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In The Event Of Death

Sunday 31 December 2006

Nurses, paramedics and care home staff from across the country, and in particular across the East Midlands, are to be offered training from coroners, police officials and undertakers to help deal with one of the most harrowing aspects of their job – dealing with death.

The University of Derby is offering a short course entitled Verification of Expected Death which consists of a theory day and then a separate session to test their abilities with Objective Structured Clinical Examinations (OSCE). These sessions test students' clinical and communication skills.

The course is designed to support front–line medical staff to understand the procedures related to handling such a sensitive area of work.

More than 40 people can take part in the next course at the University's Kedleston Road Campus in Kedleston Road, Derby in January 17 next year – and places are still available.

Dr Nigel Chapman, Coroner for Nottinghamshire, will lead a panel of experts for the event alongside University of Derby academics, scenes of crime officers and other police officers.

Course participants will learn:
communication skills, support available for professionals, verification of death theory, verification of death practical demonstration, the role of the coroner, the role of the undertaker, what the police need to know, and what to do with a potential crime scene.

While chiefly addressing situations where the death is expected, the course will also look at what to do with suspicious and unexpected death within the parameters of the law.

The event has been organised by Carol Vaughan, Senior Lecturer, at the University on the Common Foundation Programme at the Chesterfield Campus, Chesterfield and North Derbyshire Health Education Centre. The University was approached to offer the course by the local Primary Care Trusts in the area and Tree Tops Hospice.

Carol said: "I have carried out extensive research into this area and only private companies offer such training. We have assembled a team of experts in this field to offer their guidance and expertise to nurses and paramedics. It is a valuable opportunity."

"Verification of Expected Death is obviously an emotive subject, but an area of the course related to communications and supporting people will help by offering tips on how to handle such situations."

"The course has already attracted a lot of interest including from members of the Royal College of Nursing who may attend."

For more details about the course contact Catherine Foster, based in the Faculty of Education, Health and Sciences, at the University of Derby, on email: c.foster@derby.ac.uk or telephone at 01332 591567. Please mention the OTJ.

Outbreak of PVL–positive community–associated MRSA

Monday 18 December 2006

Eight cases of Panton–Valentine Leukocidin (PVL)–positive community–associated MRSA have been identified among individuals in a hospital and their close household contacts in the West Midlands region. Four of these individuals developed an infection, two of whom subsequently died.

PVL–producing strains of MRSA have been seen in the UK before – however, the small numbers of cases reported have usually been in the community rather than a hospital setting. This outbreak is the first time transmission and deaths due to this strain are known to have occurred in a healthcare setting in England and Wales.

PVL-producing strains are more commonly contracted in the community and generally affect previously healthy young children and young adults – this contrasts with the so called 'hospital–associated MRSA' strains which do not produce PVL and are more commonly associated with causing wound infections and blood–poisoning in more elderly hospitalised patients.

Dr Angela Kearns, an MRSA expert with the Health Protection Agency, said: "When people contract PVL–producing strains of MRSA, they usually experience a skin infection such as a boil or abscess. Most infections can be treated successfully with everyday antibiotics but occasionally a more severe infection may occur."

"The Health Protection Agency is advising the hospital on outbreak control measures, and will continue to monitor MRSA infection nationally."

To see the full article on this outbreak in the Communicable Disease Report weekly publication click here.

Drive to improve patient safety

Monday 18 December 2006

The government has announced a shake-up of systems to improve patient safety as a study finds current safeguards are failing.

NHS staff should ensure incidents involving serious patient harm are reported within 36 hours, says the chief medical officer's (CMO) report.

It calls for a blame-free culture where staff feel confident to report, plus quicker and simpler reporting systems.

A British Medical Journal study says most are missed by the current system.

The National Patient Safety Agency (NPSA) estimates that 900,000 incidents a year result in harm or near harm to NHS patients.

Earlier this year MPs said nearly a quarter of incidents and 39% of "near misses" go unreported, with doctors being the worst culprits.

They criticised the National Patient Safety Agency for failing to provide enough advice on improving safety.

The CMO report recommends the NPSA refocus its efforts to concentrate on collecting and analysing patient safety information.

Plans are also afoot for a national campaign to encourage clinical staff to report incidents.

These can include medication errors, equipment defects and patient accidents, such as falls.

Most incidents 'missed'

The York University authors of the BMJ study analysed data from the local reporting system in a large NHS hospital trust in England as well as case notes for the same patients.

From a random sample of 1,006 admissions, 324 patient safety incidents were found – 136 (42%) resulting in patient harm.

The 21 incidents missed by case note review were minor, whereas the 130 incidents missed by the reporting system led to patient harm.

Thus, the routine reporting system missed most patient safety incidents that were identified by case note review and detected only 5% of those incidents that resulted in patient harm.

Chief Medical Officer Sir Liam Donaldson said: "Improvements have been made across the NHS to embed patient safety into everyday practice."

"However, more needs to be done to accelerate the pace of change in this area."

He added: "Often it is systems that have failed, rather than any individual being at fault."

A spokesman for the NPSA said: "We endorse the move to an open and fair culture where staff feel confident to report, as the more we know about the sort of incidents that occur, the more we can do to address problems."

"We're already seeing a change in reporting patterns."

Source: BBC News

Awareness of, and testing for, Hepatitis C is increasing

Monday 18 December 2006

A life–saving technique dubbed a "brain bypass" has been carried out for the first time in the UK.

A new report from the Health Protection Agency shows that the number of people newly diagnosed with hepatitis C has increased; from 2,116 in 1996, to 7,580 in 2005. New figures also show that testing for hepatitis C has increased overall, for example, in GP surgeries', testing has increased by almost 60 per cent between 2002 and 2005.

The latest estimates on the number of adults infected with hepatitis C showed there were around 231,000 in 2003. Many of these infected people do not realise they have the virus as it can take years or even decades for symptoms to appear. Early treatment, however, is effective at clearing the virus in the majority of people. It is therefore important that individuals at risk are tested by their GP or other health services.

Dr Helen Harris, a Hepatitis C expert from the Agency said "This is the second annual report on Hepatitis C from the Health Protection Agency, summarising current knowledge of the infection and the action being taken to tackle it. Hepatitis C is very under–diagnosed simply because people are unaware that they are carrying it. By increasing awareness of the infection, more people will be tested, will receive earlier and more effective treatment, and they can avoid passing it on to others."

"We estimate that almost 6 in 10 people with hepatitis C injected drugs at some point in their past. If someone has ever shared equipment for injecting drugs – even if it was a long time ago, and even if they only did it once or twice – they could be at risk from hepatitis C. A simple blood test can establish whether someone has ever been infected with the virus."

Professor Pete Borriello, Director of the Agency's Centre for Infections said, "Testing for hepatitis C has increased significantly, however there is still much work to be done as a significant number of individuals remain undiagnosed. If you don't know you've got it, you can't do anything about it. Health services should consider this as they formulate strategies to increase testing."

The report highlights the Department of Health's hepatitis C awareness campaign, FaCe It, which has now reached over 16 million people. The exhibition campaign visits cities across England and features large photographic portraits of people living with Hepatitis C.

Hepatitis C in England – An Update 2006 is published by the Health Protection Agency and contributors. To see a full copy of the report click here.

UK 'brain bypass' op breakthrough

Monday 18 December 2006

A life–saving technique dubbed a "brain bypass" has been carried out for the first time in the UK.

The operation, which has been carried out abroad, was performed on four UK patients with brain tumours and aneurysms – blood vessel weakness.

It works – like a heart bypass – by re–routing blood supply around the problem using a piece of grafted vein.

All the operations were carried out successfully, the London King's College Hospital team said.

The technique, known as Elana, was originally developed in Holland and has been carried out on about 300 patients worldwide so far.

The main benefit is that it eliminates the need to temporarily clip the artery and cut off the blood supply, which increases the risk of stroke.

Neurosurgeon Christos Tolias, who headed the team, said the operations were a "real advancement in the field".

"In all operations performed no patient has died or suffered deterioration as a result of using this technique, as compared to conventional treatment."

"The advancement will make a significant difference to the treatment we can offer these patients."

"The traditional method will still be used for the majority of cases, but this gives us an option for people with large tumours or aneurysms where clipping is not sufficient."

The technique has been used on a patient with a tumour at the base of the skull and three with giant aneurysms.

Cut

It uses two specially designed tools, a laser catheter and an implanted ring.

The catheter makes a hole in the affected vessel wall, and the ring prepares the connection between the artery and the graft vein.

The ring is either directly attached to the artery, with the graft vein being attached afterwards or the graft and the ring can be attached simultaneously. This is done using microsurgical techniques.

The laser catheter is then inserted into the graft vein, and cuts out a hole through the artery wall.

Blood flow through the graft indicates that penetration of the artery has been successful.

The tumour or aneurysm can then be cut away or isolated.

But Professor Tipu Aziz, a neurosurgeon at Oxford's John Radcliffe Hosptial, said the technique was not new.

"As well as being used in other countries, the approach is used in other bypass operations."

"I would also say that this form of survery will only be relevant to a select few patients."

Source: BBC NEWS

More mystery deaths than thought

Monday 18 December 2006

The rate of sudden unexplained deaths in England is around eight times higher than previously thought, warn experts.

Around 500 people may die every year from sudden arrhythmic death syndrome, a study published in Heart shows.

SADS is linked to a genetic heart defect and family members should be screened to prevent more deaths, the researchers said.

The study also found that only one–third of cases had been correctly identified by post–mortem.

The researchers identified 56 cases of SADS from 115 coroners' reports of unascertained causes of death.

None of those who died had a history of heart disease, and they had all last been seen alive within 12 hours of death.

The average age of death was 32 and 63% were men.

Four had had some heart symptoms in the 48 hours before death, and two–thirds had experienced cardiac symptoms at some point in the past.

From their sample, the researchers calculated that the total annual numbers of SADS cases per 100,000 of the population was 0.16.

This figure was higher than the number of SADS deaths listed in national statistics, at 0.10 per 100,000 of the population.

But, when the researchers added up all the unknown causes of death in national records that might have actually been SADS, they uncovered a potentially much bigger discrepancy.

They found the rate could be as high as 1.34 per 100,000 – up to eight times higher than they had estimated and equating to 500 deaths per year.

Underreporting of SADS could be due to deaths being misclassified, inconsistency in referral by coroners or families not agreeing to further expert cardiac examination, they explained.

Some of the deaths in the study were attributed to heart attack or other causes, such as epilepsy and drowning.

Genetic link

Almost one in five SADS cases had a family history of sudden unexplained deaths before the age of 45.

Previous research by the team showed a 22% incidence of underlying inheritable cardiac disease.

The team concluded that SADS should be a certifiable cause of death and that affected families should be screened by a specialist.

"Deaths from SADS occur predominantly in young males," the researchers concluded. "When compared with official mortality, the incidence of SADS may be up to eight times higher than estimated."

"Families with SADS carry genetic cardiac disease, placing them at risk of further sudden deaths."

Ellen Mason, a British Heart Foundation heart nurse, said: "Clearer ways to identify possible victims of SADS are vital."

"If a person dies from SADS, specialist centres can offer genetic screening to their bereaved families. Monitoring people who could be at risk of SADS and giving them specialist treatment may prevent further tragic deaths."

"By underestimating the number of deaths caused by SADS every year, families who might be at risk may slip through the net and this may result in further tragedies."

Anne Jolly, from SADS UK, said the charity heard from many families left devastated and bewildered after the premature sudden and unexpected death of an apparently healthy child or spouse.

She added: "When there is no cause of death given this adds to their confusion and pain."

"Some of these conditions are genetic and it is important that other family members seek specialist advice as they too may be at risk of death from the same genetic condition."

Source: BBC NEWS

'NHS-wide faults' led to deficits

Wednesday 13 December 2006

Mismanagement at all levels of the NHS in England has led to the current multimillion pound deficit, a committee of MPs has found.

The Commons health select committee said existing deficits were made worse by the cost of new staff pay deals and the expense of meeting NHS targets.

But it added local financial mismanagement was also a factor. Last year's NHS deficit was £547m.

The government said it had increased NHS spending since it came to power.

Shifting targets

The committee said historic deficits, long hidden, were revealed when the government changed the rules so trusts could not underspend their capital budget to subsidise current spending.

But it said the government fuelled the problem by agreeing to new pay deals for doctors and nurses using estimates of the cost which were "hopelessly unrealistic".

And far more staff have come in to the NHS than were proposed by the government.

In addition, meeting national targets such as the requirement that no patient should wait more than four hours in A&E had been costly.

Changing targets at short notice also placed unnecessary financial costs on trusts, the report said.

It attacked short–term measures being used by the government to address deficits.

And it said raiding staff training budgets was "unacceptable", and warned such cuts were affecting staff morale and could damage the quality of the workforce.

Trusts criticised

MPs also warned other "soft targets" such as mental and public health service budgets should not be raided to ease trusts' deficits.

And they said the creation of a new contingency fund to help out failing trusts and top–slicing primary care trusts' (PCTs) budgets should only be temporary measures.

However, the committee also said trusts should shoulder some of the blame for the current situation.

It cited one hospital trust which recruited staff without knowing if it could afford to pay them, and a primary care trust which had failed to recruit key finance staff.

The report said: "The most basic errors have been made; there are too many examples of poor financial information, inadequate monitoring and an absence of financial control."

It said the NHS may well be in balance as a whole by the end of this financial year, but warned trusts with the highest deficits were unlikely to be in the black within the next five years.

The MPs say the government should change the NHS's accounting system, which both reduces a trust's income by the amount of its deficit while also asking it to repay the sum owed.

More funding

Kevin Barron, chairman of the committee, said: "I hope the rush for balancing all NHS budgets does not mean further top–slicing next year, particularly in areas of high health inequalities."

Both the British Medical Association and the Royal College of Nursing condemned the decision to raid training budgets.

And Professor Stephen West, who is on the Council of Deans and Heads of UK Health and Nursing Professions, said: "The universities and statutory bodies were advised that this was a one–year blip where they needed to make some significant reductions."

"Unfortunately it would appear that this was not, and that in order to balance the books there is going to have to be a two or three–year period of reductions in education and training."

However Dr Gill Morgan, chief executive of the NHS Confederation which represents managers, said: "It is a shame that the health select committee has taken the easy route of blaming NHS managers for all the financial problems in the NHS."

Health Secretary Patricia Hewitt said the NHS budget had doubled since 1997 and would almost triple by 2008, when UK healthcare spending would reach the European average.

"As a result of this investment, backed by reform, the NHS has cut waiting times, built new hospitals and surgeries, paid for more doctors and nurses to work and train, and improved access to healthcare for millions of people."

But she said a small number of trusts had built up deficits "due to overspending and inefficient use of their funding".

Shadow health secretary Andrew Lansley warned financial problems were leading to cutbacks when reform should have led to service improvements.

Sandra Gidley, Liberal Democrat health spokeswoman, said targeting "soft targets" such as staff training and mental health services was a "false economy", the effects of which would be felt for years to come.

Source: BBC NEWS

Woman has double hand transplant

Tuesday 12 December 2006

A Spaniard has become the first woman in the world to receive a double hand transplant.

A team of surgeons at Hospital La Fe in Valencia carried out the pioneering operation.

After 10 hours in the operating theatre, doctors say Alba, 47, from Castellón, whose full name has not been released, is recuperating well.

The woman faced the press this week, and looked happy and content despite heavy bandages on her hands.

Alba said after waking up from the anaesthetic and seeing her new hands for the first time, she thought: "They look beautiful!"

The operation took place on 30 November after a suitable donor was found.

It involved a team of more than 10 medical professionals, including surgeons and anaesthetists.

Arms matched

The surgeons performed the transplants on both arms simultaneously after adjusting Alba's forearms to match the size of the donor's.

Bones were fixed with metal plates and screws, and microscopic surgery was used to attached the arteries, veins and nerves.

Alba had both her original hands amputated after an explosion in a laboratory where she was studying chemistry nearly 30 years ago.

Pedro Cavadas, the lead surgeon, said she should have sensitivity and movement in her new hands within five to six months.

Mr Cavadas has told the Spanish press that the intention of the surgery was to allow Alba to lead an independent and normal life with two useful hands.

He admitted that it was difficult to know exactly how much use Alba will be able to make of her hands.

But he added: "In any case this is much better than any prosthesis."

Six double–handed transplants have been carried out on men. The first was carried out on a 33–year–old man in France in 2000.

Source: BBC NEWS

HPC In Focus – Issue 8

Tuesday 12 December 2006

Issue 8 of HPC In Focus is available to download online (along with previous issues)

Please feel free to advise your colleagues.

Top clinicians argue case for NHS reform

Tuesday 05 December 2006

Two of the top clinicians in the country today publish reports on the need to change how emergency care and heart and stroke services are delivered to ensure that patients get the best care in the right place.

Sir George Alberti, National Clinical Director for Emergency Care and Professor Roger Boyle, National Clinical Director for Heart Disease and Stroke, both argue that traditional A&E departments are not the only option when dealing with life and death situations. The reports also include personal accounts of the recent service changes and improvements to patient care that they have seen in their own areas of expertise and that are already making a difference for patients.

Presenting his report to leading health experts, Professor Roger Boyle said:

"There have been vast improvements in the treatment of heart disease since the National Service Framework was published in 2000. We have seen an increase in the number of heart attack patients treated within 30 minutes of arrival at hospital from 38% to an impressive 83%. Paramedics are now trained to assess, diagnose and provide thrombolysis treatment at the scene and eleven pilot schemes are in place to test the feasibility of providing angioplasty as the first treatments for heart attack patients."

"Looking to the future, I expect to see 500 fewer deaths, 1000 fewer recurrent heart attacks and 250 fewer serious complications such as stroke, every year as a result of developments in the speed and effectiveness of treatment for heart attacks. A further 1000 stroke victims a year would regain independence rather than die or be left dependent on others if they were given clot–busting treatment in specialist centres. By giving life–saving drugs to heart attack victims on their doorstep and using clinical judgements to by–pass A&E to deliver heart attack and stroke patients directly to specialists, we are acting only in the best interest of the patient. This is not driven by saving money but by the aim of saving lives."

Outlining details of his report, National Clinical Director Sir George Alberti said:

"Care for emergencies is good, and indeed there has been a transformation in A&E departments over the last five years. But there is increasing specialisation and we need to ensure that people are seen quickly by an experienced doctor or health professional."

"We have to be upfront and tell the public that, in terms of modern medicine, some of the A&E departments that they cherish are not able to provide this type of care and cannot and will not be able to provide the degree of specialist services that modern medicine dictates and the public deserves. That means we have to change services so we can deliver safe, high-quality care to everyone who needs it, when they need it."

"Every service cannot be offered by every A&E department - it never has been, and never can be - so it makes sense to create networks of care with regional specialist centres to give the best possible treatment to the sickest people. For the majority of people, care is still going to be as local as it ever was. Major emergencies affect a relatively small number of people. For most people, care will continue to be as local – or indeed more local – than ever."

Speaking at the breakfast event, Health Secretary Patricia Hewitt said:

"The NHS is at a crucial stage in a ten year process of investment and reform, and as part of this process, a number of service changes are being proposed across the NHS. The prompts for these changes are not only financial, as many would have us believe."

"The NHS is changing because medicine and patients needs are changing. As both National Clinical Directors have highlighted, the NHS in the future will save more peoples lives by taking the most seriously ill patients to the right specialist centre. But it will also give many people with less serious conditions more convenient care by taking A&E to the patient rather than expecting every patient who wants urgent care to go to A&E."

"Mending Hearts and Brains" by Prof. Roger Boyle and "Emergency Access" by Sir George Alberti, are available on the Department of Health website

Leaked paper reveals Labour fears on NHS

Tuesday 05 December 2006

Government must be smarter, health secretary says at private briefing

Patricia Hewitt and other ministers have privately conceded that the government is in real difficulty over its efforts to sell controversial health reforms, a minute of a private briefing reveals.

At a brainstorming on the future of the NHS between the health secretary and ministers last Thursday, some raised anxieties about the way the reforms were being presented to the public. "Too often the debate on public service reforms seemed to pitch the government against frontline staff," said the minute, which was marked restricted.

One unnamed minister warned Ms Hewitt that financial pressures were mounting too.

This was because "increasing life expectancy and medical advances would lead to new pressures, which would need to be reconciled with the public's expectations about taxation".

The minute reveals that Ms Hewitt admitted that the government needed to "be smarter about communications".

She said the government needed to involve senior NHS staff to help make the case for change. "Where clinicians are prepared to make the arguments for reform, it can have a high impact," she told the meeting.

