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Scorpion in operating theatre causes a stir
Friday 23 December 2005
Athens - A live scorpion found in a Greek hospital operating room just weeks after a rat tail surfaced in the soup of another establishment has revived a long debate in Greece about the quality of public health services on offer.
The scorpion was discovered on Wednesday in the operating room of Venizelio Hospital, on the southern island of Crete, a Health Ministry official said yesterday.
The ministry ordered an investigation to determine the cause of this intrusion, without excluding the possibility that the small arthropod simply crawled in out of the vegetation that surrounds the hospital.
Officials are more suspicious about the rat tail - found last month in a pot of soup at the Athens psychiatric hospital of Dromokaitio - amid reports that it appeared to have been sliced by a knife. Mindful of potential sabotage, the authorities have sent a report to the public prosecutor.
Occurring within weeks of each other, the two cases are the latest in a series of incidents undermining the Greek public health service's already fragile reputation.
While in opposition in 2002, current Prime Minister Costas Karamanlis had raised an uproar after spotting a cockroach during a visit to a state hospital in Athens.
Repeated efforts to overhaul the public health sector have had limited success in eliminating a general disdain for state hospitals. - Sapa-AFP
CMO LAUNCHES NEW WEBSITE GIVING VITAL INFORMATION TO PEOPLE CONSIDERING COSMETIC SURGERY
Thursday 22 December 2005
Chief Medical Officer Sir Liam Donaldson today launched a new website providing important information for people considering cosmetic surgery. Last year Sir Liam asked Harry Cayton, Director for Patients and the Public, to convene an Expert Group to look at the regulation of cosmetic surgery. One of their key recommendations was that patients and the public should have access to detailed, accredited advice on cosmetic surgery including what standards to expect from providers, what qualifications to look for and what questions to ask.
The Chief Medical Officer said:
“Good public information on cosmetic surgery is essential. People need help and support to make informed choices about whether to have cosmetic surgery or a non-surgical cosmetic treatment. Well informed patients can help to drive up standards among providers in a field of healthcare where there have been concerns. I am sure that the web material will be widely used and will make a significant contribution to raising awareness among both the public and the providers.”
“It is in the interests of everyone working in the field to make sure that the public have access to reliable information. The Department of Health was fortunate to be able to draw on the expertise of a wide range of stakeholders in the professional, voluntary and independent sectors in putting this material together. I would like to thank those organisations who contributed.”
The website features useful information including:
- Questions to ask yourself about your reasons for wanting cosmetic surgery and your expectations of the results the procedure will bring, as well as some alternatives to cosmetic surgery.
- A handy 'cosmetic surgery checklist' of questions to ask, help to make sure that the provider gives you all the details you need to know in order to make an informed decision on whether cosmetic surgery is right for you.
- Information on how to check that the surgeons, doctors, dentists, nurses and beauty therapists who will be carrying out the cosmetic treatment have the right qualifications and experience.
- An A-Z list of all cosmetic procedures, what to think about to start with, what the treatment involves, what results you should expect and any risks you may need to know about
- Information on what to do if you are not happy with the results or have a complaint to make about a cosmetic surgery or treatment
Harry Cayton, National Director for Patients and the Public at the Department of Health, said:
“I am pleased with the progress made in implementing the recommendations of the Expert Group. The publication of this web-based information is one of the ways we can help people be more knowledgeable about cosmetic surgery and what they can expect from their treatment.”
Professor John Lowry, Chair of the Senate of Surgery's Cosmetic Surgery Interspecialty Committee, said :
“The Committee greatly welcomes publication of greater information and more reliable guidance for patients considering cosmetic procedures. This will complement the work already well advanced in the development of enhanced training and assessment of practitioners, compliance with minimum healthcare standards and the monitoring of newly emerging techniques.”
Sally Taber, Head of Operational Policy at the Independent Healthcare Forum, said:
“Our members are very keen to promote the website which better informs the general public, as the vast majority of cosmetic surgery/procedures is performed in the independent sector.”
* The patient information can be accessed here.
Fury over surgery cancelled five times
Thursday 22 December 2005
A woman whose operation to remove her gall bladder was cancelled five times has criticised her treatment by the National Health Service as a "shambles".
In the latest cancellation, Megan Kendall, 31, was about to enter the operating theatre at Dorset County Hospital, Dorchester, when the surgery was halted because a second qualified doctor was not present. Miss Kendall said she broke down as months of frustration “boiled over”.
She said she has had to take time off from her job as a pre-school assistant because of the stress caused by the repeated cancellations.
Miss Kendall, from Weymouth, was told in March that her gall bladder should be removed. The surgery was booked for Nov 30, but it was changed to Dec 7. Other cancelled dates followed before she was admitted for a fifth time on Dec 14.
Miss Kendall said she had yet to receive an explanation from West Dorset General Hospital NHS Trust. “They say sorry, but they don't take the blame for it.”, she said.
She is now due to have the operation on Dec 23. The trust said it was sorry for causing distress to Miss Kendall.
Source: Telegraph.co.uk
By Richard Savill
Surgeons receiving £1,500-a-day extra to slash waiting lists
Monday 19 December 2005
SURGEONS are being paid three times their normal daily wages by desperate health chiefs racing to beat the clock over waiting times targets.
Consultants in the worst performing areas of the country are being paid more than £1,500 a day overtime on top of their normal NHS wages to help cut waiting lists.
Scottish Executive ministers have ordered hospital chiefs to meet new targets by the New Year that ensure all patients receive appointments and treatment within six months of being referred by a GP.
The huge payments are being made under a clause in the consultants' new contract that came into force this year.
It states that consultants must be paid three times their hourly rate for any waiting times work they do outside of their normal 40-hour working week. But other NHS staff are paid just time and a half for overtime work.
Details of the clause will heap further pressure onto the Scottish Executive for approving the contract which has seen consultants' pay packets soar above the £100,000 mark.
Health bosses have already spent more than £25m on short-term measures such as sending patients for private treatment in an attempt to meet the targets. But official figures have revealed there are still more than 13,000 patients who have been on waiting lists beyond six months.
As a result Scotland's health boards have scheduled dozens of extra operating sessions in the last month, which has seen senior medical staff earn thousands of pounds in overtime.
The last-minute spending spree has angered politicians and campaigners who claim the cash should be invested in increasing NHS capacity rather than “crisis management”. The huge overtime payments for waiting times work means that consultants in some areas are earning up to £10,000 on top of their £100,000 annual salaries.
All 15 of Scotland's health boards have admitted paying consultants overtime to reduce waiting lists.
In Grampian two orthodontists have carried out 10 extra clinics while a general surgeon has held two clinics, all at three times their daily rate. Another specialist in Dundee said he was paid £1,500 for just one day in the operating theatre.
He said: “This is work where we are solely operating on waiting times patients so we can get through a fair number in a day.”
“But it is an extremely expensive process for the health service as they have to pay not just for the surgeons but also the other theatre staff and the anaesthetist.”
A report by Audit Scotland last week revealed that the new contract for consultants has cost the NHS an extra £32m last year and a further £16m this financial year but said it was unclear whether it had boosted productivity.
Privately, health officials now admit that the new pay deal failed to tie in the extra cash to guarantees for extra work, causing vast sums of the NHS budget to be used up for little visible gain.
SNP shadow health minister Shona Robison hit out at the triple payouts.
She said: “These measures are expensive crisis management. The fundamental point is that NHS capacity has to be increased if patients waiting times are to be kept down in the long-term.”
Many surgeons also believe the funding should be invested in long-term capacity. Dr Peter Bennie, deputy chair of the BMA Scotland's consultants committee, said: “The Scottish Executive is going to fall far short of its target of recruiting 600 extra consultants by the end of the year.”
“This means that consultants are having to work overtime to ensure patients are being treated within the waiting times.”
According to the latest figures released in November this year there were 1,249 inpatients and day cases still waiting for NHS treatment. There were also 11,854 outpatients waiting for an appointment.
But there are also a further 35,000 patients referred for treatment who currently do not have a waiting times guarantee after being moved onto so-called hidden lists with Availability Status Codes that can see them being left untreated for up to five years.
The Scottish Executive has promised to abolish these codes by the end of 2007 as well as impose a new waiting time target that will see patients being treated within 18 weeks.
But many fear health boards will struggle to keep waiting times down as all boards have had to resort to specially allocated non-recurring funding to meet this year's target.
Lanarkshire has spent around £2m on buying capacity from private health firms while Greater Glasgow has spent more than £1.9m.
Many health boards have also sent patients to be treated at the Golden Jubilee National Waiting Times Hospital in Clydebank. Figures released last week revealed it costs more than £1,600 an hour to carry out an operation at the hospital, more than twice the average cost of operations in Scotland.
Dr Andrew Walker, a health economist at Glasgow University, said: “There are serious questions about whether this is the best use of the NHS resources. Targets to reduce waiting targets seem to have been introduced with no detailed planning on whether they were feasible or affordable.”
Health Minister Andy Kerr said: “We have expressed a clear expectation to Boards that the work they carry out in keeping waiting times down will be conducted as part of their normal business and will therefore be paid at standard pay rates.”
THOUSANDS SPENT ON IDLE OPERATING THEATRES
SCOTLAND'S hospitals are spending thousands of pounds on operating theatres that are sitting idle for most of the week.
Three health boards - Argyll and Clyde, Dumfries and Galloway and Lothian - are now paying more than £1,100 an hour to carry out operations compared to last year when no health board spent more than £1,000 an hour.
The average cost of using one of Scotland's 345 operating theatres for an hour has also risen from £710 to £767. But the amount of time patients are actually being treated on operating tables has barely changed with theatres being used for an average of just 27 hours a week, compared to 26 hours in 2004.
The figures come after Audit Scotland revealed that, despite record investment of £8bn in the NHS, debts by health boards have increased while the benefits to patients health have been difficult to quantify.
Four health boards, Argyll and Clyde, Lanarkshire, Grampian and Western Isles, have amassed deficits of £91m, while the Executive's health department overspent by £32m.
Statistics on hospital running costs have also revealed that many health boards are running their operating theatres at twice the cost of other areas.
Argyll and Clyde, the health board with Scotland's biggest debt, is the country's second most expensive area to have an operation, costing £1,148 an hour. The theatres, however, are unused for 23 hours a week. NHS Dumfries and Galloway has also seen a dramatic drop in activity with four hours being shaved off its weekly operating time, while costs have soared to more than £1,160 an hour.
Even between Scotland's two largest health boards there are massive variations. In NHS Greater Glasgow it costs the taxpayer £579 for every hour a theatre is used, in NHS Lothian it costs almost double that amount at £1,110.
Source: RICHARD GRAY
HEALTH CORRESPONDENT
scotlandonsunday.com
Hospitals fail cleanliness checks
Friday 16 December 2005
Two-thirds of NHS and private hospitals are failing to meet the highest standards of cleanliness, snapshot inspections have revealed.
The Healthcare Commission sent unannounced “hit squads” into 99 hospitals in England this summer.
Inspectors found mental health hospitals had particularly poor cleanliness standards.
The Department of Health said it would work with the commission and other agencies to help failing hospitals.
Until now, patient surveys and planned inspections by patient groups have been the main sources of information on cleanliness.
However, in these spot-checks inspectors went to 37 NHS acute hospitals, 33 NHS mental health and community hospitals, 11 independent acute hospitals and 17 independent mental health hospitals.
They looked at medical equipment, beds, sinks, bedpans and toilets.
The inspectors also looked at outpatient departments, and - if appropriate - A&E departments to check for spillages, blood, general stains, debris and dust.
One hospital was not included in the results as it is disputing its score.
Good management 'crucial'
They found a third of the hospitals visited achieved the highest standards in cleanliness across the board.
While 33 hospitals met the highest standards (classed as band one), 43 were classed as having “room for improvement”.
Evidence of systemic problems was found in the worst performing 22 hospitals, indicating that cleanliness was unsatisfactory for an environment where clinical care was provided.
But all six worst-performing organisations were mental health hospitals in the NHS or independent sector.
Whether or not “in-house” cleaning teams were used made no difference to cleanliness standards, the commission found.
Fears have been raised in the past that using outside companies was more likely to mean lower standards.
Instead, the crucial factor was whether the cleaning teams were effectively managed and working in partnership with other staff.
Those hospitals failing to meet the highest standards will now be given action plans to help them improve.
Cleanliness spot-checks will also form part of the new annual health assessments planned for NHS organisations.
'A helpful survey'
Simon Gillespie, head of operations at the Healthcare Commission, told the BBC: “There were some excellent results in the NHS and independent sector.”.
“But there were too many organisations with unacceptable levels of cleanliness, predominantly in mental health facilities which is particularly distressing.”
He added: “I wouldn't want to go to one of these worst hospitals.”.
“The bottom line is walking into an organisation and your feet sticking to the floor because it hasn't been cleaned adequately, smelling the toilets some way before you can see them, urinals encrusted with limescale and urine is really pretty horrible.”
Chris Beasley, chief nursing officer for England, Chris Beasley, told the BBC Today programme only a small number of hospitals were poor, but the situation was still “totally unacceptable”.
“It's just as important for people who have severe mental health problems to have a clean and comfortable environment as it is with somebody who is going to have open heart surgery.”
Dr Paul Grime, chair of the British Medical Association's occupational health committee, said: “Too many of these hospitals are falling short. It is particularly worrying that, despite patients' concerns high numbers of hospitals have not set up robust cleaning systems.”.
