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MRSA 'cut by stopping injections'

Friday 9 May 2008

A hospital trust has claimed to have eliminated MRSA bloodstream infections by stopping the routine practice of administering intravenous injections.

Winchester and Eastleigh Healthcare NHS Trust has instead begun prescribing the insertion of cannulae – a small tube used for giving intravenous fluids.

Doctors are able to monitor the tubes more closely for signs of infection.

The trust said since the introduction last November there have been no new cases of MRSA infections.

This figure covers all forms of MRSA, including bloodstream infections (also known as bacteraemia) and wound infections.

This compares to 2007/08 when there was 11 reported bloodstream infections. The maximum level set as acceptable by the government is 12.

'Big improvement'

The trust, which runs the Royal Hampshire County Hospital in Winchester and the Andover War Memorial Hospital, believes that if the same practice was adopted nationwide MRSA levels would drop dramatically.

Previously, patients who were likely to need intravenous fluids or drugs in this way were given a cannula as a routine part of their medical care.

But now the technique can only be prescribed by specialists trained in their insertion and they are signed off by a doctor.

Once inserted, the cannula tube is flushed with a saline solution and inspected on a daily basis.

A scorecard is then used to regularly rate its appearance and spot any irregularities or signs of infection.

Dr Chris Gordon, consultant physician and divisional director for medicine at the Trust, said: "It is well known that cannulae can cause bloodstream infections, such as MRSA, which is why we were so keen to make these changes."

Derek Butler, chair of MRSA Action UK, said: "It is an excellent step forward, a big improvement. I applaud what they are doing and I would like to see it rolled out nationally."

"It will help fight MRSA levels as another piece of best practice."

Source : BBC

Blood of 2,500 donors thrown away

Friday 9 May 2008

Blood from more than 2,500 donors has had to be thrown away after a refrigeration unit broke down, costing the National Blood Service £350,000.

The refrigeration unit at the service's centre on the site of Southampton General Hospital broke down last week.

Quality regulations stipulate blood must be stored at between 2C (36F) and 6C (43F), the service said.

The blood "breached our rigorous quality standards and, therefore, has had to be discarded," it added.

No patients were directly affected.

"Due to a problem with the refrigeration plant, we were unable to issue red blood cells from our Southampton centre last week (Monday–Thursday)," a spokeswoman said.

"The supply of platelets and other products was unaffected and normal service for red blood cells was resumed on Friday 2 May."

"No patients were affected by this event."

Emergency contingency plans to ensure the hospital continued to be supplied with blood had been tried and tested, she said.

"These were put into effect on discovery of the problem, with emergency deliveries continuing to operate from our Southampton centre throughout this period."

"We should emphasise that the regular maintenance checks carried out across all our centres make events such as this a very rare occurrence."

She added: "Finally, we do value our donors very highly."

Source : BBC

Surge in cases of superbug that is harder to tackle than MRSA

Friday 9 May 2008

Cases of a hospital superbug more difficult to treat than MRSA have soared by 40 per cent, experts are warning.

Stenotrophomonas maltophilia, or Steno, thrives in the black 'gunk' that lines shower heads and taps. It kills around 300 Britons a year.

Some strains of the bug are resistant to all available antibiotics, making it harder to treat than the highly–publicised MRSA and C diff infections.

With the number of cases in British hospitals rising by around 40 per cent between 2001 and 2006 to around 1,000 a year, scientists say there is an urgent need to find new ways to combat it.

Bristol University researcher Dr Matthew Avison said: 'There are a number of drugs which can be used to treat MRSA but with Steno, in many cases there is only one drug that works'.

'We are seeing increasing resistance abroad to that one drug and there are no new drugs going through clinical trials. There is a desperate need for a new way of approaching the problem,' he added.

Although found in many homes, Steno only causes a problem in hospitals, where the seriously ill are unable to fight it off.

Those at risk include the elderly, intensive care patients and cancer patients whose immune systems have been weakened through chemotherapy.

After entering the body through tubes used for feeding, breathing or draining urine, the bug quickly multiplies, causing blood poisoning that proves fatal in around 30 per cent of cases.

Dr Avison, who has unravelled Steno's genetic sequence, said: 'This is one of a number of organisms that is becoming increasingly common as we keep people alive longer in an iller and iller state'.

'The immune system breaks down and, if you haven't got a competent immune system, the infections can strike.

'If your immune system is strong, these organisms are perfectly harmless.

'Anecdotal evidence is that there are increasing numbers of infections and, more importantly, the infections we are seeing are becoming increasingly difficult to treat up to the point where we now have strains which are completely resistant to everything we can throw at them.'

The sequencing of Steno's DNA, published today in the journal Genome Biology, could help scientists develop new ways of fighting it.

Researcher Dr Lisa Crossman, of the Wellcome Trust Sanger Institute near Cambridge, said: 'If we know which proteins cause it to stick to surfaces, we could try to develop compounds that interfere with this action'.

'If we understand its antibiotic resistance mechanisms, we might be able to design inhibitors that block them.' The inhibitors could then be given alongside antibiotics, to ensure they work properly.

The Department of Health said a 'clean and safe' NHS was a top priority and added that millions of pounds had been invested in infection prevention, training, upgrading isolation facilities, new equipment and better surveillance.

Source : Daily Mail By FIONA MacRAE

Lord Darzi sets out tough rules for changes in the NHS

Friday 9 May 2008

Five pledges will ensure that change is transparent and driven by the best evidence

Leading clinician and Health Minister Lord Darzi today issued five pledges to the public and staff on how the NHS will handle changes to services. He set out a rigorous process requiring any change to be transparent, clinically evidenced, locally led and for the benefit of patients.

Lord Darzi's report 'Leading Local Change' comes ahead of his final report on the next stage of NHS reform.

This new report, aimed at the public, patients and staff, signals that whilst the NHS must never back away from necessary change to improve services and save lives, there should be important checks which any change has to undergo before it proceeds. That is why today we are making five pledges on change in the NHS, which PCTs will have a duty to have regard to:

1. Change will always be to the benefit of patients. This means that change will improve the quality of care that patients receive – whether in terms of clinical outcomes, experiences, or safety.

2. Change will be clinically driven. We will ensure that change is to the benefit of patients by making sure that it is always led by clinicians and based on the best available clinical evidence.

3. All change will be locally–led. Meeting the challenge of being a universal service means the NHS must meet the different needs of everyone. Universal is not the same as uniform. Different places have different and changing needs – and local needs are best met by local solutions.

4. You will be involved. The local NHS will involve patients, carers, the public and other key partners. Those affected by proposed changes will have the chance to have their say and offer their contribution. NHS organisations will work openly and collaboratively.

5. You will see the difference first. Existing services will not be withdrawn until new and better services are available to patients so they can see the difference.

Lord Darzi said:

"The nature of healthcare means services will always need to change, and sometimes that means re-organising how services are provided".

"Our nationwide listening events have shown me that patients, the public and NHS staff are not opposed to change in principle but want to ensure it is done to save lives and improve quality and is not driven by cost or politics".

"This is not about change for change's sake. It's about change for the right reasons, improving quality of care for patients and saving lives. These pledges mean change will be locally–led, clinically–driven and evidence–based. And an independent high clinical bar for change should reassure local people everywhere that we mean what we say".

"The right way of doing this is to put local clinicians in the lead, with the public and relevant independent experts consulted and involved at an early stage. Ensuring that changes are based on the strongest clinical evidence and are relevant to their local communities. The role of national bodies has to be to support local clinicians with the best evidence".

"We are putting in place a process that ensures the local NHS rigorously checks proposals for change to ensure they meet the highest standards. The principles and guidance published today sets out how, where necessary, the NHS will make changes that will lead to real improvements for everyone – changes that are based on clinical evidence and supported locally by patients and the public".

"The focus of my report on the next stage of NHS reform will be how we can enable local clinicians and patients to be the driving force of improvement and change in the NHS. These proposals I am setting out today are only the first part of that. Empowered patients and empowered staff are the key to world-class standards".

The detailed operational guidance also published today, Changing for the Better, builds on the work set out in Sir Ian Carruthers review of service change and reconfiguration proposals published last year.

Since the start of the Review in July last year, Lord Darzi and his team across the country have been engaging widely with patients, the public and staff working in the NHS and other local organisations. Over 60,000 people have participated in the Review including nearly 2,000 frontline clinicians and other staff who worked as members of the clinical pathway groups.

Every area of the country will publish a clinicially led vision document over the next month, setting out priorities for improving health and healthcare over the next decade. Lord Darzi's final Review report will be published in June. It will focus on enabling and supporting the changes agreed locally by patients, the public and NHS staff.

Leading Local Change, can be found here

NHS 'chaos' over surgical tools

Friday 25 April 2008

Operating theatres are being thrown into chaos and operations cancelled because of broken, missing or dirty surgical instruments, surgeons say.

The Royal College of Surgeons of England said it had contacted 250 doctors with most reporting problems.

The college said the problems have become worse since cleaning started to be handed over to private firms.

But the government said it was working with trusts and private providers to resolve any issues.

A process of upgrading decontamination services was set up by the NHS eight years ago after an audit showed the need to modernise.

Surgeon Andrew Thomas on how incomplete kits hamper operations

The Department of Health in England has provided funding to encourage hospitals to enter into deals with commercial sterilisation services.

The Royal College of Surgeons said the process of moving decontamination off site has thrown up major concerns and it wants a national audit of how these services are working.

Richard Ramsden, from the college, said: "I think we feel an intense sense of frustration and anger ourselves at the moment when we have to cancel an operation or make do with instruments that are just not quite as good as they should be."

"But much more important is the frustration that patients feel. It's a disservice to the patients."

The college has provided the BBC with photographs which it said showed instruments that have been returned without proper sterilisation and examples of contamination.

Even an apparently small speck will lead to an instrument being rejected by a surgeon because of the risk to patients.

'It was awful'

It said operations were being cancelled and the NHS was also having to replace expensive instruments damaged in careless decontamination.

Helene Rigate, who has had her hip operation at Leeds' Chapel Allerton Hospital postponed twice because her surgeon did not have the right surgical instruments, said: "To be honest I didn't know whether to laugh or cry."

"I just could not believe that I'd been put through this a second time and then pipped at the post again. It was awful. I was really upset."

"This is supposed to be the 21st century. We're supposed to have sorted these things out. I was angry and upset and a bit stunned as well."

In a statement Leeds Teaching Hospitals NHS Trust apologised to Ms Rigate and said it was urgently working to resolve problems with the decontamination services which had been moved off site to a unit run by a private contractor.