She said it was also necessary "to involve the public and patients through patient panels, working with local MPs so they focus on ensuring the best health outcomes for their constituents rather than the number of beds, pursue value for money through shorter hospital stays which the evidence shows can often result in better health outcomes as well as savings".

The minute also shows that Ms Hewitt told ministers she was determined to press on with the reform, despite the criticisms from colleagues.

The meeting was part of a frank debate being led by Downing Street and the Treasury into the future direction of all government policy. She argued that "it was true there would always be clinicians and frontline workers who did not welcome reforms, but the government has to take on the argument and win over NHS staff and the public".

The situation has become so acute that Ms Hewitt has staked her ministerial position on returning the NHS in England to financial balance by the end of March.

The health secretary will adopt a tougher approach today when she launches a counter–attack against campaigners across England who are protesting about proposals to close key facilities at NHS hospitals.

She will parade medical experts who are convinced that hundreds of lives could be saved every year if the NHS reorganised to provide specialist care in a small number of regional centres.

Five weeks ago the Guardian identified more than 50 campaigns against proposed or rumoured closures that are building up into the most widespread and prolonged unrest since the poll tax revolt in 1990.

Most of the campaigns present the closures as an economy measure to eliminate NHS overspending. Ms Hewitt will argue that her plans for restructuring the NHS are driven by the need to save lives, not money.

She will also present reports by Sir George Alberti, the government's emergency care tsar, and Roger Boyle, the heart disease tsar, calling for patients with the most serious conditions to be treated in specialist centres.

Sir George is expected to back proposals from the Royal College of Surgeons and other senior clinicians for "super–regional" A&E departments serving populations of between 400,000 and 500,000.

These plans imply that 50 or more of the existing A&Es might be downgraded into urgent care clinics providing a less comprehensive service.

Ms Hewitt is expected to stress, however, that the changes should not be imposed from the centre.

Local NHS managers should seek agreement with their hospital consultants and GPs on solutions that fit the local geography and health needs, avoiding excessive ambulance journey times for people in sparsely populated rural areas.

A Department of Health spokeswoman said: "Very few of 18.5 million people who attend A&E departments have life-threatening conditions".

"Many are just in pain, while others are just uncertain. For these people it is better to offer more convenient and appropriate care closer to home."

"But patients in a critical life–threatening emergency needed to be taken to super regional A&E departments with 24–hour consultant cover and access to state–of–the–art diagnostic equipment."

Lives could be saved if heart attack patients drove past the local hospital and went straight to a specialist centre for angioplasty, a new keyhole treatment for narrowed and blocked arteries. But not every hospital could justify employing the expert surgical team required to carry out the procedure.

Source: The Guardian

Consult staff on smoke breaks, DWF tells employers

Monday 04 December 2006

Employers should bring smoking and non-smoking workers together to agree an acceptable policy on smoking before the ban is introduced on 1 July 2007, says law firm DWF.

The new rules will make it unlawful to light up in workplaces, public places and even company cars and employers who fail to comply could face fines of up to £2,500. The ban will be introduced in Wales on 2 April.

Stephen Robinson, associate with DWF says companies should develop a policy that is in line with the law and has the support of all employees: "While there is no automatic right to a smoke break, some people will still want to smoke during working hours. Employers must balance their wishes with those of non-smokers who often believe smokers enjoy more rest breaks."

He says the policy should state that it has been developed following consultation with staff to help provide a safe and healthy workplace and that it applies to all employees and visitors including contractors and workmen.

It should say what arrangements have been put in place for smokers such as 'smoking shelters' outside the premises but make it clear that smoking breaks are not an automatic right and leaving butts is unacceptable.

It should also give guidance on how managers should handle smoking in the workplace and what disciplinary action may be taken. In addition, employers should display no smoking signs and consider providing support to smokers who want to give up.

"Employers who do not enforce the ban may not only face fines, but also employment tribunal claims and in the long term even personal injury actions," adds Robinson. "Having a clear policy which is communicated to staff and enforced by the employer should minimise these risks."

DWF is one of the fastest growing law firms in the UK, with over 370 legal advisers (including 70 partners) and 595 people based in Manchester and Liverpool. DWF provides a range of services grouped under the following practice areas: Corporate, Banking & Finance, Litigation, Real Estate, People, Insurance.

£10m burns centre to 'give hope'

Wednesday 29 November 2006

A burns research centre which a charity says offers "hope to thousands" is to be set up in both Cardiff and Swansea.

The Healing Foundation UK Centre for Burns Research will examine physical and psychological effects of burns, and how to improve treatment and support.

The £10m centre, the UK's first, is joint initiative by both cities' universities and Morriston Hospital with the charity Healing Foundation.

Over 14,000 people are admitted to UK hospitals with serious burns each year.

About half of those are children under 16.

The new centre will be located at the Heath Park campus of Cardiff University's School of Medicine and the Centre for Burns and Plastic Surgery at Morriston Hospital.

It will look at the physical effects of burns, including inflammation and scar formation and the psychological and social aspects of living with burn scars, long-term rehabilitation and prevention.

Organisers said they had fought off competition from across the UK to win the award.

'Prestigious'

Cardiff University said it would support the centre by making a £5m investment in new staff and a £4m investment in new and refurbished laboratories.

William Dickson, director of the Centre for Burns and Plastic Surgery at Morriston, said: "This prestigious award – the first and only chair of burn injury study in the UK – will put Wales at the international forefront of burns research."

Brendan Eley, chief executive of the Healing Foundation, a charity which funds research into disfiguring conditions and has Falklands veteran Simon Weston as its "lead ambassador" said the centre would "provide hope to thousands".

He said: "This award represents a major step forward in our goal to improve the treatment, care and long-term understanding of burn injuries".

'Great news'

"The Cardiff/Swansea centre will become a global leader, improving the outcome for patients, enhancing our understanding of burns and offering hope to thousands of people, worldwide."

Health and Social Services Minister Brian Gibbons welcomed the award as "great news" for Wales.

"It is a mark of how highly regarded the academic team in Cardiff University is and how respected the clinicians and care staff of the Welsh Centre for Burns and Plastic Surgery have become", he said.

Source: BBC NEWS

National Cot Locator for critically ill babies

Monday 27 November 2006

A new system to find intensive care cots for sick and premature babies was launched today by Health Minister, Ivan Lewis.

Developed by clinical and professional experts, the National Cot Locator will allow nurses and clinicians to see at a glance where available cots are located around the country. Around 40 level 3 neonatal intensive care units in England will be covered on the system.

Neonatal networks aim to provide 95% of neonatal intensive care for babies locally. However, in circumstances where babies have to be transferred outside of the local network and also to more specialist units, the cot locator will allow these transfers to be planned and co-ordinated way.

Health Minister, Ivan Lewis, said:
"About 17,000 babies a year require neonatal intensive care. On the occasions when a suitable cot is needed outside of the local network, a call to the National Neonatal Cot Locator will provide immediate up-to-date information about more distant options, making sure that these transfers can happen quickly, are effectively planned and can go as smoothly as possible."

"This will make a real difference to families and professionals seeking to ensure that babies and parents get the best possible care in usually very challenging circumstances."

Andy Cole, Chief Executive of Bliss said:
"BLISS welcomes this important strategic development. We hope to see the cot locator have a significant impact across England on the crucial issues of available cots and transfers for babies in need of intensive care."

Over the last year, the average number of cots available was 957, ranging between 900 to over 1,000 cots according to demand.

New NICE guidance to reduce the risk of transmission of Creutzfeldt–Jakob disease (CJD) via surgical procedures

Saturday 25 November 2006

The National Institute for Health and Clinical Excellence (NICE) has issued guidance to the NHS on reducing the risk of transmission of Creutzfeldt–Jakob disease (CJD) via surgical procedures.

NICE has recommended that:

For certain surgical procedures carried out on the brain or eye (which carry a higher risk of potential transmission than other procedures):
- Steps should be taken urgently to ensure that instruments do not move from one set of instruments to another. Practice should be audited and systems should be put in place to allow these surgical instruments to be tracked
- Supplementary instruments that are used in these procedures should either be single use or should remain with the set to which they have been introduced
- A separate pool of new reusable surgical instruments should be used for children born since 1 January 1997 (who are unlikely to have been exposed to BSE in the food chain or CJD through a blood transfusion) and who have not previously undergone these procedures
For neuroendoscopy, a procedure using a tube inserted into the brain :
- Rigid neuroendoscopes should be used whenever possible. They should be of a kind that can be autoclaved (steam cleaned at a high temperature and pressure) and they should be autoclaved after each use.
- All accessories used through neuroendoscopes should be single use
- A separate pool of new neuroendoscopes should be used for children born since 1 January 1997
For all other surgical procedures, the risk of possible transmission of CJD is so low that it does not justify a change to single-use instruments.

Professor Peter Littlejohns, Clinical and Public Health Director at NICE and Executive Lead for this guidance says: "CJD is a terrible disease but thankfully it is extremely rare. This guidance is still important however, in order to help reassure the public that everything possible is being done to keep this risk as low as possible whilst also ensuring that surgeons have clear guidance."

Professor Bruce Campbell, Surgeon and chair of the committee who developed the guidance on behalf of NICE said: "Our guidance recommends two really important and practical measures for minimising the risk of CJD being spread by operations that NHS Trusts should implement immediately. The first is to be sure that all surgical instruments remain in their sets. The second is to check that systems are properly in place to track all instruments, so we know that they have stayed in their sets and we know which patients they have been used on."

Commenting on the use of single use instruments for surgical procedures, Professor Campbell continues "NICE has carefully considered the idea of introducing single use instruments for a whole range of operations. The problem is that single use instruments simply don't exist for many operations. They take time to design and produce and they have to be of very high quality, otherwise patients may be harmed. We have also had to bear in mind that effective methods for removing CJD infectivity from instruments are likely to be available and widely introduced within 5 years. Therefore our recommendations for changes in practice have to be both practical and achievable within a short time frame."

Lester Firkins, lay member of the CJD Advisory Committee says: "As someone whose son died from vCJD, I consider even one preventable death to be one too many. There are so many uncertainties around this disease and whilst the only way to remove all risk is to destroy every single instrument after every single intervention, I understand that in practice this is unachievable. I have been fully involved in the NICE review process throughout and am comfortable that the final guidance fully takes into account the best research evidence as well as the cost implications for the wider NHS."

The full guidance, which includes a list of all the surgical procedures covered by the guidance, can be found on the NICE website.

Inquiry launched after woman dies and four fall ill in operating theatre

Tuesday 14 November 2006

Police and managers at Britain's largest hospital have begun an investigation after it emerged that one patient had died and four others had fallen ill during surgery in the same operating theatre.

All five patients were operated on in the neurosurgical theatre at the Queen's Medical Centre (QMC) in Nottingham during the past three weeks.

The woman, aged 36, whose death has prompted the investigation had undergone spinal surgery on Thursday when her condition suddenly deteriorated in what the hospital described as "a very marked and unexpected way". She died on Friday. Sources said it was thought, at first, that the woman died as a result of an allergic reaction to anaesthetic but her death was later deemed "unexplained".

Detectives are expected to examine the possibility that either the surgical equipment or the drugs used in the theatre may have been faulty. They will also consider the possibility that equipment might have been tampered with.

A spokesman for the QMC, Europe's largest teaching hospital, would not confirm or deny last night whether anyone had been suspended in connection with any of the incidents. But staff working in the theatre at the time of the operations are likely to be interviewed.

The four patients who fell ill are now said to be well.

Peter Homa, QMC chief executive, said: "This was so unusual that we immediately looked to see if any other patient had experienced similar problems. This identified that possibly four other patients had experienced similar unexpected – though much less severe – clinical problems during surgery."

"Our own urgent inquiries continue, and we are being valuably supported by the police in the investigation of this unusual sequence of events."

All other neurosurgical patients have now had their cases delayed. All emergency neurosurgery was halted yesterday and it will start again today in a different theatre.

The hospital moved quickly to reassure all patients and their families. In a statement, it said: "Investigations will continue until we have gained a complete understanding of what occurred, and can put in place appropriate permanent safety checks or changes in practice."

"We would like to reassure all patients and their families that we are confident that the exceptional safety checks and additional measures we have introduced will ensure the safety and well-being of our patients."

Source: Independent, by Ian Herbert

ROYAL COLLEGE OF SURGEONS' PRESIDENT CALLS FOR JOINT MULTI–PROFESSIONAL TEAM TRAINING ACROSS ALL ROYAL MEDICAL COLLEGES

Friday 10 November 2006

The President of the Royal College of Surgeons (RCS), Bernard Ribeiro will say today (Friday 10 November) how important team–working – and team–training – is for surgeons. "Traditionally, nurses, doctors, surgeons and anaesthetists and other members of the medical team have trained separately. But, we work together. We should train together. There is strong evidence that training is far more effective when all members of the team develop their skills together."

"Professional failures are more often due to behavioural difficulties, personal conflict, lack of insight, systems failure or defective infrastructure than technical failings or lack of knowledge. Accidents are rarely caused by a single individual. They are more often the result of a sequence of avoidable errors or organisational defects."

Mr Ribeiro opens a one–day conference at the Royal College of Surgeons today – Everybody's Business: Lessons from High–Risk Industries for the Safety of Patients.

"The outcomes of surgical procedures have vastly improved due to advances in technology and technical skills," says Mr Ribeiro. "Surgery has become technically more complex and specialised. It takes a long time to acquire the skills. But there are other non–technical factors to take into account in the operating theatre – human factors."

The Royal College of Surgeons has introduced a new course into surgeons' training which has been developed with the help of human factors experts and senior airline training captains.

"It aims to improve the way we work together," says Mr Ribeiro, "and reduce the risk of harm from errors. It supports the generic skills defined in the new surgical curriculum – those of communication; collaboration with one's colleagues; professionalism; and acting always in the best interest of the patient. These are the key principles which should guide all surgeons in their practice. Future trainees will be expected to demonstrate competence in these areas and maintain these skills throughout their careers."

Mr Ribeiro has made surgical training his Presidential commitment. "I have pressed the Government on the importance of taking training into consideration as they continue with their plans to introduce more Independent Sector Treatment Centres. I have pointed out to the Prime Minister the impact of the European Working Time Directive. And I have said publicly many times that the damaging effect on training of the twin political realities of public service targets and NHS deficits will have repercussions on the safety of patients."

ROYAL COLLEGE OF SURGEONS' PRESIDENT CALLS FOR JOINT MULTI–PROFESSIONAL TEAM TRAINING ACROSS ALL ROYAL MEDICAL COLLEGES

Friday 10 November 2006

The President of the Royal College of Surgeons (RCS), Bernard Ribeiro will say today (Friday 10 November) how important team–working – and team–training – is for surgeons. "Traditionally, nurses, doctors, surgeons and anaesthetists and other members of the medical team have trained separately. But, we work together. We should train together. There is strong evidence that training is far more effective when all members of the team develop their skills together."

Mr Ribeiro opens a one–day conference at the Royal College of Surgeons today – Everybody's Business: Lessons from High–Risk Industries for the Safety of Patients.

The Royal College of Surgeons has introduced a new course into surgeons' training which has been developed with the help of human factors experts and senior airline training captains.

NHS's new computer system 'useless'

Friday 10 November 2006

Health workers lack confidence in a new NHS computer system and few believe it will help them do their jobs better, according to a new survey.

The survey of more than 300 NHS staff in London showed most workers are angry that their views were not taken into account before the introduction of the system, which is aimed at improving information passed between hospitals and GPs.

Trade union Amicus said its study showed lack of staff involvement was symptomatic of how the NHS is run.

National officer Kevin Coyne said: "It's appalling that so many NHS staff lack confidence in the implementation of the world's largest civil IT project."

"Without consulting the people who will use these IT systems, the NHS management and IT providers will leave patients and NHS staff floundering in the dark."

"We are dealing with systems which can either vastly improve the way we treat patients or hinder it."

"Amicus is calling on the NHS and its providers to give users a greater say and more information on the delivery of the new system."

"While the NHS has undoubtedly got better, morale amongst health service employees is at rock bottom. This is made worse by a series of rapidly-introduced changes that have been introduced without staff involvement."

One health worker told the union he believed computer systems had been developed at great cost but were "useless".

Workers taking part in the survey included scientists, psychologists and pharmacists.

Joint RCN and Unison march through Leeds on Saturday 11 November, 2006

Friday 10 November 2006

Around 2,000 nurses, cleaners, porters, along with other clinical and hospital staff will march through the centre of Leeds on Saturday 11 November, 2006, protesting against the impact of budget deficits on NHS services at the Leeds Teaching Hospitals Trust and other hospitals in the region.

The march will assemble at 10.45am in the car park at the rear of the Yorkshire Playhouse, beneath the Department of Health building on Quarry Hill, central Leeds, LS2 7UP.

Timetable

10.45 March assembles
11.15 Photocall with RCN Deputy President, Bobbie Chadwick; & Kevin Austerberry, Regional Director for Yorkshire & the Humber
11.30 March commences and follows route along Eastgate, Vicar lane, Duncan Street onto Briggate
12.30 Rally at Briggate. Speakers include RCN Deputy President, Bobbie Chadwick.

NHS Supply Chain Announces Two New Supplier Conferences

Wednesday 8 November 2006

NHS Supply Chain, incorporating the former NHS Logistics and some of the scope of NHS Purchasing and Supply Agency, announces that it is hosting two supplier conferences, for current and potential suppliers.

The events take place on Monday 13 and Tuesday 14 November in Leeds and Heathrow respectively, from 1.00pm – 6.15pm.

Key services include procurement, logistics, e–commerce and customer and supplier support, across the following key areas:

theatre/surgical services
medical
food and facilities (including office supplies)
clinical markets
orthopaedics
cardiology
pathology
ophthalmics
renal
dental
resonance imaging

The supplier conferences will provide companies with precise details on how the contracting and tender process will work, plus discuss key areas such as innovation and clinician engagement. There will be a chance to meet with NHS Supply Chain management to discuss ways of working.

To register, visit www.supplychain.nhs.uk or www.logistics.nhs.uk and click on the supplier conferences button.

For further information, please contact Liz Perry.

Source: NHS Supply Chain PRNewswire

HPC launches fees consultation

Monday 6 November 2006

The Health Professions Council (HPC) has launched a three month consultation to ask registrants and stakeholders for their views on the level of increase in fees.

The HPC's existing fees have remained unchanged over the last three years despite a steady increase in the costs of regulation and inflation. This consultation sets out why the HPC is proposing an increase and how the money will be spent. In particular, the increase will enable the HPC to manage the growing number of fitness to practise allegations which have more than doubled since its inception. It will also be used to help maintain the register, develop the levels of engagement with registrants and the public and to maintain the high standards of approvals visits carried out by the education department.

Anna van der Gaag, HPC President said "It is vital that the HPC has an appropriate and realistic level of income to enable us to operate effectively, give registrants an efficient service and to protect the public".

"We are looking forward to listening to registrant and stakeholder views on our proposals. Anyone who wishes to take part in the consultation and have their views heard, can write to us with their comments by post or email. We look forward to hearing a variety of views and ideas over the coming months."

In the consultation, the HPC have put forward two options for renewal fees and for the fees charged to applicants who have successfully completed an approved course and are applying to be registered for the first time. It also proposes that the scrutiny fees charged for processing applications via the international, EEA and grandparenting routes should increase. The HPC also propose to introduce higher fees for people who are applying to come back on to the Register.

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

The consultation will run until Tuesday 6 February 2007. If the proposals are adopted the changes to the fees will be effective from June 2007. Existing registrants would pay the new renewal fee when their profession next renews its registration.

The full documents are available on-line and a copy can be downloaded from here.

Warning over privacy of 50m patient files

Wednesday 1 November 2006

Call for boycott of medical database accessible by up to 250,000 NHS staff

Millions of personal medical records are to be uploaded regardless of patients' wishes to a central national database from where information can be made available to police and security services, the Guardian has learned.

Details of mental illnesses, abortions, pregnancy, HIV status, drug-taking, or alcoholism may also be included, and there are no laws to prevent DNA profiles being added. The uploading is planned under Whitehall's bedevilled £12bn scheme to computerise the health service.

After two years of confusion and delays, the system will start coming into effect in stages early next year.

Though the government says the database will revolutionise management of the NHS, civil liberties critics are calling it "data rape" and are urging Britons to boycott it. The British Medical Association also has reservations. "We believe that the government should get the explicit permission of patients before transferring their information on to the central database," a spokeswoman said yesterday.