“And the fact that some mental health hospitals have seriously poor levels of cleanliness paints a disturbing picture.”
Poor standards
Health Minister Jane Kennedy said: “We recently announced £130m capital funding specifically to update mental health environments and will be announcing further work on enhancing the environment soon.”.
She said the department would work with the commission and other bodies to rectify poor standards where they had been found.
Shadow Health Secretary Andrew Lansley said: “Every hospital should achieve the highest level of cleanliness. Despite countless government initiatives, standards remain unacceptably low.”.
And Liberal Democrat health spokesman Steve Webb said: “This report is a wake-up call to a complacent government that warm words and task forces are not enough to end the scandal of dirty hospitals.”.
Story from BBC NEWS: © BBC MMV
Resuscitation Guidelines 2005
Friday 16 December 2005
The “Resuscitation Guidelines 2005” are published in A4 booklet form by the Resuscitation Council (UK).
The booklet contains detailed information about Emergency Life Support and can be obtained from the Resuscitation Council (UK). Please refer to publications page of their website for full details of this and other publications available from the Council.
Viafin-Atlas Ltd./Viafin-Atlas Inc. Announce New Invention - 'Artificial Retractable Foreskin'
Tuesday 13 December 2005
SALISBURY, England, Dec. 12 Viafin-Atlas Ltd. and Viafin-Atlas Inc. are proud to announce the arrival and commercial availability of the world's first "Retractable Foreskin Prosthesis" or "Artificial Retractable Foreskin" for circumcised men.
The product has been designed for men of all ages who suffer diminished sensitivity in their penis. The product is manufactured in Britain and has patents pending in 131 countries.
For information, visit the website.
Or contact:
James Williams, Managing Director, Viafin Atlas Ltd.
President, Viafin Atlas Inc.,Unit No. 1, The Malverns Business Centre
Cherry Orchard Lane, Salisbury SP2 7JG, England
Tel: 01722 322611
Fax: 01722 330009
Source: PRNewswire
Emergency surgery wait for Cavan patient
Tuesday 13 December 2005
A patient who had been prepared for surgery in Cavan General Hospital had to be left lying by the operating theatre for several hours when staff had to attend another emergency operation.
The patient was in the operating theatre and about to receive an anaesthetic when a second emergency arose last Thursday night.
The only two theatre nurses and anaesthetist there had to leave her to attend to the other case as it was of higher priority.
The woman was left for several hours before being transferred to St James's Hospital in Dublin later that night for surgery.
The Health Service Executive said Cavan was able to cope with the two emergencies.
Hospital campaigners say lives were put at risk and are warning this situation will arise again when Cavan takes all surgical cases from Monaghan Hospital on 1 January.
Source RTE News
Surgeon death rates in spotlight
Friday 9 December 2005
Scotland's information commissioner has called on the NHS to publish details of the death rates of individual surgeons.
The health service has been reluctant to release figures in the past as they may be open to misinterpretation.
Officials insist that the best surgeons often take on the trickiest cases and could have lower survival rates.
However, information commissioner Kevin Dunion said the public had a right to know and was perfectly capable of understanding the figures.
Not technical
Mr Dunion has been tasked with ensuring public bodies are conforming to the Freedom of Information Act.
NHS Scotland has a record of how many patients die under the care of individual surgeons and Mr Dunion has said that this information should be openly available.
Patients have been calling for more openness ever since the Bristol Royal Infirmary (BRI) scandal when surgeons were found to have continued carrying out heart operations on children even though they had higher than average death rates.
A handful of hospitals in England have independently published individual information already and several more are considering it after requests under the Freedom of Information Act.
Mr Dunion has now recommended the publication of such information north of the border.
He said that as the information was not technical, the general public was perfectly capable of interpreting it.
President of the Royal College of Surgeons of Edinburgh John Smith said it was right to inform the public, but any league table had to be comprehensive.
Mr Smith told BBC Radio's Good Morning Scotland programme: “Bland figures about how many people die as a result of a particular surgeon operating don't take into account the other factors that have to be borne in mind.”.
'Meaningful data'
“It's not just the surgeon, it's the whole team involved in looking after the patient who contribute to the outcome.”
“And it is obviously to do with the patient themselves.”
Maria Shortis had a daughter who died in the heart surgery scandal at BRI between 1991 and 1995.
Ms Shortis said she welcomed more openness, but had concerns about how the public would view the figures.
She said: “Any information that's put out in league tables, unless it's meaningful and has been risk stratified, could just be used to place people against one another and I'm not sure that's useful.”.
“So it has to be meaningful data.”
Story from BBC NEWS:
© BBC MMV
New clues on young heart deaths
Friday 9 December 2005
Scientists from Cardiff University claim to have made a breakthrough in unravelling the cause of sudden cardiac death (SCD) in young people.
Researchers at the Wales Heart Research Institute examined the cause of the syndrome, which is believed to be hereditary.
The team said work is now being carried out to develop new therapies.
Daniel Yorath, 15, the son of ex-Wales football manager Terry, is among those to have died from the condition.
In their research, the Cardiff University team identified that certain heart channels which release calcium mutate, which prevents them closing properly.
Too much calcium is then released which is believed to lead to disrupted heart rhythms and cardiac arrest.
Dr Christopher George led the research, which was funded by the British Heart Foundation.
He said that the new findings will help to discover treatments to stabilise the condition in people who have the faulty gene.Dr George said work was already being carried out to develop a new therapy which scientists hope will restore proper channel closure and prevent SCD in susceptible individuals.
“This is crucial new evidence that mutation-linked abnormalities in cardiac calcium release may arise from defects in the channel structure,” he said.
“Although there is a long way to go, this finding gives us vital clues that the precise stabilisation of these channels may represent the best way to prevent this catastrophic disease in people containing this faulty gene.”
Daniel Yorath was 15 when he collapsed in 1992 as he was playing football with his father in their back garden.
Daniel, who had just signed schoolboy forms with Terry Yorath's former club Leeds United, died from a heart condition known as hypertrophic cardiomyopathy, one of conditions under the umbrella of SCD.
Story from BBC NEWS:
© BBC MMV
The Health Profession Council's December's Newsletter, HPC In Focus, is now available.
Friday 9 December 2005
This issue and November's, (Issue 1), are available to download from their website.
In this issue:
- Tips for maintaining your HPC Registration
- HPCheck public website launched
- Report from listening Events in Scotland
- November Fitness to Practise hearings
- Interview with a Registration Assessor
- Scope of Practice
Old Operating Theatre Museum moves from attic to crypt
Tuesday 6 December 2005
Southwark's Old Operating Theatre, Museum and Herb Garret will be moving temporarily from the attic to the crypt of St Thomas' Church while essential repairs are carried out on the roof.
Seldom before seen by the public, the crypt opened on Monday with medical exhibitions, artworks and a programme of events.
Built by Christopher Wren's master mason Thomas Cartwright and completed in 1703, St Thomas' Church is the oldest surviving part of the original St Thomas' Hospital. The double vaulted crypt was used for the storage of coffins, and is thus known as the Coffin Crypt. For a while, the crypt was rumoured to have been the location of the hospital's operating theatre, until the rediscovery of the actual theatre in the church attic in 1956. During 18 weeks of roof repairs to the attic, this historic venue will at last be open to the public, six days a week.
As well as medical exhibits, the crypt will also house a workshop area, providing family friendly activities for children in the new year, and a replica theatre for demonstrations of Victorian surgery, as well as an expanded gift shop. The crypt will also be the venue for the display of part 2 of the current "Suture" exhibition - visceral interactive video art by Phillip Warnell and Richard Squires, incorporated into the museum's medical displays.
This will be an exciting new opportunity for the museum to expand on what is currently being offered to the public," said museum director Kevin Flude. "The additional space means that a workshop area can be provided, so that the museum as a whole will become much more interactive and child-friendly."
The Trustees of the Old Operating Theatre Museum and the Trustees of the Borough High Street Amenity Foundation are assisting Chapter Group Plc in the funding of the repair of the roof of St Thomas' Church. These repairs are part of a schedule of restoration of the fabric of the entire property, which is a grade 2* listed building. The restoration is supported by Southwark Cathedral, Southwark Council, and English Heritage.
The church - which ceased to be a place of worship in the late 19th century - was damaged during the building of the Jubilee Line Extension in the mid-1990s. In 2004 the church was placed on the Buildings at Risk Register.
Source: London SE1 website team
NHS trusts 'delaying operations'
Saturday 3 December 2005
Hospitals have been told to delay operations to reduce debts faced by primary care trusts, according to reports.
The trusts involved are said to be trying to postpone paying for operations until the new financial year begins in April.
But the Government has washed its hands of the practice, saying it was an “operational issue for the local NHS”.
It comes just two days after Health Secretary Patricia Hewitt admitted the health service could be facing a deficit of £620 million.
A letter leaked to today's Times reveals hospitals within Harrow Primary Care Trust, which is reportedly facing an £8-12 million deficit, have been told to delay surgery.
The document, written by Dr Ken Walton, chairman of the trust's professional executive committee, tells GPs it has “reluctantly” asked hospitals to “do the minimum required to meet national targets”.
It says: “This means that patients sent for outpatient appointments will only be seen at 10-13 weeks (national target 13 weeks) and elective surgery will be delayed until the sixth month (national target six months).”
In a statement, the trust defended its policy.
It said: “Harrow PCT is taking action to control its expenditure that will not affect the quality of care given to its patients. All patients in Harrow will be seen within national targets.”
Similar practices are also reported to be taking place to save money at trusts elsewhere in the country.
Source: icScotland.co.uk
American Heart Association Announces Updated Emergency Care Guidelines
Saturday 3 December 2005
DALLAS, TX -- November 2005 -- New emergency care guidelines include dramatic changes to cardiopulmonary resuscitation (CPR) and emphasis on chest compressions, according to authors of the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
The guidelines are published online and can be accessed from: http://www.americanheart.org
Health Regulator suspends Reading Operating Department Practitioner
Friday 2 December 2005
An ODP from Reading, Berkshire has been suspended for a year by the Health Professions Council (HPC). A panel of the Conduct and Competence Committee met on the 30th November 2005 to consider the case of David Miller in Kennington, London.
The panel met to consider the allegation that Mr. Miller's fitness to practise as a registered health professional is impaired by reason of his misconduct whilst employed at the Princess Margaret Hospital in Windsor.
The basis of the allegation is that on 13th January 2005 Mr Miller was on duty at the Princess Margaret Hospital, Windsor, and when he was required to be in the operating theatre, he was found in a toilet cubicle with a syringe next to him. The syringe contained fluid which was later analysed and found to contain Codeine, a Class B drug, and Ketamine. The Council's case is that Mr David Miller had injected himself with these drugs.
The Panel heard evidence from 7 witnesses and found them all to be credible. Accordingly, the Panel is satisfied to the appropriate standard that Mr Miller did inject himself with Codeine and Ketamine whilst he was on duty on 13th January 2005 and was found to be in a state of collapse. There was no evidence submitted to show that the use of this drug combination was clinically necessary. By virtue of this act he impaired his fitness to practise by way of misconduct. Under the Standards of Conduct, Performance and Ethics of the Health Professions Council, Mr Miller did not act in the best interests of patients, clients and users. Nor did he maintain high standards of personal conduct. He did not carry out his duties in a professional and ethical way and acted in a manner which would damage the professions' reputation.
Accordingly, the Panel finds the allegation well founded.
Paul Archer, Chair of the Panel said: “Taking account of Mr Miller's previous good character and that there was no evidence submitted to question Mr Miller's competence. The Panel has decided to suspend Mr Miller's registration for a period of one year. In all the circumstances the Panel believes this to be a proportionate sanction which will protect the public and maintain confidence in the profession.”
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 people who do not meet these standards or who use a protected title illegally.
Royal College of Nursing launches new guideline for fasting before surgery
Wednesday 23 November 2005
The guideline will be launched at the Preoperative Association Conference. The aim of the guideline is to address current variations in fasting practice to the benefit of patients. Under the new guidance the Royal College of Nursing (RCN) recommends patients can be given water and clear fluids 2 hours before general anaesthesia and 6 hours for food. Babies can be given breast milk 4 hours before general anaesthesia. Providing clear guidance will benefit patients in many ways, increasing comfort and well-being prior to surgery and by reducing symptoms such as dehydration and nausea.
The Quality Improvement Programme at the RCN Institute produced the guidance working with a multi disciplinary guideline development group. RCN members identified the need for clinical guidance on this topic, to help nurses and other healthcare professionals deliver evidence based care and improve patient outcomes. The guideline has been endorsed by leading professional organisations such as the Royal College of Anaesthetists.
Dr Ian Bullock, Senior Research and Development Fellow said: “We hope this guideline will be used for adapting policy across trusts and help standardise practice, improving patient experience before and after surgery”.
RCS PRESIDENT CALLS ON PRIME MINISTER TO RELEASE SURGEONS-IN-TRAINING FROM EUROPEAN WORKING TIME DIRECTIVE
Thursday 17 November 2005
Mr Bernard Ribeiro, President of The Royal College of Surgeons of England, has written to the Prime Minister asking him to try to secure an opt-out arrangement from the European Working Time Directive for surgeons-in-training in the UK. Mr Ribeiro has told the Prime Minister that the EWTD's undue emphasis has had a detrimental impact on the quality of surgical care provided to patients in the UK.