"In both cases affecting this patient, staff were not happy that all the instruments were of a useable standard."

"Patient safety is always our top priority."

B Braun Sterilog, which provides cleaning services for the hospital, said: "We work closely with our partner NHS trusts to deliver our shared goal of bringing the sterilisation of surgical instruments up to the highest standards."

Orthopaedic surgeons are particularly angry at the failings in the new decontamination services.

Andrew Thomas, from the British Orthopaedic Association, said there was a wealth of anecdotal evidence of the problems, which include gynaecological instruments being packed by mistake into trays for orthopaedic operations.

"The view from the average orthopaedic surgeon is that moving the decontamination offsite is a recipe for chaos."

A handful of partnerships with private decontamination services are already operational in England but many more are currently being negotiated.

The orthopaedic surgeons want a moratorium on any more contracts being signed until it can be shown that off site services meet clinical standards.

Mike Jackson, a senior national officer at Unison, added: "We have warned time and time again that taking sterilisation services out of hospitals and replacing them with supercentres – which are often miles away – is a recipe for disaster."

A Department of Health spokesman said: "We have invested over £200m in improving decontamination services in the NHS in England since 2001 and we will continue to support trusts to provide the highest standards of decontamination of instruments as part of their drive against healthcare associated infection."

"We are helping trusts to draw up a local action plans where necessary and we are working closely with both them and the private sector provider to resolve any issues."

Source: BBC

NHS Trust In £350,000 'Alice In Wonderland' Recruitment Splurge

Tuesday 22 April 2008

Health workers, not accountants, should be recruited, says Unite

A cash-strapped NHS trust that wants to severely cut back on patient services at Bridlington Hospital is spending money big–time..on more finance staff.

Scarborough and North East Yorkshire Healthcare NHS Trust are advertising for 12 new staff for its finance team that could mean an annual salary bill of more than £350,000 this is despite the trust imposing a recruitment freeze since last November.

Unite Head of Health Kevin Coyne said: "We are entering an Alice Wonderland world where you employ more finance staff to oversee cuts to services. For –350,000, you could employ an extra 14 frontline healthcare staff providing patient care".

"Because they are not replacing nurses on the wards, staffing levels are at dangerously low levels at Bridlington Hospital. There is not even a replacement for the hospital gardener, but there seems to be no freeze on finance staff recruitment, in fact exactly the opposite, a veritable splurge".

The posts advertised range from £75,114–a–year for a Head of Finance and Procurement 'seeking a real springboard' for their career to £15,523–a–year for Payables Clerk – 'we are not looking for just anyone'.

This recruitment bonanza comes after more than 37,000 local people signed a petition, handed in at Downing Street last month, opposing the closure of the cardiac monitoring unit and two acute medical wards at Bridlington Hospital.

Unite fears, that if the closures are allowed to go ahead, patients lives could be put at risk if they have to travel the 22 miles to Scarborough hospital for emergency treatment.

Kevin Coyne said: "We are not against proper financial procedures, but healthcare priorities in this part of North East Yorkshire are topsy–turvy – senior trust managers need to take a serious reality check and listen to local people".

HPC launches fees consultation

Tuesday 15 April 2008

The Health Professions Council (HPC) has launched a three month consultation to invite stakeholders for their views on its proposed fees increase for 2009.

Each of the thirteen professions the HPC regulates renews its registration in two–yearly cycles. During the last fees consultation HPC asked registrants whether it should review its fees every two years. The majority of respondents agreed that they would prefer this method so that any increases were incremental and more manageable.

Having reviewed the fees, HPC are inviting anyone with an interest in this issue to respond to the fees increase consultation. The consultation clearly sets out why the HPC is proposing an increase and most importantly how the money will be spent.

The proposed fee increases are moderate, for example the renewal fee is currently £72 and will increase to £76. The increase will allow the HPC to manage the increase in fitness to practise cases and the costs allied with them. Fitness to practise is the largest cost for the HPC and accounted for 27% of the budget in 2006/7.

It will also help us maintain and improve other important functions such as registrations. This includes the costs associated with handling and processing applications for all forms of registration, reviewing and updating standards, and visiting education providers to approve and monitor education programmes to ensure they meet HPCs standards. We continue to strive to keep our costs to a minimum wherever possible.

HPC President, Anna van der Gaag, commented;

HPC is the only UK multi–professional regulator and we are committed to giving our registrants an efficient service as well as meeting our objectives in protecting the public.

Its therefore important that we set our fees at a realistic level to ensure that we continue to function effectively as a regulator. We look forward to listening to stakeholder views on our proposals.

In the consultation, the HPC have proposed an increase to all registration and scrutiny fees. These increases will affect renewals, readmission, restoration, international/EEA and Grandparenting fees.

The Council is consulting with a variety of stakeholders, including professional bodies, employers, higher education institutions and others with an interest in the HPCs work.

When the HPC last consulted on fees between November 2006 and January 2007, respondents commented on the cost of producing and sending consultation documents to each registrant. In light of this the Council are sending the consultation document to its comprehensive list of stakeholders only and not direct to all registrants. However, registrants who wish to respond to this consultation can download the document or request a hard copy.

The consultation will run until 14 July 2008. If the proposals are adopted the changes to the fees will be effective from 1 April 2009. Existing registrants would pay the new renewal fee when their profession next renews its registration.

Responses to the document can be made by:

Writing to:
Fees consultation
Health Professions Council
Park House
184 Kennington Park Road
London
SE11 4BU
E-mail: consultation@hpc-uk.org
Fax: 020 7820 9684

If you would prefer your response not to be made public, please indicate this when you respond. We will publish on our website a summary of the responses we receive, and the decisions we have taken as a result.

The full documents are available on-line and a copy can be downloaded from the HPC website

NHS staff survey shows significant improvement in hospital infection control

Wednesday 9 April 2008

NHS staff report improvements in infection control, support from managers and high levels of job satisfaction and training opportunities

NHS staff are reporting significant improvements in hand–washing and infection control, according to the results of a survey announced today by the Healthcare Commission.

Of all acute trust staff who responded to the survey,

82% believe that the trust does enough to promote the importance of hand washing to staff (relative increase of 17% since 2005)
71% believe that the trust does enough to promote the importance of hand washing to patients, service users and trust visitors (relative increase of 25% since 2005)
83% believe that infection control applies to them (relative increase of 12% since 2005)

As well as progress in infection control, staff reported improvements in many other aspects of working in the NHS.

The survey showed levels of staff training remain high with 94% reporting access to employer supported training and development opportunities in the last 12 months. More staff are receiving appraisals (61%, up from 58% in 2006) which are proven to impact positively on patient experience, and more staff have a personal development plan (52%, up from 48% in 2006).

According to the survey, job satisfaction remains high and staff feel better supported by their managers and their trust in achieving a good work–life balance. The majority of staff are using flexible working options (73%, up from71% in 2006).

Health Minister Ann Keen said,

"I know from past experience as a nurse that working in the NHS is demanding but immensely rewarding and it is encouraging that in its 60th year, the majority of staff continue to report high job satisfaction."

"The Department of Health has made it very clear that cleanliness should be the top priority for all NHS trusts and we have invested an additional £270 million per year until 2011 to help them to do so."

"We have instructed hospitals to adopt a range of measures to prevent the spread of hospital infections, including the deep cleaning programme, the reintroduction of matrons and the 'Bare Below the Elbows' dress code."

"It is very satisfying to hear that our high standards for infection control are being taken seriously by the majority of hospitals."

Johnson: proposed three-year pay award is good news for staff, the NHS and patients

Monday 7 April 2008

Health Secretary Alan Johnson today announced that the Department had agreed with NHS Employers, UNISON and the Royal College of Nursing (RCN) a proposed three–year pay package for all NHS Agenda for Change (AfC) staff – including nurses, midwives and Allied Health Professionals – which will now be subject to consultation by members of all the trade unions covered by AfC. The proposed package incorporates the NHS Pay Review Body Recommendation for 2008/09.

The proposal includes:

acceptance in full of the 2008/09 NHS Pay Review Body's recommendations for a 2.75 per cent pay rise for nurses and other healthcare professionals from 1 April 2008;
2.4% headline award in 2009/10;
2.25% headline award in 2010/11;

additional changes to the pay structure in Years 2 and 3 that would give extra financial support for the lowest paid workers, allow quicker progression up the pay ladder and increase the earning potential for hundreds of thousands of staff.

Alan Johnson said:

"I am extremely proud of the outstanding professionalism of NHS staff and the high level of care they deliver for patients day in, day out."

"Today's announcement recognises their tremendous efforts. A multi–year deal ensures security for staff and allows them to plan for their future and the future of their families."

"It also ensures long–term stability for the NHS, which can now push ahead with challenging health reforms with a greater degree of security. Patients will see real benefits as the deal fits with the planning cycle of the NHS over the next three years, meaning the health service can focus on delivering improvements such as reducing waiting times and tackling infections on a solid financial base."

"I would like to thank the NHS Employers and unions for their positive approach to negotiations. I believe we have worked towards achieving a fair and affordable deal that is good for staff, the NHS and patients."

Chancellor of the Exchequer Alistair Darling said:

"A three year pay deal gives certainty for NHS Agenda for Change staff and provides further stability for the wider economy."

The decision means that:

The minimum starting salary for nurses will now be more than £20,000 for the first time (£20,224) from April 1. This is 24% increase since 1997 in real terms.
Experienced midwives will now have an earnings potential of £32,653 from 1st April 2008 – an increase of 70% in cash and 28% in real terms since 1997.

The Government is also today accepting in full the recommendations of the Doctors and Dentists Pay Review body for 2008/09. These are:

2.2% increase for hospital doctors and hospital doctors and dentists in training;
3.4% increase in the gross earnings base for general dental practitioners (GDPs). This is intended to result in an increase in GDPs income of 2.2% after allowing for an increase in expenses;
increasing payments to GP practices for providing core services - known as the Global Sum by 2.7% which having taken account of the cost of expenses equates to a 2.2% increase in earnings;
no increase in the protected income that most GP practices receive.

This means that overall impact of the Doctors and Dentists Pay Review body is estimated as a 0.2% average increase in payments to GP practices. It will allow the NHS to invest the up to 1.5% guaranteed for primary care for 2008/09 in new patient services.

Alan Johnson said:

"We want to make sure that GPs work reasonable hours and are fairly rewarded but this must be matched by further improvements in patient services and access."

"This why we're honouring our commitment to increasing investment in GP services by 1.5%, which is equal to £105 million. Most of this investment will now go into improving the range and quality of services offered by GP practices and into further improving patient experience, for instance by expanding services provided at weekends or evenings, or by making physical improvements to surgeries."