And a Guardian inquiry has found a lack of safeguards against access to the records once they are on the Spine, the computer designed to collect details automatically from doctors and hospitals. The NHS initiative is the world's biggest civilian IT project. In the scheme, each person's cradle–to–grave medical records no longer remain in the confidential custody of their GP practice. Instead, up to 50m medical summaries will be loaded on the Spine.

The health department's IT agency has made it clear that the public will not be able to object to information being loaded on to the database: "Patients will have data uploaded … Patients do not have the right to say the information cannot be held."

Once the data is uploaded, the onus is on patients to speak out if they do not want their records seen by other people. If they do object, an on–screen "flag" will be added to their records. But any objection can be overridden "in the public interest".

Harry Cayton, a key ministerial adviser, warned last month of "considerable pressure to obtain access to [the] data from … police and immigration services", but he is confident that these demands can be resisted by his department.

Another concern is the number of people who can view the data. The health department has issued 250,000 pin–coded smart cards to NHS staff. These will grant varied access from more than 30,000 terminals – greater access for medical staff, and less for receptionists. Health managers, council social workers, private medical firms, ambulance staff, and commercial researchers will also be able to see varying levels of information. Officials say the data will be shared only on a need–to–know basis. But Guardian inquiries show a lack of safeguards.

Although data protection laws supposedly ban unnecessary build–ups of computer information, patients will get no right to choose whether their history is put on the Spine. Once uploading has taken place, a government PR blitz will follow. This will be said to bring about "implied consent" to allow others view the data. Those objecting will be told that their medical care could suffer.

The government claims that computerised "sealed envelopes" will allow patients selectively to protect sensitive parts of their uploaded history from being widely accessed. But no such software is yet in existence. It is being promised for an unspecified date. Some doctors say "sealed envelopes" may be too complex to be workable. The design also allows NHS staff to "break the seal" under some circumstances. Police will be able to seek data, including on grounds of national security. Government agencies can get at records, according to the health department, if "the interests of the general public are thought to be of greater importance than your confidentiality". Examples given of such cases include "serious crime and national security".

The department's guidelines say: "The definition of serious crime is not entirely clear … Serious harm to the security of the state or to public order, and crimes that involve substantial financial gain or loss will … generally fall within this category." The health department says confidentiality can already be breached in such cases.

At present, police have to persuade a GP, who knows the patient, to divulge limited facts, or insist on a court order.

Under the new system, data may be disclosed centrally and anonymously, at the touch of a button. Health department privacy advisers say they do not wish to allow police to have clinical information. But they are prepared to disclose patients' addresses.

Another safeguard initially promised was that all patients would be able to check their records on the internet for mistakes. But a system involving the issue of smart cards to patients has not yet been tried out.

Current criminal penalties are so weak they have failed to stop tabloid journalists and private detectives raiding such data on an industrial scale, according to a recent special report by Richard Thomas, the information commissioner.

Sir John Bourn's National Audit Office also wrote a recent report warning of significant concerns among NHS staff "that the confidentiality of patient information may be at risk". But officials persuaded the NAO to delete the warnings in the published version.

The original draft said: "Patient confidentiality remains a controversial issue among critics … both as regards the adequacy of the planned safeguards to protect information, and whether patients should have a right to opt out of having their information recorded".

Source: The Guardian, David Leigh and Rob Evans

HPC cautions Operating Department Practitioner

Monday 30 October 2006

A Panel of the Conduct and Competence Committee met on the 18th, 19th and 24th October to consider the case of Angus Sutherland at The Health Professions Council in Kennington, London. The panel heard the allegation that his fitness to practice was impaired by reason of misconduct whilst employed by Addenbrookes NHS Foundation Trust in that he used the internet excessively during work hours and accessed inappropriate websites during work hours which included pornography.

Chair of the Panel Ian Griffiths said… "The Panel finds that the use of the internet was excessive. This finding the Panel makes by reference to the standards of behaviour they would expect of a registered health professional – it does not make that finding by reference to the Trust's internet policy. Clearly many of the sites visited were inappropriate. This conduct clearly amounts to misconduct. Equally clearly this misconduct impairs Mr Sutherland's fitness to practice."

"However, there was no risk that patients would have been exposed to the images being viewed by Mr Sutherland and there was no scope for patients to be affected by his behaviour. Further, there is no evidence that other members of staff were affected by his activities. Although the sites were pornographic, there is no evidence or suggestion that any sites involved children, bestiality or violence."

"Although Mr Sutherland has not admitted the allegations, the Panel has had the opportunity to observe him over a long period of time and has come to the conclusion that the whole saga has had a devastating effect on him. The Panel is satisfied that there is a low risk of repetition of this sort of behaviour."

The Panel concluded that a caution order for a period of two years would be the most appropriate sanction in this case.

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.

Maggots drop into hospital:
Major clean-up after accident

Wednesday 25 October 2006

Maggots have been falling from air vents near operating theatres in Barnet Hospital, it was revealed this week by hospital staff.

One worker said that in two weeks, 50 maggots had fallen from the ceiling, but a hospital spokesman said there had been only three.

The maggots, which had apparently been eating dead pigeons, fell onto the floor between two operating theatres on the hospital's third floor.

They first appeared after flies laid eggs on pigeons' carcasses which had nested in the hospital roof, in Wellhouse Lane, Barnet.

A staff member said: "When birds died, they are not being removed from the building. The problem is not being fixed but the hospital is trying to stop them from coming into the theatres."

"The other week, maggots were falling through the air vents in the ceiling between theatres one and two, about five feet away from the theatre. They were dropping like there's no tomorrow."

"I was standing there and we counted 50. I was shocked - operating theatres are meant to be the most sterile places in a hospital. If a maggot fell onto a patient during surgery and the wound was open, they could get an infection."

But a hospital spokesman said staff had found some dead pigeon remains in a part of the loft that was awkward to access, which is why the incident happened, but that it had all been cleared out and resealed.

He said: "In the past there was a problem that maggots had dropped through the ceiling into the theatres. The ceilings were sealed up and the cracks were made airtight."

"What happened recently was that three maggots fell, not in the theatres but in the corridor. Within an hour of it happening, there were people in the roof checking everything. There has been absolutely no impact on clinical care."

He added that regular checks would take place and the hospital had employed the services of a hawk to scare pigeons away.

Alex Nunes, chairman of Barnet Hospital's Patient and Public Involvement forum, added: "It is pretty worrying. It's a very unpleasant accident, and I know the hospital has been very disturbed by it."

"We are very upset that such a thing could occur, but the hospital has done all it can to disinfect, clean and prevent a reoccurrence and stop the pigeons from getting in."

SOURCE: Hendon & Finchley Times By Alex Galbinski

Veils Banned to Muslim medicos in Birmingham Hospital

Monday 23 October 2006

Adding fuel to the already raging controversy in Britain, Birmingham city hospitals have banned Muslim medicos from donning full−face veils.

Birmingham University School of Medicine has passed this ban on wearing of a full-face veil by Muslim women in an attempt to "help to aid good communications" between Muslim medical students, their colleagues and patients.

The University will allow Islamic women to cover their faces in lectures and around campus but would not be permitted to do so in the "clinical environments" of hospital buildings and GPs' surgeries. Only in the sterile surroundings of an operating theatre can they cover their faces - with regulation surgical masks.

The ban extends to women Muslim students who has been required to show their faces if they are talking to patients in hospital or surgery or if they are in meetings with other medical staff.

Presently the school has 450 students of all faiths who are sent to practise to a number of different hospitals and primary care units, including the University Hospital of Birmingham NHS Trust.

Birmingham has a large population of Muslims of South Asian origin.

A spokesman said, "We do not place restrictions on the wearing of headscarves by staff or students, except in cases where they are required to work in a clinical environment."

"This is particularly the case when it involves direct contact with patients. In these cases students are allowed to wear a headdress as part of their religious observance, as long as it does not cover the face."

"This is necessary to help aid communications with patients and other colleagues," the spokesman said.

This move comes close on the heels of a nationwide debate over wearing of veil that was sparked by Commons Leader Jack Straw's comments that he asks Muslim women to remove their veils when they visit his constituency office in Blackburn, northwest England.

According to him the veil made community relations "difficult" and removing it would improve communication.

Muslim Labour MP Khalid Mahmood, whose constituency is in Birmingham, said "We have to consider the safety and security of all, as there is times when people must be identified."

He added, "Removal is fine where professional issues are called into question, when doctors and nurses meet with patients."

Source: Medindia
NLA

NHS pay rise plans prompt anger

Monday 23 October 2006

Doctors' leaders have voiced anger over proposals for pay rises below the rate of inflation for NHS staff.

The British Medical Association accused the government of trying to "claw back" money by suggesting staff should get only 1.5‰.

It says pay should go up by 4% to motivate doctors and attract new recruits to the profession.

The Department of Health warned pay rises had to be affordable or patient services funding would suffer.

In March, the government awarded a pay rise of 3‰ for dentists, 2.5‰ for nurses and 2.2‰ for junior doctors.

But consultants are angered by their staged increase, which saw them get a 1‰ rise on April 1 and a further 1.2‰ increase in November.

BMA chairman James Johnson, said: "The Department of Health proposal for a pay uplift of only 1.5‰ is an attempt to claw back the pay increases resulting from the contracts introduced for consultants and GPs in the last few years."

"We don't negotiate contracts in good faith for them to be whittled away over the succeeding years."

"Doctors are working intensively and under pressure to cut waiting times and deliver high−quality services. They deserve a pay rise that reflects their continuing hard work, not one that erodes the value of contracts the government has agreed to."

Balancing the books

Peter Allenson, from the Transport and General Workers' Union, said: "Offering health workers an effective pay cut is an insult."

"To recommend a below−inflation rise is particularly baffling."

Karen Jennings, from Unison, said a 1.5‰ pay increase would work out at less than 2p an hour extra for newly−qualified nurses and paramedics.

"It is also less that half the latest retail price index figure which stands at 3.6‰," she said.

A spokeswoman for the Department of Health said all staff groups had benefited from the improved pay and conditions, adding: "A 1.5‰ uplift will deliver a 4‰ increase in average earnings for NHS staff, which compares with the current average across the whole economy."

"The NHS is facing a challenging financial period with the need to change a £512m deficit in 2005/06 into lasting financial balance."

"It is clear that a period of pay restraint is necessary to support the NHS in achieving that lasting balance."

"Pay uplifts must be affordable otherwise funding for patient services will suffer."

"If pay levels are too high, NHS employers may well need to reduce staff posts."

Josie Irwin, of the Royal College of Nursing, said: "For the government to say more than 1.5‰ would mean more job losses and redundancies is an outright threat; you can't deliver care without staff and, ultimately, it's about where the government chooses to spend public money."

Negotiations are ongoing about pay rises for all health workers, with the government and several unions submitting evidence to independent pay review bodies.

Story from BBC NEWS

Give up or we won't operate, smokers told

Monday 23 October 2006

Smokers will be denied life-changing operations unless they agree to kick the habit, it was revealed today.

Cash-strapped hospitals say patients will not be given treatments such as hip and knee replacements until they try to give up. Those who fail could be denied treatment all together.

Managers in Norfolk and Newcastle, where trusts are millions of pounds in debt, say smokers are at a greater risk of complications and the move will help save them money on further care.

But critics accused them of putting its finances before the health of its patients − and warned it could lead to surgeons being "brow-beaten" into breaking the Hippocratic Oath.

The move will hit patients of Norfolk Primary Care Trust which is £50million in the red and provides healthcare to the residents of Norwich and surrounding towns and villages. Newcastle-Under-Lyme PCT in north Staffordshire, which is £1.4million in debt, has taken a similar decision.

Last year, health bosses in east Suffolk barred obese patients from the operating theatre until they tried to lose weight.

While urgent operations are not covered by the Norfolk policy, the treatments include hip and knee replacements as well as hernia operations.

Norfolk PCT said smokers were being targeted because they are at increased risk of complications and take more time to recover from surgery meaning they have longer − and more expensive − stays in hospital.

Stopping smoking will reduce the risk of complications − and cut the cost of their care. Simple saliva tests can quickly prove if a smoker is telling the truth about quitting.

Defending the move Dr John Battersby, the trust's director of public health, said: "The situation across Norfolk is that one in four people smokes and that is the same for the proportion of people coming through for surgery."

"There is increasing evidence that smokers have three times the number of complications as non-smokers."

"What we are proposing is that if someone who smokes is being referred for surgery, we would instead want them to be referred to a smoking cessation clinic and give them three months to stop smoking."

Dr Battersby added: "What we are doing is asking people to have a stab at giving up for three months and at the end we would review the situation. Some people will have stopped and will go on and have a referral for surgery. Others will not have stopped."

In those cases, decisions will be taken along the lines of clinical need.

The PCT says if smokers have tried hard and need the surgery, they may get it. But if it is felt they have not made a strong effort to stop and are at high risk from the proposed surgery, they may not be referred to the operation at that stage.

Dr Battersby said: "I am not saying there is an absolute block on smokers getting surgery but there is evidence that if they successfully stop smoking they have a much lower risk of developing complications and there will be a better outcome for them."

"There is a cost implication in terms of those complications. If they stop, it is going to have a positive impact on the health system."

The trusts are taking advantage of guidance from the Government's medical rationing body, the National Institute for Health and Clinical Excellence, which allows them to take patients' lifestyles into account when deciding if a treatment would be effective.

Smokers, however, claim they are being discriminated against. Neil Rafferty, of the pro-smoking pressure group Forest, said: "This is blackmail, pure and simple."

"Smokers pay their taxes like everyone else. In fact, because of the very high duty on tobacco, they probably pay a lot more tax than the average person."

"They are entitled to free healthcare and health trusts do not have the right to make up conditions."

Other critics say that while there are valid medical reasons for recommending smokers quit before an operation, finances, should not play a part in the decision to operate.

Michael Summers, of the Patients Association, said: "Finance has got nothing to do with making sure people are made well and every effort should be made to do it the best one can."

He added that managers doctors could be forced into breaking the Hippocratic Oath, under which they pledge to treat the ill to the best of their ability.

"The patient is the responsibility of the doctor or surgeon, not that of the manager of the PCT," he said. "The responsibility is a moral one. Many of those doctors and surgeons will have taken the Hippocratic Oath and therefore they shouldn't be brow-beaten by managers over whether a patients should or should not have an operation."

Liberal Democrat Health Spokesman Steve Webb said: "If it is about making surgery more effective, that is quite legitimate."

"But if it is a back door way of trying to reduce demand and save money, it is picking on smokers."

"We all do things that are bad for our health and we shouldn't discriminate against one particular group."

Simon Lockett, secretary of the British Medical Association's Norfolk committee for GPs, said: "Clearly the PCT believes it has got to act as quickly as possible because of its financial position but I think GPs would be very concerned about this idea."

"GPs refer people when they think people need to have things done. Most people who smoke wish to stop anyway and we really do not think it appropriate that they should be disadvantaged by being forced to wait for important operations."

The ban comes as the NHS struggles to cope with mounting debt.

Officially, the deficit for the last financial year is £512million, however, it is claimed the true figure is near £1.3billion.

The Government says simple measures such as reducing staff turn-over and cutting down the amount of time patients spend in hospital before operations could save the health service £2.2billion a year.

Launceston hospital set to feel industrial unrest impact

Monday 23 October 2006

Patients undergoing elective surgery at Launceston General Hospital may be affected by industrial action today.

Operating theatre nurses have joined their colleagues in the north-west, imposing bans on elective surgery unless there are safe staffing levels.

Last week, Health Minister Lara Giddings announced the state would adopt new staffing models for operating theatres to try and stop the action.

But the Australian Nurses Federation says it will make no difference to funded nursing positions in surgeries.

The federation's Neroli Ellis says Launceston will feel the effects of the strike from today.

"Launceston had the bans commence on Friday when we had two theatres closed anyway, so those elective surgery cases will be reviewed on a daily basis and we do expect some to be cancelled this week", she said.

Revolutionary Adhesive for Prostheses Saves the NHS Money!

Thursday 5 October 2006

Professor Alan Roberts OBE, has made a major break through for the plastic and reconstructive surgery field by masterminding and developing − Zeflosil, a prosthetic adhesive, which is used to attach devices to the skin.

"Zeflosil is the first product of its kind to be produced in the UK", said Professor Roberts, "it can be used on patients who have had any cancer reconstructive surgery or on patients undertaking colostomy treatments, and also on the attachment of diagnostic devices", he added.

Zeflosil will be marketed through Prosthetic Solutions Ltd, a company recently established by Professor Roberts. Prosthetic Solutions is based in the Bioscience Business Incubator at the University of Bradford's Institute of Pharmaceutical Innovation (IPI)

"It was an excellent choice to be based at the IPI as I have access to pharmaceutical analysis, expertise and equipment, and a wide network of business services and support", said Professor Roberts.

"The IPI incubator provides new companies a prestigious address, laboratory and office space and a support system during their early development", said Dr Kevin Adams, Bioscience Business Incubator Manager, "It is really exciting to see Prosthetic Solutions get their first product to market. It's even better when you know that there are more significant developments in the pipeline." he added.

During clinical trials Zeflosil exceeded all expectations and has recently achieved quality standards such as CE marking (EU approval), and approval by MHRA (Medicines and Healthcare Products Regulatory Agency)

"Using Zeflosil gives the patient ease of application, other benefits include durability and cost effectiveness compared with other products available in the market place", said Professor Roberts. "In fact, I am currently in discussion with senior management from NHS Trusts following the results of Zeflosil", he added.

Professor Roberts specialises as a Consultant Clinical Scientist, he is a former Director of the Centre for Clinical Prosthetics, Department of Plastic and Maxillo−Facial Surgery; and former Director for Research and Development for Bradford Teaching Hospitals NHS Trust.

He is currently Chairman of the Bradford Research Ethics Committee and Professor of Biomaterials in Surgery at the Academic Surgical Unit, Schools of Medicine, University of Hull and Honorary Professor of Biomaterials, University of Bradford. Professor Roberts has received many National Honours and Awards and has an International standing in the field of Material Science in medicine.

The IPI Bioscience Business Incubator is keen to support pharmaceutical entrepreneurs who are looking to develop innovative ideas.

For further information on how the IPI can support business please contact Dr Kevin Adams, Bioscience Incubator Manager, Institute of Pharmaceutical Innovation

Man died from massive blood loss after surgery

Thursday 5 October 2006

A coroner has ordered further investigations into how a patient died from massive blood loss after an operation at Bradford Royal Infirmary.

Cancer sufferer Victor Dewhirst died in May last year, the morning after surgeons removed his right lung. An inquest heard how Mr Dewhirst, 62, of Queen's Road, Bradford, had eaten breakfast and was sitting in a chair having an X-ray when he "just went very white", collapsed and died.

Surgeon Alan Mearns, who has since retired, said the blood loss into Mr Dewhirst's chest was "a no−win situation".

At the inquest in Bradford yesterday a statement from Staff Nurse Annaliza Tacardon told how the operating theatre did not have the right staples needed to close Mr Dewhirst's pulmonary artery so Mr Mearns said he would "stitch" instead.

Giving evidence, Mr Mearns said he had carried out about 400 lung removals and in about 80 to 100 of them he had used stitches, in the remainder he had used staples. But he said he had 30 years' experience of suturing vessels in chests.

Mr Mearns also said there was "only a fortnight to go", at the time of Mr Dewhirst's operation before the cancer theatres at BRI were closed and the service moved to St James's Hospital in Leeds. He said: "We were basically clearing out all the stocks. We would only take the big equipment with us."

Cynthia Hocklea, an operations director at BRI, said theatre staff should have been responsible for checking levels of stock but said it was a possibility no one had checked the staple supply.

She said Bradford Teaching Hospitals Trust had since carried out a review of its theatre ordering systems and introduced an electronic system which alerted them when staff needed to re−order certain supplies.

Pathologist Dr Karen Ramsden said the post−mortem examination found Mr Dewhirst's pulmonary artery "completely open" and although there was still a ligature round it, the suture that looped round the artery had slipped.

Mr Mearns told the inquest the pulmonary artery was an elastic−like vessel and that he had to accept his sutures were not tight enough but stressed if he had been too rough with the artery it could have torn. He said: "My closure was adequate at the time but there's been enough slack in it for some kind of pull-back in the vessel to occur."

Mr Whittaker adjourned the inquest for further investigations after independent medical expert Francis Wells, a consultant cardiothorasic surgeon at Papworth Hospital, Cambridge, raised the possibility a surge of blood pressure might have led to the blood loss which he described as "tragic, extremely bad luck".

After the hearing, Mr Dewhirst's widow Linda, 54, said her family's search to get an answer into why he died would continue. She said: "We can't move forward. All we want to know is the truth. Victor was a bubbly, happy-go-lucky man with three grandchildren who he adored. It's been a horrendous 16 months."