Mr Ribeiro, who became President of the RCS in July, continues to work at Basildon University Hospital. He draws on his personal experience to describe surgical trainees' feelings at being unable to provide total care for their patients and their frustration at losing training opportunities.
“Surgery is a craft specialty”, he tells the Prime Minister, “that requires substantial time in which to gain essential operative skills. At the same time, it is about being with the patient on the whole of his or her 'journey', providing the reassurance of continuity”.
The EWTD became law for junior doctors in August 2004. It reduced the working week to a maximum of 58 hours. In 2007 the working week will be further reduced to 56 hours, and possibly to 48 hours by 2009 (this could be extended to 2012).
Before the introduction of the EWTD, most senior house officers (SHOs - the junior category of surgical trainee) were either resident on-call (ie they could rest at the hospital in between periods of activity) or non-resident on-call (ie on call from home and only called in to the hospital for emergencies). Now, more than half of them (57%) are working shifts of up to 13 hours, followed by 11 hours continuous rest in every 24-hour period. Of these, almost half are working one week of nights in seven (1:7) in this pattern, or more frequently.
In this working period, SHOs are largely providing service work in hospitals rather than receiving the direct training which is vital to their career progression. Little surgical activity takes place at night and so SHOs working full shifts at night lack training opportunities. In addition, they miss out on daytime training (when most surgery is carried out) because they have to take compensatory rest after night work. This results in them spending less time with their trainer(s) and having less training time in theatre.
Full shift night working creates problems with trainees' concentration and learning, and this is more marked after the fourth consecutive night on call.
A Safer Place for Patients:
learning to improve patient safety
HC 456 2005-2006 Report by the Comptroller and Auditor General
Thursday 3 November 2005
According to a report by the National Audit Office published on the 3rd of November 2005, around a half of incidents in which NHS hospital patients are unintentionally harmed could have been avoided, if lessons from previous incidents had been learned. Whilst reporting has improved at the local level, at the national level progress on developing a national reporting and learning system has been slower than envisaged in the Department of Health's 2001 strategy 'Building a safer NHS for patients'. Overall, there remains a clear need to improve evaluation and sharing of lessons and solutions by the large number of organisations with a stake in patient safety. There is also a need for a clear system for monitoring that lessons are learned.
The report by head of the NAO Sir John Bourn on progress made by the NHS in improving the patient safety culture concludes that, at the local level, the vast majority of trusts have developed a predominantly open and fair reporting culture, driven largely by the Department's clinical governance initiative and more effective risk management systems. There are, however, trusts where a blame culture still predominates. There is also scope for trusts to improve their strategies for sharing good practice.
An NAO survey found that, in response to the encouragement to report, there have been year on year increases in the number of patient safety incidents and in 2004-05, there were around 980,000 reported incidents and near misses. Patient safety incidents are estimated to cost the NHS some £2 billion a year in extra bed days.
A retrospective study of patient records in two English hospitals found that just over 10 per cent of patients experienced an 'adverse event'. Around half of these (5.2 per cent) were judged to have been preventable. Responses to the NAO survey showed that, in 2004-05, trusts recorded some 2,081 deaths as a result of patient safety incidents, but it is widely acknowledged that there is significant under-reporting of deaths and serious incidents. Other estimates of deaths range from 840 to 34,000 but, in reality, the NHS simply does not know.
According to the NAO, trusts are now more likely to be fostering open and questioning communication between staff in teams. Almost all trusts reported that they had made progress in reducing the culture of blame; but surveys of nurses and other non-medical staff highlighted that they perceived that the blame culture continues to exist in the NHS. And there was still more to do to achieve a fully open and fair culture with regard to communicating with patients. In the NAO survey, 69 per cent of trusts had criteria for staff to follow, but only 24 per cent routinely informed patients when those patients had been involved in a reported incident. And six per cent of trusts did not inform patients at all.
All trusts had established effective reporting systems at the local level - although, despite the general increase in reporting, a substantial number of incidents still go unreported (an estimated 22 per cent, mainly medication errors and incidents leading to serious harm). Reporting of near misses is also low, mainly owing to different perceptions of what constitutes a near miss.
The roll-out of the National Patient Safety Agency's National Reporting and Learning System has taken two years longer than the December 2002 date originally envisaged. The new target date was for all trusts to report to the system by June 2005, but by August 2005 at least 35 trusts had still not reported any data.
Most trusts pointed to specific improvements derived from lessons learnt from their local incident reporting systems, but these lessons are still not widely promulgated, either within or between trusts. And the National Patient Safety Agency has provided only limited feedback to trusts of evidence-based solutions or actions derived from the national reporting system.
The NAO has made a number of recommendations aimed at enhancing and sustaining the development of an effective safety culture; improving the reliability and completeness of reporting; and encouraging learning and the development of effective solutions. For example: trusts need to evaluate their safety cultures and develop systems in which NHS employees need not fear blame or unequal treatment if they report incidents; and patient safety must become a core part of professional clinical training.
The report also recommends that there should be a clearer definition of 'near-misses' and encouragement of staff to report them and that the Department should explore the possibility of a single point to which all staff can report, for example, via the National Programme for Information Technology in the NHS.
Patients also need to be engaged by trusts in identifying important patient safety issues and in helping to design solutions. There should be better dissemination of learning between trusts. And the National Patient Safety Agency needs to expedite its evaluation and feedback programme and focus on developing solutions to nationwide problems with the Healthcare Commission taking responsibility for ensuring that appropriate solutions are implemented across the NHS.
Sir John Bourn said :
"Reducing unintentional harm to patients in NHS hospitals is a central tenet in the management of healthcare quality and risk. Two factors are crucial to this: the establishment of a culture in which incidents can be reported easily, honestly and without fear of blame; and the ability to ensure that lessons learned from these incidents are successfully promulgated to NHS staff both locally and nationally. What today's report shows is that the Department of Health and the NHS have made some progress in both of these areas - but not enough."
"There needs to be significantly faster progress at the national level in ensuring effective evaluation of numbers, types and causes of incidents. And lessons and solutions must be better evaluated and shared by all organisations with a role in keeping patients safe."
Reports are available from the date of publication on the NAO website.
Infection in orthopaedic surgery report 'lacks confidence'
Thursday 3 November 2005
Commenting on new statistics released by the Department of Health on surgical site infections (SSIs) in orthopaedic surgery, Chairman of the Association for Perioperative Practice (AfPP), Jane Reid, said:
“The results from the first mandatory survey of SSI in orthopaedics are interesting because the reported rates of infection are low and the infections detected are described as minor and not deeply embedded in the wound.”
“These results do however need to be interpreted with caution and questioned because many of the results are from very small samples. Additional factors which may undermine our confidence in the report concern the lack of attention to variables such as the age of the patient, the complexity of the procedure and perhaps more importantly the length of post-operative stay which will have an impact on the data collected.”
Ms Reid continued: “The results are useful because they are a base from which further investigation can be undertaken on how we reduce SSIs. For instance, some variation in the rates might be explained by differences in post-operative follow-up techniques. It should be possible to examine these, identify and implement best practice to minimise infection and enhance the care of patients.”
AfPP host an orthopaedic Specialist Interest Group on their website. Any Association member wanting to access more information on orthopaedic issues can use this area by visiting www.afpp.org.uk.
The Department of Health report is available by clicking here.
Health Professions Council launch newsletter
Sign up for the first issue of 'HPC In Focus'
Thursday 3 November 2005
The Health Professions Council today launched the first issue of its newsletter titled 'HPC In Focus', designed to keep people informed about its work. Marc Seale, Chief Executive said... “We feel that it is very important to communicate with our stakeholders and this newsletter will enable us to do so more effectively.”
The newsletter will be available at the beginning of each month and will be sent by email to everyone who subscribes by emailing newsletter@hpc-uk.org. It will also be available on-line at www.hpc-uk.org/publications/newsletter.
The first issue contains an update on renewals, recent fitness to practise hearings and a report from the first meeting of the professional liaison group who are drafting information for continuing professional development. It also contains a special report on consultations, looking at why HPC consults and how people can get involved in the decision making process.
NHS Waiting Lists Can Be Eliminated
- Claims John Petri, a practicing NHS surgeon
Tuesday 19 October 2005
Whilst others talk of reducing NHS waiting lists, John Petri, a practicing orthopaedic surgeon from the James Paget Hospital, Great Yarmouth and a nominee for the 2005 Medical Futures Innovation Awards claims that they can be completely eliminated.
He cites himself as a practical example of how a focus on "surgeon utilisation" rather than "theatre utilisation" led to a three-fold increase in the number of operations he performed and a subsequent reduction in patient waiting lists from over a year, to just a few weeks. "Patients can be offered a date for their operation, at a time which is convenient for them," claims the enterprising surgeon.
"In France, the infrastructure is more efficient so waiting lists are not a problem. All I have done is to apply my French experience to the UK system and I have abolished my waiting list" claims the French trained surgeon.
His simple solution to the problem of long NHS waiting lists is to maximise the surgeon's operating time by working closely and efficiently with his anaesthetic colleagues. When implemented, 'The Petri System' can increase surgeons' utilisation by almost 90%.
"Previously I was spending most of my time kicking my heels rather than operating which is what I am paid for", said Petri. "We don't really need more staff or even have to throw more money at the problem: we just need to utilise existing assets better" he added.
John Simpson, President of the Royal College of Anaesthetists and a Judge for the Medical Futures Innovation Awards comments, "This innovation shows that a harmonious working relationship between the surgeon, anesthetist and the entire theatre team can lead to efficient and safe clinical care. This demonstrates that a motivated and empowered clinical team is able to improve service delivery from the ground up."
John Petri is one of 40 nominees in this year's Medical Futures Innovation Awards to be announced on the 3rd November 2005.
The Awards, which were set up in 2001 by a practicing NHS doctor, Dr Andy Goldberg, are designed to encourage and promote a culture of creativity, innovation and leadership amongst healthcare professionals and facilitate the successful commercialisation of these ideas.
This year's winners will be announced on Thursday 3rd November 2005, at Old Billingsgate, London
BETTER NHS RESPONSE FOR PATIENTS HARMED BY HEALTHCARE
Friday 14 October 2005
Under the NHS Redress Bill published today, patients will no longer have to go to court to get compensation, care, apologies and investigations if something goes wrong with their NHS hospital treatment or care.
The NHS Redress Bill gives the Secretary of State the power to establish an NHS Redress Scheme and place a duty on providers and commissioners of hospital services to ensure patients receive a more consistent, speedy and appropriate response to clinical negligence. The scheme will cover low monetary value claims, with the initial upper limit expected to be set at £20,000. It is designed to offer patients a real alternative to litigation, avoiding the long delays and legal costs typical of the current system.
Other key elements of the NHS Redress Bill and Scheme include: - Provision for patients to receive redress in the form of care. - A duty on all scheme members to appoint an appropriate person responsible for learning from mistakes. - A more proactive approach to clinical negligence, with the onus no longer on the patient to initiate a claim. All scheme members will be required to review adverse incidents and trigger the scheme themselves, where appropriate.
The aim of the scheme is not to cut costs, but to ensure NHS money goes directly on benefiting the patient with less spent on legal costs.
Health Minister, Jane Kennedy says:
"The NHS Redress Bill means fairness for patients, not fees for lawyers. It is an important step in preventing a US-style litigation culture.
The vast majority of NHS patients receive safe and effective care, but we have to recognise that in our modern, increasingly complex health service, mistakes do happen.
We want to improve patients' experience of the NHS by giving patients what they tell us they want when something goes wrong with their care - an apology, an explanation of what's happened and action to put things right. We need to move away from the current way of responding to clinical negligence, which is characterised by variations in outcomes, long and complicated processes and legal costs that often exceed amounts paid out to patients.
The NHS Redress Bill enables us to provide a better and more consistent response to patients when something goes wrong with their NHS care. By understanding the implications of clinical negligence and giving practical support to patients and their families when things go wrong, the NHS will be in a better position to learn from mistakes and drive up the standard and quality of care provided in the future."
The NHS Litigation Authority (NHSLA), will be responsible for overseeing the Scheme and managing the financial compensation. Scheme members will be required to report all cases which may fall within the Scheme to the NHSLA. The NHSLA will then establish liability and, if appropriate, the level of compensation. If financial compensation is not appropriate, the patient will still have the right to receive an investigation, explanation, apology and, if appropriate, remedial care.
Steve Walker, Chief Executive of the NHS Litigation Authority says:
"The NHS Redress Scheme should enable us to deliver access to justice even faster and more economically in future."
The Bill published today sets out the broad powers needed to establish the NHS Redress Scheme. Details of the Scheme will be provided in secondary legislation which will be published for consultation after the Bill receives Royal Assent.
Gary Fereday, Policy Manager at the NHS Confederation says:
"We welcome today's Bill if it can succeed in its aim to make the cumbersome compensation process more effective."
"Where patients are entitled to compensation, they should get it more quickly and more efficiently. We will work with our members to ensure that the detail of the legislation will be workable for patients and NHS organisations on the ground."
The NHS Redress Bill builds on a commitment made in 2001 to reform the current clinical negligence system and the proposals set out in the Chief Medical Officer's report, "Making Amends". The NHS Redress Scheme is expected to come into force in 2007/8.