"Promoting health, tackling health inequalities and improving patient access are all priorities for us, and we will work closely with the British Medical Association to assess the areas of greatest need."

Health workers to tackle climate change

Monday 7 April 2008

Health workers and local authorities throughout the country are being encouraged to play their part in tackling the health effects of climate change, Public Health Minister Dawn Primarolo announced today

The 'Climate Change guidance documents' issued today provide guidance on tackling climate change and promoting sustainable communities, in order to further improve health and reduce health inequalities. The aim is to help health workers plan how to mitigate and adapt to climate change, for example the guidance documents give advice on how they can:

design buildings that stay cool in the summer, warm in the winter and flood-resilient;
reduce their carbon footprint and encourage others to do so;
protect the public further through continuing public awareness campaigns such as 'The Heatwave Plan'; and
raise awareness of climate change and the health effects.

The guidance documents underline that the UK needs to address the threat of climate change and adapt to it. Local health professionals are asked to consider the health impacts of climate change and are informed of how societies can adapt to the most severe impacts - such as heatwaves and flooding, with adequate planning.

It is also about minimising the future effects of climate change by reducing emissions, both in the workplace and at home.

Ms Primarolo said:
"Climate change is a real threat and we must do everything we can to reduce its effects - for example by reducing our carbon footprint – but we must also learn how to adapt to it."

"Health professionals are key to communicating the health risks of climate change and I would urge them to play their part."

"The UK Government is leading the way in persuading the world that we must all turn our attention to the health effects of climate change – the WHO recently congratulated us for winning the minds of other countries."

The guidance documents are published two months after the Department of Health and the Health Protection Agency published the 'Health Effects of Climate Change' which outlined some of the effects that climate change could have on the health of UK citizens if no action is taken.

The UK is leading the way in considering the health effects of climate change. At the WHO Executive Board Meeting in January, the UK put forward a resolution on the impacts of climate change on health and health systems which received overwhelming support from other countries. The WHO Director General congratulated the UK on achieving an unprecedented level of consensus. This will now go forward for consideration by the World Health Assembly in May.

The Department Health is already taking action and has been working with other departments on the development of the Adaptation Policy Framework, which will be published later this year, setting out the Government's programme of action on climate change impacts.

For a copy of the guidance, click here

The joint DH and HPA report 'Health Effects of Climate Change in the UK' which was published on 12th Febraury 2008 can be found here.

Hospital to reduce patient deaths

Monday 7 April 2008

Bosses at Salford Royal Hospital have announced plans to cut the number of deaths on its wards by 1,000 over the next three years.

Staff at Salford Royal Hospital, which is also known as Hope, aim to reduce fatalities by cutting infection rates and improving treatments.

The initiative, launched by Health Secretary Alan Johnson, will cost £1m.

Staff will be given the time and cash to introduce and test improvements on their wards.

Hospital chief executive David Dalton said: "Despite the extraordinary hard work and best intentions of hospital staff, patients are harmed in hospitals every day."

Complications commonplace

"Fortunately, catastrophic events are rare but we must acknowledge that, unintentionally, a significant number of our patients experience some harm."

"Hospital–acquired infections, bad reactions to drugs, surgical errors, pressure sores and other complications are commonplace."

"Most harm happens not as a result of staff doing the wrong thing but as a result of failures in the hospital's systems and processes. We want to do something about this."

"We aim to save a further 1,000 lives over three years and reduce harmful events by 50% over three years."

The hospital is already one of the safest in the country, with official statistics showing there were 200 fewer deaths than predicted there last year.

Source: BBC

Two die after receiving organ transplants from teenager who had cancer

Monday 7 April 2008

NEW YORK Two patients died and two are undergoing chemotherapy after receiving organs from a teenager who died of cancer, US authorities said.

Doctors first thought that Alex Koehne, 15, died of meningitis and followed his parents' wishes that his organs should be used to help others before it was discovered that he died of a rare form of cancer.

A 52–year–old man who had the boy's liver and a 36–year–old woman who received his pancreas died of the same cancer.

Two men, aged 46 and 64, received the boy's kidneys, which have now been removed, and are undergoing chemotherapy. Doctors did not discover that the teenager died of anaplastic T–cell lymphoma and that his organs were infected with the disease until a month after his death on March 30 last year.

A New York State health department inquiry cleared the Stony Brook University Medical Centre, where the donation took place, of blame after it found that the disease was extremely rare and very hard to diagnose. (PA)

Source: Times Online

HPC In Focus

Saturday 5 April 2008

Issue 16 of HPC In Focus is now available to download

Previous issues are also available

Fatal bird flu cases in Pakistan

Saturday 5 April 2008

The first case of human–to–human transmission of avian flu in Pakistan has been confirmed.

Tests carried out by the World Health Organisation (WHO) show that bird flu killed some members of a family in north–west Pakistan late last year.

The WHO says steps were taken to prevent future fatalities in the area.

Pakistan's north–west and southern regions were hit by bird flu last year. Thousands of birds were culled to control the spread of the disease.

Brothers

The confirmation of people dying from bird flu came on Thursday, after samples collected from a family in the north–western city of Peshawar tested positive.

Dr Mukhtiar Zaman Afridi, head of the isolation ward for avian flu patients at Khyber Teaching Hospital in Peshawar, told the BBC that a poultry worker in Peshawar apparently passed the disease on to members of his family.

The worker, whose name is being withheld on the request of the WHO, was brought to the hospital with avian flu symptoms on 29 October 2007, he says.

He has fully recovered since then.

But on 12 November, the elder brother of the poultry worker was brought in with similar symptoms. He died a week later.

On 21 November, two more brothers of the same worker came down with bird flu.

One of them died on 28 November, while the other has recovered, Dr Afridi said.

Apart from the poultry worker, none of the others was found to have had any direct contact with sick or dead poultry.

Genetic sequencing tests performed by WHO laboratories in Egypt and the US on samples collected from three of the four brothers established human–to–human transmission.

'Appropriate steps'

Serum taken from all three was found to have been infected by the H5N1 avian influenza virus.

A WHO report says the tests suggest "limited human–to–human transmission."

It adds, however, that this "outbreak did not extend into the community, and appropriate steps were taken to reduce future risks of human infections."

Pakistan's north–western region is home to 85% of the country's poultry farms.

Source: BBC

Radical reformation plans for NHS

Thursday 3 April 2008

The number of local health boards (LHBs) in Wales could be cut from 22 to eight under proposals unveiled by the Welsh Assembly Government.

The plans would also spell the end for the internal market in the NHS with direct assembly government funding.

The Conservatives accused Labour of an "embarrassing climbdown" only five years after Wales' five health authorities were scrapped.

The health minister said the proposals would help improve patient care.

The plan is now out for a three–month consultation.

In a statement released by the assembly government, Health Minister Edwina Hart, said her aim was to "improve patient care and the patient experience" and to have "administrative arrangements for the NHS that are effective".

The proposals include abolishing the NHS's "internal market" by providing funding from the Welsh Assembly Government or an NHS Board for Wales directly to hospital trusts and LHBs.

Communities

The only LHB which is guaranteed to remain under the proposals is that for Powys.

The 22 LHBs were created in April 2003 by former Labour assembly government health minister Jane Hutt.

They reflected the map of local councils in Wales and were intended to bring decision–making closer to communities.

Wales' five health authorities – Dyfed-Powys, Iechyd Morgannwg, Gwent, Bro Taf and North Wales – were abolished at the same time and £31m of debt was wiped out.

Ms Hutt at the time said the LHBs would provide "local solutions to local problems".

Each was created with 26 representatives across health and local social services – including dentists, pharmacists, doctors and patients – looking at local needs.

Such a major reduction in the number of health boards would be a dramatic policy U–turn by Labour.

Conservatives and Plaid Cymru criticised the move at the time, claiming it would increase bureaucracy. There has been criticism since that the LHBs are simply too small, with expertise spread too thinly and were not big enough to deal with the NHS trusts, who manage hospitals.

The idea of the internal market was to promote competition between trusts to provide services, and therefore make them more efficient.

In reality, LHBs very rarely commissioned from hospitals outside their areas, so the "market" was largely non–existent.

Health economist Marcus Longley told BBC Wales cutting the number of LHBs was politically pretty embarrassing because it was a Labour assembly government that introduced them.

NEW HEALTH MAP

Conwy, Denbighshire, Flintshire and Wrexham
Anglesey and Gwynedd
Carmarthenshire, Ceredigion and Pembrokeshire
Powys
Bridgend, Neath Port Talbot and Swansea
Cardiff and Vale of Glamorgan
Merthyr and Rhondda Cynon Taf
Blaenau Gwent, Caerphhilly, Monmouthshire, Newport and Torfaen

The LHBs were set up to match the number of local councils across Wales, but now there was potential for conflict.

The consultation also looks at three options for establishing a NHS Board for Wales.

It could be run along the lines of a special health authority, a civil service board or as an advisory board to support an assembly government NHS chief executive.

Conservative health spokesman Jonathan Morgan said: "This is an embarrassing climbdown by the assembly government."

"Edwina Hart has been forced to try and repair the damage caused to the NHS by her colleague Jane Hutt."

Mr Morgan said LHBs lacked capacity and expertise and Labour had made a "catastrophic mistake" when the 22 bodies were introduced.

Liberal Democrat health spokeswoman Jenny Randerson said they did not believe the current system was sustainable.

"However we've serious concerns that any new system must keep strong links with local authorities," she said.

"My great concern is that this is a further step in the Labour–Plaid government's centralising agenda."

Source: BBC

Hospital staff bonus criticised

Thursday 3 April 2008

An NHS hospital trust which has a £7.5m surplus in its budget is coming under fire for its decision to give every full-time member of staff a £250 bonus.

East Kent Hospitals NHS Trust said staff had worked "harder and smarter" to improve efficiency during the year.

"We felt it important to reward staff, who worked very constructively with us," said chief executive Stuart Bain.

But leader of Shepway Lib Dems, Lynne Beaumont, said the money should have been used to employ more nursing staff.

The trust, which runs the Kent and Canterbury, Queen Elizabeth The Queen Mother, William Harvey, Buckland and Royal Victoria hospitals, has saved over £20m this financial year, according to Mr Bain.

"We found different ways of organising our services to ensure that people are seen much quicker than they used to be."

"Over 90% of people are now treated within 18 weeks of being referred to us by their GP."

He said the trust was allowed to retain £7.5m of its surplus, of which £1.5m was being used to reward staff, from cleaners to consultants, and £6m was being reinvested in services.

