together with an action plan for improvement to be presented to Parliament within 12 months.

Paul Jenkins, from the charity Rethink, said: "It's absolutely shocking that people are being sectioned unnecessarily, just so they can get access to the treatment they are entitled to. Being sectioned, although sometimes necessary, can be extremely distressing and should only be used as a last resort.

"Treatment is much less likely to work if it is imposed on patients against their wishes. Health professionals should be aiming to build a trusting partnership with their patients and to take away their liberty unnecessarily like this, completely undermines that trust."

Dr Julie Chalmers, the Royal College of Psychiatrists' lead for mental health law, said: "We share the committee's concerns over the severe pressure on beds, and believe this is an issue that needs to be urgently addressed.

"However it is also important to ensure that there are a range of effective community services to support people who are in crisis before the need to consider hospital admission arises.

mengele plus

Monday 16 September 2013

NHS patients 'should not face constant moves'

NHS patients 'should not face constant moves'

Case study