A copy of the NHS Redress Bill can be viewed at www.dh.gov.uk/actsandbills or www.parliament.uk
The NHS Litigation Authority is a Special Health Authority (part of the NHS), responsible for handling negligence claims made against NHS bodies in England. For more informaton www.nhsla.com
UK Health Regulator removes Operating Department Practitioner from Register
Friday 14 October 2005
An operating department practitioner from High Wycombe has been removed from the Register by the Health Professions Council (HPC). A panel of the Investigating Committee met to consider the allegation that an entry in the register relating to Mr. Hockley has been fraudulently procured in that he failed to declare in his application for readmission to the Register dated 3rd March 2005 his police cautions and convictions. The cautions and convictions were for a number of drug related crimes including possessing a class A drug and possessing a controlled drug with intent to supply.
Lionel Campuzano, Chairman of the panel, said.. "The Panel is satisfied that Mr Hockley failed to disclose the convictions referred to in the notice of allegation, did so knowingly and that accordingly his registration was obtained fraudulently. The panel is unanimously of the opinion that the Registrar should be ordered to remove his name from the Register."
The Health Professions Council is a UK wide health regulator set up to protect the public. It sets standards for thirteen health professions. The HPC only registers people who meet its standards for their professional skills, behaviour and health, and will take action against people who do not.
Can Perioperative Personnel Trust Their Protection in Theatre?
Launch of New ICNA, AFPP and AODP Endorsed Publication
"Trust and Protection"
Monday 26 September 2005
A new publication - "Trust and Protection" - endorsed by the Infection Control Nurses Association (ICNA), Association of Perioperative Practice (AFPP) and the Association of Operating Department Practitioners (AODP) - was launched at the ICNA conference in Torquay on Monday 26th September 2005.
This publication aims to raise awareness among theatre personnel of the vital importance of adopting best practice procedures, regarding their own theatre apparel and protocols in order to reduce their risk of infection.
The new Trust and Protection' publication highlights the main risk factors associated with working in the theatre environment, and outlines the best practice methods which should be utilised by all Trusts to ensure that their perioperative personnel are as safe as possible and therefore at minimal risk from infection.
This publication has been developed by an independent group of experts who are concerned that little legislation controls the use of theatre apparel, and that many theatre personnel simply focus on protecting the patient but take personal risks. The group reported that it was not uncommon for many theatre personnel to be unconcerned about the very real risk of contamination by a patient's blood or bodily fluids.
In light of the current infection rates within hospitals, the publication of 'Trust and Protection' is very timely as it aims to change behaviour and raise awareness of the potential dangers that theatre personnel are exposed to on a daily basis.
This new publication is the fourth in a series of highly regarded, AfPP (formerly the NATN) and AODP endorsed publications 'Under Scrutiny - Are You at Risk' (published August 2003), 'Considering the Consequences' (published February 2003) and the AfPP endorsed 'Surgical Drapes and Gowns In Today's NHS' (published May 2001). Together these publications act as a valuable resource for any health professional looking to make an informed decision about surgical drapes and theatre apparel used in the perioperative environment.
'Trust and Protection' has been compiled by an independent working group including representatives from theatre management, infection control, operating department practitioners and medical microbiology.
To receive free copies of the new 'Trust and Protection', publication as well as 'Under Scrutiny - Are You at Risk', 'Considering the Consequences' and 'Surgical Drapes and Gowns in Today's NHS' please contact hsdcommunications on 01923 777277 or email enquiries@hsdcomm.com.
CATASTROPHES IN ANAESTHETIC PRACTICE
- NEW ASSOCIATION GUIDELINES
Wednesday 14 September 2005
The Association of Anaesthetists of Great Britain and Ireland (AAGBI) launch a set of new guidelines today that aim to give practical guidance to anaesthetists who have encountered a catastrophe in their practice as well as guidance for colleagues and managers on how best to manage the situation so that public confidence is maintained. A particular emphasis is the recognition and support required and afforded to all those involved in a catastrophe - these may involve both practical as well as psychological support. The new publication "Catastrophes in Anaesthetic Practice" will be launched during the Association of Anaesthetists of Great Britain and Ireland's Annual Congress - Manchester, 20 - 23 September.
Although deaths due to anaesthesia are extremely uncommon, with an estimated incidence of 0.5-0.8 per 100,000 anaesthetics, anaesthetists are all likely to experience a death on the operating table at some point in their careers. In the majority of cases, death is expected and the cause is understood. However, the psychological impact on staff following death or serious injury to a patient should not be underestimated and each hospital must have a procedure for dealing with and investigating catastrophic events.
Dr Michael Wee, chairman of the working party comments: "As an organisation the Association recognises that catastrophes during anaesthetic practice can happen. This document aims to suggest pragmatic ways of dealing with the aftermath of a death or serious injury during anaesthesia - suggesting positive ways in investigating and preventing further catastrophes if there had been an equipment/drug/human error, and helping our fellow anaesthetists cope so that they are not a liability but continue to be an asset. The training and ethos of anaesthesia to avoid harm and maintain patient safety at all times puts additional stress on the anaesthetist, therefore it is vital that colleagues, hospital, Trust, family and society in general to provide practical help and support."
The guidelines "Catastrophes in Anaesthetic Practice" have been sent to all members of the Association, and interested groups and will be available to download from the Association of Anaesthetists Website.
Bomb hospital to close 100 beds
Thursday 10 August 2005
A hospital which played a key role in treating London bomb victims plans to shut 100 beds to save money. The Royal Free Hospital, in north London, which has 1,000 beds, said fewer patients would stay overnight in an attempt to tackle debts of £10.2m.
The trust said the deficit was a major factor in it dropping from a two star rating to zero stars in 2004/5.
But health workers union Unison said the closures "made no sense" while London was under threat of attacks.
The trust said no staff would be made redundant although some would be retrained.
And treatment would be made more efficient so patients would not need to stay in hospital for such long periods of time.
Those that did need to stay nearby would be offered on-site hostel or hotel accommodation.
This accommodation would need investment along with new theatre and radiology equipment, the trust said.
Andrew Way, the trust's chief executive, said: "I genuinely believe that although these changes are borne out of necessity, they present a real opportunity for the Royal Free to take a fresh look at how it provides many of its services and that can only be good for patients."
But Unison's Geoff Martin said: "The idea that you can prop this up with day surgery is completely flawed.
"We are moving into the busy winter period and with the continued threat of terrorist attacks in London, to be closing frontline services in the capital makes no sense at all."
The hospital treated 61 of the 7 July casualties and MPs in the House of Commons praised the hospital for its actions at the time.
Source: BBC NewsI C E
Thursday 14 July 2005
"In Case of Emergency (ICE)" Campaign
The Ambulance Service have launched a national "In Case of Emergency (ICE)" campaign with the support of Falklands war hero Simon Weston and in association with Vodafone's annual life savers award.
The idea is that you store the word " I C E " in your mobile phone address book, and against it enter the number of the person you would want to be contacted "In Case of Emergency". In an emergency situation ambulance and hospital staff will then be able to quickly find out who your next of kin are and be able to contact them.
Multiple contacts may be recorded using the format ICE1, ICE2, etc.
It's so simple that everyone can do it.
Clear standards and tough inspection for all healthcare providers
Friday 15 July 2005
Health Minister, Jane Kennedy, on the 15th of July launched new legislative proposals for Action on Health Care Associated Infections (HCAIs) In England, to form part of the Health Improvement and Protection Bill.
The four key components of the HCAI legislation are:
A new code of practice- A new duty on NHS bodies providing healthcare to follow the code with a parallel duty on the Healthcare Commission (HC) to assess compliance with it
- A new discretionary power available to the HC to issue an improvement notice
- Directions for improvement or sanctions which may be taken against those who, in the view of the Secretary Of State or Monitor, continue significantly to breach the code.
Relevant elements of the code will be reflected in regulatory arrangements under the Care Standards Act 2000 so that private healthcare establishments and care homes are also subject to enhanced standards on infection control.
Jane Kennedy said:
"Many NHS trusts have already made real improvements on hygiene and infection control. We want to make good infection control and hygiene practice a statutory duty for the NHS, with a detailed code of practice setting out the actions all healthcare organisations must implement."
"To underpin this the Healthcare Commission will have a new duty to assess performance and when necessary issue improvement notices. If, in exceptional circumstances, a trust fails to act appropriately on an improvement notice then steps to ensure quick action will be taken and powers to remove whole Boards or individual members will be used, where necessary."
"Because we know that HCAIs can occur in any setting where health care might be given, similar proposals will be extended to the private and voluntary health care sectors and to care homes. These proposals will require amendments to regulations made under the Care Standards Act and will be subject to separate consultation in the autumn."
The hygiene code covers a wide range of areas. Requirements for NHS bodies include:- appropriate systems to minimise the risk of healthcare associated infections and defined responsibilities for infection control
- a Director of Infection Prevention and Control
- a Board approved and reviewed infection control programme
- a Board approved cleaning strategy with specified cleaning procedures and frequencies
- providing written information for service users and the public
- education and training for all staff on healthcare associated infection
- audit evidence that policies are implemented and reviewed
To make real progress on hygiene and infection control means taking responsibility throughout the organisation with clear management arrangements, strong clinical leadership and clear minimum standards and guidance on infection control that everyone sees as part of their job. The code will help ensure this happens and will work in conjunction with existing guidance and tools such as Towards Cleaner Hospitals, Winning Ways and the Saving Lives framework. The code will also need to be updated to reflect changes in practice and developments in knowledge and will therefore exist in a form that allows updating.
Compliance with the code will be assessed by the HC, who will be under a parallel duty to satisfy themselves that those bodies to which the code applies conform to it in full. It will be for the Commission to consider how best it might assess compliance. The Government expects that assurance will form part of the Commission's annual performance assessment against the standards and targets. The Commission's approach is set out in detail in their recent publication "Assessment for improvement".
There will be specific powers to enable the HC to issue improvement notices. It will be at the discretion of the Commission whether to issue such a notice where it is of the opinion that there has been a significant breach of the code. The decision to issue an improvement notice will usually follow discussion between the service provider in question and the Commission and is only likely to be taken when the Commission is concerned at the adequacy of the response of the organisation.
The improvement notice will set out clearly those elements of the code in which the establishment is in breach and will also define the period of time that the HC considers reasonable to effect compliance. In addition, the HC may recommend steps to be taken in order effectively to ensure compliance. However, where it makes such a recommendation it will be advisory only. It will be for local management to determine the measures it needs to put in place to comply with the code.
The Secretary of State and Monitor, as the regulator for NHS Foundation Trusts, already have a range of powers to require a NHS organisation to take specific actions. If the Commission judges that an improvement order is not dealt with appropriately their response might range from requiring action such that the Trust would quickly comply with the requirements of the Code of Practice through to dismissal of the Board, or of individual members, where such action was appropriate.
Murray Devine, Safety Strategy Lead at the Healthcare Commission, said:
"Our key role as a regulator is to promote improvement in the quality of healthcare and public health. We welcome the concept of a statutory code of practice as an additional tool to help lever in improvement in an area of great concern to patients and the public."
Day surgery theatres operating for only 16 hours a week
Monday 11 July 2005
Better use of day surgery could free hospital beds with no extra investment
Hospitals could reduce pressure on ward beds and bring down waiting lists, and at the same time provide better care for patients, by using day surgery more efficiently, the Healthcare Commission says in a report published today (Monday).
Forty-five percent of the theatre time allocated for day surgery is not being used because of cancelled operations, late starts, and excessive delays between operations. The result is that, on average, day surgery theatres are only being used 16 hours a week.
The Healthcare Commission's report on day surgery in England found that at least an extra 74,000 patients a year could have day surgery, rather than be admitted as inpatients, if the least efficient units started employing the practices of the best. This would release inpatient beds for operations on other patients.
The report comes following the Secretary of State for Health, Patricia Hewitt, warning that high levels of investment in the health service won't continue indefinitely and that there is "a potential pot of gold" to be gained through efficiency savings.
Anna Walker, chief executive of the Healthcare Commission said: "Efficiency and good patient care go hand in hand. When operations are cancelled or when patients stay overnight for something which could be done in a single day, patients are inconvenienced and resources are wasted".
"Our report shows that there is already capacity within the NHS to treat 74,000 more patients a year in day surgery and by doing so, hospital beds would be freed up. NHS trusts need to build on the local reports that they have already received as part of this review and investigate why more day surgery is not being done and do all that they can to reduce cancellations. The worst performers need to learn from the best. We will be talking with the trusts, the Department of Health, Monitor and the strategic health authorities to ensure the lessons in this report about the scope for greater efficiencies are acted on".
The detailed study, which looked at the way day surgery is conducted in 313 day surgery units in England, also found that one in every 10 day surgery units cancel more than a third of the available operating theatre sessions and many patients have their operations cancelled at short notice.
The study also found that overall staff numbers in day surgery units are rising faster than their activity. It shows that in nearly 40% of day surgery units, there is no single consultant in charge, a factor which may be hampering more efficient use of resources
However, the report does highlight considerable improvements in some aspects of day surgery, both in patient care and in the management and extent of day surgery. For example, more patients are now receiving good written information prior to being admitted for surgery as compared to four years ago. More patients are also being given the opportunity to choose a convenient date for their operation and more individual appointments are arranged so that patients wait do not have to wait so long for their operations. The number of patients who fail to show up for their appointments has also fallen.
The report recognises that the total number of day surgery admissions for 25 suitable common procedures has increased by 12% over the last four years. However, the bulk of this increase is accounted for by cataract operations. For a number of these common procedures the proportion of admissions that are for day surgery has gone down.