Source:
This is Bradford.co.uk
Kathie Griffiths

Man needed surgery after sex with hedgehog

Thursday 5 October 2006

A Serbian man needed emergency surgery after he had sex with a hedgehog on a witchdoctor's advice.

Zoran Nikolovic, 35, from Belgrade, says the witchdoctor told him it would cure his premature ejaculation.

But he ended up in an operating theatre after the hedgehog's needles left his penis severely lacerated.

A hospital spokesman said: "The animal was apparently unhurt and the patient came off much worse from the encounter. We have managed to repair the damage to his penis."

Source: Ananova

Linkz Healthcare Provides Careers in New Zealand

Thursday 5 October 2006

Healthcare recruitment specialists, National Locums, report high levels of interest in their Linkz Healthcare service, which enables UK health professionals to experience a complete career and lifestyle change by working and living in New Zealand.

New Zealand is keen to recruit healthcare staff, particularly nurses of all grades, midwives, operating department practitioners and radiographers, either on a permanent basis or for extended tours of duty, in full or part time positions.

The natural beauty, mild climate, sporting facilities and less frantic lifestyle of New Zealand have all contributed to make it a favourite emigration destination for the British, so it's no surprise that National Locums' ability to arrange high quality healthcare career opportunities is creating such a stir.

The service operates in reverse too, providing employment within the NHS and the UK's private health organisations for trained New Zealanders.

Speaking of the service's success, Rae McGlone, a Director of National Locums and a recent Regional Finalist in the National Business Awards said: "We are delighted to be able to assist anyone with the necessary healthcare qualifications to enjoy a new career in New Zealand − we are finding that the lure of working there is particularly appealing to many healthcare professionals who have become frustrated and disillusioned working within the NHS."

Further Information:
Rae McGlone or Mark Hathway
Tel: 0870 129 8538
www.nationallocums.com

First national strike threatened in the NHS Blood Service

Thursday 5 October 2006

Amicus is warning that it is preparing to ballot for industrial action in the NHS blood service over the potential closure of fourteen blood centres across the country.

The health union say that putting at risk centres in Leeds, Newcastle, Sheffield, Manchester, Liverpool, Birmingham, Bristol, Plymouth, Southampton, Tooting, Colindale, Brentwood, Oxford and Cambridge threatens the loss of hundreds of highly skilled technical and scientific staff from the NHS and will leave major cities without facilities for the testing and processing of blood.

Amicus say the cuts are being made without meaningful consultation with either the trade unions or the local communities and despite making representations to the NHS Blood and Tissue Authority, its' head, Peter Garwood, announced at a meeting of the British Blood Transfusion Society last week that the existing centres are to be replaced with new super centres in Bristol and unnamed locations in the South East and the North.

The union has pledged to lobby Health Ministers, MPs and councillors to fight the closures and says it will ballot its 2,000 members on strike action if the plans go ahead.

Amicus' National Officer for Health, Kevin Coyne, said: "This mirrors exactly what is wrong with the NHS reform agenda."

"Modernisation is being rushed through without engagement and consultation with either staff or local communities."

"Furthermore, hundreds of technical and scientific staff jobs are being put at risk and these highly skilled jobs cannot just be recruited or relocated to different parts of the country."

"The NHS and the nation has invested millions in training these staff and now proposes to just dispose of them."

"The geographical gaps in service will also mean delays for the vital testing of blood for many thousands of people, putting lives at risk and making the service dependent upon a charity − air ambulances, in emergencies as motorways cannot be relied upon."

Amicus say existing centres need to be replaced with at least five national centres, with additional facilities required in the North East, North West and the Midlands.

The Birmingham, Plymouth and Southampton Centres test for HIV, Hepatitis B and C, Syphilis and also for confirmation of Blood Group and screening for rare antibodies. Blood is also processed to split into red cells, plasma and platelets. The Birmingham Blood Centre also does Nucleic Acid Testing on blood donations for the whole of the Midlands and South West England to prevent infection with Hepatitis C.

Wrong body part op claims 'rise'

Tuesday 3 October 2006

Operations in which patients had the wrong body parts operated on have risen by a half in the last three years, claim figures show.

Last year, 40 patients in England had claims settled by the NHS Litigation Authority – up from 27 in 2003–4. The cost of settling the claims topped £1m. Among the mistakes were cases of the wrong leg and hips being operated on. Campaigners said the errors were “unforgivable” and should never happen. The data was released by the NHS Litigation Authority after a Freedom of Information request.

There were 27 claims settled for what is known as “wrong site surgery” in 2003–4, rising to 35 the following financial year and 40 in 2005–6. Over the period, the cost of settling those claims, including damages and costs, increased from £447,694 in 2003-4 to £663,145 the following year and £1,098,975 last year. A third of claims involved surgery on the wrong tooth, but wrong hips, knees and legs were also operated on.

Peter Walsh, chief executive of Action Against Medical Accidents, said: “These are accidents that should not be happening. This is not rocket science. It is all about having the correct procedures in place, it is not like we are talking about risk surgery. These mistakes have devastating impact on patients and is unforgivable.”

A Department of Health spokeswoman said: “Millions of surgical procedures are carried out safely and correctly every day in the NHS and only a tiny number of cases are ever performed incorrectly. But the government is very clear, NHS patients who are injured as a result of clinical negligence should receive correct and full compensation.”

And she added last year guidance was issued to doctors to ensure consistent methods were used to mark which body parts were due to be operated on.

Source: BBC NEWS

NHS external manager bill 'soars'

Tuesday 12 September 2006

The NHS in England is set to spend £172m this year on external management consultants — a rise of 83% in two years — the Conservatives have claimed.

Welwyn Hatfield MP Grant Shapps used the Freedom of Information Act to obtain figures from 76% of NHS trusts.

The data shows a link between trusts with the biggest debts and most job cuts, the Tories said.

But the Department of Health said the figure should be seen in the context of the annual £70bn NHS budget.

NHS trusts are able to employ external consultants for advice on how to run their services and staff.

The government has also enlisted companies like KPMG and Price Waterhouse Coopers to act as “turnaround teams” for some failing trusts.

'Dubious effect'

In their report, the Tories said trusts' spending on management consultants was increasing, and that the use of consultants was a “reliable yardstick” for job losses and debts.

The report added that a total of £93.8 million was spent in 2004/05 on external consultants, rising to £117.9 million in 2005/06.

The projected spend for 2006/07 is £171.6 million.

The figures were calculated using the data returned from trusts, and projections for the remainder.

Mr Shapps said several trusts refused to respond to his request, adding they had an even worse track record than some in the report.

He added: “I think it's extremely dubious as to how much effect these consultants are having, other than sacking lots of staff.”

The government needed to look at whether taxpayers were getting value for money when jobs and services were being cut and wards closed, he continued.

'Waste'

The report said 10 of the worst trusts had millions of pounds of debt, yet had a projected spend each of between £1.9 million and £3.6 million on consultants for 2006/07.

Brighton and Sussex University Hospitals NHS Trust owes more than £6 million and is cutting 325 jobs, but has a projected consultants spend of £3.6 million, it added.

Maidstone and Tunbridge Wells NHS Trust has a debt of more than “16 million and 300 job cuts but a projected spend of £3.5 million.

And United Lincolnshire Hospitals NHS Trust owes more than “11 million, and is cutting 320 job cuts but has a projected spend of £2.7 million on consultants for 2006/07, the report said.

Dr Paul Miller, chairman of the British Medical Association's (BMA) consultants' committee, said he would not be surprised if trusts' total spend was even higher.

He added: “The NHS is wasting hundreds of millions of pounds on management consultants who don't have the answers.”

“I would like the secretary of state to stop the NHS wasting all this money on management consultants — it takes money away from patient care.”

Dr Miller, who has an MBA, continued: “The NHS needs good management and good managers but that involves people who know the trust, the staff, the locality and the services it provides — not just people parachuted in from outside with no health experience.”

A spokeswoman for the Department of Health said it not comment on the figures in the report because there were no details of what kind of services were included in the costs, and said the total spend on management consultants was not collated.

“However, any figure should be looked at in context — the NHS budget is over £70 billion and the NHS is one of the largest employers in the world.”

She denied that there was a link between deficits and the use of management consultants and said independent evaluation had found “no common cause” for deficits.

Source: BBC NEWS

Government moves to curb number of ineffective treatments in the NHS

Monday 11 September 2006

SOMETHING'S OP
Patient facing ear surgery is horrified when nurses start shaving … his chest

A DAD in hospital for an ear op realised something was wrong when nurses started to shave his chest before surgery. John Jeffrey, 40, spoke out to alert staff just moments before he was due to receive an anaesthetic.

The customer services worker, who was due for treatment to repair a perforated ear-drum, had mistakenly been booked in for a lung op.

He believes there was a mix-up with his medical records, as he has previously had surgery for a collapsed lung.

Last night, John said: “If they had gone ahead with the pre-med, I would have ended up in the operating theatre.”

“Thank goodness I said something when I did. The surgeon and nurses seem mortified when they realised what had happened.”

“I can laugh about it now - but that's because I spoke out in time.”

He is partially deaf in his right ear after an accident and now faces a delay while his op is re-scheduled.

He was admitted to East Kilbride's Hairmyres Hospital on Friday.

John, who lives in the Lanarkshire town, said at first he assumed his chest was being shaved as part of the usual procedure.

He explained: “When I had surgery on my chest before, they shaved my thigh so a monitor lead could be attached. I assumed something similar was happening with my ear operation, so I did not say anything.”

"In any case, you put your faith in the doctors and nurses.”

“They are the experts and you take it for granted they know what they're doing.”

It only dawned on him he had been booked for the wrong op after a nurse mentioned something he knew related to lung surgery.

John said: “When I told the nurse and anaesthetist that I was in for an ear operation, they looked shocked and called the surgeon.”

“He said they don't even do ear operations at that hospital.”

It's understood the blunder happened after John remained on Hairmyres' waiting list following his lung operation at Glasgow Royal Infirmary.

A Hairmyres spokeswoman said: “Patients on our lung waiting list are sent a letter and telephoned ahead of surgery.”

“We would expect anyone who has had their surgery in another board area to inform us of that before they came to hospital.”

Source: Daily Record Craig Mcdonald

Government moves to curb number of ineffective treatments in the NHS

Thurday 7 September 2006

NICE proposals to release millions in NHS resources and reduce health inequalities

Health Minister Andy Burnham today announced that the National Institute for Health and Clinical Excellence (NICE) will begin a significant new programme of work to help the NHS identify and stop ineffective interventions and make health services more equitable across the country.

Reducing ineffective practice will potentially allow the NHS to reinvest millions of pounds on drugs and approaches that do improve patient care.

Andy Burnham said “This is not about cutting services that benefit patients. New drugs and treatments are continually emerging and trusts have to make difficult decisions about how to invest funding. I believe this important new work will show how the NHS can free up millions of pounds from obsolete or ineffective treatments.” “NICE has an excellent track record in identifying and recommending the most effective new treatments for widespread use in the NHS. But we need to ensure that we balance this with better advice on unnecessary and ineffective interventions that can be stopped.”

In his annual report earlier this year, Chief Medical Officer Liam Donaldson highlighted unnecessary tonsillectomies and hysterectomies as procedures being regularly performed at an annual cost of £21million to the NHS, despite other treatment options being available. He called for disinvestment from established interventions that are of no proven value.

Commenting on today's announcement Liam Donaldson said “As technology advances to expand the range of possible health interventions, it is important that effective therapies to address significant health problems are adopted and that ineffective treatments are abandoned. NICE's new work programme will support this vital process by providing an objective assessment of the evidence.”

As well as developing a new stream of guidance on treatments, which may be inappropriate or unnecessary for patients, NICE's programme of work will include:

actively promoting existing NICE recommendations, on topics such as home haemodialysis.
specific advice for NHS commissioners Identifying and highlighting recommendations within existing guidance that reduce ineffective practice

Further information on this work, including details of the first topics that the programme will look at, are being published today by NICE.

NICE will select the topics included in the new programme, based on clear criteria. Details are available at www.nice.org.uk

The CMO report was release in July 2006 and can be found here.

DoH gives DHL and US purchasing giant Novation a mission to create a monopoly in NHS procurement

Tuesday 5 September 2006

The Department of Health today announced its decision to go ahead with the outsourcing of the NHS Logistics Authority to DHL. Although not named in the DoH announcement it has been established that US purchasing giant Novation will perform the vital role of procurement of NHS supplies under this agreement. This deal will give DHL and Novation control of almost one third of a total NHS medical supplies and equipment market worth around £3.7bn a year. However, the DoH makes clear that DHL/Novation will be expected to increase that market share by as much as possible over the course of the 10 year contract.

The DoH have charged DHL with making savings of £1bn over 10 years, while DHL claims that it stands to make a further £1.6bn profit from the deal. This adds up to around a 12‰ cut in NHS procurement spend over the next 10 years, and there are fears that this will impact on the quality of service to patients.

ABHI Director General John Wilkinson has expressed grave concerns over this deal,

“This is a bad day for patients and the NHS. A very efficient and collaborative supply chain partner stands to be replaced by a purchasing organisation which will be focused on price and will restrict choice for patients and clinicians. The UK is already established as a “slow, late adopter” of modern treatments and it is difficult to see how this transaction is going to improve matters. In most markets the competition authorities get uneasy when one player gets around 25% market share. Here we have a company which says that it has control of around 33% of the supply market to the NHS and is aspiring to achieve 80 to 90%. This will put DHL/Novation in a position of considerable power over hospitals and suppliers and could create a dangerously anti-competitive environment. This whole deal has been conducted in virtual secrecy with minimal consultation or parliamentary scrutiny, and with no evidence produced on how this new regime will benefit patients or the taxpayer”.

There are also serious concerns over the role of the US giant Novation in this deal. In the US Group Purchasing Organisations (GPO) such as Novation have come in for strong criticism for alleged anti-competitive practices and financial secrecy, and are the subject of an ongoing US Senate investigation. A recent report into GPOs by the International Centre for Corporate Accountability states,

“The GPO industry is a classic example of a highly concentrated oligopolistic structure, where a handful of companies control over 80% of the hospital supplies purchased through GPOs. This oligopolistic market structure has allowed these privately owned and controlled entities to extract excessive rates of return for their own benefit and to the detriment of their member hospitals.”

Audit Office pledges new report on NHS

Tuesday 5 September 2006

The National Audit Office is to publish a new report into the UK's largest IT investment, the £12.4bn National Programme for IT in the NHS.

Its decision follows criticism by MPs of the Audit Office's June 2006 report on the NHS programme.

Greg Clark, a member of the House of Commons Public Accounts Committee, said the June report was “the most gushing” of all NAO reports he had read. Another member of the Public Accounts Committee, Richard Bacon, said the NAO's report on the NPfIT was not up to the organisation's usual high standards.

The NAO's value for money reports on IT projects are usually one-offs. So its decision to produce two reports on the NPfIT is an unusual step.

Since the publication of the NAO's report on the National Programme, several developments have worried IT managers and some executives on the boards of NHS trusts across England:

A loss of £382m at iSoft, the main software supplier to the programme. The company is also the subject of an investigation by the Financial Services Authority.
The crash of a datacentre which interrupted NPfIT services in some cases for several days. Some IT managers and executives on boards of NHS trusts are now unsure whether they want to rely on national services for critical clinical systems such as medical records and e-prescriptions.
Persistent suggestions that Accenture, the NPfIT's supplier in the east of England, might have withdrawn from supplying most major hospitals. Accenture, which operates between the borders of Scotland and the edge of London, has declined to comment.
Independent surveys by Nursix and Ipsos Mori which indicate that support for the way the programme is being implemented may be waning among some groups of NHS staff.

Clark said that in the light of recent events the published NAO report “raises more questions than it answers”. He added his committee would hold a new hearing on the NPfIT, based on a new NAO report. He expected the hearing to occur next year.

In its June report the NAO said it “may return to carry out a further examination at a later date should this appear necessary”. But last week its spokesman told Computer Weekly that the NAO had decided to publish a new report, though no date has been set.

The NAO has always stated it would be likely to do another report on the programme in the future and NHS Connecting for Health has always expected this given the scale and complexity of the programme. When the NAO chooses to do this report at some point in the future NHS Connecting for Health will co-operate fully.

Why a new report is needed

The NAO's report, published in June, was replete with praise for Connecting for Health, the agency running the National Programme for IT in the NHS.

But its tone was in marked contrast to three draft reports seen by Computer Weekly. The drafts had been through a six-month “clearance” process which allowed Connecting for Health to refuse to sign off a report if it disagreed with its factual content.

The final report omitted some of the most serious criticisms of the programme. It did not mention the effect on NHS trusts of software delays.

Source: ComputerWeekly.com — Tony Collins

DHL Wins Contract Worth GBP 1.6 Billion Revenue Over 10 Years With the UK Government's Department of Health

Tuesday 5 September 2006

DHL Logistics has won a 10-year deal totalling GBP 1.6 billion /Euro 2.3 billion in revenue to manage GBP 22 billion/Euro 32 billion total spend with the UK Government's Department of Health. DHL will target over GBP 1 billion/Euro 1.4 billion savings over the contract period back to the English National Health Service (NHS). Under the agreement, DHL will run a division called NHS Supply Chain, on behalf of NHS Business Services Authority, and be responsible for delivering all procurement and logistics services across an initial 500,000 products to support 600 hospitals and other health providers in England. The business will ensure that public health (NHS) authorities can dedicate more resources to patient care and continue to manage their cost base. It will help protect existing jobs and lead to the creation of over 1,000 additional positions.

John Allan, Chief Executive of DHL's Logistics division and Management Board Member of Deutsche Post World Net, says, “This contract is both good for staff and good for the NHS. We are committed to targeting savings on behalf of the Department of Health that can be directed back to patient care by building upon the success of both NHS Logistics and some of the scope of the NHS Purchasing and Supply Agency. The contract will ensure that NHS Trusts get access to a wide range of high quality, innovative products that will be selected by having extensive dialogue and testing procedures with clinicians. We are thrilled to play such a major part in this change to manage and deliver a world-class supply chain for the NHS.”

John Pattullo, Chief Operating Officer for DHL Exel Supply Chain, Europe, Middle East and Africa, adds, “By applying commercial experience and procedures to core logistics and procurement functions, and working very closely with the supplier community, we now have a unique opportunity to deliver innovative, high quality products to support public health in England. This is exactly the kind of strategic sourcing deal where we think we can generate major value for our customers, in this case - the NHS.”

The range of products NHS Supply Chain will manage encompasses a wide range of goods including key supplier and maintenance contracts, food, bed linen, office equipment, stationery, cleaning products, patient clothing, medical and surgical equipment (such as operating theatre equipment and machinery) dressings and provisions. NHS Supply Chain will have its own management team and be governed by a Board dedicated to managing the performance of the operations. In addition, it will be overseen by the NHS Business Services Authority, a government body responsible for managing core public sector support services.

In 2008, DHL will open a new 250,000 sq ft UK-based DHL distribution centre (DC) to act as a stockholding hub for food and other products. It is expected that around 1,000 extra employees will be recruited to manage this distribution centre, and an additional DC in 2012.

With extensive experience in the healthcare sector, including over five years experience with the former NHS Logistics, DHL will build upon existing knowledge, relationships and capabilities to pass savings back to the Department of Health. In addition, DHL will have freedom to invest and develop the business along commercial best practice, work even more closely alongside industry professionals and suppliers, and introduce more employees to the benefits of working alongside DHL.

About NHS Supply Chain

NHS Supply Chain, operated by DHL's logistics business on behalf of the NHS Business Services Authority, manages the entire supply chain for core products. By focusing on the procurement, supply, logistics and delivery of goods - such as bed linen, medical and surgical equipment, and maintenance products - it enables healthcare providers to better manage their cost base and focus on patient care. DHL will work with its subcontractor, Novation, a US-based group purchasing organisation on the procurement activities relating to this business. With its own, distinct management team, NHS Supply Chain is committed to creating further value for public health providers in England.

Based in Alfreton, Derbyshire, UK, the business employs around 1,650 staff in seven locations. For further information, visit www.supplychain.nhs.uk.

About DHL

DHL is the global market leader of the international express and logistics industry, specializing in providing innovative and customized solutions from a single source.

DHL offers expertise in express, air and ocean freight, overland transport, contract logistic solutions as well as international mail services, combined with worldwide coverage and an in-depth understanding of local markets. DHL's international network links more than 220 countries and territories worldwide. 285,000 employees are dedicated to providing fast and reliable services that exceed customers' expectations.