The Lib Dems on Shepway Council led a campaign to stop the sale of Victorian buildings at the Royal Victoria Hospital in Folkestone.

The trust confirmed last June the sale would go ahead, but said services would not suffer from being transferred to a new unit.

"The whole reason for closure of wards at the Royal Victoria was because there was no money and now we are told they are £7.5m under–spent," said Ms Beaumont.

"It is not a bad idea to reward staff, but they deserve far more than £250."

"The whole point is the budget is being mismanaged."

"That £1.5m could have provided more nursing staff in the front line and taken pressure off the people who have really worked their socks off in the last year."

"It is very odd and people are very angry."

Source: BBC

ODP struck off after suspension for drug theft

Friday 28 March 2008

Operating department practitioner, Alan Sutheran has been struck off the HPC Register after a panel of the Conduct and Competence Committee met to review a suspension order previously imposed on him.

At a hearing on 8 September 2006, a panel determined that Mr Sutheran's fitness to practise was impaired by reason of misconduct. The panel found that while employed by North Tees and Hartlepool NHS Trust he stole drugs from the hospital where he worked and injected them at the end of his shifts.

This initial 12 month suspension order was reviewed on 3 September 2007. The panel decided to extend the suspension order for a further six months.

Mr Sutheran did not attend the final hearing held in London on 25 March 2008 and he failed to provide the panel with sufficient details of his addiction recovery.

Panel Chair, Derek Adrian–Harris, commented:

"Mr Sutheran has on a number of occasions been told that it would be necessary for him to produce compelling evidence of his fitness to return to practise."

"He has also been advised of the importance of attending the hearings. In these circumstances the panel does not think that it would be appropriate to yet again repeat what has been made perfectly clear."

How can technology transform the patients' experience of the NHS?

Friday 28 March 2008

Tuesday 13 May 2008, 9.30am–4.00pm, King's Fund, London

In his recent speech on the NHS, the Prime Minister highlighted the importance of patients becoming more active and empowered in making decisions and shaping their own health care. Technology can play a vital role in this, providing opportunities for patients to manage their own conditions and access information about their health.

This conference will enable managers and health care professionals to gain insight and understanding into the potential uses of technology in enabling them to help patients make choices and ultimately in improving care. The conference will also look at the barriers and challenges to patients engaging with technology and how these might be overcome.

The conference will include the following speakers.

Alasdair Liddell, Senior Associate, King's Fund, on how technology can improve the patient experience.
Ronnette Lucraft, Commercial Director, NHS Direct, on multi-channel health.
Hazel Price, Telehealth Project Manager, Kent County Council, on how they are using innovative technologies to support patients in their care.

IN FOCUS: Interactive session – how can patients use technology and the challenges to the NHS

In an increasingly digital environment, where consumers are given more choice than ever, their expectations of technology are rising. Patients – or 'health care consumers' – are also becoming more demanding. The NHS, however, has not kept up in the technology race with consumer services such as online banking and social networks. Why is this so? This session at the conference will explore the barriers and challenges to the uptake of heatlh technologies and what needs to be done to overcome them. The sessions will look at:

Maintaining health
Managing a condition
Receiving care.

Places at this event are limited so we recommend that you reserve a place as soon as possible by downloading a registration form from our website or booking online. For further information and to download the full programme, please visit our website or email us and we will be happy to provide you with more details.

Nurse regulator 'dysfunctional'

Tuesday 11 March 2008

The nurse and midwives regulatory body has an ingrained culture of "racism and bullying", an MP says.

Labour's Jim Devine called the Nursing and Midwifery Council dysfunctional in a Westminster Hall debate as he read out testimonies from whistleblowers.

Health minister Ben Bradshaw responded by saying he took the "long–standing problems extremely seriously" and was asking other regulators to intervene.

The NMC is in charge of regulating the 700,000 nurses and midwives in the UK.

Mr Bradshaw said he was asking the Council for Healthcare Regulatory Excellence (CHRE) and Charity Commission to look into the accusations.

He added that the "nuclear option" of a full Privy Council inquiry was still open to the government if the situation could not be resolved and confidence in the regulator rebuilt.

In a statement released after the debate, Mr Bradshaw said: "I take these matters extremely seriously."

"The large majority of the matters raised relate to internal matters concerning the internal proceedings and management of the NMC."

His intervention comes after Mr Devine, a former psychiatric nurse who has been campaigning for a while about the alleged problems at the regulator, raised the issue.

Integrity

Mr Devine said: "As a self–governing regulator, whose purpose is public protection in the public interest, the NMC should be run with integrity, competence and transparency."

"Unfortunately this appears not to be the case."

"The NMC appears to be a fundamentally dysfunctional organisation, where the priority of those in charge of the organisation is to maintain the status quo at the expense of proper transparency and good governance."

He said there appeared to be "an ingrained culture of bullying and racism as a means of preventing good governance in general and, in particular, any proper examination of what is going on".

The Livingston MP read out testimonies from anonymous whistle–blowers who had been members of the council.

One former member said the NMC had a "culture of institutional bullying" and "domination by a few individuals".

The NMC has set up an inquiry into the allegations, with an external body set to investigate charges of racism.

Source: BBC NEWS

National 'Recruitment' Pay Judgment 'Undermines Stubborn' Doncaster NHS Managers

Saturday 8 March 2008

A landmark judgment in favour of a Lancashire maintenance technician, which means he will receive almost £7,000 in back pay under a NHS national agreement, has 'undermined' a 'stubborn' NHS trust in Doncaster.

A Lancashire employment tribunal awarded the technician about £6,900 due under the Agenda for Change national agreement which says that recruitment–and–retention premia (RRP), worth £3,000 a year, should be paid to maintenance staff, as there is a skills shortage in these job categories.

The tribunal said that Lancashire Teaching Hospitals NHS Foundation Trust was guilty of 'an unlawful deduction of wages' in refusing to pay the technician the premia since 2005.

However across the Pennines, Unite – the third largest union in the NHS – is in a long–running dispute with Doncaster and Bassetlaw Hospitals NHS Foundation Trust which 'stubbornly' refuses to award 25 electricians, plumbers and fitters £9,000 back pay, dating from 2004 under the same agreement.

As a result, the trust has been hit by strike action, and over–time and on–call bans during the five–month old dispute.

Unite's Head of Health, Kevin Coyne said: "The Lancashire judgment – running to 34 pages – holes below the water line the stubborn refusal by the managers at the Doncaster and Bassetlaw Hospitals NHS Foundation Trust to pay the premia. Employment tribunals are sending them an unmistakeable message to settle this dispute."

"One must also consider the enormous legal bills that are being run up by trusts by their intransigence in failing to recognise national agreements they have signed up to in the first place. This money could have been much better spent on frontline care for patients and clients, and not squandered on legal costs."

"The Lancashire trust argued that the agreement only applied to existing – not new – maintenance staff. This argument has now been firmly rejected, as it has in other parts of the UK, notably Northern Ireland and Newcastle where employers originally did not want to pay either 'new' or 'old' staff the RRP."

Patient smells a rat

Saturday 8 March 2008

A Hertfordshire teenager refused a knee operation – after surgeons told him there could be a dead rat in the operating theatre.

Andrew Cowper, 19, walked out after a consultant apologised for the stench and assured him staff were trying to find the corpse.

The teenager, who had waited 11 months for the knee op, told The Sun: "He said the smell didn't represent a health risk but I was appalled."

"I asked him, 'If you were me would you have the operation?' He looked at me and said 'no', so I decided there and then I wasn't going to go ahead."

"If there was one dead rat there could have been others rotting nearby."

The dead rat was found later in the roof of another part of the hospital, away from the operating theatres.

Andrew, of Welwyn Garden City, had damaged a cruciate knee ligament playing football.

A spokesman for the town's Queen Elizabeth II hospital said the operation would be rescheduled.

Source: Ananova

Developing e–Learning in the Health Sector: Course–Source Offers Free Event for Health Professionals

Thursday 6 March 2008

E–learning specialists Course–Source are offering senior learning professionals from within the NHS and the private sector a chance to discover how to maximise e–learning initiatives for clinical services and healthcare organisations. The free event, to be hosted by Course–Source at the Royal Society of Medicine on Thursday 3rd April 2008, will have a special focus on rapid design, development and delivery.

The event features top e–learning expert Laurence Wilson who, together with Course–Source, won a coveted National Training Award for his work designing and delivering a groundbreaking online programme in intra–operative cell salvage. The conception, design, delivery and success of this initiative, which has since been adopted by the UK Blood and Tissue Transplantation Services, will be explored first.

Laurence will then be joined by Robert Furnivall, from software company, MindJet, to demonstrate how online Mind–Mapping can speed up the all important design process.

Mike Alcock, Director of Atlantic Link, providers of the world's most advanced rapid e–learning tools, will demonstrate how NHS Scotland and Cigna Healthcare are creating stunning e–learning quickly and cost–effectively.

However the most rapid development of all is to use professional content that has already been developed! Richard Norrie of FAST Healthcare, a leading UK provider of Health specific off–the–shelf e–learning will talk about how they have developed their programmes, and finally Course–Source Founder and Director Ken Wood will demonstrate how the new Course–Source online learning portal at www.HealthELearning.net can be used to deliver, administer and track highly successful e–learning programmes.

To register for this learning and networking opportunity for senior health professionals only, or to express interest in similar events nationwide, please contact Course–Source on 020 7689 6700 or email info@course-source.net. More details

Patients say day surgery is "like McDonald's"

Thursday 6 March 2008

Patients admitted for day surgery have compared it to going for a meal at McDonald's, according to a study by an academic from the University of Salford.

Dr Anne Mottram from the School of Nursing investigated patients' experiences of undergoing day surgery as part of her PhD research – and found that the efficiency and speed of the procedure reminded them of fast food chains or other retail outlets.

Anne said: "I interviewed 145 patients about their experiences of day surgery and the majority were happy with their treatment. They talked about the efficiency and speed of the unit, the professionalism of the staff and cleanliness, as particular areas of satisfaction."

"Many of them likened it to going McDonald's and several said the managers of the NHS should take a leaf out of the McDonald's' management systems to enable users to have a quick, speedy, clean service in health care."

A lot of the patients Anne interviewed were happier with the care they received in day surgery than that they had experienced as in–patients. They also liked the idea that they would be going back to their own bed at the end of the day.

"The popularity of day surgery is due to society's desire for speed in all aspects of our lives – fast food, speed dialling, speed dating, instant access to cash via cash machines and fast internet connections," she said.

"Patients seem to want surgery, like so much else in their lives, to be fast."

