Friday 23 January 2015

Treatment of whistleblowers a stain on NHS, say MPs

Treatment of whistleblowers a stain on NHS, say MPs

Nurse with patients

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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."

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Saturday 3 January 2015

Whooping cough proteins evolving 'unusually' fast

Whooping cough proteins evolving 'unusually' fast


Baby having the DTP jab, which protects against whooping cough

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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.
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What is whooping cough?
Bordetella pertussis
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
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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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Learning disability GP health checks 'show results'

Learning disability GP health checks 'show results'

A GP checking a patient's blood pressure

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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.

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