DHL is a Deutsche Post World Net brand. The group generated revenues of 45bn euros in 2005. Visit www.dpwn.com or www.dhl.com for further information.

Source: PR Newswire

Arrogant surgeons 'risk another Bristol babies scandal'

Tuesday 5 September 2006

ARROGANCE and complacency among doctors could lead to another medical disaster on the scale of the Bristol babies scandal, the Royal College of Surgeons has warned.

Five years on, patients are dying on operating tables because some doctors are still failing to act on the lessons of the scandal that led to the deaths of 30 babies, the college says.

This weekend leading surgeons compared the operational failings causing surgical blunders in NHS theatres to the institutional deficiencies that contributed to Nasa's 1986 Challenger and 2003 Columbia space shuttle disasters.

Tony Giddings, a member of the college's council and a former consultant surgeon, says the NHS has not changed its practices significantly since poor operating techniques led to the scandal at Bristol.

“Do we need to have a second Bristol before we can actually make the cultural changes that are needed?” said Giddings. “We have continued to have avoidable deaths in surgery because the lessons that were so clearly set out in Sir Ian Kennedy's report [into the scandal] have not been acted upon.”

Last weekend The Sunday Times disclosed that more than 300 babies a year were being left with brain damage because of oxygen starvation caused by lack of proper care at birth. A government watchdog also warned that more than 2,000 people died last year because of blunders by NHS staff.

Giddings says although most surgeons are now aware of their own limitations, some are still putting patients' lives at risk because they believe they are infallible.

“There are some surgeons who have a seriously flawed opinion of their own capabilities,” he said. “If you are a surgeon and doing dangerous work you need to have a degree of self-assurance and confidence but it can turn into arrogance.”

“Surgeons can become too familiar with the dangers of the operating theatre and lose that capacity to be properly respectful of those dangers.”

“After the first shuttle disaster, although the astronauts changed a few practices, their attitudes and beliefs did not really change and they still thought they were masters of their situation. Nasa had a second disaster and then they really had to change.”

The college wants the government to make it mandatory for all surgeons to be trained in skills such as communication and teamwork.

In 2001 Sir Ian Kennedy, the chairman of the Bristol inquiry, recommended national procedures whereby surgical teams — including the consultant, anaesthetist, and theatre nurses — should meet routinely to review their performance. This has not happened, according to the college, and, until it does, avoidable deaths will continue.

The college insists that the actual number of avoidable deaths are up to 10 times higher than the 2,159 patient deaths recorded by the National Patient Safety Agency, since only a fraction are reported.

Research published in 2004 put the annual number of patient deaths due to medical error at 40,000.

In one notable case, Marc de Leval, a professor of paediatric surgery at Great Ormond Street Hospital for Children, admitted that mistakes he made in surgery resulted in babies' deaths. He volunteered to retrain in the early 1990s after seven babies he performed heart surgery on died. Another surgeon, a consultant urologist from southwest London, admitted this weekend that one of his patients died after he removed the wrong kidney. The patient later died of complications.

The surgeon, who did not wish to be named, said it was essential that junior staff were free to speak up if they suspected a mistake.

“There are surgeons who are fairly intimidating and people would feel it is difficult to challenge their views,” he said.

Source: Source: The Sunday Times Sarah-Kate Templeton and Jane Feinmann

HIV 'switches off' immune cells

Monday 21 August 2006

US scientists say they have discovered how HIV evades the body's natural defences against viral infections.

HIV disarms the T cells sent by the body to fight it by flicking a molecular switch on the cells.

In the laboratory, the researchers were able to block this switch and restore T cell function, Nature reports.

Drugs are already available that can do the same, but the scientists say more safety studies are needed.

“Risky”

The drugs may not be specific enough and could cause nasty side-effects, they cautioned.

Lead researcher Bruce Walker, a Howard Hughes Medical Institute researcher at Massachusetts General Hospital in the US, said: “One has to proceed with real caution because if you turn back on an immune regulatory switch that the body has decided to turn off, you could trigger serious immunological problems.”

Ideally, a treatment would only target the HIV-specific T cells, but techniques for such a targeted approach do not yet exist, he said.

The T cell switch controls a pathway of cellular events called programmed death-1 or PD-1.

The US researchers, working with colleagues at the Doris Duke Medical Research Institute in Durban, studied blood samples from 71 people who had recently contracted HIV but who had not yet commenced anti-HIV treatment.

They also looked at samples from four HIV-positive individuals taken before and after they had begun antiretroviral therapy.

HIV appeared to turn the T cell switch off, triggering the inhibitory PD-1 pathway.

“Turn off”

Furthermore, higher PD-1 expression was associated with more severe functional impairment of T cells.

PD-1 expression dropped when HIV treatment began, however. Blocking the PD-1 pathway restored T cell function.

He said the next step would be to see if the T cells can be turned back on in HIV-infected people in a way that will benefit them without incurring any serious side effects.

The researchers are also exploring whether PD-1 measurements could be used to guide treatment.

Dr Walker said: “Currently, we just count the number of T cells to decide when to treat someone, but we are excited about the possibility that adding PD-1 measurement might tell us more about the likelihood of progression of the disease and need for treatment in infected people.”

Roger Pebody, treatment specialist for Terrence Higgins Trust, said: “This study is promising, and we hope that it will help researchers develop new therapies that may be available over the next decade.”

A spokeswoman from the international HIV and Aids charity AVERT said: “This research is certainly encouraging, and fills another gap in scientists' knowledge about how HIV functions.”

“However, as the researchers themselves say, further trials and studies are needed before we can hope to turn this knowledge into a new therapy for HIV, particularly if there is a risk of triggering any sort of auto-immune disease in the individual concerned.”

Source: BBC NEWS

Union to fight hospital job cuts

Friday 18 August 2006

Union officials have announced plans to fight the loss of nearly 1,200 jobs and 186 beds after the merger of two Nottingham hospitals.

Public sector workers' union Unison has joined forces with the Royal College of Nursing in a campaign to halt the cuts.

Unison say the changes could affect patient care at the City Hospital and the Queen's Medical Centre.

The hospital said providing patients with the best possible care is the hospital trust's overriding goal.

'Public concern'

The trust also said it was working hard to minimise any compulsory redundancies.

Staff consultation on the changes, which will affect consultants, nurses, clerical staff and management, ended on Monday.

Mike Young from Unison, said the changes will worry members of the public.

“When they realise it will be a longer waiting list for beds, longer waiting times for appointments, less opportunity to see doctors and consultants - they'll be seriously concerned about the impact,” he said.

Unison held a meeting of its members on Wednesday to draw up a plan of action to fight the cuts.

Source: BBC NEWS

Healthcare Associated Infections

Monday 31 July 2006

An on-line course led by the National Public Health Service for Wales to train more health professionals to help further reduce the risks of healthcare associated infections was launched by Welsh Senior Medical Officer Dr Mike Simmons, recently.

This training, backed by the development of 'champions' in all areas of healthcare, is part of the Welsh Assembly Government's continuous efforts to combat these infections.

Health Minister Dr Brian Gibbons said: “It is everyone's responsibility to play their part in reducing the risk of healthcare associated infections, and the new champions will be able to support staff in maintaining patient safety."

Speaking at the Infection Control Nurses Association Conference in Cardiff, Dr Simmons said: “While healthcare associated infections will never be entirely preventable, the NHS in Wales is working hard to minimise any spread of infection. This can be achieved if all healthcare workers and patients play their part.”

“The new on-line training will allow staff to learn more about infection control and the latest control measures. It will provide them with the skills and knowledge they need to ensure good practice in preventing these infections and maintaining a safe environment for both patients and staff.”

“This course, and what is already in place will help us drive down infections even further.”

“It is clear that people want to know about the risks they face when it comes to contracting infections. The National Public Health Service recently published data on how each Trust is performing in this area. The publication of this data is an important step towards showing that we are achieving this.”

More information on the new on-line course can be found on the NHS Wales website. The training will take about 16-20 hours and can be completed in around 16 weeks depending on the time available to the participant. Although the programme is designed to be self-directed, each participant will require some mentorship support.

The National Public Health Service for Wales publishes data on healthcare associated infections. It allows patients to see for themselves the infection rates at their local Trust. The latest figures can be found on the National Public Health Service's website

NHS faces 'complete collapse of morale'

Monday 31 July 2006

Health unions have warned the government of a “complete collapse of morale” in the health service, should the breakneck speed of NHS reform remained unchecked.

A delegation led by the TUC met health secretary Patricia Hewitt to express concerns about the “creeping privatisation” of the service, the pace of change and the lack of consultation.

The crisis talks came as UNISON threatened strike action over the government's plans to privatise the award-winning NHS Logistics.

The health unions have also committed to a major joint campaign to press home the problems faced by their members.

“It's clear that there will be no let up in the pace and direction of change in the NHS,” said UNISON head of health Karen Jennings after the meeting.

“So over the summer we will be issuing some strong challenges to the government over its policies - and that will include the possibility of industrial action.”

Major campaigning on the NHS will include demonstrations and rallies across the country, she added, “because staff and the public are very worried about what's happening to their national health service.”

TUC general secretary Brendan Barber said Hewitt had recognised that present consultation arrangements needed to be reviewed urgently.

“But our prime concerns remain,” he said. “Health unions support reform that delivers better patient care. But too many current changes seem to be driven by an ideological preference for the private sector and will not benefit patients”.

“The government's relentless changes and preference for privatisation is causing growing frustration among staff who want the NHS to succeed, but think their views have not been taken into account,” he added.

“Unless ministers listen to those working in the frontline, and work in partnership with those they rely on to deliver change, they risk undermining the principles on which the NHS has been built.”

The joint campaign of health unions will include fringe meetings at the TUC and Labour Party conferences in September. Unions are also considering a lobby of parliament, and regional and national demonstrations.

Source: UNISON

Heat leads to postponed operations

Monday 31 July 2006

Urgent operations were postponed at a hospital in southern Sweden after the humid weather made floors in the operating theatre slippery.

Blekinge hospital in Karlskrona said that soaring temperatures and humidity of over 80 percent had left the hospital's ventilation systems unable to cope on Monday.

The hospital's chief anaesthetist, Christer Nilsson, said that the bad air would have made it hard for the medics to concentrate during the operation. Condensation had made the floor slippery, causing a safety risk.

“Technicians came and fixed the system, so that it dried up within a few hours,” he told the Sydöstran newspaper.

The hospital said that during the summer the only operations scheduled were urgent procedures. But Nilsson insisted that patients were never in any danger and that in the event of an emergency another room in the hospital could have been found.

All the postponed operations were carried out later in the day, the hospital said.

Source: The Local (Sweden's News in English) James Savage

CHIEF MEDICAL OFFICER PUBLISHES REVIEW OF DOCTORS' REVALIDATION

Saturday 29 July 2006

Review of non-medical regulation also published

Professor Sir Liam Donaldson, the Chief Medical Officer (CMO), 14th July 2006 published his review into the regulation of the medical profession.

Good Doctors, safer patients was undertaken following the publication of the The Shipman Inquiry: fifth report, which was highly critical of the General Medical Council (GMC) and the broader arrangements for medical regulation. The CMOs recommendations were received by the Secretary of State and will now go out to consultation.

A Department of Health review into the regulation of non-medical professionals – undertaken concurrently with the CMO's review – was also published today. A similar consultation will also be undertaken.

The main recommendations in Good Doctors, safer patients include:

The creation of unambiguous, operationalised standards for generic and specialist practice to give a clear, universal definition of a 'good doctor' and to allow patients, employers and doctors themselves to have a shared understanding of what is expected of doctors. These standards would be incorporated into the contracts of doctors.
Devolution of some of the powers of the GMC, as statutory regulator, to the local level. This would be accomplished through the creation of a network of trained and accredited General Medical Council affiliates.
The creation of an independent tribunal in order to adjudicate on fitness to practise matters – the GMC would focus on the assessment and investigation of cases.
A renewed focus on the assessment, rehabilitation and supervision of doctors with performance problems where these problems are not borne of malice.
Greater public & patient involvement – to ensure public and patients work with GMC affiliates in making decisions around fitness to practice, and with medical Royal Colleges in the process of re-certification.
A new twin-track system of revalidation – re-licensure for all doctors and re-certification for those on the specialist and GP registers.

Sir Liam said:

“Good Doctors, safer patients is the first comprehensive review of medical regulation for over 30 years.”

“The vast majority of doctors practise medicine of a very high quality and deliver care to patients with skill and compassion. The proposals that I have made are designed to help these doctors to maintain their standards and to achieve excellence, as much as they are designed to identify poor practice.”

“Patient safety has been my primary concern. There must be a robust revalidation process. At present, a senior doctor can go through a 30 year career without undergoing a single assessment of their fitness to practise, whereas an airline pilot, meanwhile, would face over 100 checks over a similar timescale.”

“I have made many recommendations to allow doctors to improve their practice and also increase public confidence in the regulation system.”

“The Shipman case was one of unparalleled gravity and Dame Janet Smith's report marked a significant landmark. A number of my proposals reflect the recommendations made by Dame Janet herself. However, changes to systems for medical regulation were long overdue, irrespective of Shipman.”

“Patients put their trust in their doctors often at a major moment in their lives. They are right to do so but my review has shown that the public and doctors think that this trust must be underpinned by a strong system to assure good practice and safe care.”

“I wrote my report following a consultation exercise amongst the profession, stakeholders and the public, research into public and professional attitudes, regulation in other high-risk industries and medical regulation overseas. In addition, I held regular meetings with an advisory group to discuss the complex issues involved.”

Other recommendations put forward in the report are:

moving from the criminal standard of proof to the civil standard in fitness to practise cases;
a stronger role for the medical Royal Colleges;
reshaping the governance of the GMC to ensure that Council members are equipped with the right mix of skills to hold the executive to account and enable the organisation to deliver its key goal – assurance of patient safety – in the long term; and
unifying postgraduate and undergraduate education to ensure that approaches to learning, standards and inspection in medical education from undergraduate to postgraduate level can be addressed seamlessly.

Health Secretary Patricia Hewitt said:

“This extremely important report will be considered carefully and I grateful to Sir Liam for undertaking this review.”

“These recommendations take full account of Dame Janet Smith's findings and also build upon the changes already introduced by the GMC.”

“In his considerations of the issues Sir Liam has rightly sought to balance the need to ensure the highest quality of patient safety with the concerns of the medical profession.”

Commenting on the recommendations from the review of medical and non-medical regulation Patricia Hewitt said:

“I welcome the publication of both these reports and the authorative contribution they make.”

“Professional regulation is a complex area. That is why I am announcing a consultation period to allow comments to be made on the recommendations of both reviews.”

The recommendations of the review of non-medical regulation include:

regulation of the professions should form one integrated and consistent framework across the different professions, and should link up better with the measures employers take to satisfy themselves that their staff are working safely;
consulting on options for creating more independent adjudication about cases where someone's fitness to practise causes concern;
the need to provide objective and robust assurance that individual professionals remain fit to practise by standardising the content and enhancing the value of workplace appraisal;
every registered professional will need to revalidate, but the amount of detail they need to provide will vary depending on how much risk to patients their work creates; and,
a major employer role in revalidation, with a system to check that employers fulfil this duty with parallel arrangements where there is no employer.

Chief Nursing Officer Chris Beasley said:
“At the heart of good quality healthcare is the public's confidence and trust in the health professional providing that care. The regulation of professionals is an essential part of creating that trust.”

“We have no significant concerns about the performance of non-medical staff. However, it is five years since we set up the NMC and HPC and therefore timely to review them alongside the CMOs review.”

The CMOs report Good doctors, safer patients can be found here.
The review into non-medical regulation can be found here.

The Health Professions Council (HPC) announces its reaction to the Department of Health's report into the future of non-medical healthcare regulation in the UK and the Chief Medical Officer for England's report 'Good doctors, safer patients'.

Saturday 29 July 2006

Commenting on the reports, Marc Seale, Chief Executive and Registrar of the HPC said: “We welcome the publication of the two consultations on the future regulation of healthcare professionals.”

“Over the next four months the Council will consider the documents in detail and discuss the issues raised, their response to the consultation and the implications for the HPC and regulation as a whole. In particular, the Council will wish to discuss the area of revalidation and its potential cost to health professionals.”

Commenting further on the proposals, Marc continues “We welcome the proposals and see many of the recommendations as an endorsement of our current practices already implemented across the organisation. We are pleased that other regulators will be adopting our practices, particularly in the areas of lay representation, accountability to Parliament, our approach to witness protection and information services for complainants and the adoption of civil standards of proof.”

“The Council will be working closely with the Department of Health, the other regulators and the professional bodies to ensure that proposed improvements to public protection are implemented as soon as is practical, and that further change remains on the agenda.”

“The report rightly places public protection as the over-riding aim of any reform, endorsing common standards on health, character and fitness to practise of health professionals. It also calls for a single source of advice and a single investigation process. HPC is highlighted for its ability to deliver the functions which public protection requires, across 13 health professions, and we are therefore encouraged by the implication that professions to be regulated in the future are likely to join the HPC.”

Anger at plan to let Bupa use NHS facilities

Friday 21 July 2006

CRITICS of healthcare privatisation have attacked plans to pay Bupa to use NHS operating theatres and wards to treat NHS patients.

Two months ago, private health group Bupa was selected as the preferred bidder as part of a second wave of NHS contracts to reduce waiting lists.

In Tyneside, Wearside and Northumberland, it will be contracted to carry out 5,586 elective procedures and provide consultations for 18,000 outpatients in a range of specialities.

But it needs time to build a treatment centre on Tyneside and to expand its hospital in Wasthing, Wearside, in order to fulfil its NHS contract.

So as a stop-gap measure, Bupa will be given part of the NHS Surgery Centre, in the grounds of the Queen Elizabeth Hospital, Gateshead, and an operating theatre and ward at North Tyneside General Hospital, in North Shields, will also be put at its disposal.

Those opposed to what they see as the creeping privatisation of the NHS say the plans amount to the NHS paying Bupa for the use of its own facilities.

North Durham MP Kevan Jones said: “It is the economics of the madhouse. We all know that waiting lists are well down now and there is spare capacity in NHS hospitals. Wouldn't it be better to use that spare capacity rather than bringing in the private sector?”

Liz Twist, North-East spokeswoman for Unison, said: “This is not in the best interests of the NHS, patients or staff.”

An NHS North-East spokewoman said: “Bupa will use NHS facilities at North Tyneside hospital and at the North East NHS Surgery Centre, in Gateshead, on a temporary basis until building works are completed on the site of North Tyneside hospital and facilities at the existing Bupa hospital at Washington are expanded. These arrangements will be for the exclusive use of NHS patients.”

She stressed Bupa would be paid a standard NHS fee for each patient.

Ian Renwick, of Gateshead Health NHS Foundation Trust, said: “The trust has been approached by Bupa about the possibility of entering into a partnership to treat those patients through our surgery centre. A series of meetings has been arranged to look in detail at this proposal. Once these discussions have reached a conclusion, details of any agreement and arrangements will be released.”

The news came as Darlington Primary Care Trust appealed to people across the town to help reduce its debts by not attending accident and emergency (A&E) at Darlington Memorial Hospital unless absolutely necessary.

The trust, which overspent by £1.2m last year, said it cost up to £1,500 every time someone visited A&E.

It said many of the 50,000 Darlington people who went to A&E each year, did not require hospital treatment and urged them to see their GP or go to the town's walk-in centre instead.

Source: The Northern Echo

Health Professions Council elect New President

Wednesday 12 July 2006

At a meeting held at Park House on the 11th July, it was announced that Registrant speech and language therapist Dr. Anna van der Gaag is to become the new president, replacing Professor Norma Brook who stepped down last week.

Dr. Anna van der Gaag, a chair of the Communications Committee and member of the Education and Training Committee will take up the position immediately.

“As President I will lead the work of the Council through active collaboration and engagement, strengthening cooperation between council members and the Executive. As President I will offer a complementary perspective to that of the Executive.”

“I am proud to be part of the regulatory reform process and am committed to seeing the HPC play a full part in future debates. The HPC needs to be a strong voice in the debate, a voice that is rooted in clearly articulated values, and judgements based on careful analysis. I know that I have the necessary commitment and strength of purpose to lead the HPC into the future, making it more effective and more meaningful to the public, patients and professions alike.”

Anna has been engaged in clinical work, university teaching, management and research working in the four UK countries. At a national level she has been involved in Department of Health funded evaluations of professional competence and the role of support workers in the NHS; this has led to further work on professional standards, clinical audit, organisational review, measuring the effectiveness of interventions and patient and public involvement. Anna has also served on profession specific and multi-disciplinary committees, including the DH Therapy Professions Research Group, the National Centre for Clinical Audit, Kings Fund Clinical Effectiveness Group and research and education committees of both European and International professions associations.