Bug trust chief leads NHS review

Monday 3 March 2008

A former NHS chief whose trust was hit by a superbug scandal is now working for a consultancy and running a review at two hospitals in Surrey and London.

Ruth Harrison is the former chief of Stoke Mandeville Hospital, Bucks, which saw 33 deaths in a superbug outbreak.

She is reviewing women's and children's care at Epsom and St Helier NHS.

Michael Summers, from the Patients Association, criticised the move but the NHS trust said Ms Harrison had "considerable and relevant experience".

'Golden goodbye'

Mr Summers said: "Patients may think it odd that those in charge of a major hospital leave it with infection rates soaring, leading to deaths and disabilities, and can later go on to obtain employment within the health service, advising patients on their health."

Trust spokesman Simon Morgan said management consultancy Durrow was hired to manage the review, after a competitive tendering process.

He said: "Lead consultant from Durrow, who will act as programme director, is Ruth Harrison, who has considerable and relevant senior experience in the NHS."

"Ruth will report to the chief executives of the three partner organisations involved in the review, Surrey Primary Care Trust, Epsom and St Helier University Hospitals NHS Trust, and Sutton and Merton Primary Care Trust."

He said the £52,000 fee charged by Durrow was being split by the three trusts, with Epsom and Helier paying just over £17,000.

The trust runs Epsom General Hospital in Surrey, and St Helier Hospital in Carshalton, south London.

Newspaper reports said Ms Harrison left her job at Stoke Mandeville in 2006 with a £140,000 "golden goodbye", the day before a damning report was published into an outbreak of the diarrhoea bug, clostridium difficile.

Thirty three patients died and 334 fell ill at the hospital between 2003 and 2005.

Source: BBC NEWS

NHS parking in Wales 'to be free'

Monday 3 March 2008

Patients, staff and visitors will be able to park for free at almost every NHS hospital in Wales by the end of 2011, it will be announced later.

The Welsh Assembly Government is expected to confirm free parking will start from 1 April this year.

Those hospitals whose parking is run by external companies will have to reduce costs until contracts expire.

The changes, the first in the UK, have been welcomed by patient groups but trusts say they will add to pressures.

The reforms will mean that by the end of the current assembly term in 2011, only four hospital sites out of a total of 130 should still have parking charges in place.

The Welsh NHS Confederation, which brings together all Welsh NHS organisations, said the reforms would "inevitably" add to the pressures placed on trusts.

'Tax on sick'

Nearly £5.4m was collected by NHS Trusts in Wales from hospital parking charges in 2006/07.

It led to the British Medical Association (BMA) last week demanding car park charges be scrapped, claiming they are "a tax on the sick".

The announcement will fulfil the assembly government's commitment to reform charges for hospital parking, which was set out in the One Wales document outlining the agenda of the Labour and Plaid Cymru coalition.

Health Minister Edwina Hart is expected to say: "Car parking charges fall heavily on people frequently attending NHS hospitals, whether they are patients, staff or visitors."

"They are at best an inconvenience and at worst an unfair expense."

"Over time, all NHS patients, visitors and those who care for them will not have the expense or inconvenience of charges."

"By the end of the current assembly term, the vast majority of NHS sites will have free parking for all."

It is believed that NHS trusts with external contracts will also have to reduce parking fees by funding schemes to reduce costs until deals expire or are ended.

Cath Lindley, general manager for Macmillan Cancer Support in Wales, said: "Cancer patients have long been calling for parking costs to be scrapped."

"On average, cancer patients make 60 trips to hospital from diagnosis to treatment to follow up, and as a result they are hit particularly hard, both financially and emotionally, by travelling costs and unfair parking charges."

"These reforms would go some way towards reducing the financial burden that can come with a cancer diagnosis."

It is expected that the additional costs to the NHS in Wales will be met from within annual NHS funding allocations.

It is also understood trusts will be required to submit plans on how they will deal with additional costs, potential increases in demand, promotion of green transport modes and the potential use of spaces by commuters and shoppers.

Mike Ponton, director of the Welsh NHS Confederation, said: "It costs a lot of money to run car parks and the dilemma now is how to meet these costs without impacting on patient care."

"It will inevitably add to the pressures placed on trusts to provide services and balance the books."

"It will be even more important now to find new ways of controlling car parks to avoid misuse, particularly where hospitals are near town centres."

There are no plans to abolish the charges in England, although a Department of Health spokesman said "all government polices are always under review".

Source: BBC NEWS

Dirty scalpels bring 5,000 ops to a halt

Sunday 2 March 2008

Surgery is being cancelled, sometimes as patients lie anaesthetised, after outside cleaning firms return theatre equipment unsterile and broken.

Thousands of hospital operations are being called off because surgical instruments are dirty, missing or broken. In some cases anaesthetised patients have been woken up and returned to the ward, says the organisation representing many of Britain's senior surgeons.

Problems have emerged since hospitals began outsourcing sending surgical instruments such as scalpels, forceps and microscopes to be sterilised at new cleaning centres.

'Around 5,000 patients a year turn up at the hospital expecting to be operated on but are told before they make it to the operating theatre that their procedure can't happen because the hospital doesn't have the instruments,' said Andrew Thomas of the British Orthopaedic Association, which represents over 1,000 orthopaedic consultants.

'In addition some people are being anaesthetised and then the hospital staff are finding out that the instruments aren't right in some way, for example that some pieces are dirty or unavailable, or that they've been given the wrong instruments because they've been mislabelled [after external cleaning],' Thomas said.

Leaders of Britain's 8,500 theatre nurses last night claimed that patients' health was at risk because of the problems. 'We can't rely on the very tools of our trade to be back, complete and clean in order for operations to go ahead,' said Diane Gilmour, of the Association for Perioperative Practice.

'If you delay an operation that's an emergency, or have to use another set of instruments to achieve the same outcome - for example, where the surgeon has to change the procedure he planned to do because the correct instruments weren't available – that's putting patient safety at risk.'

A new survey by the association has highlighted problems including patients waking up to learn that their surgery did not happen because surgeons discovered too late that they had not been given the equipment they needed because it had been wrongly labelled after being cleaned off–site.

In other hospitals lengthy turnaround times involved in getting specialist equipment back from the cleaners 'reduces the frequency of the number of procedures that can be carried out and therefore in some cases patients are cancelled,' theatre nurses disclosed.

All hospitals used to clean their surgical equipment on the premises. But fears over hospital superbugs, the possible spread of variant CJD, the human form of mad cow disease, and growing commercialisation in the NHS means about a quarter of hospitals have now contracted out the process to outside firms, and others are planning to follow suit.

Last March Aberdeenshire man Alan Paterson's 12–hour operation to remove a blood clot was cancelled when he was already lying on a trolley and connected to monitors. Surgeons at the Aberdeen Royal Infirmary had noticed that three sets of instruments they planned to use were not sterile and so had to be discarded.

There were around 3,000 'decontamination clinical incidents' involving the cleanliness or availability of instruments at Sandwell Hospital and City Hospital, both in Birmingham, between April and September 2007 alone. That included 283 cases of protective paper wraps around sterilised instruments being broken, which rendered them unuseable. Department of Health rules state that two sets of instruments must be available before an operation goes ahead, for safety reasons.

A surgeon at City Hospital, where at least one patient has awoken to find their operation cancelled, said: 'When the cleaning of our instruments was outsourced nine months ago we were assured that the company who were going to do it were experts and highly–trained. But it was a shambles. There was meant to be an eight–hour turnaround and a fast two–hour turnaround to get instruments back, but in reality sometimes things weren't coming back for three, four or five days.

'The firm was also having such problems reassembling microscopic instruments used in keyhole surgery that we had to send staff there to show them how to put pieces of equipment back together properly,' he added.

The latest bulletin from the NHS Decontamination Programme admits there have been 'teething problems around instrumentation and tray processing which required resolution'. Steps have been taken 'to ensure maximum patient safety and minimum service disruption', adds the scheme's February 2008 update. In a survey last year a minority of health trusts admitted that 1,765 operations had been called off at the last minute in 2005–06 because of instrument problems.

The Department of Health said it was helping primary care trusts in areas where problems are most acute to draw up action plans. 'Trusts and other healthcare providers make their own decisions on decontaminating their instruments, and decontamination can be carried out locally or remotely. However they elect to decontaminate their instruments, trusts must ensure that they have adequate instrument supplies to maintain services,' said a spokeswoman.

The nurses' view

Theatre nurses describe their own experiences:

'Following outsourcing we experienced instruments being returned still with blood and bone clearly visible.'
'A surgeon had to change the procedure he was carrying out twice because of lost or broken instruments.'
'Nobody can follow the order of the operating list. It is dictated by which instruments are available.'
'We should have asked for a lot more instruments, but we were told the fast–tracking process would be eight hours. We are lucky if this is within 24'

Source: The Observer

Hospital staff axed in porn probe

Wednesday 27 February 2008

Hospital bosses have taken action against more than 50 hospital workers over the sending of an obscene e–mail.

A total of 13 employees at the Newcastle Hospitals NHS Foundation Trust have been sacked, 28 have been disciplined and 10 still face action.

It follows an eight–month probe after a pornographic image of an elderly woman from an x–rated website was sent to staff at the city's Freeman Hospital.

Four workers were sacked last September when the e–mail surfaced.

It is believed staff working on a ward for elderly patients at the Freeman had been looking at the image on work computers.

'Zero tolerance'

But the investigation has now spread to other hospitals in the city after staff forwarded the offensive e–mail.

A Trust spokeswoman said: "The offensive material in question was of a nature that we are not prepared to tolerate and hence exercise zero tolerance in this respect."

"We have investigated 51 cases and dismissed 13 members of staff with a further 28 being the subject of disciplinary action."

"Of these 28 there are 10 cases outstanding which have yet to be heard in accordance with our policy and practice/code of conduct."

Ian Daley, regional officer for public sector union Unison, said: "We are very concerned that staff are forwarding inappropriate e–mail attachments."

"As a union we do represent staff that have got themselves into trouble and it has taken up a huge amount of time and energy in the Newcastle Trust. Clearly we cannot condone this behaviour."

Source: BBC

Victorian Surgery

Wednesday 27 February 2008

Demonstration of an operation without anaesthetics or antiseptics!

"A patient preparing for an operation was like a condemned criminal preparing for execution."

A demonstration of an operation without anaesthetics or antiseptics, in Britain's only remaining wooden 19th century Operating Theatre. A real Victorian amputation set awaits!

How will you survive…?