Anna Walker commented: "It is good to see that the patient experience of day surgery has improved over recent years. I'm particularly glad that more information is being given to patients and that they have greater choice over the time of their operation. However, there also needs to be a named consultant responsible for every day surgery unit in the country so they can champion further improvement".
Further information on the Healthcare Commission is available on www.healthcarecommission.org.uk.
Doctors clash over new role of surgical assistants
Monday 27 June 2005
Doctors are at loggerheads over a government proposal to allow nurses and physiotherapists to carry out simple surgical procedures.
The British Medical Association, which represents all doctors, today said the plan to train nurses and other health professionals to become surgical care practitioners (SCPs) is "seriously flawed" and should be "significantly changed".
The association claims that the proposal means SCPs will be able to work independently and unsupervised in hospital theatres.
But the Royal College of Surgeons of England (RCS) - which is responsible for education and training standards - helped draw up the consultation document on the SCP proposal and says the BMA has got its facts wrong.
Consultant surgeon Linda de Cossart who chaired the working party that drew up the proposal and is a member of the RCS, said: "There are certain people who are determined to eliminate this project. I think it's all about how you interpret the words 'working independently'."
She said that SCPs would work under the supervision of a consultant surgeon in the operating theatre and they would be able to assist with operations.
Ms de Cossart said: "That has always been the intention and was written, I think, very clearly. But how people read things is interpreted by their mind."
The consultation document on the proposal for SCPs was published at the end of March. The deadline for comments expired last week.
But in a statement released this morning the BMA said: "Doctors were deeply concerned that under the proposals SCPs will be able to work independently."
The BMA wants SCPs to be supervised by surgeons and to face the same kind of regulation as doctors. Until a proper regulatory framework for SCPs was established any plan to expand their number in the NHS should be postponed, it said.
Alan Russell, a deputy chairman of the BMA's consultants committee, said: "The most important characteristic of a surgeon is not only their technical skill in any given procedure but their judgment and ability to make a decision about what is the appropriate treatment, how to respond to the unexpected and to recognise when they have reached the limit of their expertise.
"It takes many years of training and experience to competently make these decisions but SCPs will only have a fraction of this expertise."
A spokesman for the BMA said: "At the moment the way that the proposed framework is set out there is no structure in place to prevent SCPs working without proper supervision."
He added that until a professional regulation framework for SCPs was in place the BMA was unlikely to change its views.
A Department of Health spokeswoman said: "Surgical care practitioners are skilled practitioners who will be able to carry out simple surgical procedures - freeing up doctors to deal with more difficult cases.
"SCPs will always be part of the surgical team. The consultant will decide what can, or cannot, be delegated to them and the consultant retains overall responsibility for the patient."
She added: "The role of a surgical care practitioner is not a new one - some NHS staff have been performing this type of role since 1989."
In March, when the health minister Lord Warner announced proposals to expand the number of SCPs working in the health service, he said they would boost the professional skills mix and help reduce waiting lists.
The two-year training programme to become an SCP will be offered to nurses, physiotherapists and operating theatre assistants.
Source: Guardian Unlimited Debbie Andalo
Friday June 24, 2005
Anaesthetist job plan for nurses
Thursday 9 June 2005
The NHS in Scotland is considering training nurses, science graduates and other hospital staff to look after the anaesthesia of patients during surgery.
The move is designed to tackle a growing shortage of the experts.
The so-called anaesthesia practitioners would monitor the condition of a patient during minor operations.
Under the proposals, a fully trained consultant anaesthetist would always be present when the patient went under and came round.
They would also be nearby if needed.
The system is already being piloted in England, and is commonly used in Europe and the United States.
Highly Trained
Any pilot in Scotland is not expected before the autumn.
An anaesthetist is a highly trained medical doctor whose function it is to make patients insensitive to pain during surgery.
He or she will monitor the way the body responds before, during and after the anaesthetic is administered.
There are more than 8,000 anaesthetists in the UK who are involved in the care of two-thirds of all hospital patients.
As well as preparing patients for surgery, they are involved in acute and chronic pain management, leading resuscitation teams and managing intensive care units.
Story from BBC NEWSPublished: 2005/06/06 16:13:14 GMT © BBC MMV
Health Professions Council joins teams with the FA to show rogue practitioners the red card
Monday 24 May 2005
The Health Professions Council (HPC) has launched an awareness campaign aimed at alerting patients to the fact that some healthcare professionals may not be what they seem.
They have enlisted the support of The Football Association (The FA) to raise awareness of a new initiative to protect patients from rogue practitioners who may falsely be laying claim to a protected title.
The HPC are calling on consumers to protect themselves by checking the on-line register of more than 150,000 professionals to ensure their practitioner is fit to practice. Healthcare professionals using a title regulated by the HPC have until 8th July to prove they meet national standards for their professions and to register. A failure to register will mean a practitioner breaking the law if they continue to use the title.
The HPC have been working with top science and medicine officials at The Football Association to ensure that physiotherapists employed by leading clubs in England and Wales register themselves before the July deadline.
The HPC have conducted independent research among 100 football physios representing top clubs in both England and Scotland. The research revealed that of 100 physios questioned, 43 had still not registered with the HPC. Following consultation, 39 of the 43 have said they will take steps to register, while The FA has worked with the HPC to distribute registration application packs.
Alan Hodson, Head of Exercise Science and Medicine at The Football Association said: “I am pleased to be supporting the Health Professions Council at the launch of what is an important public protection campaign."
“As leaders in the field of sports medicine representing physiotherapists at the very top of their field, The Football Association is committed to ensuring all our physios are both aware of the July deadline, and are aware of all steps necessary to register."
“This is an important initiative and I would urge every patient visiting a healthcare professional to ensure the person they are seeing is both registered and fit to practice. There is a tendency for both the public and patients to assume that healthcare professionals are fully qualified and competent, but sadly this is not always the case. By consulting the HPC register, patients now have the tools to protect themselves.”
An independent body and separate from both the National Health Service (NHS) and Department of Health (DOH), the Health Professions Council is responsible not only for establishing and maintaining the register but also taking action against registered professionals who do not meet the professional standards it sets.
Between April 2004 and 31 March 2005, the HPC investigated complaints against 172 healthcare professionals, imposing a range of penalties that included both suspension and practitioners being struck off the register.
Marc Seale, HPC Chief Executive and Registrar said: “The Health Professions Council has been working exhaustively over the last two years to consult with our 13 healthcare professions and to explain why it is so important, both to the public and to the professionals themselves, that they chose a registered health professional."
“With the 8th July deadline fast approaching, the time is now right to raise awareness among the UK public and patients as to the role of the register, how they access it, and how they can register any concerns or complaints they have about a healthcare professional."
“More importantly, after 8th July, the HPC will have real teeth in being able to protect the public by preventing rogue practitioners from using a protected title and, indeed, potentially suspending or striking a professional off the register if their performance falls below agreed standards of conduct, performance or professional ethics."
“These are very exciting times and it seems fitting in what is the week following the FA Cup Final that The FA is supporting us in this important public protection campaign. Physiotherapists working for our top football clubs are among the cream of their profession and I am delighted that The FA has been so forthcoming in their support of the HPC and registration.”
The HPC register can be accessed online at www.hpc-uk.org. The HPC is urging members of the public to check that their healthcare professional is registered before making an appointment and to contact them if they believe someone is using a protected title but is not registered. In addition, anyone who wishes to register a complaint about a registered healthcare professional can do so by contacting the Fitness to Practise Department at the HPC on 020 7840 9814.
DRIVE TO REDUCE SPENDING ON AGENCY STAFF
Friday 20 May 2005
A scheme to reduce NHS spending on agency staff was announced today by Health Minister Lord Warner.
Speaking at a conference in London, he welcomed the launch of the Reducing Agency Costs Project, a scheme that brings together 30 NHS Trusts from across England.
The project, led by South West London Strategic Health Authority and NHS Professionals, aims to reduce participating Trusts' spending on agency staff by drawing on good practice from across the country.
Last year the NHS spent just under £1.45 billion on agency staff, which accounted for 5.06 per cent of the total NHS spend on pay in England.
Targeted actions to reduce the NHS spend on agency nursing, particularly in London, resulted in savings of £65million last year.
Lord Warner said:
"Temporary staff can provide an essential service to the NHS by providing care to patients on a flexible basis but costs of agency staff in the NHS have been rising too rapidly.
"The implementation of Agenda for Change and Improving Working Lives means that staff in the NHS now benefit not only from improved pay and conditions but increased access to flexible working schemes including part-time working, self-rostering and flexible retirement.
"I believe it is important that Trusts' manage their flexible workforce requirements in the most economical and effective way possible and this means reducing spend on agency staff.
"There is growing evidence that demand for often expensive agency staff can be managed down through better planning and more flexible use of NHS staff. For example, Nottingham City Hospital reduced their agency spend by £900k last year after working with NHS Professionals.
"If Trusts do use agencies they should work with those who the NHS's own Purchasing and Supplies Agency has already developed agreements. This ensures we maximise the collective buying power of the NHS to drive down costs and raise quality standards."
Carmel Flatley, Chief Executive of NHS Professionals said:
"This programme provides a real opportunity for the NHS to take more control of the temporary staffing agenda.
"NHS Professionals will support the sharing of best practice and provide practical example of how working together Trusts are able to make flexible staffing an integral part of their overall workforce strategy."
Julie Dent, Chief Executive of South West London Strategic Health Authority
said:
"South West London Strategic Health Authority is delighted to be overseeing this project. As Chief Executive of an SHA I strongly believe that NHS trusts, within a local health economy, have a responsibility as local employers to drive up standards of care by ensuring rigorous audit regimes are in place, and achieve best value for money by procuring staff through collective buying power achieved within Agency Framework Agreements."
STATEMENT FROM THE NEW SECRETARY OF STATE FOR HEALTH, PATRICIA HEWITT MP
Tuesday 10 May 2005
Patricia Hewitt MP said:
“I am delighted and honoured to be given the job of Secretary of State for Health. John Reid and Alan Milburn put in place a programme of investment and reform that is beginning to deliver results. I am determined to drive forward our plans to create a patient-led NHS in the direction set by the Prime Minister, while keeping up the pace of change set by my predecessors.”
“Over the next three months I will be doing a lot of listening and learning from the real experts - patients and staff. I intend to get around all parts of the NHS, finding out for myself what patients feel about the care they are receiving and shadowing staff as they carry out their duties. I will listen to everyone, whether medics or midwives, cleaners, porters or physiotherapists, stop-smoking teams or our new breed of personal health advisors.”
“As patients and consumers, we are better informed today about our health care than any previous generation. A modern health and social care system has to be completely focussed on the needs of its users. The 2 million people who work in the NHS and social care are also themselves patients and users. I know they all want to treat patients and users the way they and their families would want to be treated and that is the purpose of our reforms.”
Patricia Hewitt, was formerly Minister for Small Business and E-Commerce at the Department of Trade and Industry, Economic Secretary at the Treasury and Secretary of State at the DTI. Ms Hewitt has been a Member of Parliament since 1997. She was educated at the Canberra Girls' Grammar School and Newnham College, Cambridge University.
Patricia Hewitt was Press and Broadcasting Officer and Policy Coordinator to the then Leader of the Opposition, the Rt. Hon. Neil Kinnock; Deputy Director of the Institute for Public Policy Research, and Director of Research for Andersen Consulting. In 1993 Ms Hewitt wrote About Time, a book focussing on changes in work and family life. Ms Hewitt was Deputy Chair of the Commission for Social Justice and was a member of the Social Security Select Committee before taking up her Ministerial post. In her spare time, Patricia Hewitt enjoys reading, theatre, music and gardening. She is married with one son and one daughter.
Uniforms key to superbugs fight
Wednesday 27 April 2005
Nursing leaders, launching a 10-point plan to fight superbugs, say clean uniforms are key.
They set out how hospitals should tackle hospital infections at their annual meeting in Harrogate.
The Royal College of Nursing warned that poor NHS laundry facilities meant nurses could be carrying bacteria, including MRSA, on their uniforms.
It called for 24-hour cleaning teams and a confidential system for reporting staff who do not wash their hands.
10-point plan
The 10-point plan said nurses should be given enough uniforms to enable them to have a fresh outfit for each shift.
It also called for matrons to have mandatory powers over cleanliness standards in wards, and for each hospital ward to be given ring-fenced "ward environment" budgets of £5,000.
Hospital-acquired infections, including methicillin resistant Staphylococcus aureus (MRSA), are estimated to kill around 5,000 people each year in the UK.
Reducing the number of patients affected by "superbugs" has become one of the key health issues of the election campaign.
Contamination risk
A study published in Nursing Standard magazine showed only a quarter of trusts washed uniforms, meaning most nurses have to launder them at home, increasing the risk of contamination
Researchers surveyed 86 trusts in the UK.
Less than half - 47% - provided staff with enough uniforms to have a clean outfit for each shift, with 43% providing only three to four uniforms per nurse.
And 91% said staff had to wash their uniforms at home, although most were given inadequate instructions about how high a temperature was needed to kill any bacteria on the clothing.
Writing in Nursing Standard, researchers led by Kathryn Nye from the Health Protection Agency, said: “The potential for cross-contamination and spread of organisms such as MRSA within healthcare facilities, the homes of staff and the community is clear.”