Dr. Anna van der Gaag will replace Professor Norma Brook who has been President of the HPC for the past five years. She added … “I'm delighted that Anna has been appointed and I look forward to seeing her lead the organisation as it continues to go from strength to strength.”

Living patients face organ harvesting

Wednesday 12 July 2006

AUSTRALIAN organ donors may in future have their bodies prepared for transplantation while they are still alive.

The Australian Health Ethics Committee's working party is seeking to extend the transplant preparations to patients who are certain to die after experiencing “cardiac death” - when their heart stops beating and their circulation stops.

In the past, transplant preparations have been carried out on brain-dead patients.

The procedure involves taking the patient to an operating theatre for the surgical insertion of tubes into their major arteries to prepare for cleansing of the organs after death, blood tests and drug administration. This helps preserve their organs.

Peter Joseph, chair of the ethics committee's working party on organ donation, said extending the preparation procedures to living patients was necessary to preserve solid organs such as hearts, livers, lungs and kidneys, which deteriorate quickly after circulation stops.

“There is only one state of death, but there are two ways in which a doctor can certify death as having occurred: brain death and cessation of circulation,” he said.

Brain death is when doctors conclude through tests that a patient has lost all brain function completely and permanently.

Organs can then be preserved via a ventilator for the purposes of donation.

“In people who are brain dead these preparations are legitimate and present no ethical barrier,” Dr Joseph said.

“Brain death is easy. If the brain is dead the person is dead, but the organs are being maintained for the purposes of transplantation.” “If somebody has died by cessation of circulation - in other words, if the heart has stopped beating - within a few minutes the organs deteriorate by themselves.”

The proposed changes are outlined in the National Health and Medical Research Council's draft consultation paper, which states: “Sometimes the severity of a person's injuries means that they are unable to survive even if there is still some brain function.”

“To improve the chances of organs being suitable for transplantation, some treatments are needed before the person dies (e.g. blood tests, surgical insertion of a tube into the main artery of each leg).”

When asked whether it would be possible that somebody could be aware of the fact they were being prepared for organ harvesting, Dr Joseph said: “Yes, it would.”

But he said it would not be done without the permission of the donor or the donor's family.

“We do not believe that this is covered by the general permission to donate,” he said.

“If ante-mortem [before death] intervention does occur, it requires specific consent.”

The committee wants legislation made uniform so the practice is legal in all states and territories.

“There are interstate differences to some of these procedures that may well be … actually illegal,” Dr Joseph said.

Source: The Sun-Herald
Leo Shanahan

Health Professions Council reviews Standards of Conduct, Performance and Ethics

Wednesday 12 July 2006

The Health Professions Council are reviewing their Standards of Conduct, Performance and Ethics and would like to receive feedback for their standards.

The Standards describe what is expected of registrants in terms of their professional behaviour. For example, we say that registrants should act in the best interest of their patients, clients and users and get informed consent to give treatment. You can access a copy of the standards on our website.

Rachel Tripp, acting Director of Policy added… “I believe it is really important that we engage with stakeholders and registrants and continue to review the standards as they will undoubtedly need to be updated every few years. ”

“We published the standards in 2003 after consulting widely with our stakeholders. Now the standards have been in place for over three years we think that it's important that we review them to make sure that they are working. In particular, we want to make sure that the standards continue to be relevant to our registrants and conform to public expectations of health professionals.”

To start the review, the HPC is encouraging stakeholders to contribute their comments on what they think about the existing standards. The HPC are keen to hear people's views on the following questions;

1. Do you think the introduction clearly explains the role and purpose of the standards?
2. Do you think the standards are appropriate and relevant to all registrants?
3. Do you think there are any standards which need more information or which might usefully be reworded?
4. Do you think there are other standards which you think should be added?

The informal consultation will run until Wednesday 6th September and comments should be emailed to policy@hpc-uk.org.

NHS staff 'not reporting errors'

Friday 07 July 2006

Too many NHS staff still do not report lapses in patient safety, MPs say.

The Public Accounts Committee said nearly a quarter of incidents and 39% of “near misses” go unreported, with doctors being the worst culprits.

And the cross-party group said more should be done to cut the number of errors, especially those which cause serious harm or death.

Nearly 1m lapses in patient safety were recorded in 2004-5. The government said lessons were being learned.

The committee, which based most of its findings on a report by the National Audit Office last year, also attacked the National Patient Safety Agency for failing to provide enough advice on improving safety.

The NHS agency was set up five years ago to develop a national reporting scheme to help the NHS learn lessons from lapses in safety.

One in 10 patients are estimated to be unintentionally harmed under the care of the health service. These can include medication errors, equipment defects and patient accidents, such as falls.

But the committee said the system was too complex and the agency was not offering value for money.

The MPs also said there had been a lack of progress by NHS trusts in the last six years since a report by the chief medical officer attacked the “blame culture” that existed in the NHS for hampering the improvement process.

The study said few NHS trusts “have formally evaluated their safety culture” and “insufficient progress” had been made on achieving targets set out by the Department of Health.

And it added only 24% of trusts routinely inform patients involved in a reported incident and 6% do not involve patients at all.

Many trusts are also not complying with safety alerts issued by the NPSA.

'Failures'

Committee chairman Edward Leigh, a Tory MP, said: “What this points to are two related and deep-seated failures.”

“One is the failure of the NHS to secure accurate information on serious incidents and deaths.”

“The other is the failure on a staggering scale to learn from previous experience.”

Peter Walsh, chief executive of the charity Action Against Medical Accidents, said: “We hope the report will give an injection of urgency into work to improve patient safety.”

But Chief Medical Officer Sir Liam Donaldson defended the NHS, saying improvements were being made.

He added: “Over the last five or six years we have put in place a comprehensive patient safety framework in this country which is admired internationally.”

NPSA joint chief executive Susan Williams said: “The NPSA has already acted on a number of issues identified in the report and will work with the Department of Health to consider the report's recommendations carefully.”

“The agency remains committed to helping improve patient safety in the NHS and working with the local NHS to deliver this.”

Source: BBC News

NHS barred from hiring foreign nurses

Tuesday 04 July 2006

Thousands of international nurses will be prevented from getting jobs in the UK to give homegrown students better employment opportunities, the Government announced today.

Under the plans, overseas nurses will be barred from applying for junior posts unless a UK nurse or a nurse from the EEA (European Economic Area) cannot fill the job.

The move applies to nurses in bands 5 and 6 - those with between a few months experience and around one a half years.

The bands are being taken off the Home Office shortage occupation list and it means employers will have to advertise vacancies to homegrown students before looking abroad.

The Royal College of Nursing (RCN) said the move “beggars belief” with overseas nurses being made a scapegoat for the financial crisis in the NHS.

But Health Minister Lord Warner insisted that large-scale recruitment of international nurses was only ever intended “to be a short-term measure”.

Extra investment in training meant there was no longer a need to hire junior nurses from abroad, he said.

The change does not affect nurses already working in the UK and there would still be specialist nursing vacancies, he added.

He said: “The aim of the NHS has always been to look towards home-grown staff in the first instance and have a diverse workforce that reflects local communities.”

“The NHS has seen historical levels of investment and a period of expansions in the nursing workforce since 1997 in order to help reduce waiting times, improve access to services and ensure high quality treatment and care.”

“On top of this we have made a huge investment in education and training and in the development of robust recruitment and retention policies. This is now bearing fruit.”

Steve Barnett, director of NHS Employers, also said today that the organisation was trying to get a clearer picture of how UK graduating nurses will fare in getting jobs this year.

In London, Manchester, Leeds and Essex, employers expect to be able to hire all their newly qualified staff but there were “real issues” in the East and West Midlands, he said.

Mr Barnett said it was not yet clear how many nurses in the East and West Midlands were experiencing difficulty in getting jobs.

RCN General Secretary Dr Beverly Malone said of today's announcement: “International nurses have always been there for the UK in times of need and it beggars belief that they are now being made scapegoats for the current deficits crisis.”

“Removing nursing from the list of recognised shortage professions is short-termism in the worst possible sense.”

“We know that the vast majority of international nurses are employed in bands 5 and 6, the very bands which are going to be affected.”

“If this proposal goes ahead I guarantee that the effects will be far-reaching and immediate.”

“Over 150,000 nurses are due to retire in the next five to 10 years and we will not replace them all with home-grown nurses alone.”

“We also have to remember that this blanket ban on international nurses will also apply to the independent sector who are heavily reliant on international nurses to carry on providing care and are not in the position of financial crisis the NHS finds itself in.”

“If there is solid evidence to show that we no longer need international nurses in the UK's healthcare system both now and in the future, then we urge the Government to provide it - something they have yet to do.”

“Until that time, the RCN will remain convinced that this is a bad decision for patients, for nurses and for the UK healthcare system as a whole.”

Source: Daily Mail (3.7.06)

30 June 2006
Statement by Patricia Hewitt, Health Secretary

Monday 03 July 2006

Sir,

Contrary to reports in some newspapers, there is no question whatsoever of 'privatising' the NHS. This Government is committed to a publicly-funded health service that is free at the point of use and available to all, regardless of means.

Primary Care Trusts are and will remain public, statutory bodies responsible for using their growing budgets to commission the best possible services for local people. They can never outsource this responsibility, or ask others to make these decisions for them.

Some PCTs have indicated that, to support them in their task, they would like to consider the possibility of buying in some management and support services, including the detailed data analysis that helps to underpin sound commissioning. In order to give PCTs this option, the DH intends to place a national framework contract with suitably qualified providers.

There is no obligation on any PCT to use such services; each PCT Board will make its own decision following appropriate local consultation. Our intention is that those PCTs that wish to go down this road will be able to activate a call-off contract quickly and cheaply, without the need to go through expensive and time-consuming local tenders.

Most PCTs also employ district nurses, health visitors and many other frontline staff who provide vital clinical services. They are not affected in any way.

The OJEU document which inspired these newspaper reports contained drafting errors and therefore did not accurately reflect Government policy, which is why it was withdrawn. Our policy was set out in the White Paper Our health, our care, our say earlier this year, when we said: “There is no requirement or timetable for PCTs to divest themselves of provision.”

The Department of Health will be issuing new tender guidance that accurately reflects our policy.

Yours sincerely

Patricia Hewitt
Secretary of State for Health

NDSREF: 135026
Issued by : DOH Press Office

Social Market Foundation
Ann Rossiter's response to outsourcing NHS commissioning

Monday 03 July 2006

The Director of the Social Market Foundation, Ann Rossiter, questioned the government's plans to handover commissioning healthcare for NHS patients to large management consortia.

Ann Rossiter said:
“Today's announcement from Lord Warner that the government plans to give private firms responsibility for commissioning health care services for NHS patients marks a dangerous departure for the NHS.

Commissioning services involves making important strategic decisions about priorities for the NHS and should remain the preserve of government, not least to ensure that everyone's health needs are met.

Government needs to be clear about the difference between commissioning and procurement. Firms with experience of administration and bulk purchasing have an important role in helping primary care trusts to obtain value for money.

While some primary care trusts are clearly struggling to purchase the healthcare services which sufficiently meet the needs of NHS patients in their area, taking away decisions about services from NHS managers and handing it to large private companies is not likely to result in better services for patients.

If the government is sincere about putting users at the heart of public services then providing primary care trusts with adequate resources and training so that they become expert in commissioning would be a more successful strategy and may go towards reducing the current postcode lottery of primary care faced by patients.”

Ann Rossiter Director of the SMF is available for interview/comment. To arrange an interview please contact Jo Saunders on 020 7227 4402.

About the Social Market Foundation:
The SMF was established in 1989 to provide a source of innovative economic and social policy ideas. Steering an independent course between political parties and conflicting ideologies, the SMF has been an influential voice in recent health, education, welfare and pensions policy reform. Our current work reflects a commitment to understanding how individuals, society and the state can work together to achieve the common goal of creating a just and free society. For further information on our work go to www.smf.co.uk

Funds aid stress research

Wednesday 21 June 2006

Research into the impact of stress on the performance of operating theatre nurses has resulted in PhD student Brigid Gillespie gaining a prestigious scholarship.

The Griffith University student, who has 20 years experience as a registered nurse, has been awarded the Centaur Memorial Fund for Nurses Fellowship.

The Centaur Memorial Fund for Nurses was established to honour those nurses who died while serving on the Australian Hospital Ship Centaur which was torpedoed and sunk just off the Queensland coast during World War II.

The §15,000 scholarship is awarded each year to a Queensland registered nurse and PhD candidate researching a topic that will enhance professional nursing practice.

Brigid, of Ormiston, is studying how well operating theatre nurses cope with stress and whether they decide to remain in the workplace or leave.

She hopes the research will be used by managers of health care organisations and nurse educators to develop strategies to deal with stress in order to retain staff, as well as make nurses more aware of what factors can trigger stress.

Early research has indicated that nurses feel stress if there is a lack of communication between themselves and their colleagues, or lack of knowledge in certain situations.

“We need to develop the staff we have. There's no point talking about recruitment when we can't get our heads around retaining the staff we have”, Brigid said.

“As a patient, you also want to know the staff looking after you are competent and have an acceptable knowledge base. If we don't provide appropriate support for those new people coming (into theatres), they won't stay. I feel very passionate about that.”

Griffith University professor Marianne Wallis, who is supervising Brigid's PhD, said the study would inform nurse managers and policy makers.

“By contributing to supporting nurses in their work role, there is the potential to improve the quality of patient care”, she said.

Source : Bayside Bulletin 19.6.06

Country to follow the hospital's 'lean' lead

Wednesday 21 June 2006

A PIONEERING scheme to cut waste and inefficiency at the Royal Bolton Hospital is set to be extended to the rest of the country.

Nine months ago the hospital became one of only six in the world and the only one in the UK to introduce “lean thinking”.

Over those nine months, paper work has been reduced at the hospital and patients are discharged more rapidly.

Lean thinking tracks people from the moment they enter the hospital until the moment they leave to make sure they are treated in the most efficient way.

Mortality rates have been cut by a third after services were redesigned around the needs of the patients, instead of the convenience of the staff.

David Fillingham, chief executive of the Royal Bolton Hospital, said: “What makes lean thinking so powerful is that it engages the enthusiasm of frontline staff.”

Lean thinking is the principle that work is a process which can be streamlined, with maximum efficiency, by the removal of waste and by close observation at each stage.

Since the introduction of lean thinking, the length of time it takes a patient to get from the accident and emergency to the operating theatre has been reduced by 38 per cent. Paper work has been cut by 42 per cent and the total time patients spend in hospital has been slashed by 32 per cent.

Lean thinking in the pathology department, where blood samples are tested, lean thinking has been used to clear holdups in the system.

It has cut the time taken to process samples from between 24 to 30 hours to between just two and three hours.

Staff levels have been reduced and extra people are being redeployed within the hospital, the space the department needs is 50 per cent less than previously and the time taken to do most jobs has been slashed by 90 per cent.

Lean thinking was developed by Toyota, and has been adopted by Tesco, the RAF and the Royal Air Force.

Dr Gill Morgan, who is the NHS Confederation chief executive, said: “We know that our case for extra funding will fall on deaf ears unless we cut out waste in the system. The work in Bolton show us what can be done.”

“Lean thinking works because it is based on doctors, nurses and other staff leading the process and telling us what adds value and what doesn't. They are the ones who know.”

Source: www.thisislancashire.co.uk (Jane Lavender)

Mysteries of Anaesthesia

Wednesday 21 June 2006

Researchers at Lancaster University are spearheading a project, which has the potential to shed light on the mysteries of anaesthesia.

Anaesthesiology is a subtle and imperfect science that is not currently well understood. Without it most modern surgical procedures would be impossible but the mechanisms causing loss of consciousness are not clear. This can result in complications such as a patient regaining consciousness during an operation or, in the most extreme circumstances, death.

The Lancaster University-led BRACCIA project is exploring ways in which the brain's electrical activity varies with the depth of anaesthesia and how waves present in these electrical signals interact with heart and respiration rhythms.

Changes in these three signals, and how they interact with one another, can be used to provide a crucial insight into the changes taking place in the human body during anaesthesia.

The ultimate aim of the project - which is backed by a €1.42 million grant from the European Commission – is to develop the understanding needed to create a new, effective anaesthetic monitor which could be used in operating theatres to keep track of a patient's level of consciousness.

Medical Physicists at Lancaster University are co-coordinating an international team including physicists, biomedical engineers, information scientists, physiologists, neuroscientists and anaesthesiologists working within the Czech Republic, Germany, Norway, Slovenia and Switzerland as well as the UK.

More than 140 patients undergoing surgery will be monitored at both the Ulleval Hospital in Oslo and at the Royal Lancaster Infirmary, Lancaster. The volunteers will have their brain, heart and respiratory signals monitored and recorded before during and after anaesthesia. This should give researchers important information about the progression from unconsciousness to consciousness.

The research will also bring new insights into relationships between brain, heart and breathing – exploring how they interact and which function is driving the others.

Data collected during these experiments will be monitored and interpreted at Lancaster University using some of the latest analysis techniques under development by other BRACCIA partners.

Project scientific coordinator Dr Aneta Stefanovska, of Lancaster University's Physics Department, on whose earlier research in Ljubljana the whole project is based, said: “This is ground breaking research using nonlinear dynamics to deepen our understanding of the body and how its systems interact. This new knowledge has a very clear application and we hope it could eventually be used to develop a failsafe system for measuring anaesthesia levels in patients. It would also enable us to explore the effects of anaesthetic drugs on consciousness.”

Professor Peter McClintock, also of Lancaster University's Physics Department, said: “This is a very exciting project, and a wonderful note on which to introduce our new undergraduate degree schemes in Physics with Medical Physics.”

Professor Andrew Smith of the Royal Lancaster Infirmary said: “Unintentional awareness - that is, when anaesthetised patients are awake when they should be asleep - is an uncommon but potentially traumatic complication. There are a number of electronic monitors available to assist anaesthetists in trying to avoid this problem, but none is 100 per cent reliable. We hope that BRACCIA will help us shed light on how the brain's activity changes during anaesthesia and in the future this may go some way towards developing a more reliable monitor of depth of anaesthesia.”

Conditions of practice for Westbury operating department practitioner

Wednesday 21 June 2006

An operating department practitioner from Westbury, has been given a conditions of practice order by the Health Professions Council (HPC).

A Panel of the Conduct and Competence Committee met on the 9th June 2006 to consider allegations that Mr. Mark Campbell's fitness to practise as a registered health professional was impaired by reason of his misconduct whilst working at Westbury Community Hospital in that he:

Removed quantities of Propofol and Midazolam from the day surgical unit without permission;
Removed a Cannula and a syringe from the day surgical unit without permission;
Self-administered drugs, referred to in (1) above.

Martin Ryder, Chair of the Panel said. “Mr. Campbell has admitted the facts set out in the particularised allegation. He has further admitted that those facts amount to misconduct. While admitting that such misconduct impaired his fitness to practise at the time of the events, he does not admit that his fitness to practise is currently impaired.”

“While accepting that the background to the incident was a psychotic incident for which Mr. Campbell was not to blame, the removal and administration of drugs is an extremely serious matter which has continued to impair Mr. Campbell's fitness to practise since April 2005. It is therefore necessary for the Panel to proceed to consider the issue of sanction.”

Accordingly, the Panel decided to impose specified conditions of practise upon Mr. Campbell for a period of 18 months. In all the circumstances the Panel considers this to be a proportionate sanction.

Health Professions Council

HPC Introduce CPD requirements from July 2006

Wednesday 31 May 2006

The Health Professions Council (HPC) will require all health professionals on the Register to undertake Continuing Professional Development (CPD) from 1st July 2006. This will now be a legal requirement for the future registration of 170,000 health professionals across the UK. The first audit of these standards will take place in July 2008 with chiropodists and podiatrists being the first profession to be audited, followed by operating department practitioners. The 11 other professions currently on the HPC register, will be audited during 2009/2010.

The standards mean that health professionals will have to provide evidence of CPD relating to their previous two years of practice from summer 2008. The evidence will have to show that the CPD an individual has undertaken has contributed to the quality of their practice and demonstrates that it benefited the service user. The standards apply not only to those in clinical practice, but also to those working in research, management or education.

Speaking about the CPD standards, Professor Norma Brook, President of the Health Professions Council said:

“This is an important event in the development of self-regulation. We believe that it is a vital part of our basic function, which is to protect the public, that we require individual registrants commit themselves to their own professional development and that employers, too, recognise the importance of CPD. We will therefore be requiring all of our registrants to undertake CPD and be seeking to ensure that the CPD carried out by our professions is robust and effective.”