Speaker(s):
Museum Curatorial Staff | talks

Date and Time:
21 March 2008 at 2:00 pm

Duration:
30 minutes

Venue:
Old Operating Theatre, Museum & Herb Garret
9a St Thomas' Street
Southwark
London
SE1 9RY

020 7188 2679

More at Old Operating Theatre, Museum & Herb Garret…

Tickets:
£5.45/£4.45/£3.00

Available from:
To book in advance call 020 7188 2679 or email curator@thegarret.org.uk to reserve a place.

Security fears as thousands of NHS smartcards go missing

Thursday 7 February 2008

Thousands of new NHS smartcards giving computer access to patient details have already gone missing, raising fresh fears over the security of the Government's IT programme, Pulse can reveal.

After requests to hundreds of NHS bodies under the Freedom of Information Act, Connecting for Health revealed that 4,147 smartcards had been reported missing – 1,240 last year alone.

At least 142 have been stolen, including 17 in one area – Hammersmith and Fulham PCT. Smartcards have now been issued to 438,314 NHS staff, with the number of users eventually expected to top 1.2 million.

Information obtained by Pulse suggests the number of missing cards could be higher than NHS chiefs admit. Among 221 NHS bodies replying to FOI requests, 2,887 cards were reported missing, including 1,400 last year alone. Extrapolating from this, the number of missing cards would be closer to 6,000. Connecting for Health insisted its data is accurate, with multiple reporting explaining the discrepancy in the figures.

Either way, Pulse's investigation shows an alarming lack of attention to security. In almost every case, lost or stolen smartcards were reissued automatically without investigation, and no disciplinary action has been taken against any staff member. One trust in 10 admitted it had no idea how many cards had been lost or stolen.

Professor Ross Anderson, a security engineering expert at the University of Cambridge, said: "You can't expect stuff to remain confidential if a few hundred thousand people have access. There will be several hundred at any time who've lost their smartcards and thousands who leave terminals logged on or share cards in other ways. There just isn't either the culture or incentives for trusts to investigate data compromises properly."

A Connecting for Health spokesman said: "As soon as a smartcard is reported lost it is disabled. It cannot be used by anyone finding it without a six–digit pin number, which is issued directly to users."

Richard Hoey, deputy editor of Pulse, said: "The real message here isn't how many smartcards are being lost, but how many trusts are failing to keep proper records or gear themselves up to deal with security breaches. It's hardly surprising that there is so little faith among doctors in the Government's ability to design a computer system that keeps patient details safe."

Full story

Source: Pulse, the leading newspaper for General Practitioners.

ODP struck off for theft of controlled drugs

Tuesday 5 February 2008

An operating department practitioner has been struck off the HPC Register after being convicted of theft of controlled drugs. In July 2007 at Wood Green Court Benjamin Lavender was sentenced to 51 weeks imprisonment suspended for two years.

When he appeared in court, Mr Lavender admitted stealing over a thousand ampoules of opiate drugs Alfentanil and Fentanyl while employed at University College Hospital NHS Trust between January and March 2006.

A panel of the HPC Conduct and Competence Committee heard that Mr Lavender had previously appeared before a HPC panel on 6 May 2005 for a markedly similar allegation. Following a conviction in 2004 for stealing opiate drugs, Mr Lavender was made a subject to a five year caution order by the HPC. The panel noted that the present allegation had occurred within the first year of the caution order.

Panel Chair, Martin Ryder commented: "On the basis of all the evidence available to it, the panel has concluded that Mr Lavender should not be allowed to work in an environment where he has access to controlled drugs. Indeed in a letter to the HPC, Mr Lavender himself has realistically acknowledged that he should not work in such an environment. The consequence of these factors is that there is that there is only one sanction that the panel can impose and that is striking off."

The Health Professions Council is an independent, UK-wide health regulator set up by the Health Professions Order (2001). The HPC keeps a register for thirteen different health professions and only registers people who meet the standards it sets for their training, professional skills, behaviour and health. The HPC will take action against health professionals who do not meet these standards or who use a protected title illegally.

NHS paid £120 an hour for nurses

Monday 4 February 2008

Hospitals have paid over £120 an hour for agency workers to cover for gaps in staffing, according to latest figures.

The highest amounts paid for an agency nurse were £121.59 an hour by the Royal Berkshire trust and £121.10 by the Chesterfield and Royal Hospital trust.

The figures for the past year were obtained by the Conservative Party under the Freedom of Information Act.

Last year, the Commons Public Accounts Committee said temporary nurses helped NHS flexibility but could be costly.

Job cuts

Shadow health secretary Andrew Lansley said: "Labour's chaotic, short–term planning has let down NHS staff. Some stability for them is the least we would have expected from the billions that the government has poured into the NHS."

"It's incredible that agency staff can be paid such high hourly rates when jobs are being cut at the same time. This is typical of the waste that's occurred under this government."

The Tories say average hourly rates in the NHS are £15.66 for a nurse, £24.14 for a junior doctor and £60.31 for a consultant.

The highest figures for non–clinical agency staff were £119 an hour for a 'turnaround director' at Coventry Teaching Primary Trust and £110 an hour for financial staff at Heatherwood and Wexham Park Hospitals Trust in Berkshire.

'Important role'

At the other end of the scale, the most Bath and North East Somerset Primary Care Trust paid for an agency nurse was £31.15 an hour and the most expensive agency worker at South Western Ambulance Trust was a deputy finance director who received £33.33 an hour.

A spokesman for the Royal Berkshire Hospital said: "We are unsure what the figure represents but it may well be that the sum was paid as a one-off payment for expert medical care. The hospital will be checking its records further."

Temporary staff are employed in the NHS to cover changes in workload, vacant positions and short-term absences.

The Public Accounts Committee report said: "Properly managed, temporary nurses play an important role in helping hospitals achieve flexibility."

"Excessive use can be costly, particularly when trusts are heavily reliant on agency nurses. High use of temporary nurses can also have a negative impact on patient care and satisfaction."

Source: BBC NEWS

Thousands asked for decontamination experiences

Thursday 31 January 2008

Thousands of theatre nurses and perioperative staff are being asked for their experiences of new decontamination procedures.

The request for feedback, undertaken by the Association for Perioperative Practice (AfPP), is thought to be among the largest of its kind to focus on outsourced decontamination arrangements. It asks respondents to send their experiences of outsourced arrangements in confidence to the organisation who will then take the results to the Chief Nursing Officer and the National Decontamination Team of which AfPP is a member.

Specifically, AfPP members are being asked whether or not they feel outsourcing has been positive or negative in terms of patient care and everyday clinical practice. They are asked if they were consulted about the outsourcing before it happened. Finally, AfPP members are asked if there are more instruments available or if shortages occur due to mislabelling, dirty instruments, mixed–up sets or for any other reason.

Diane Gilmour, Decontamination Lead for AfPP, commented: "Any reasonable person would expect teething troubles with new ways of working such as outsourced decontamination. The crucial test is whether initial problems are ironed out quickly and whether new problems occur."

Ms Gilmour continued: "Anecdotal evidence suggests there have been some issues and we want to give everyone involved on the ground the opportunity to have their say on positive as well as negative aspects of the service."

Views can be emailed to richard.cooper@afpp.org.uk in strict confidence. The closing date for responses is 25 February 2008.

NHS bosses 'bully one in 12 staff'

Tuesday 29 January 2008

Government targets could be partly to blame as hospitals agree to tackle management abuse.

Nearly one in 12 staff working in the NHS has experienced bullying or harassment by their manager, according to government figures. An official survey of doctors, nurses and administrators shows the scale of the culture of bullying that has to be tackled by hospitals and primary care trusts.

NHS Employers, the body responsible for workforce conditions in the health service, blamed the high figures on organisational change and uncertainty last year, when many trusts were facing redundancies and financial cuts. But other groups, such as the British Medical Association, believe that the introduction of targets into hospitals has also encouraged bullying, because it can be mistakenly seen as a way of hectoring staff to reduce waiting times.

One of the trusts with the highest rates is the Liverpool Women's Hospital, where 14 per cent of staff said they had experienced bullying or harassment from managers or team leaders over the past 12 months, according to a wide NHS survey in October 2006. The trust, rated as 'excellent' last year by the health watchdog, the Healthcare Commission, took the unusual step of hiring actors to act out bad situations so that staff could recognise bullying behaviour. Its chief executive, Louise Shepherd, said: 'We do appreciate that we did have a problem. Ironically, part of the reason we believe we scored highly on bullying was because we highlighted the issue early on, so more staff felt able to report it.'

'But we have done a lot to try to tackle this. We set up a number of groups to look at the problem and define what bullying meant. The scenarios we presented with trained actors made staff think a lot about their behaviour ... If trusts want to offer good patient care, they can't do that if the relationships between the staff are not right.'

The survey, carried out as part of the commission's assessments of trusts, showed that 8 per cent of staff had experienced bullying, harassment or abuse from their team leader and 11 per cent experienced it from colleagues. Only two out of five staff felt that their trust took effective action in cases of bullying and harassment. One in 100 staff said they had been physically attacked by a manager, and a similar proportion had been attacked by colleagues.

Other trusts that had high reported rates of bullying included the Royal National Orthopaedic Hospital and the Whittington Hospital in London, and the Great Western Ambulance Service trust in Wiltshire. The staff most likely to have had problems were radiographers, midwives, social care managers and staff working in ambulance control rooms.

Andrea Hester, head of employment services at NHS Employers, said: 'This survey was undertaken at a time when the NHS was going through a great deal of organisational change. As a result, we've issued guidance to trusts to help them combat workplace bullying.'

Experts say bullying can thrive where the environment is highly competitive and where it is accepted as a tool for motivating staff. It is increasingly being seen as a more crippling problem for employers than other forms of workplace stress, because it can undermine self–esteem to the point where it becomes impossible for people to work.

A BMA spokesman said: 'The vicious cycle of bullying in medicine has to stop. It's not good enough for people to think that just because they had a hard time they can dish out the same treatment to the next generation of doctors. Bullying is not just a problem for students, juniors and staff grade doctors. Consultants can be bullied by their peers and by managers. The highly pressurised target ethos in the health service only adds to the culture of bullying where it can be mistakenly seen as a way of motivating staff.'

Source: Guardian Unlimited – Jo Revill, Whitehall editor The Observer, Sunday January 27 2008

NHS review enters next phase

Friday 25 January 2008

Creating a world–class NHS which prevents illness as well as improves quality of care, moved a step closer today as NHS staff, patients and members of the public came together to discuss emerging themes from the Our NHS Our Future review led by Lord Darzi.

Over a thousand people across the country will be asked for their input on how the NHS can deliver health services in their local area.