“Minimum standards for uniform provision, changing facilities and laundering need to be agreed and introduced nationally as a matter of urgency.”
“One more uniform each”
RCN general secretary Beverley Malone said: “There has been a terrific amount of work to highlight the importance of hand-washing in combating MRSA.”
But she added: “It's common sense that healthcare staff should have a separate uniform for each shift they work, but we know this often isn't the case and the implications for infection control are obvious.”
“If the next government committed to providing just one extra uniform for each nurse working in the NHS today, they would need to provide 400,000 more uniforms.”
“But extra uniforms are just the beginning. We also need to make sure that hospitals provide laundry and changing facilities so that staff know their uniforms have been washed at a high enough temperature and that they are not forced to travel to and from work in them.”
“Some of our nurses report having to change in and out of their uniforms in ward toilets. This is completely unacceptable” she said.
Anger over MRSA summit snub
Monday 18 April 2005
Doctors and NHS bosses have been attacked for snubbing a conference on hospital superbug MRSA. About 1,400 health professionals have attended the Patients Association's summit on Thursday and Friday.
But the Patients Association hit out after only a handful of NHS trust chief executives and one doctor went.
Politicians, who were also attending the summit to set out how they would tackle the problem, were also critical.
Deaths linked to the superbug doubled between 1999 and 2003 to nearly 1,000 a year, according to a report by the Office for National Statistics in February.
But the government claimed last month it had turned the corner after latest figures showed that the numbers treated for the infection fell by 6% in the last year.
The Patients Association organised the Clean Hospitals Summit to come up with a plan on how to tackle the problem, inviting chief executives from nearly 200 NHS trusts.
Scores of trusts sent officials, but the conference organisers said they were disappointed the top bosses were not there.
Association trustee Vanessa Bourne, who shared a platform with MPs from the three main political parties, said:
“There have not been that many doctors and chief executives here.”
“Do they really think hospital acquired infection is not their business?”
“It is not good enough.”
Liberal Democrat health spokesman Paul Burstow said doctors and NHS trust chief executives “should have been” at the conference.
And Shadow Health Secretary Andrew Lansley added: “It is a pity.”
Health Minister Lord Warner said it was important everyone in the NHS worked together in partnership to fight MRSA.
A spokesman for the NHS Confederation, which represents health service managers, said: “It is up to chief executives to decide who they should send. It is certainly an issue that is very important.”
Source: bbc.co.uk
Nick Triggle - BBC News health reporter at the Clean Hospitals Summit
NEW TRAINING PROGRAMME HERALDS A NEW ERA IN UK MEDICINE
Monday 04 April 2005
New junior doctor training curriculum launched
A groundbreaking change in postgraduate medical training begins today with the publication of a new curriculum for junior doctors, part of the Modernising Medical Careers programme.
Under the new curriculum trainee doctors will have to demonstrate they are competent in a number of areas including communication and consultation skills, patient safety and team working as well as the more traditional elements of medical training.
Features of the Foundation Programme Curriculum include:- The framework for a structured two-year training programme which will give trainees exposure to a range of career placements across a broad spectrum of specialties including accident & emergency, obstetrics & gynaecology and anaesthetics. The programme aims to give each trainee the opportunity to have experience in primary care and provide opportunities for experience in smaller specialties and academic medicine, not normally available at this stage of training
- Explicit standards of assessment and structure supervision for trainees, where an educational supervisor will oversee each trainee and each post will benefit from a dedicated clinical supervisor
- The requirement for trainee doctors to learn a range of skills including communication, the undertaking and use of research, time management and use of evidence and data. Each of these skills will be assessed through an agreed method prior to completion of the programme.
Chief Medical Officer for England Sir Liam Donaldson said “The Foundation Programme curriculum marks a new era in UK medicine. For the first time, doctors will have the opportunity to explore a range of career options, while ensuring that their acute clinical and professional skills are secure and robust.”
“This is very much a 'curriculum for patient safety', ensuring that at the end of their two years of training doctors are both confident and competent and we are delighted that the UK is leading the world in innovations in medical education.”
Health Minister John Hutton said:
“The new two-year Foundation Programme will allow students a broader range of 'tasters' in areas of medicine they have not had access to before.”
“We are moving to a situation where 80 per cent of patient care will be provided in primary care environments so we want more trainees to spend time in places like GP surgeries and Walk-in Centres as the shift towards treatment in primary care settings rather than hospitals becomes the norm.”
Dr E M Armstrong, Chief Medical Officer of Scotland said: “The aim of the Modernising Medical Careers programme is to ensure that patients are seen and treated by trained doctors rather than, as at present, by doctors in training. To achieve this our young medical graduates need to acquire the requisite skills and competences to achieve specialist accreditation over a shorter period than has been the case in the past. The Curriculum for the Foundation Years in Postgraduate Education and Training is a key building block in this new process and I very much welcome its launch today.”
Chief Medical Officer to the Welsh Assembly Government Dr Ruth Hall said: “Graduates will have the opportunity to gain understanding of the whole range of NHS medical practice in their series of six four month attachments. This will strengthen the sort of NHS professional team working that we all wish to promote. It has been long recognised in educational circles that a second introductory year for doctors was required. In introducing this now we are delighted to say that the UK is at the forefront of worldwide educational practice. The new Foundation Programme ensures that doctors receive a structured training programme, regular assessments and good careers advice.”
Chairman of the Academy of Medical Royal Colleges Professor Sir Alan Craft said: “The curriculum is an important piece of work. It heralds a new era in medical training and education in the UK. As healthcare changes, the Foundation Programme curriculum will ensure that doctors going through the system are fit for the modern healthcare service.”
F2 pilot Dr Kate Grisaffi said: “My experience of the Foundation Programme has been very positive. I chose to do it because it gave me the opportunity to experience a wide range of specialties. The best thing about this being part of this pilot was developing the generic skills essential for all doctors - good acute care skills, communication and teamworking skills.”
The curriculum, officially unveiled by the Modernising Medical Careers (MMC) programme on 4 April, follows on from publication earlier this year of the General Medical Council's The New Doctor 2005. The key principles in The New Doctor 2005 have been used to shape the new MMC Foundation Programme curriculum, which is due to take its first influx of trainees this August.
Until 2007, Foundation Year 1 (F1) trainees will continue to undertake a year in PRHO-approved training placements, including at least three months in both medicine and surgery. As part of the ongoing development of F1, increasing focus will be placed on assessing core competencies gained along the training pathway.
A number of assessment tools are being piloted with over 1,750 trainees across the UK in order to develop a robust, validated process for proving a trainee's competence ahead of full General Medical Council (GMC) registration and progression into the second year of foundation (F2).
The foundation curriculum will ensure that trainees move seamlessly from F1 into F2 following assessment and subsequent GMC registration.
An electronic copy of the curriculum can be found at the Modernising Medical Careers website.
National Association of Theatre Nurses response to consultation on the Surgical Care Practitioner curriculum
Friday 25 March 2005
The National Association of Theatre Nurses (NATN) welcomes the Department of Health (DH) consultation on the Surgical Care Practitioner (SCP) curriculum that has been developed over the last fifteen months to underpin the SCP role. NATN contributed to the steering group on this issue.
Theatre Nurse leaders believe the curriculum will standardise the education for the SCP role and provide accreditation and quality assurance. This will in turn improve quality of patient care and safeguard public confidence.
Jane Reid, Deputy Chairman of NATN said: “Modernising medical careers, the introduction of Working Time Directives and ensuring patients receive their surgical care quickly, necessitates a review of the traditional demarcations between professionals. The Surgical Care Practitioner role provides an excellent clinical career route for registered professionals who wish to expand their scope of practice.
The benefits to patient care of registered professionals expanding their practice has been demonstrated through the New Ways of Working in Surgery pilots. Patients in particular have commented positively about their experience of being cared for by SCPs who have developed from a nursing, ODP and physiotherapy base.”
Mrs Reid continued: “However, we do not support the enthusiasm that is shared by some to widen the entry gate to include options for graduate direct entry. Whilst fully supportive of the NHS Careers Framework and the skills escalator, NATN wants to see more work undertaken in the area of graduate direct entry to safeguard standards of surgery and the quality of patient care.”
PATIENT SAFETY COMPROMISED BY LACK OF TRACKING AND TRACING FOR INDIVIDUAL MEDICAL DEVICES
Monday 14 March 2005
Unveiling the findings of its fourth special report into hospital acquired infection since 2000, the Patients Association today called for the adoption across the NHS of modern electronic “data capture” systems to allow individual medical devices to be tracked as they move around hospitals and external cleansing facilities. Many Trusts still use paper-based systems to record instrument usage, a potential threat to patient safety, according to new research published today by the Patients Association. The survey looked in particular at whether the back-up systems were in place to quickly withdraw problem medical devices, such as when a high cross-infection risk is identified from a previous patient.
“The findings of our latest survey on hospital acquired infection indicate that patient safety is not as good as it could be. Among the hospital professionals we surveyed, it would seem very clear that the current government guidance mandating the tracing of sets of instruments in trays is insufficient and doesn’t have professional support. I hope Ministers will take note and act to ensure improved tracking systems, tagging each and every instrument, are mandated across the NHS” said Simon Williams, Director of Policy at the Patients Association.
97% of hospital staff surveyed by the Patients Association said that the new generation of off-site sterile service decontamination “super centres” due to be built in the next few years need to have tracking and tracing systems for individual medical devices in order to guarantee effective patient safety. 78% of respondents said that better tracking systems would improve patient safety within current hospital facilities as a whole.
Explaining the findings, Simon Williams said: “Current Department of Health guidance only requires the tracking of trays of instruments, not individual items. This limits the effectiveness of attempts to trace instruments which have been used on a patient later found to have a high risk infection. Too many Trusts seem to be resisting investing in the latest systems because department of health guidance doesn’t call for full instrument tracking systems. This must be impacting on patient safety.”
The new 2004/05 Patients Association survey also reveals on-going fears among health professionals about the overall cleanliness of medical devices. This repeats the findings of the previous Patients Association surveys in 2000, 2001 and 2002. Almost a quarter of front line hospital professionals surveyed by the Patients Association at the end of 2004 reported frequent cleanliness problems with medical devices after the decontamination process had taken place. Around one-in-ten respondents said up to 5% of devices they saw had problems after cleaning. “In a large hospital that’s many hundreds of devices a year” said Simon Williams. The Patients Association is worried by such high levels of problems with cleaning when millions of pounds has been spent on new medical device decontamination equipment since 2001.
Simon Williams, Director of Policy for the Patients Association, said:
“This survey overwhelmingly shows that there is a strong need to track individual surgical instruments to protect patient safety using modern IT systems. With the development of the new network of super centres, the Department of Health needs to update its guidance to hospitals on the requirements for tracking and tracing systems. With the technology now available to individually code most medical devices the reasons for resisting this significant patient safety step must be few. The continuing concerns about overall instrument cleanliness we report today just add to the need for action.”
Copies of the reports are available on request and at www.patients-association.com.
These issues, and others, will be discussed at the Patients Association Clean Hospitals Summit on 14/15 April 2005 in central London. See www.cleanerhospitals.co.uk for more details.
Source: Response Source
Go-ahead for cancelled op ’fines’
Monday 07 March 2005
Hospitals will effectively be fined for cancelling operations and failing to offer a new date for surgery, Health Secretary John Reid has confirmed.
His pledge follows a row over Margaret Dixon, 69, whose operation on a broken shoulder has been repeatedly cancelled.
From later this year, a new date must be given within 28 days of ops being cancelled or they could be given to another hospital with money following.
The move completes a programme to give greater patient choice in the NHS.
But the Conservatives say hospitals are forced to cut back on operations in order to meet “distorting targets” set by ministers.
For 60 years, NHS hospitals had been able to hold onto cash to pay for operations whether the procedure was carried out or not, Mr Reid told ITV1’s Dimbleby programme.
“Coming into effect this year, the money will follow you to whichever hospital you go to,” he said.
“In other words, the hospital that cancels the operation will lose the money.”
’Exceptional case’
Last week, Tory leader Michael Howard challenged Prime Minister Tony Blair to explain why Mrs Dixon, of Cheshire, has had an operation to rebuild her broken shoulder cancelled seven times.
On Sunday, Mr Reid insisted Mrs Dixon’s case was “exceptional” as she not only needed surgery on her broken shoulder but also suffered from unrelated conditions including diabetes, obesity, renal failure and heart problems.
He acknowledged that about 67,000 NHS operations - or less than 1% of the total - were cancelled each year.
But he said that the rise in cancellations was largely due to an increase in the number of procedures taken every year.
The proportion cancelled had fallen every year since 2000, he said.
“What I’m saying is that, while I am happy to deal with those exceptions, the real question is, is the health service generally better than it was seven or eight years ago?”
’Leaked letter’
The Conservatives, meanwhile, have released the results of a survey of more than 70 NHS Trusts which they say show a combined deficit of £350m.
Many were already cutting back on operations or closing wards to try to make ends meet by the end of the financial year, shadow health secretary Andrew Lansley said.
A leaked letter from one primary care trust to a hospital instructed it to stop carrying out non-urgent operations for financial reasons, he said.
“The government is planning to fine hospitals because they don’t have the resources to meet the distorting targets set by ministers” Mr Lansley said.
“It’s time to stop wasting money on bureaucracy, targets and endless government agencies and instead to start spending money where it is really needed - in the front line.”