“The HPC offers a clear framework with flexibility at the centre of our decisions, but CPD will be the responsibility of the individual.”

Registrants will be able to undertake CPD through an extensive range of learning activities (for full details, please see website) however if CPD is already being carried out, for example in conjunction with a registrant's professional body, there will be no need to duplicate the work already done.

National Patient Safety Agency alerts NHS to risks with high dose morphine and diamorphine injections

Friday 26 May 2006

The National Patient Safety Agency (NPSA) today advised the NHS in England and Wales to review and improve measures for prescribing, storing, administering and identifying high dose morphine and diamorphine injections.

More than 75,000 ampoules of morphine and diamorphine are given to patients every year. The drugs are used to relieve severe pain associated with conditions such as cancer, during heart attacks and after operations. They are safe and effective if prescribed, prepared and administered in accordance with professional guidelines.

Between 2000 and 2005 seven case reports were published of deaths due to the administration of high dose diamorphine or morphine to patients who had not previously received doses of opiates. These case reports prompted the NPSA to review reports in the National Reporting and Learning System on the same subject. Between January and October 2005 the NPSA received 16 reports of similar patient safety incidents, two of which resulted in deaths.

Many of these incidents involved diamorphine and morphine 30mg ampoules being selected in error for lower strength ampoules and causing overdoses. Overdoses of morphine or diamorphine can cause breathing problems, unconsciousness and, in rare cases, be fatal.

Some other incident reports highlighted problems with high doses of these medicines being given mistakenly to patients who had not previously received lower doses of the opiates and had not built up a tolerance to the medication. In these cases, the patient's lack of tolerance meant that the dose was too high for them.

To help staff guard against errors, the NPSA has issued a Safer Practice Notice (SPN) to all NHS organisations advising them to put measures in place to protect patients from simple but potentially fatal mistakes. The actions are:

risk assess and have procedures in place for safely prescribing, labelling, supplying, storing, preparing and administering diamorphine and morphine injections;
review therapeutic guidelines for the use of diamorphine and morphine injectable products for patients requiring acute care, including post administration observation of patients who have not previously received doses of opiates;
update information concerning the safe use of diamorphine and morphine injectable products as part of an ongoing programme of training for healthcare staff on medicine practice;
ensure that naloxone injection, the antidote to opiate-induced respiratory depression, is available in all clinical locations where diamorphine and morphine injections are stored or administered.

The NPSA's Medical Director, Professor Sir John Lilleyman, said: “Morphine and diamorphine are vital elements of treatment for many conditions and incidents relating to the use of these drugs are very rare. However, as our reporting system shows, patients can be harmed by mistakes that are easily avoidable. We urge organisations to act quickly to implement the recommendations of the Safer Practice Notice.”

“This Safer Practice Notice illustrates the value and importance of the reports that staff make to the NRLS: if we are aware of problems then we can take action to help stop them happening again. By reporting mistakes or failures in patient care, locally and nationally, healthcare staff can help the NHS learn about and address these problems.”

Professor Mayur Lakhani, Chairman of Council, Royal College of General Practitioners (RCGP) said: “Morphine and diamorphine are commonly used in primary care and the RCGP endorses this NPSA safer practice notice. As a practising GP, I would urge all practices to take heed of this important advice.”

The recommendations outlined in the NPSA's SPN are applicable to all NHS care locations where morphine and diamorphine are stored, used or administered. Implementing the recommendations will also help staff and organisations meet existing safe practice guidelines on the use of controlled drugs.

The Medicines and Healthcare products Regulatory Agency (MHRA) has agreed changes to the packaging of all opiates to make it easier for staff to tell different strengths of morphine and diamorphine apart.

Patients requiring higher doses of morphine and diamorphine for palliative care purposes will still receive the medication they need and are not affected by the SPN recommendations.

Surgeon orders kit on Ebay

Monday 22 May 2006

A surgeon at a top Norfolk hospital resorted to ordering vital medical equipment from internet auction site Ebay.

General surgeon Kevin Murray had already ordered £45,000 of equipment to set up his new operating theatre at the James Paget Hospital, in Gorleston.

But he forgot to order a surgical retractor, an essential item which holds wounds open while operations take place.

In order to save time he bypassed official channels - and instead bought the retractor off Ebay. When hospital officials found out, the retractor was confiscated before it had been used during surgery.

But after being checked and sterilised, it has been returned to Mr Murray - and is now in use in his operating theatre.

Roy Haynes, JPH director of human resources and operations, said the instrument was confiscated, checked and sterilised and posed no threat to public health.

He said: “When Mr Murray was first appointed he wasn't aware of the administrative procedures we have in place where instruments are concerned.”

“He was asked which equipment he required and we ordered £45,000-worth for him. But he had forgotten to order the retractor and for speed he ordered it on Ebay.”

“We have strict procedures for disinfecting and initially the instrument was taken from him and put through the disinfecting process.”

“I am pleased to say that once the process had been completed, the retractor was handed back to him and that really is an end to the matter.”

Mr Murray refused to comment yesterday, but other hospital workers said that they were shocked that it was quicker to buy equipment off commercial websites than it was to order it through official channels.

Surgical items may not be a mainstay of auction house Ebay - it deals more with collectibles, cars, CDs and cameras - but yesterday there were appendectomy retractors available with a starting bid of £13.26, an abdominal retractor at £26.56 and numerous other medical lots, mostly from the USA.

Source: Norwich Evening News 24

Doctor before conduct panel

Tuesday 9 May 2006

A COVENTRY hospital doctor was yesterday - 8.5.06 - facing a misconduct hearing after being accused of indecently assaulting two females working in an operating theatre.

Dr Gerard Furlong, who works at the city's Walsgrave and Coventry and Warwickshire hospitals, was appearing before the General Medical Council.

The consultant anaesthetist was summoned before the GMC's Fitness to Practice Panel in Manchester.

The panel was this morning deciding whether the hearing should be open to the press and public.

Dr Furlong is accused of touching the breasts of two female members of staff while on duty in the operating theatre.

He is alleged to have received three separate warnings about inappropriate behaviour towards female colleagues.

It is further alleged he was informed that concern had been raised by students concerning inappropriate comments he had made during lessons.

A spokesman for University Hospitals Coventry and Warwick-shire NHS Trust said: “Dr Gerard Furlong is currently off sick. It is not appropriate for the trust to comment on Dr Furlong's behalf.”

Source: icCoventry.co.uk Alan Harris

Cutting bed time can recoup hospital £1m

Monday 8 May 2006

CASH-strapped hospital bosses today announced plans to cut the time patients spend in bed - saving £1m in the process.

Blackpool Victoria Hospital revealed it is to reduce the stay of some surgical patients in a bid to become more efficient.

Management says some people are currently being taken into hospital earlier than necessary in order to “reserve” their beds for when they come out of the operating theatre.

Bed shortages have seen some “medical” cases placed in beds supposed to be for surgical patients and some operations were in turn having to be cancelled at the last minute due to a lack of accommodation.

Now surgical beds will be “protected”, meaning they will be kept empty for the patients when they come out of their operation.

To do this patients can be admitted on the same day as their surgery, instead of staying in hospital the night before. The changes will save £1m due to a reduction in costs.

Blackpool, Fylde and Wyre Hospitals NHS Trust is reportedly £10m in the red and faces a financial black hole of £22m in the coming year.

A trust spokeswoman said: “Surgical patients at Blackpool Victoria Hospital have traditionally had a longer than average length of stay.”

“There are many reasons for this, but one of the key pressures has been the need to admit patients earlier than would normally be necessary to ensure that a bed is available.”

“The trust underwent a 10-week diagnostic process earlier this year which highlighted the need for it to be more efficient, particularly to reduce its length of stay for patients.”

A new pre-operative assessment area is being created on ward six - currently a female surgical ward. It will be run by nurse practitioners who will carry out pre-operative tests before patients have their surgery.

More day surgery will also be carried out with the opening of the new multi-million pound day surgery unit.

However, some nurses are worried the changes will be bad news for patients and make surgery like a “production line”.

The trust has been quick to head off any accusation patients would be rushed through and will not get the correct pre and post-operative care.

One member of staff, who did not wish to be named, said: “I don't know what it will mean for patients, but with the Government's new Payment by Results, which means you get more money the more work you do, it feels like they are trying to get more patients through. It's going to be quite rushed. If I was a patient, I wouldn't want to feel I was being rushed through.”

“The staff are worried about their jobs.”

The trust has told The Gazette there will not be any job losses as a result of the changes.

And Steve Pettit, consultant general surgeon and clinical director for general surgery, today countered claims patient care could suffer.

He said: “These changes will allow many patients to be admitted on the day of their operation, rather than on the day before which is often what happens at present.”

“The risk of their operation being cancelled because of bed availability will also be greatly reduced.”

Source: blackpooltoday.co.uk - emma.harris

HIDDEN NHS JOB CUTS OUTRAGEOUS - WEBB

Monday 8 May 2006

Commenting on nearly a thousand more NHS jobs cuts in Manchester and Birmingham, Liberal Democrat Shadow Health Secretary, Steve Webb MP, said:

“The latest news of hundreds more NHS job cuts are the first of many we expect over the coming weeks.”

“The Health Secretary has kept her job whilst thousands of doctors and nurses are losing theirs. Many people will think this the wrong way round.”

“The Liberal Democrats warned that job cuts announcements were being delayed until after the local elections and we are already seeing evidence of this.”

“It's outrageous the public weren't told the full truth about NHS job cuts before they voted.”

Inquiry into hospital drugs death

Friday 28 April 2006

AN INQUIRY has been launched at a Wirral hospital into the storage of drugs after a worker died of a suspected overdose of medication only available from his workplace.

Operating theatre technician Kevin Murphy, 27, was found dead in a car with a specialist needle in his arm and drugs, normally used by anaesthetists, nearby, an inquest heard.

Police and ambulance services were called after a passer by reported seeing a man with a hypodermic needle in his arm.

Drugs used in hospital operating theatres were discovered on the front passenger seat of the car.

Mr Murphy, of New Chester Road, Bromborough, had last been seen at 3am that same morning at the home of his partner, with whom he had nine-month-old twins. He had been at a party held to celebrate her birthday, during which the couple were said to have argued.

Paul Holt, Director of Operations and Chief Nurse at Wirral Hospital NHS Trust, said: “We can confirm the drugs involved are widely used in operating theatres and are accessible to healthcare professionals.”

Mr Holt added: “Although we believe the way in which we currently store the drugs involved balances the need for security with the need for easy access, we will be examining whether there are any other appropriate storage options.”

The inquest was adjourned.

Source: Liverpool.co.uk By Liam Murphy Daily Post Staff

Pakistani hospital left forceps in girl for three years

Thursday 27 April 2006

Pakistani authorities sacked three doctors, two paramedics and a nurse for leaving forceps in the abdomen of a 17-year-old girl during surgery three years ago.

The implement was detected in an X-ray last week when the girl complained of severe pain and was brought to the teaching hospital where the operation was carried out in southern Sindh province, they said.

“We have terminated three doctors for this unpardonable irresponsibility after an inquiry found them guilty of negligence,” provincial health secretary Naushad Shaikh told AFP Wednesday.

The authorities have also fired two operating theatre technicians and a nurse of the People's Medical College Hospital in Nawabshah town, 265 kilometers (165 miles) north of Karachi, he added.

The girl had to undergo a second operation to remove the forceps.

“She has been operated upon and now she is stable,” Shaikh said.

It is the fourth recent case of hospitals in Sindh leaving surgical instruments inside patients after surgery.

A woman died at the same hospital last month while another woman died in Hyderabad city due to similar negligence by surgeons.

Source:TODAYonline.com

KING'S FUND NHS REPORT MORE PROOF OF GOVERNMENT FAILINGS

Wednesday 26 April 2006

Responding to the new King's Fund report, Deficits in the NHS, suggesting that the NHS deficit could exceed £1 billion, Liberal Democrat Shadow Health Secretary, Steve Webb MP said:

“These deficits have Patricia Hewitt's fingerprints all over them. The new contracts for GPs, consultants and other NHS staff, were all negotiated centrally.”

“All of the targets that Trusts have to meet are determined centrally. The Government cannot tie the hands of Trusts, telling them how much to pay their staff and what targets they have to meet, and then condemn them for not being able to balance their books.”

“These are huge deficits which highlight gross financial mismanagement by the Government. To spend record amounts on the NHS and still to have almost daily announcements of cuts in frontline services beggars belief.”

“The breakneck pace of Government reform means that Trusts are having to resolve problems that have built up over decades in a matter of weeks. Far from speeding up the pace of reform, as the Prime Minister has said, it needs to take place at a more gradual rate to give Trusts a chance to plan carefully on a long-term basis.”

Hospital is a financial risk to NHS

Friday 21 April 2006

NHS accountants have raised concerns about the viability of Withington Community Hospital less than a year after it opened.

The hospital, which cost £19.5 million to build, was opened officially by Princess Anne in September last year.

However, the Audit Committee of South Manchester Primary Care Trust said the under-use of the Nell Lane hospital's theatre for operations posed one of the most significant financial risks to the PCT.

The theatre is available to be rented out to surgical teams from Wythenshawe Hospital but currently it is only being used on two days of the week, Mondays and Fridays.

This has left a shortfall of £600,000 in SMPCT's budget.

SMPCT says it is now working with Wythenshawe Hospital and other organisations in the NHS to try to attract more operations to the hospital.

Keith Pickering, director of finance at SMPCT, said: “The Audit Committee's job is to flag up potential problems to the Trust Board arising from any areas of the PCT's work.”

“Where Withington Community Hospital is concerned, the only issue which the Audit Committee highlighted as a problem is the under-use of the hospital's operating theatre capacity for general anaesthetic procedures. We are working closely with Wythenshawe Hospital to resolve this.”

However, a spokesman for South Manchester University Hospitals Trust, which runs Wythenshawe Hospital, said they were in a catch 22 situation.

She said: “We would love to use any spare capacity to get the waiting lists down but we can't afford it.”

She explained that Wythenshawe Hospital is paid by SMPCT to undertake operations and that Wythenshawe then pays to rent the theatre at Withington Community Hospital. Without extra funding from SMPCT, Wythenshawe Hospital is unable to pay for any more theatre time.

The spokesman added: “It's a bit of a vicious circle really.”

A spokesman for SMPCT said that changes in the running of the NHS, under the banner Payment By Results reforms, would mean instead of being paid though block agreements at the end of the year, hospitals would be paid for the number of procedures undertaken.

She said the PCT was exploring ways to get more patients through the door now they can choose where they want to go for treatment.

Ideas include the making of a marketing video to send to GPs explaining what services are available at the hospital and how they can be accessed.

Withington Community Hospital has two other operating theatres.

One, which is running to capacity, is used for cataracts surgery, while the other, which is used for minor procedures, runs four days a week.

Other departments are being fully used and some, such as general outpatients, the women and children's departments and the Walk-In Centre, which is open seven days a week, have more activity than expected.

First published by the South Manchester Reporter (Emma Scott)

TACKLING NHS CRISIS NEEDS MORE THAN EMPTY WORDS - CABLE

Wednesday 12 April 2006

Commenting on Tony Blair's meeting today with Strategic Health Authority chiefs, Liberal Democrat Shadow Chancellor, Vince Cable MP, said:

“Tackling the financial predicament that is damaging the NHS will take more than empty words. Trusts need time and long-term planning to overcome this current cash crisis.”

“The NHS has invested heavily to gain the highly skilled staff it needs. These reforms could lead to many thousands of them being made redundant.”

“Rushing through costly reforms and reorganisations will do nothing to help PCTs deliver a world class health service which gives value for money.”

“In addition, the Government must conduct an urgent audit into the wasteful £6.2bn IT system which has been imposed on the health service.”

On Monday the Liberal Democrats released research predicting that the current NHS cash crisis could lead to up to 24,000 redundancies.
Today think-tank Reform released a report, which predicted that reforms could lead to up to 100,000 NHS redundancies.

Call for review of NHS IT upgrade

Wednesday 12 April 2006

The £6.2bn upgrade of the NHS IT system needs to be independently investigated, leading computer scientists say.

The group of academics have written to MPs questioning whether the plans are robust enough to meet the demands of the NHS, Computer Weekly magazine said.

But the government said the programme was under “constant review” and was “resilient”.

The 10-year IT programme is aimed at linking more than 30,000 GPs in England to nearly 300 hospitals by 2012.

It involves an online booking system, a centralised medical records system for 50m patients, e-prescriptions and fast computer network links between NHS organisations.

The senior academics question whether the National Programme for IT has been properly designed and rigorously reviewed to meet the needs of 24-hour health care.

They pointed out the nature of the NHS means it would have to support huge volumes of data and traffic.

They also raise questions about patient confidentiality - health professionals across the country will be given access to electronic care records.

GPs have already gone on record warning the system might not have enough safeguards in place.

The letter said: “Concrete, objective information about NPfIT's progress is not available to external observers”.

“Reliable sources within NPfIT have raised concerns about the technology itself”.

Concerns

“We propose that the Health Select Committee help resolve uncertainty about NPfIT by asking the government to commission an independent technical assessment with all possible speed.”

Cambridge University expert Professor Ross Anderson, one of more than 20 signatories of the letter, said it crystallised the “growing concerns felt by many people”.

The warnings come after the IT upgrade has been dogged by controversy.

Reports have suggested Oxford's Nuffield Orthopaedic Centre experienced major difficulties when it introduced the patient records system with some patients being “lost in the system”.

And GPs in Nottinghamshire have complained that the choose and book system which allows online appointment booking is not secure enough. The system is already a year behind schedule.

A spokeswoman for the Department of Health said: “The National Programme for IT is under constant review, scrutiny and audit by parliament and government bodies”.

“It is a robust and resilient programme of health care IT delivery in the NHS.”

“We remain confident that the technical architecture of the national programme is appropriate and will enable benefits to be delivered for patients, while ensuring value for money to the taxpayer.”

Source: BBC News

Round up some patients and reopen the operating theatre. The Health Secretary is paying us a visit.

Thursday 06 April 2006

A debt-ridden hospital yesterday reopened an operating theatre that had been closed for 10 months - for the visit of Patricia Hewitt, the Health Secretary.

The University Hospital of North Staffordshire, which plans to lay off 1,000 staff to tackle overspending of £15.5 million, carried out extra eye operations, drafted in more nurses and made a ward look busier than normal to impress Miss Hewitt.

It shut one of its two eye theatres last June after losing part of a contract to carry out operations. Since then the theatre has been used about once a week for other procedures. But staff were told last Thursday that Miss Hewitt was visiting and that for the day the theatre would be doing eye operations again.

A doctor told The Daily Telegraph: “We were told that because she was coming there would be two theatre lists instead of the usual one and we got a message to reopen the theatre.”

“We had to wash out and check all the equipment, the microscopes and the cataracts operating machine. The nurse who ran the theatre before was called back in and for the first time in almost a year the theatre was used for eye operations again. All this was so that the hospital could show Miss Hewitt that all was well and that cuts could not affect patient services, which is of course rubbish.”

“It was an incredibly sneaky thing to do but then the management is obsessed with spin rather than trying to run a good hospital. What Miss Hewitt won't see is that tomorrow, the next day and for the foreseeable future the eye theatre will be closed again.”

Miss Hewitt was visiting the hospital as part of a Government programme to promote more day surgery. As she arrived she was heckled by protesters angry at the job cuts, which include up to 350 nurses. Staff fear that the losses will be highly damaging to patient care.

Miss Hewitt was shown around the North Staffordshire Royal Infirmary site, including a day care centre and a ward with patients awaiting eye surgery.

The doctor said: “I am sure she was very impressed with what she saw but it was stage-managed. Staff were furious when they found out what was going on.”

Details of the extra ophthalmology list, with about seven cataract operations, were sent to staff by e-mail from Julie Slater, the directorate manager of specialist surgery. There was also an extra locomotor list, which deals with bone-related problems. The e-mail said that she appreciated how difficult it had been to find the extra staff required and mentioned Miss Hewitt's visit.

A hospital spokesman said the idea that it carried out extra work to impress Miss Hewitt was “complete rubbish”. Some surgery had been moved to the ward but that was because the ward had originally been set aside for an audit.

“We did not want to show the minister an empty room, so we simply swapped the audit day,” he said.

Miss Hewitt denied during her visit that Government policy had contributed to hospitals' debts. She said: “It is important to keep things in perspective and remember that, across the board, the imbalance is less than one per cent.”