The event follows the nationwide engagement events in September and the subsequent interim report which set out Lord Darzi's emerging vision for the NHS.

To provide greater clarity on patients' preferences for improved GP access, one of the biggest concerns emerging from the Review so far, participants in today's events will be asked:

– If they have noticed any difference in GP opening hours since the interim report was published in October; and,

– How easy it is for them to book an appointment with their GP practice more than two days ahead

Lord Darzi, said:

"This Our NHS Our Future review presents a real opportunity for everyone – patients, public and staff – to have a say in shaping the NHS for the 21st century. I am very excited by the energy and commitment of clinicians and patients up and down the country who are working hard to identify the right local solutions for improving the NHS in their communities."

"As the NHS enters its 60th year it is a perfect time to look at the current challenges and how the NHS needs to respond to ensure top quality care for all."

As part of today's event, participants in each SHA will look at a range of health and social care models ranging from maternity and child health to acute care and mental health. This will include an outline of what care looks like now in these areas and what it might look like in the future, based on feedback gathered so far from clinicians, staff and members of the public as part of the Review.

NHS staff and members of the public who wish to take part in the Review and share their views on the future of the NHS can complete an online questionnaire

Op theatre staff look to ballot over pay

Friday 25 January 2008

A GROUP of NHS staff could be balloted for industrial action because they are owed up to £20,000 each by their employers.

About 20 operating department practitioners at the Royal Gwent Hospital, Newport, have not received any unsocial hours payments from Gwent Healthcare NHS Trust for almost two years.

The payments are made as part of the new Agenda for Change pay structure, for working unsocial hours, such as weekends, night shifts and public holidays.

It is understood that the staff members, who are part of the anaesthetics team in the hospital's main theatre, are owed between £10,000 and £20,000 each – rising by about £500 a month.

Unison, which represents the staff members, is now preparing ballot papers for a vote on industrial action if the matter is not resolved.

But despite the NHS Staff Council, which operates the new pay system, agreeing that the practitioners are entitled to the pay, Gwent Healthcare NHS Trust has yet to make the money available.

A letter from the NHS Staff Council is expected to be discussed at the meeting of the Welsh Partnership Forum next month.

Dave Galligan, head of health for Unison in Wales, said, "The staff have been trying to resolve this issue for 23 months and have been extremely patient."

"The position is spelled out by the UK council as non–negotiable. The fact the trust is ignoring this strikes us as high–risk strategy as there is an inevitability there will be some form of reaction or backlash from staff."

"If the meeting affirms what the staff council has said and the trust doesn't adopt it, then that makes a mockery of the whole process."

"We are currently at the stage of preparing for a ballot for industrial action."

The operating department practitioners are an essential part of the anaesthetics team, without which planned and emergency surgery could not happen.

They work with surgeons, anaesthetists and theatre nurses to help ensure every operation is as safe and effective as possible.

Agenda for Change, which applies to the majority of NHS staff, was introduced in October 2004 in a bid to modernise pay and working conditions.

Unsocial hours payments for working on Saturdays and week nights range from time plus 30%, to time plus 50%. Staff who are entitled to the extra money for working on Sundays and public holidays are paid from time plus 60% to double time.

There have been problems implementing Agenda for Change since its introduction in Wales – unions have blamed delays in switching staff over onto the new scheme for plummeting morale and there have been allegations some staff have not received up to three years' worth of back pay.

And some of the deficits run up by NHS trusts in Wales have been blamed on shortfalls in funding for Agenda for Change.

A spokesman for Gwent Healthcare NHS Trust said, "The letter from the NHS Staff Council will be discussed at the next meeting of the All Wales Partnership Forum who will clarify how this relates to all–Wales guidance."

"We fully appreciate the concern of staff. However, this is a national issue and we have to wait until clarification is received as to whether the NHS Staff Council response upholds the all–Wales guidance used by trusts."

"Once the outcome of this meeting is known, we will review our position and communicate directly with staff."

Source: icwales.co.uk - Madeleine Brindley, Western Mail

EU Demands Hospital Bug Screening For All Health Workers

Tuesday 15 January 2008

New measures must be taken to protect healthcare workers from healthcare acquired infections such as MRSA, according to a report to be adopted today by the European Parliament.

The report focuses on the need to reduce workplace–related diseases and accidents across the EU and in particular to better protect vulnerable workers such as those in healthcare.

Hospital and care home staff are exposed to exceptional risk on a daily basis, including from twenty life threatening viruses such as Hepatitis B and C and HIV/AIDS, infections such as MRSA and needlestick injuries. The UK has one of the worst records on healthcare acquired infections in the European Union.

Liz Lynne MEP (LibDem), Vice President of the European Parliament's Employment and Social Affairs Committee, tabled two crucial amendments to tackle healthcare acquired infections such as MRSA, calling for screening of workers and an EU–wide code of conduct to enable better sharing of best practice amongst EU countries.

Speaking today in the debate, Liz said:

"I am pleased that this report talks about better implementation of current directives. I also welcome calls for better inspection. There is no point in Member States paying lip service to implementation as many do in the health and safety field, then quite often it is those very same Member States who call for more legislation, even if the scientific and medical evidence does not establish a risk."

"Where I believe we do need legislation, and we called for this in 2005, is to prevent the over 1 million needlestick injuries which affect healthcare workers each year across the EU. Imagine the horror if you are accidentally pricked by a needle and then have the horrendous wait to see if you have contracted a serious infection such as HIV or Hepatitis B. The European Commission must now heed our call and bring forward an amendment to the 2000 Biological Agents Directive."

&In some areas of course, exchange of best practice is probably enough and that is why I am pleased that my amendments on healthcare acquired infections passed in committee. Infections like MRSA are not only serious for patients in hospital but also for workers."

"Rates of infection vary considerably between Member States. The UK, for example, has a ten times higher rate than the Netherlands. We need to know why and how we can learn from best practice. That is why I called in one of my amendments for an EU Code of Good practice on healthcare acquired infections and to encourage screening of health workers."

Extra specialist staff for tackling hospital infections

Wednesday 09 January 2008

Health Secretary unveils new infection control strategy

Every hospital trust in England will be able to recruit two infection control nurses, two isolation nurses and an antimicrobial pharmacist with millions of pounds of extra investment for infection control in the NHS, Health Secretary Alan Johnson announced today.

New stringent requirements outlined today in the Government's strategy to tackle healthcare associated infections (HCAIs) also mean that NHS Foundation Trust applications will not be supported by the Secretary of State unless trusts are consistently hitting local targets on both MRSA and C. difficile.

'Clean, safe care' draws together current HCAI initiatives and details new areas where the NHS should invest the extra funding of £270 million per year by 2010/11 to support infection control and cleanliness in the NHS.

This funding will allow local organisations to invest up to £45m on additional specialist staff, who play a crucial role in cleanliness and infection prevention & control.

Alan Johnson said:

"We have gone from what has been described by the HPA as 'a seemingly unstoppable rise in MRSA bloodstream infections throughout the 1990s' to a 10% fall in cases of MRSA, thanks to the hard work and dedication of NHS staff, but we know that there is still more to be done."

"The investment of an extra £270 million and this strategy will help the NHS to continue the good work going forward. Patients have my assurance that the Government will not take its foot off the pedal and will continue to do all we can to tackle infection."

From February 2008, a new nationwide campaign will be launched to remind the public, GPs and other doctors that using antibiotics is not effective on many common ailments. The campaign will also highlight that inappropriate use of antibiotics can increase the emergence of antibiotic–resistant strains of infections and that prudent prescribing is therefore required.

Alan Johnson continued:

"Healthcare associated infections are everyone's responsibility from NHS cleaning and care staff to me as Secretary of State – and I take that responsibility seriously."

"The past 60 years have seen great advances in healthcare and medicine. For example, the use of antibiotics have saved countless lives, but antibiotics do not work on most coughs, colds and sore throats and their unnecessary use can leave the body susceptible to gut infections like Clostridium difficile. The new pharmacists that trusts will be able to recruit will be key to ensuring proper antibiotic prescribing on wards."

As well as recently announced initiatives including a new 'Bare Below the Elbows' dress code and every hospital to have undergone a deep clean by March 2008, the Strategy outlines further areas that the Department is leading on to support the NHS in the fight against HCAIs. These include:

Hospitals will receive more money earmarked to tackle infection – The national tariff uplift includes a specific element to tackle infection, meaning that trusts have additional resources at their disposal Additional fines for trusts not improving infection rates – as set out in December's Operating Framework for 2008/09, the new national contract will allow PCTs to fine Trusts that are not hitting local targets on Clostridium difficile improvement. This is over and above the fines that the new Care Quality Commission will be able to place on Trusts that are in breach of the hygiene code.

Promoting innovations – a range of programmes designed to accelerate the development and uptake of new technologies

Guidance on HR procedures to be developed in conjunction with Trade Unions – including the importance of induction and training on infection prevention and control for staff

A cleaning summit held by the NHS Chief Executive – focussing on cleaners as part of the solution to infections and cleanliness and not part of the problem

Chief Nursing Officer Christine Beasley said:

"Healthcare associated infections and cleanliness in hospitals are often linked, and rightly so. We know that patients do not want to receive care in a dirty hospital. A clean environment is extremely important its own right, as well being the best platform from which to tackle HCAIs."

"Preventing infections requires a range of measures, from prudent antibiotic prescribing to implementing best practice in chronic wound management and only a comprehensive approach will succeed in driving down numbers."

'Clean, safe care' sets out where there are national expectations and requirements for the NHS in tackling HCAIs– but also guides NHS organisations as to the actions and investment that will be most effective in continuing to tackle infection and improve cleanliness in their local area. The document is also written with patients, public and staff in mind. It can be found here.

Standard reveals hospital workers flouting basic rules on hygiene

Tuesday 08 January 2008

Hospital staff are breaching basic hygiene rules designed to fight deadly superbugs, an Evening Standard investigation has found.

An undercover reporter discovered doctors and nurses at a major London hospital routinely failing to clean their hands between seeing patients. The reporter, who worked as a cleaner at Barnet Hospital, also found:

Nurses and cleaners broke rules stating they must wash their uniforms between shifts, raising the risk of infection.
Surgeons wore theatre scrubs in the canteen despite signs on every hospital floor warning them not to.
Doctors failed to keep their arms bare below the elbow despite an instruction issued by Health Secretary Alan Johnson in September.
Cleaners argued with nurses about removing clinical waste despite orders that wards should work as a team.