Awareness during General Anaesthesia
Wednesday 02 March 2005
“A recent television programme (’When Anaesthesia Fails’. Channel 4 February 28th 2005 ) highlighted the occurrence of patients being aware during surgery conducted under a general anaesthetic. There is no denying that such an incident is unacceptable and the experience will have a major adverse impact on the patient. As devastating as the effect can be on the individual patient, it is important to put such events into context.
The Association of Anaesthetists of Great Britain and Ireland has been in existence for more than 70 years and represents more than 9,000 anaesthetists. One of the founding principles of the Association was to encourage the development of the specialty with particular emphasis on patient safety. To this end, the Association has long had a Safety Committee that has worked with patients, industry and regulatory authorities to ensure that anaesthesia and its associated activities are delivered to the highest standard for patient safety. Underpinning this drive for safe anaesthesia has been the recognition of the importance of monitoring the patient throughout an anaesthetic; the Association document on Minimum Standards for Monitoring has become the accepted gold standard for anaesthetic provision. The most important contribution to patient safety is the continuous presence of a highly trained and skilled anaesthetist who has the benefit of modern equipment to deliver and monitor the patient’s condition.
Given this high level of recognition of the importance of monitoring, how is it possible for awareness to occur under general anaesthesia? The introduction of anaesthesia into clinical practice more than 150 years ago represented a watershed in healthcare; gone were the screams of pain and fear associated with surgery, to be replaced by unconsciousness. In order to allow major surgery in those early days, often large doses of anaesthetic were needed, and if insufficient was given, the patient would move and alert the anaesthetist to the need for more. The development of more complex surgery, led to further developments in anaesthesia. Profound muscle relaxation is necessary for major intra-abdominal and thoracic surgery; to achieve this with very high doses of anaesthetic would cause unwanted effects on the patient’s heart and other organs. The discovery of curare and the introduction of muscle relaxant drugs allowed such surgery with lighter levels of anaesthesia, but removed the important monitor of possible awareness - that of patient movement. Thus, a potential risk of awareness was of necessity introduced into anaesthetic practice so as to allow the development of life-saving surgery.
The risk of awareness under general anaesthesia is therefore not new to anaesthetists and over the years, many strategies have been used to prevent it and many methods used to detect it. What is important to stress is that explicit awareness (where a patient recalls events under general anaesthesia) is rare. This should not be confused with implicit awareness where the brain retains the ability to take information into the subconscious part of the brain but has no spontaneous recollection of the information. Unfortunately, most quotes of incidence as used in the aforementioned programme conveniently combine the two; the figure for explicit awareness, usually not associated with pain, is probably around 1 in 1000, and may be even lower. In many cases of explicit awareness, the underlying cause is found to be a technical fault in the method used to deliver the anaesthetic.
Modern anaesthesia is remarkably safe and has become so because of the vigilance of the anaesthetist and the development of monitors to allow accurate assessment of the patient’s vital signs. The monitors used in anaesthesia are highly sophisticated and are designed to give absolute accuracy in measurement. However, one area where there has been difficulty is achieving a monitor with this level of accuracy has been in the depth of anaesthesia. Over the years, the mainstay of monitoring for awareness has depended upon the body’s physiological responses (fast heart rate, sweating) being observed by the anaesthetist and appropriate action taken. Additional information can be obtained by techniques as the ’isolated arm’ as demonstrated in the aforementioned programme. In recent years, more sophisticated monitors that interpret brain activity (bispectral index analysis) or its response to stimuli (evoked potentials) have been developed and have started to be introduced into clinical practice. These seem to hold a deal of promise as reliable monitors of depth of anaesthesia, but given the rarity of explicit awareness in clinical practice, it make take some time before it is possible to say with absolute certainty that the monitor will always predict a state of awareness. The overall lack of funding for anaesthetic research in the UK makes it very difficult for anaesthetists to conduct robust research in such areas. Promises of additional central funding for medical research do not seem to extent to unsolved problems such as awareness.
Whilst in no way wishing to belittle any episode of awareness occurring under general anaesthesia, it must be set in context. Anaesthesia is very safe and explicit awareness is rare. Anaesthetists are well aware of the problem and have worked towards its elimination. If the current range of monitors prove themselves to be totally reliable, they are likely to be introduced throughout clinical anaesthesia. However, the cost of these monitors is not insignificant (about £5,000 per monitor) and hospitals with, say, 20 anaesthetics sites will have to balance that expenditure against other clinical needs.”
Professor Mike Harmer
President, Association of Anaesthetists of Great Britain and Ireland
The National Patient Safety Agency and The Royal College of Surgeons of England act to protect surgical patients
Wednesday 02 March 2005
The National Patient Safety Agency (NPSA) and The Royal College of Surgeons of England today jointly launched new advice to the NHS to help make surgery safer. The recommendations promoting “correct site surgery” encourage a consistent approach to marking the patient for surgery and provide staff with a checklist to ensure important steps have been taken to protect the patient.
This includes advice for surgical teams on where, how and when the patient should be marked to show where an operation should take place, who should mark the patient and the people who should be actively involved in the process.
The NPSA’s Medical Director, Professor Sir John Lilleyman said: “Mistakes during surgery can have devastating emotional and physical consequences for patients and their families. For the staff involved too, incidents can be distressing, while members of their clinical teams and the wider organisation can become demoralised and disaffected. Implementing these new recommendations will help surgical teams make patient care safer.”
Mr Hugh Phillips, President of The Royal College of Surgeons of England said: “We urge all surgical teams to adopt these guidelines. As the professional body committed to promoting and advancing the highest standards of surgical care for patients, the College has been working closely with the NPSA to ensure that the guidance is practical for our members and surgical teams across the NHS. The aim of the guidance is to promote best practice to help improve patient safety.”
A review of claims brought to the attention of the Medical Defence Union from 1990-2003 found 306 cases relating to operations that went wrong. Of these 306 cases, 119 (39%) operations were carried out on the wrong side of the patient. Of these operations carried out on the wrong side of the patient, 24 (20%) occurred in Orthopaedics & Trauma and 58 (49%) in dentistry where the wrong tooth was removed.
Data from the NPSA’s National Reporting and Learning System (NRLS) pilot study involving 28 acute trusts between September 2001 and June 2002 identified 44 patient safety incidents associated with the word wrong, covering wrong procedure, site, operating list, consent, patient name and notes.
A further NPSA study while the NRLS was being tested involving 18 acute sites between November 2002 and April 2003 identified 15 patient safety incidents linked to wrong site surgery. Fortunately three of these were prevented, but two led to the wrong procedure and one related to intervention on the wrong side. The outcomes of the other nine were not recorded.
The patient safety alert 06 — correct site surgery is available on the NPSA’s website.
NPSA issues new safety advice to NHS on reducing the harm caused by misplaced nasogastric feeding tubes
Monday 28 February 2005
The National Patient Safety Agency (NPSA) on the 22nd February 2005 issued new advice to the NHS on reducing the harm caused by misplaced nasogastric feeding tubes. Nasogastric tubes are used to provide liquid nutrition to patients who have swallowing or feeding difficulties.
On rare occasions, tubes can be mistakenly inserted into the lung rather than the stomach without staff, patient or the carer realising the error. Studies have shown that conventional methods used to check the placement of nasogastric feeding tubes can be inaccurate.
At least 11 patients have died as a result of misplaced nasogastric feeding tubes between December 2002 and December 2004. A further 13 incidents involving nasogastric feeding tubes have been reported to the NPSA’s National Reporting and Learning System (NRLS). Of these 13, 11 were classed as causing no harm/low harm to the patient, one moderate harm and one serious harm.
The Chief Medical Officer for England, Sir Liam Donaldson said, “Every year hundreds of thousands of patients benefit from nasogastric feeding when tubes are placed correctly and without incident by healthcare staff and carers. Incorrect positioning is rare, but can cause serious harm. This alert is another example of the unremitting focus we are putting on patient safety, learning from things that go wrong and using that learning perhaps to save lives of future patients.”
The precise number of nasogastric feeds carried out each year is not known. Data are not collected routinely. However, figures from the NHS Purchasing and Supply Agency (PASA), which distributes the feeding tubes, suggests that between 750,000 and 1,000,000 tubes are used per year. PASA distribute approximately 500,000 in the NHS though some Trusts make their own purchasing arrangements.
The NPSA alert recommends the methods that should be used to confirm correct placement of the nasogastric feeding tube and asks NHS acute trusts, primary care organisations and local health boards in England and Wales to immediately review their local guidelines for this procedure. They should also carry out an individual risk assessment prior to nasogastric tube feeding, review and agree local action required and report misplacement incidents via their local risk management reporting systems.
Feeding through a nasogastric tube is a relatively common procedure across all age groups who have swallowing or eating difficulties, often after operations. Thousands of these procedures are done daily without incident, providing a vital aspect of care. However, rarely, things do go wrong.
The Patient Safety Research Group at the University of Birmingham has commissioned further research to assess the existing testing methods. This will include specific work on the best methods to test positioning of the tube when used in newborn babies. The NPSA will be collaborating with the Medicines and Healthcare products Regulatory Agency (MHRA) and industry to identify any further contributing factors.
The NPSA has issued advice on the following tests to check the correct position of the nasogastric feeding tubes.
Recommended:- the pH of aspirate (stomach contents) should be measured using pH indicator strips in the range 0 to 6, with half-point gradations
- radiography (X-rays) is recommended but should not be used routinely. Fully radio-opaque tubes with markings to enable measurement, identification and documentation of their external lengths should be used.
- the ’whoosh’ test which involves the use of a syringe to push a small volume of air down the nasogastric tube whilst the sounds produced are monitored with a stethoscope
- testing the acidity/alkalinity of aspirate using blue litmus paper
- observing for signs of respiratory distress is often ineffective in detecting a misplaced tube
- monitoring for bubbling at the proximal end of the tube is unreliable because the stomach also contains air and could falsely indicate respiratory placement
- observing the appearance of the feeding tube aspirate is unreliable because gastric contents can look similar to respiratory secretions
NEW PROCEDURES TO CUT NHS DISCIPLINARY BILL
Thursday 17 February 2005
Health Minister John Hutton today announced measures aimed at tackling the cost of long drawn-out disciplinary procedures and staff suspensions within the NHS. New disciplinary procedures for NHS doctors and dentists aim to cut the multi-million pound salary bill of suspended NHS staff by speeding-up investigations into their performance.
Under the new procedures, cases will be completed quickly and fairly. Where possible, poor performing doctors will be re-trained and returned to safe practice.
Most capability cases going to a hearing will be resolved within 13 weeks - from when a case is established to the final decision. The current target for handling disciplinary cases is 32 weeks, but many cases become unnecessarily prolonged. Consultants making an appeal to the Health Secretary could see their case take a further eight months to be resolved.
A Public Accounts Committee report, published last year, put the cost of delayed disciplinary cases at £40 million a year. Around 70 per cent of the cost was for doctors suspended on full pay and legal costs of protracted cases.
John Hutton said: "We must do all we can to avoid doctors and dentists being suspended for long periods on full pay. The existing procedures are unjustifiably prolonged and are not fair to NHS staff, taxpayers or patients.
"The new process ensures resources are not diverted away from patient care into the pockets of lawyers. Minor cases will be resolved faster. Exceptional cases will be guaranteed the close attention needed to safeguard patients, while also offering fair treatment to doctors and dentists.
"This move improves the thoroughness in which allegations against doctors and dentists will be investigated. It is about achieving the right balance between protecting patient interests and getting innocent staff back to work for the good of the NHS."
Chief Medical Officer for England, Sir Liam Donaldson, said: "These reforms reinforce other recent measures all of which put an unremitting focus on patient safety whilst treating the small number of doctors who have serious problems with their practice, fairly and effectively."
Steve Barnett, Director of NHS Employers, said: "These new procedures will bring clarity and coherence to what has always been a complex and difficult situation for employers in the NHS.
"The old process did not work in the interests of patients, NHS organisations or doctors and dentists and needed to be resolved. The new approach will enable employers to identify and attempt to remedy any potential problems before damage is done."
The new disciplinary procedures, which form part of the first national disciplinary framework for NHS medical and dental staff, abolish the outdated right for consultants on the verge of being sacked to appeal to the Health Secretary.
The procedures end the distinction between personal and professional misconduct. As a consequence, NHS doctors and dentists will be disciplined for misconduct under the same procedures as any other NHS staff member.
A period of assessment and rehabilitation is introduced so that NHS Trusts make effective use of the National Clinical Assessment Authority. Only if help is refused or fails will NHS doctors and dentists go before a panel set up to hear capability cases.
The national framework comes into force on 1 June 2005.
’Maintaining High Professional Standards in the Modern NHS’ is available on the Department of Health website.
NHS staff show what they’ve got
Wednesday 9 February 2005
NHS employees across Yorkshire and Humber are being given the opportunity to win up to £7000, and improve working practice/patient care, through their own ideas and innovations.
This is through a major competition, launched by Medipex – the NHS Innovation centre for the Yorkshire and Humber region, which aims to identify individuals and teams in the NHS who may have an idea or invention that could be used in practice.
Richard Clark, Chief Executive of Medipex Ltd says:
“Through its staff, the NHS harbours a whole host of brilliant ideas for new innovations as well as solutions to problems – sometimes straightforward, sometimes ingenious. We hope that the NHS Innovation Competition will encourage all NHS staff – including doctors, nurses, porters, therapists and admin staff, in the Yorkshire and Humber region, to capture their ideas and inventions and let them be known.”