The lapses come despite a crackdown on hygiene at Barnet and Chase Farm Hospitals Trust – the first in the country to be issued with an improvement notice by the Healthcare Commission in July. The trust's Clostridium difficile and MRSA rates have since fallen and the watchdog says it is following orders to clean up and has made improvements.

But despite halving C.diff infections to 113 in the last quarter, infection rates are still among the highest in London.

The Standard investigation raises concerns over the minimum standards applied by the Department of Health's legally enforceable hygiene code – now apparently being met by the trust.

Our reporter was employed as a £5.10–an–hour cleaner at the 900–bed hospital, which opened in 2003. It cost £40 million, funded by a Private Finance Initiative.

He discovered alcohol hand-cleaning gel dispensers had been prominently placed outside every ward with signs instructing staff and visitors to use them but they were frequently ignored.

Trusts are obliged to "educate" visitors about sanitation but cannot make them use the dispensers. Guidelines issued in 2001 say staff should clean their hands between seeing patients. Domestic staff were illequipped with uniforms. Most did not wash their clothes between shifts and travelled to and from work in their own shoes, potentially carrying infections. A hygiene code states staff clothes, including uniforms, should be "clean and fit for purpose".

Wards appeared to be clean and staff responded quickly to incidents. But other signs indicated a lax approach to hygiene. Clinical waste bins were left next to clean laundry, increasing the contamination risk. Cleaners employed by Medirest, part of the Compass Group, a large public sector catering and cleaning services provider, were thorough in their work but appeared isolated from staff in charge of cleanliness.

Rules for matrons say cleaners should be made to feel part of the ward team, to create "joint ownership" of cleanliness. But there seemed to be clear lines between nurses and matrons and the contracted cleaners who answered to non–medical supervisors. Refuse collectors said staff had been cut by up to a third to save money and cleaners complained of untrained agency workers covering staff shortages.

Medirest today said all new recruits underwent training and cleaners had not been cut back. A spokesperson said: "We have increased the number of employees by 30 in recent months to focus on minimising C.diff. It is only on rare occasions that we need to supplement our workforce with agency staff."

Barnet and Chase Farm NHS Trust said it would investigate the areas highlighted by the Standard and it took infection control very seriously. A spokesperson said: –In the last year we have spend an extra £500,000 on increased levels of environmental cleaning. We have reduced the number of new cases of C.diff from 74 in April to 16 in November.–

She said the trust had made significant improvements on good hand hygiene, and hospital staff could have used personal alcohol hand gel when entering wards.

Undercover cleaner's diary: dirty uniforms and nurses who don't wash their hands

It is a tough job for low wages. The kind of work British people will not do. All the other recruits are recent African immigrants on visas. Most work 12#– or 14–hour days seven days a week. Our induction is sufficiently thorough, covering health and safety regulations and infection control measures to combat MRSA and C.diff. We are told we will be provided with two sets of uniform and a pair of boots, which must only be changed into at the hospital.

Saturday 10 November

I'm told there is no uniform. Instead, I'm given a pair of dirty old overalls. I'm not provided with boots either. I have to wear my own trainers, which I wore on to the site and wear back the following day - in breach of infection control guidelines. I'm given rubber washing up gloves as there are no waste handling gloves. I'm working with Thomas Williams, a cleaner for two years, on refuse duty. We find yellow clinical waste bags and boxes of contaminated needles left by nurses on the floor with household waste instead of the locked yellow bins where they should be stored. Thomas tells me this is a regular occurrence and that it is not our job to pick them up off the floor. I see cleaners and staff going into wards without cleaning their hands with the gel dispensers at every ward entrance. I estimate only one in four visitors and staff obeys the rules. During a break I'm told by the other cleaners that there are regular staff shortages with untrained agency workers brought in to make up the shortfall. The number of permanent refuse collectors was cut from three to two to reduce costs.

Sunday 11 November

Deanne (one of the managers) says three people have not turned up for work, so the other refuse collector (Wilfrid) is reassigned to porter duties, leaving Thomas and me to do the whole hospital. I find clinical waste bins left next to clean laundry. The bins are taken out of doors next to the laundry store but as they are heavy and difficult to push they are sometimes left next to clean bedding. I see several doctors wearing stethoscopes going from the canteen on to wards despite signs telling them not to. I see nurses and cleaners going between the intensive care unit and the general Aspen Ward without cleaning their hands.

Monday 12 November

I am working the evening shift with Wilfrid. I am told we should be trying to do two rounds of refuse collections. Wilfrid tells me later that this is impossible. He complains the day shift are not doing their rounds frequently enough. He appears to be correct. We find four clinical waste bins completely full with 20 other bags dumped on top or on the floor. Two nurses finish their shift and leave for home in their uniforms. The hand gel dispenser outside Palm Ward is empty during visiting hours. Other dispensers nearby do contain hand gel.

Tuesday 13 November

A medic wearing scrubs is eating in the canteen despite signs warning staff that they will not be served if they are wearing surgical clothing. Another doctor comes in wearing a long-sleeved top and a stethoscope around her neck. A clinical waste bag splits while I'm removing it from one of the wards. It is not double–bagged or tied with an ID bracelet to identify the staff member responsible. Dirty adult nappies fall on the floor. I ask for materials to clean it but am told someone else will do it, so I leave it.

Wednesday 14 November

A nurse leaves the intensive care unit with a coat over her uniform on her way home. A surgeon in operating theatre "blues" is walking around public corridors. At visiting time I see two children in school uniform hugging their grandmother without cleaning their hands. After five days of hard work, I am leaving.

News Roundup:

MRSA 'cut by stopping injections'

Blood of 2,500 donors thrown away

Surge in cases of superbug that is harder to tackle than MRSA

Lord Darzi sets out tough rules for changes in the NHS

News

Archived News Pages:

MRSA 'cut by stopping injections'

A hospital trust has claimed to have eliminated MRSA bloodstream infections by stopping the routine practice of administering intravenous injections.

'Big improvement'

Blood of 2,500 donors thrown away

Blood from more than 2,500 donors has had to be thrown away after a refrigeration unit broke down, costing the National Blood Service £350,000.

Surge in cases of superbug that is harder to tackle than MRSA

Cases of a hospital superbug more difficult to treat than MRSA have soared by 40 per cent, experts are warning.

Lord Darzi sets out tough rules for changes in the NHS

Five pledges will ensure that change is transparent and driven by the best evidence

NHS 'chaos' over surgical tools

Operating theatres are being thrown into chaos and operations cancelled because of broken, missing or dirty surgical instruments, surgeons say.

'It was awful'

NHS Trust In £350,000 'Alice In Wonderland' Recruitment Splurge

Health workers, not accountants, should be recruited, says Unite

HPC launches fees consultation

The Health Professions Council (HPC) has launched a three month consultation to invite stakeholders for their views on its proposed fees increase for 2009.

NHS staff survey shows significant improvement in hospital infection control

NHS staff report improvements in infection control, support from managers and high levels of job satisfaction and training opportunities

Johnson: proposed three-year pay award is good news for staff, the NHS and patients

Health workers to tackle climate change

Health workers and local authorities throughout the country are being encouraged to play their part in tackling the health effects of climate change, Public Health Minister Dawn Primarolo announced today

Hospital to reduce patient deaths

Bosses at Salford Royal Hospital have announced plans to cut the number of deaths on its wards by 1,000 over the next three years.

Complications commonplace

Two die after receiving organ transplants from teenager who had cancer

NEW YORK Two patients died and two are undergoing chemotherapy after receiving organs from a teenager who died of cancer, US authorities said.

HPC In Focus

Issue 16 of HPC In Focus is now available to download

Fatal bird flu cases in Pakistan

The first case of human–to–human transmission of avian flu in Pakistan has been confirmed.

Brothers

'Appropriate steps'

More deaths linked to C. Diff bug

Three more deaths have been linked to the hospital bug Clostridium difficile in hospitals in the Northern Trust area.

Radical reformation plans for NHS

The number of local health boards (LHBs) in Wales could be cut from 22 to eight under proposals unveiled by the Welsh Assembly Government.

Communities

NEW HEALTH MAP

Hospital staff bonus criticised

An NHS hospital trust which has a £7.5m surplus in its budget is coming under fire for its decision to give every full-time member of staff a £250 bonus.

ODP struck off after suspension for drug theft

Operating department practitioner, Alan Sutheran has been struck off the HPC Register after a panel of the Conduct and Competence Committee met to review a suspension order previously imposed on him.

How can technology transform the patients' experience of the NHS?

Tuesday 13 May 2008, 9.30am–4.00pm, King's Fund, London

IN FOCUS: Interactive session – how can patients use technology and the challenges to the NHS

Nurse regulator 'dysfunctional'

The nurse and midwives regulatory body has an ingrained culture of "racism and bullying", an MP says.

Integrity

National 'Recruitment' Pay Judgment 'Undermines Stubborn' Doncaster NHS Managers

A landmark judgment in favour of a Lancashire maintenance technician, which means he will receive almost £7,000 in back pay under a NHS national agreement, has 'undermined' a 'stubborn' NHS trust in Doncaster.

Patient smells a rat

A Hertfordshire teenager refused a knee operation – after surgeons told him there could be a dead rat in the operating theatre.

Developing e–Learning in the Health Sector: Course–Source Offers Free Event for Health Professionals

Patients say day surgery is "like McDonald's"

Patients admitted for day surgery have compared it to going for a meal at McDonald's, according to a study by an academic from the University of Salford.

Bug trust chief leads NHS review

A former NHS chief whose trust was hit by a superbug scandal is now working for a consultancy and running a review at two hospitals in Surrey and London.

'Golden goodbye'

NHS parking in Wales 'to be free'

Patients, staff and visitors will be able to park for free at almost every NHS hospital in Wales by the end of 2011, it will be announced later.

'Tax on sick'

Dirty scalpels bring 5,000 ops to a halt

Surgery is being cancelled, sometimes as patients lie anaesthetised, after outside cleaning firms return theatre equipment unsterile and broken.

The nurses' view

Hospital staff axed in porn probe

Hospital bosses have taken action against more than 50 hospital workers over the sending of an obscene e–mail.

'Zero tolerance'

Victorian Surgery

Demonstration of an operation without anaesthetics or antiseptics!

Security fears as thousands of NHS smartcards go missing

Thousands of new NHS smartcards giving computer access to patient details have already gone missing, raising fresh fears over the security of the Government's IT programme, Pulse can reveal.

ODP struck off for theft of controlled drugs

An operating department practitioner has been struck off the HPC Register after being convicted of theft of controlled drugs. In July 2007 at Wood Green Court Benjamin Lavender was sentenced to 51 weeks imprisonment suspended for two years.