There are two main categories of entry, which relate to ’Innovative Service Delivery’ and ’Innovative Device or Technology’. Final entries will be judged by a panel of knowledgeable and experienced professionals in recognition and development of good ideas in healthcare, and cash prizes will help to assist the individual or team in their clinical department, in making their ideas and inventions become a reality.
Three prizes will be awarded in each category totalling £7000, on the 14th April at the Thackray Medical Museum, Leeds.
This competition is open to all NHS employees in Yorkshire and Humber region. For further information and/or to enter, an application form can be downloaded from www.medipex.co.uk, alternatively contact Stephanie Bridgford on Tel: 0113 392 6454.
HPC welcomes three new Council members
Tuesday 1 February 2005
The Health Professions Council (HPC) is pleased to announce the appointment of three new members of Council. Alan Mount, Stephen Wordsworth and Mary Clarke Glass were appointed by the Privy Council and will be attending their first Council meeting today. The Council meeting is being held to discuss the structure of the HPC Register. Stephen is the Operating Department Practitioner member of Council, Alan is the alternate and Mary has been appointed as the new lay member. Operating department practitioners are the 13th profession to be registered by the HPC, they joined the Register in October 2004.
Mary Clark-Glass was formerly a lecturer in law and broadcaster in Belfast; she has been involved in equality/human rights issues since the 1970’s. Head of the Equal Opportunities Commission for Northern Ireland 1984-92, a Human Rights Commissioner 1984-1990, former member of the probation board for Northern Ireland, she also served as a Commissioner on the Commission for Racial Equality for N. Ireland. Mary is currently a GMC associate, a member of the GDC’s Fitness to Practice Committee and a non-executive director of the Royal Group of Hospitals, Belfast.
Alan Mount is Education Manager/Senior Lecturer in ODP Studies, based within the Faculty of Health at Canterbury Christ Church University College. Alan has a long history within the peri-operative field, both as a practitioner and as an educator. He was appointed in February 2002 to the Association of Operating Department (AODP) Board. He has been involved with the development of the new standards of proficiency, scope of practice and subject benchmarks for ODP in accordance with the transfer to the HPC. More recently he was awarded the Association of Operating Department Fellowship for outstanding service to the ODP profession.
Stephen Wordsworth is a senior lecturer in the Faculty of Health and Community Studies at the University of Central England. He has been a qualified operating department practitioner for 15 years and has been heavily involved in a range of curriculum development initiatives for much of that time. Whilst as a professional body council member for the Association of Operating Department Practitioners (AODP) he has acted as the Deputy Director of Education and chair of the curriculum review development group. Stephen has also acted as a specialist ODP advisor for a number of HE institutions and as recently completed QAA training for Major Review of Healthcare Programmes.
The Council of the HPC is responsible for developing strategies and policies and consists of 26 members (made up of one representative from each of the professions regulated and 13 lay members) 13 alternates, plus a president.
Professor Norma Brook, The President of the Council, said “I am delighted to welcome a new profession to the HPC Register and three new members to Council. I look forward to working along side Mary, Alan and Stephen in the near future. Council members play a vital role in the success of HPC and the new members have joined us at an exciting and challenging time.”
More information about the Council, including dates of forthcoming meetings, and minutes from meetings, is available on the Council section of the HPC website.
Members give thumbs up as NATN heads for change
Wednesday 19 January 2005
A leading UK organisation for professionals working in theatres, anaesthetics and recovery has announced a programme of change following a ballot of its members. The National Association of Theatre Nurses (NATN) announced the results of the members’ vote following a consultation exercise that showed over 75% of its members being in support of each proposal.
The most obvious change is to the Association’s name. In recognition of its growing membership of Managers, Operating Department Practitioners, Health Care Assistants and Healthcare Support Workers, NATN is set to change its name to the Association for Perioperative Practice (AfPP). This change reflects the growing diversity of the perioperative workforce and the increasing area of the Association’s influence.
NATN’s core business is education demonstrated by its national education programme including its annual Congress in Harrogate and Speciality Conference in London. The education facilities will be augmented with new online facilities concentrating on specialist areas such as decontamination, anaesthetics and research giving those interested in these areas access to up-to-date information and online communities of like-minded individuals.
Non-nurse members will be eligible to vote in the new structure and an ODP place on the Association’s Board will be guaranteed to recognise this growing and important part of the organisation’s membership.
The Association’s regional structure will be boosted through the appointment of key individuals to manage, monitor and evaluate sharing of best practice at a regional level and the employment of an Education Officer to coordinate this work. This new post will be liaising directly with governmental organisations and key partners to ensure the delivery of contemporary and relevant education.
Melanie van Limborgh, NATN Chairman, said: “These changes are designed to keep the Association at the forefront of perioperative practice and to incorporate the diverse workforce in this vast practice area. By our actions we will continue working alongside the modernisation agenda in the NHS and the independent sector fully representing all those who influence perioperative care. Our enhanced educational role and the greater diversity of our membership will ensure that the patient remains at the centre of all we do.”
The new-look Association is to be launched at a meeting of NATN’s members in Hull on 16 April.
Report by the Auditor General for Wales
NHS Waiting Times in Wales
Friday 14 January 2005
Most patients in Wales are treated within the targets set for the NHS, but some people in Wales can face long waiting times for non-emergency health treatment, Sir John Bourn, the Auditor General for Wales, reported today. As well as providing an analysis of the scale of the problem of waiting times, his report points to inefficiencies in the system of health and social care which contribute to long waiting times in Wales. The report identifies recent improvements in inpatient/day case waiting times and a range of local innovations which have contributed to improvements and which could be used more widely. Sir John Bourn urges the Welsh Assembly Government and local healthcare organisations to take rigorous action to achieve waiting times targets.
In June 2004, some 7,000 patients had been waiting over 18 months to see a consultant for a first outpatient appointment, while 1,500 people had been waiting more than 18 months for inpatient treatment. Notwithstanding differences in how waiting lists are calculated, waiting times in Wales remain longer than those in England and Scotland.
There is substantial regional variation in waiting times within Wales: waiting times are longest in south Wales and shortest in north Wales. There are also long waiting times in particular specialties: in outpatients, there are particularly long waiting times in Plastic Surgery, Trauma and Orthopaedics, Neurology and Pain Management; and for inpatient/day cases, there are long waiting times in General Surgery, Ear, Nose and Throat, Neurosurgery and Trauma and Orthopaedics.
While the report shows that although there are relatively high numbers of patients waiting over one year for inpatient/day case treatment in Wales, compared with England and Scotland, most patients face shorter waiting times. Our analysis of patients treated in three key specialties showed that 85 per cent of inpatients and day cases received treatment within twelve months. However, some people still have to wait for an extremely long time. The Auditor General found that at the end of 2003 more than 100 people had been waiting over four years for a first outpatient appointment and the same number had been waiting over four years for inpatient treatment.
This does not even give the full picture. Waiting lists only measure part of the process. They do not, for example, include the time taken waiting for diagnostic tests or therapy services. Commendably, the Welsh Assembly Government is developing systems to measure waiting times for these key parts of the patient’s journey through the health system.
The main reason that people are still waiting a long time for an outpatient appointment is that the number of GP referrals to outpatients is rising, and the number of outpatient attendances has risen by 16 per cent between April 2000 and March 2004. Local Health Boards should monitor GP referral rates more effectively and identify alternatives to referral to a consultant. Sir John’s report identifies a number of these alternatives which have helped to reduce waiting times.
The report also points to inefficiencies in the use of inpatient and day case capacity which, if improved, could free up significant additional capacity to carry out elective surgery. These include: relatively long average lengths of stay in hospital, low day case rates, high intervals between each patient occupying a bed, and high rates of cancellations and relatively low operating theatre utilisation. Bed capacity within the system is further reduced by delays in discharging patients and delayed transfers of care, both of which have significant impacts. The Welsh Assembly Government needs to ensure that it builds on the encouraging 23 per cent reduction in delayed transfers of care (excluding mental health) between November 2003 and June 2004.
The Welsh Assembly Government has introduced a Second Offer Scheme to ensure that patients likely to breach its targets for inpatient/day case surgery receive an offer of treatment by an alternative provider. It is also developing protected Orthopaedic capacity in Newport and Cardiff, and in November 2004 it announced plans to spend £30 million on new facilities including four day case treatment centres and equipment for use in diagnostic services and operating theatres.
The report highlights many local innovations which have contributed to improvement. At least 10 per cent of patients fail to turn up for their appointment with a consultant which in 2002-03 represented an annual opportunity cost of £37 million. Partial booking, where trusts contact patients around six weeks before their appointment, has increased the efficiency of outpatient clinics by reducing the number of patients who do not turn up while improving patient choice. In addition, some patients fail to attend for scheduled operations, with the result that operations are lost.
However, the Welsh Assembly Government’s waiting time initiatives, which treated 40,000 patients at a cost of £36 million in 2002-03 and 2003-2004, have provided neither good value for money nor sustainable reductions in waiting times. The Government needs a clearer and more consistent waiting times strategy backed up with stronger performance management and smarter commissioning of services.
Sir John Bourn said on today:
"Patients in Wales are waiting for too long to see consultants in outpatients and to receive non-emergency surgical treatment, NHS Wales can do better. The Welsh Assembly Government and the NHS must tackle the inefficiencies in the system and the unacceptable regional variations in waiting times. Past initiatives have treated the symptom but not always the cause of long waiting times. The Welsh Assembly Government and NHS Wales must address, and drive down, waiting times for the people of Wales."
Hutt is sacked as health minister
Monday 10 January 2005
Jane Hutt has been removed as the Welsh Assembly Government’s health minister.
Ms Hutt, 56, has come under strong criticism from Labour MPs as well as the opposition, particularly over long waiting lists.
The Vale of Glamorgan AM, the only person in the post since the assembly was formed in 1999, becomes business manager. Her former deputy Dr Brian Gibbons, a GP, replaces her.
First Minister Rhodri Morgan denied she was sacked, but said she was moved.
Previous business manager Karen Sinclair loses her place in the cabinet - but she keeps her other role as chief whip, which means she will be able to sit in on cabinet meetings as an observer.
Mr Morgan said he was confident Dr Gibbons had a unique combination of experience and talent "to build on the platform created by Jane Hutt for the health and social services of Wales since May 1999".
"I have asked Jane to take on another key cabinet position where she can help to lead the Welsh Assembly Government’s agenda and ensure that it is translated into practical action."
Mr Morgan said he had decided to separate the roles of business manager and chief whip, and was grateful for the work Ms Sinclair had done as business manager.
Dr Gibbons, 55, was brought up in County Roscommon in the west of Ireland. His father Hugh was a member of the Irish Dail, or Parliament.
Dr Gibbons became a GP in Blaengwynfi, in the Upper Afan Valley, in 1980. Dr Gibbons, who is married with two children, was elected Aberavon AM in May 1999 and appointed Ms Hutt’s deputy in October 2000.
In 2003, he was appointed deputy minister for economic development and transport.
The Conservatives, who said she had been a “disaster for the health service”, welcomed Ms Hutt’s removal.
Mike German, assembly leader of the Lib Dems, said the move was "only window dressing" unless Dr Gibbons was prepared to take "the necessary action to improve the Welsh NHS",
Dr Tony Calland, chairman of BMA Welsh Council, said Ms Hutt had "worked very hard to improve NHS Wales" and her strategy had been successful in some areas of Wales but not in others.
Source: www.bbc.co.uk
Asia earthquake update from Médecins du Monde
Saturday 1 January 2005
After the unprecedented humanitarian catastrophe that has severely affected south Asia, Médecins du Monde has mobilised its international network of delegations to bring emergency medical aid to the victims of the tsunami.
At present, 34 doctors, nurses, psychologists and logisticians are deployed in Sri Lanka and Banda Aceh (Indonesia) to bring help to victims, reactivate the healthcare systems in the disaster-stricken areas and to face the growing risks of epidemics.
In Sri Lanka we have personnel from Médecins du Monde France, Greece, Cyprus, Spain and Portugal intervening in Colombo, Galle, Batticaloa and Trincomalee. Our programmes are thus bringing necessary emergency aid to the Tamil areas, as well as governmental areas of Sri Lanka.
In Indonesia, our French team is concentrating on Banda Aceh which has been particularly affected by the tsunami because of its proximity to the earthquake’s epicentre. This region on the north of the island of Sumatra is still very difficult to access, and numerous zones are still not able to receive help. Médecins du Monde fears a worsening of the horrifying assessment announced so far, of more than 100,000 deaths, 500,000 people homeless, 900,000 children in danger, 100,000 homes destroyed and only one single hospital that has not been damaged.
As well as providing primary care, each one of our teams will make a precise evaluation of the medical and sanitation priorities that are not yet covered. They will adapt the best medical response, as well as reacting with urgency to the deteriorating situation of potential epidemics and the worsening medical conditions of survivors.
Distribution of chlorine kits and food, creation of shelters for families, medical care, vaccinations — all this is being done to avoid new losses of human life. The consequences of this tragedy will take a long time to clear. We will continue to mobilise.
Médecins du Monde UK is looking for British medics and logisticians to join in the international effort from all Médecins du Monde’s delegations. If you are interested in volunteering to help with the crisis for a minimum of one month, please contact Médecins du Monde UK on 020 7516 9103.