She said the situation at the University Hospital was “regrettable” and “a very difficult time for staff and patients” but it could not keep borrowing to cover its overspending. As a result of the recovery plan, including the job cuts, “all the people of Stoke-on-Trent and North Staffordshire will go on getting better health care”.

However, members of the NHS Save Our Staff Campaign, set up two weeks ago, were highly critical of Miss Hewitt.

After meeting her before her tour, Jim Cessford, the group's spokesman, said: “Our views were put across very forcefully. Unfortunately, I think she came with a set agenda in her mind.”

“Staff say they are already working to full capacity. They say this reduction will tip them over the edge, as well as putting lives at risk.”

Source: NEWS.Telegraph

DISCHARGE PATIENTS WHEN THEY ARE READY NOT WHEN THE SYSTEM IS - HEWITT

Tuesday 04 April 2006

'Wide variation in length of stay for operations must be reduced to improve patient care and deliver better value for money'

Health Secretary Patricia Hewitt today highlighted analysis from the National Institute for Innovation and Improvement saying there is very wide variation between hospitals in the average length of time patients stay in for particular treatments. By improving the discharge process so that patients are discharged when they are ready, not when the system is ready, the NHS can both improve patient care and save money.

For example:

There is a range of between 10.9 days in the top 10 NHS trusts to 44.5 days in the lowest performing trusts for the average length of stay for patients with a fractured neck of femur (broken hip).
Range of between 7.4 days in the top 10 trusts to 29 days in the lowest performing trusts for average length of stay for hip replacement.
Range of between 13 days in the top 10 trusts to 55 days in the lowest performing trusts for average length of stay for an acute stroke.
Range of between 6.4 days in the top 10 trusts to 20 days in the lowest performing trusts for average length of stay for knee replacement.

Whilst visiting a number of hospitals in the North-West, Patricia Hewitt said:
“The NHS is treating more people more quickly than ever before, but there are still parts of the system that can and should be far more efficient in speeding up the patient journey.”

“Cutting the variation between hospitals in patients' length of stay means patients can leave when they are clinically ready, freeing up capacity and time to deal with new patients coming in. This firstly improves services for patients but will also help the NHS to save thousands of bed days a year.”

By employing measures like starting to plan a patient's discharge on arrival, clear indications for all staff about when the patient is due for discharge and co-ordinating with families and carers to ensure arrangements are in place for timely discharge, the NHS can help reduce variations in length of stay as the following case studies show:

Case Studies

Fractured Neck of Femur Taskforce - North West London SHA.
See graph on p.3 of 'Delivering Quality and Value'

Ralph Elias, Orthopaedic Network Manager for NWLSHA, said:
“In December 2004, the North West London Strategic Health Authority (NWLSHA) set up a fractured neck of femur length of stay taskforce. This was managed through the orthopaedic network, comprising of seven Trusts and eight PCTs. Benchmarking and performance data were shared across the sector, as well as identifying challenges and bottlenecks.”

“The key changes introduced from the resulting action plans involved bringing fractured neck of femur length of stay on to the agenda of existing operational improvement programmes, identifying a clinical co-ordinator to oversee trauma patient pathways and improving multi-professional working. The average length of stay for the seven trauma units fell by 20% in the six months to June 05, releasing 2,600 bed days.”

Royal Liverpool and Broadgreen University Hospitals NHS Trust.
See graph on p.7 of 'Delivering Quality and Value'

Police probe hospital deaths

Tuesday 04 April 2006

POLICE are investigating two deaths at a Greater Manchester hospital amid fears that operating equipment may have been tampered with.

Bosses at Salford's Hope Hospital called in detectives after a plastic cap used to connect patients to an anaesthetic machine was found to have a blockage.

It is understood the probe will try to establish whether the fault was due to a failure in manufacturing, or accidental or deliberate tampering at the hospital or during production.

If staff had not spotted the blockage, it could have caused complications if it had been used during an operation. Each cap is designed to be used once then discarded.

Incidents

Police are to carry out an inquiry into operating theatre procedures and will look at two incidents last year when patients died after anaesthetic was given.

The first death was in January last year, when Sylvia Turner, 70, from Wilmslow, suffered a heart attack. She had been admitted for a cyst to be removed from behind an eye. An inquest into her death is still to be held.

The second death happened 10 days later. An inquest has been held and the cause of death was `unascertainable.'

Now, with the latest discovery, police have contacted the patients' families and told them the deaths are being looked at.

Police will also investigate a box of equipment which had its seal broken along with two syringes inside.

Unfit

David Dalton, chief executive of Salford Royal Hospitals' NHS Trust, said: “A piece of equipment, designed to connect patients to an anaesthetic machine, was examined and found to have a blockage inside it, making it unfit for use.”

“No patients came into contact with the equipment or were affected by it.”

“The safety of our patients is of utmost importance, so staff are always meticulous in examining and preparing any piece of medical equipment.”

Mr Dalton commended the vigilance of the staff who spotted the problem and immediately reported it to hospital bosses.

He said: “There could be a range of explanations as to how the equipment became blocked but we immediately informed police of the matter to ensure a thorough investigation.”

“We have now launched a joint investigation with police and will be examining different options to establish exactly what has happened.”

'Diligent'

“I would like to reassure the public that our staff will continue to be completely diligent in preparing and checking equipment.”

A statement from Greater Manchester Police said: “A joint investigation has been launched to establish how the piece of equipment came to be blocked.”

“As part of the investigation, GMP is reviewing operations and procedures carried out in the operating theatre department.”

“This will include looking into, as a matter of course, the circumstances of two patients, who were treated in the department and subsequently died in 2005.”

Source: Manchester Evening News: Neal Keeling

PRESCRIPTION PRICES IN WALES HIT A LOW OF £3

Monday 03 April 2006

Patients in Wales saw prescription prices fall to just £3 on 1 April 2006 as the Welsh Assembly Government made the next step towards their commitment of free NHS prescriptions for everyone in Wales.

Over the past 18 months patients in Wales have seen prescription prices fall from £6 to just £3. In April 2007 prescriptions will become free for everyone.

Health Minister Dr Brian Gibbons said: “Making prescriptions free for all is a major part of our drive to reduce inequalities in Wales and make health services accessible to everyone.”

“Free prescriptions for all is the simplest and most effective way of resolving any inequalities and inconsistencies in prescribing. To introduce exemptions to certain groups would be complex to introduce and implement. Our proposals are straightforward and effective. This way everyone benefits, from the chronically ill to the low paid.”

“Research shows that many people are put off taking regular medication that would help them live healthier lives because of the cost of paying for regular prescriptions. If patients cannot afford the medicines they need to treat their condition, the long-term costs to the NHS could be far greater in terms of avoidable hospital treatment. Making prescriptions free for all is a simple way of addressing this issue.”

“Our policy is unique to Wales and steps have been taken to make sure it is Welsh residents who benefit from it. We now have legislation in place which means the people entitled to reduced prescriptions are those whose medicines are prescribed by a prescriber contracted to a Welsh Local Health Board, on a Welsh prescription form and dispensed by a pharmacist in Wales.”

“This continued fall in prescription prices shows our commitment to providing the best possible access to healthcare for the people of Wales.”

NHS pay award is 'a victory for pay independence', says Amicus Health

Thursday 30 March 2006

The 2.5 per cent rise for NHS staff for 2006/07 was described as 'a victory for the independence' of the Pay Review Body by Amicus which represents 100,000 professionals working in the NHS.

Amicus' Head of Health, Gail Cartmail, said:

“Whilst this recommendation and pay award does not meet all our members' expectations, nevertheless we welcome the review body's confirmation of its independence.”

“We recognise that the review body was under considerable political pressure from the Chancellor and the Health Secretary to limit any award to 2% and we are pleased that they resisted that unacceptable pressure.”

“We believe that the role of the review body is strengthened by this outcome. We believe that the future pay awards must address the staff recruitment and retention issues for the NHS and this year's pay award goes some way towards that but there remain further opportunities to achieve this.”

Last autumn, Amicus demanded a 'substantial' pay increase for 2006/07 and in its submission to the PRB, highlighted evidence of abuse over the job evaluation process by NHS trusts which claimed they couldn't afford to implement Agenda for Change (AfC). Amicus argued that it had been reassured by government that AfC was fully funded.

UK Health Regulator removes Operating Department Practitioner from Register

Thursday 30 March 2006

An operating department practitioner from Aintree Hospitals NHS Trust has been removed from the Register by the Health Professions Council (HPC).

A panel of the Conduct and Competence Committee met on the 28th March 2006 to hear the allegation that Paul Duxbury's fitness to practise as a registered health professional was impaired by reason of his misconduct relating to his dismissal from Aintree Hospitals NHS Trust, in particular,

1.
- a) Mr. Duxbury failed to disclose his conviction for two counts of common assault in July 2002 to his employer, Aintree Hospitals NHS Trust;
- b) In July 2004 Mr. Duxbury did not disclose his conviction for assault when completing an application for a role within Aintree Hospitals NHS Trust,
- c) Mr. Duxbury failed to disclose his further conviction for two counts of assault by beating in may 2005 to his employer following previous warnings that he should do so.
2. Mr. Duxbury's fitness to practise as a registered health professional was impaired by reason of his misconduct in that he was convicted on 29 July 2002 at St. Helens Magistrates' Court of two counts of common assault.
3. Mr. Duxbury's fitness to practice as a registered health professional is impaired by reason of his conviction on 31 May 2005 at St Helens Magistrate' Court for two counts of assault by beating.

Ian Griffiths, Chair of the Panel said...“We are satisfied on the balance of probabilities that in July 2004 you did not disclose your convictions for assault when completing an application for a role within Aintree Hospital NHS Trust. We noted that you gave an explanation for your conduct in interview to the effect that you had misinterpreted the form and considered that the convictions were 'spent'. In the light of the clear wording of the application form we do not consider that you misunderstood the declaration. Further we are satisfied that you failed to disclose your convictions of two counts of assault by beating committed in May 2005 to your employer, Aintree Hospital NHS Trust.”

“We have balanced carefully all the factors in this case including your professional interests and those of the wider public. In these circumstances we consider that the only order that can reasonably be made having regard to protection of the public interest is that your name is struck from the register. We have taken it fully into account the fact that this order may well result in the end of your professional career.”

The Solicitor for the Council requested an interim suspension order and the Committee agreed to this request in the interests of the protection of the public in the event that Mr Duxbury should appeal this decision.

'People on the waiting list will die'

Monday 27 March 2006

Greg Hopkinson's job is saving lives. Health secretary Patricia Hewitt says cutting jobs to stem the NHS deficit - soaring past £1bn - will not hurt patient care. Well, Ms Hewitt, here's one surgeon who begs to differ.

Greg Hopkinson carefully ad-justs his microscope spectacles before he begins to operate on the wrist of a young man who has kidney problems. By joining together a vein and an artery at the base of the thumb, he can make the blood vessel thicken. This will allow the patient to be attached to an artificial kidney machine for haemodialysis which will clean his blood and keep him alive. The painstaking work can take two hours. No one can say whether Hopkinson will still be performing these operations by the summer. His trust, the University Hospital of North Staffordshire, is looking to cut around 1,000 jobs from its workforce of 7,000. Hopkinson has 27 years of experience as a general surgeon, but may well be one of 30 senior doctors to be sacked.

By speaking out about it, he has just doubled that risk. But he does so because the scale of the cuts is, to him, of seismic proportions. 'We have one of the highest rates of emergency admissions in the country, and yet somehow we are supposed to “absorb” this kind of loss,' said Hopkinson. 'It's not as if we are luxuriating in beds and staff. In the morning I come in to look at a list of patients I'm operating on, and I have to hunt them down as they are scattered around different wards because there are not enough beds to go around as it is. If we cut staff, that can only mean more bed closures, longer delays for care and, in the end, that does mean people dying on the waiting lists. There is no point beating about the bush, people are going to suffer.'

Hopkinson was astounded when he heard Health Secretary Patricia Hewitt tell Radio 4's Today programme last week that the funding cuts and job losses would not affect patient care, and that the Trust was in trouble because it had 'taken on too much work'. The entire hospital was consumed with anger.

'We just sat there and asked ourselves if she'd ever been in a hospital, if she had any idea of all the extra things we do, week in and week out, to keep the place running,' he said. 'What kind of fantasy land is she living in if she imagines you can lose one-seventh of your staff and for a hospital to remain on its feet?'

As the new financial year gets under way this week, things could not look bleaker for the NHS. The past few days have seen more and more trusts announcing job losses as a way of shaving millions off their expenditure. The cash crisis this year, with deficits of more than £1bn predicted across the service, means that managers have very little room for manoeuvre, and losing staff - their biggest chunk of spending - is the quickest way to save money.

Every region of the country is now affected by this 'slash and burn' approach, with losses of between 15,000 and 20,000 jobs predicted for this year. The Royal Free Hospital in north London wants to cut 480 jobs and 100 beds as a way of saving £25m. Queen Mary's Hospital in Sidcup, Kent, plans to lose 190 jobs, the bulk being nurses and midwives. Two hospitals in Shropshire, the Princess Royal and the Royal Shrewsbury, will see 300 posts go over the next year as they have debts of £30m. The New Cross Hospital in Wolverhampton has already announced that it will cut around 300 jobs as it faces a £37m debt. To the south, the Plymouth Hospitals Trust wants to lose 200 jobs in 2006. In the north-east, County Durham and Darlington NHS Trust, in the constituency of the former Health Secretary, Alan Milburn, has warned it will need to lose 700 jobs over three years to cope with the deficits.

All of this will happen in spite of the fact that there will be an extra £4.5bn for the health service for 2006/07.

How could it have come to this, after six years of unprecedented growth? Much of the extra cash has been spent on hiring new staff within the NHS, not just managers but therapists, clerks, nurses, and specialists. The last workforce survey by the government showed that, since 1999, 67,000 more nurses have been taken on, some working part-time, as well as thousands more doctors. But at the same time, their unions also won them substantial pay rises which last year took up 47 per cent of the extra money. They are now the first ones to be feeling the pain.

On the edge of Stoke-on-Trent, the City General hospital, which is part of the trust, lies across a hillside next to a large building site which was intended to be part of a new £300m development of a new hospital. The crane stands idle and there are no workmen visible. No one knows what will happen to this Private Finance Initiative (PFI) plan, which may now turn out to be unaffordable.

As the hospital faces a £15.5m deficit, managers are looking at a number of ways of saving money. If they can do more day-case surgery, instead of having patients in overnight, and if they can discharge people more quickly from the wards, the managers believe they could afford to lose up to 160 beds. These 'efficiency savings' are probably necessary but it is the prospect of mass redundancies in a hospital which has no nearby alternative to offer full healthcare that so dismays people.

The area's eight local Labour MPs went to see Tony Blair last Monday to ask for some special assistance. The Prime Minister told them he would examine ways in which they could be helped. The truth is that in a Labour stronghold such as Stoke, the party will never be kicked out of power. The Trust itself has now launched a 90-day consultation on the plans. It has employed a firm of accountants, Deloitte Touche and Ross, to advise them on finances and efficiency savings, a move that will probably cost the trust another £500,000.

The chief executive of the hospital, Antony Sumara, declined to speak to The Observer. Instead, one of his press officers said: 'We are redesigning the way we work at the moment. Our length of stays for patients are above the average and we can reduce them, and we are also looking at reducing the number of follow-up outpatient appointments. It may be possible for more patients to be seen in more suitable facilities such as GPs' clinics.

'We hope to achieve the losses through a combination of voluntary and compulsory redundancies, as well as reductions in hours, and vacancy freezes. The truth is that, as we go into the new financial year, there is a difference of some £30m between our projected income and our spending. That difference simply has to be tackled.' The trust, however, would not reveal the financial details to explain how the deficits had built up within the space of 12 months.

Nor have the staff received any clear explanation of the history behind the debt. All they know is that out of the 1,000 redundancies, of which three-quarters are likely to be compulsory, around 370 will be nurses and midwives, 200 would be healthcare assistants, 15 will be consultants, 180 will be administrative and clerical staff, and some 63 will be managers. Nina Fleming, a staff nurse who represents the Royal College of Nursing at the hospital and was brought up in Stoke, explained how bleak the future now looks for staff who have spent their careers on the wards.

'We're a cheerful group, usually,' said Fleming. 'We just tend to get on with the work, we're a big family really because people who grow up here tend to stay, not move away. That means we have good relationships with patients because we know a lot of them and their families. What is hard is about all of this is that we know it will affect patient care, whatever that woman [Patricia Hewitt] says. You can't lose 360 nurses and not have a big impact on patients.'

Fleming is worried that hands-on care will disappear. 'Who's going to be there to sit with them and talk to them about their condition? Who is going to be able to assess the elderly people and see if they are well enough to go home?' In the trust's accident and emergency unit, the nurses are busy dealing with the usual morning's work of cuts, injuries and sickness. This unit saw a record 100,000 admissions over the past year, and managed to meet the government's target of no one waiting for more than four hours. The sense of fear over what the future holds is such that few people will talk openly about what is happening. One doctor said: 'My working environment has gone from merely stressful to that of a morgue. We feel that despite all the efforts made in reducing waiting times, getting to the four-hour wait, becoming part of the new medical school at Keele and being driven close to exhaustion in the process, it's all been for nothing.'

Fleming added with some bitterness: 'We're not rolling in money here. Our local area has been considerably underfunded for years, we have a predominantly working-class population with poor health, as you would expect from an area whose two biggest historical employers have been coalmines and pottery works. All these factors have a part to play. I think it is facile to say the deficit just boils down to poor day case rates and greedy wage rises.'

The cardiology department has a good national reputation and has done much to reduce the long waits for treatment. It now manages to see patients needing an angiogram - a hi-tech heart x-ray - within two months. That delay will now rise to six months, which will inevitably mean more patients having to cope for longer with severe chest pain. The doctors are already unable to implant as many advanced pacemakers, preventing heart attacks, as they were, because the operating theatre technicians they rely upon are not being replaced.

Perhaps the toughest loss of all will be the medical secretaries - a faithful band of staff, usually women, who are the backbone of the NHS, not simply writing letters or doing administrative tasks for doctors but actually talking to patients who come regularly, fitting them into the consultants' schedule, and even giving them advice. They are paid around £14,000 a year - less than a nurse starts on - and now they will be asked to halve their hours, and their pay.

'When the secretaries go, everything falls apart,' said Hopkinson. 'There's talk of using some firm in India to write the letters and fix appointments. My goodness, don't they know what these women do? Some of them come in on a Sunday to get our letters sorted. But the people making the cuts never take account of all that goodwill that props up the service. Well, the goodwill is disappearing fast and one day, when it's gone, I suppose we'll look back and wonder how it happened.'

Source: Guardian Unlimited
Jo Revill, health editor
Sunday March 26, 2006
The Observer

Band of hope to stop errors by surgeons

Monday 20 March 2006

A British surgeon has invented a wristband that he believes will make it virtually impossible for doctors to remove the wrong organ during surgery.

It emerged last week that a pensioner had a healthy kidney removed by mistake during an operation at Ayr hospital in Scotland. John Heron, who is in his sixties and from Lugton, Ayrshire, was admitted to have his second, diseased kidney removed.

In a statement his family said: 'We are devastated by the disastrous professional errors that should never have happened.'

Mike Henley, a urological surgeon, has already persuaded his employers at Derby City Hospital to use his 'patient identity bracelet' which is a way of staff double-checking what they are doing before the surgery begins.

When a doctor first talks to a patient to obtain consent for a procedure, details of the operation are written on the band and put on the patient's wrist. The band is checked in the operating theatre, and anaesthetic is not given until the surgeon checks the notes and confirms the procedure with the patient. The surgeon initials the band and checks a final time before the patient is sedated.

The number of 'wrong site' cases in the UK is unknown but it is thought there are probably around 400 cases per year of either the wrong organ being taken out, or the wrong procedure followed.

Henley said: 'The physical wearing of the band ensures there is interaction between doctor and patient, in a way that a paper checklist never can. It also reinforces psychologically the responsibility for the doctor to check it really is the correct patient for the correct procedure.'

Source: The Observer

Fears over patient record system

Thursday 16 March 2006

The National Audit Office is being urged to investigate reports the switch to a new NHS computer system could have put patients at one hospital at risk.

Reports seen by Computer Weekly show Oxford's Nuffield Orthopaedic Centre saw “major” difficulties when it moved to the £6.2bn patient record system.

Concerns over patients being "lost in the system" were also raised.

NHS Connecting for Health, which is delivering the system, denies patients' safety was affected.

'Untoward incident'

The switch to the new system - which is part of the government's flagship modernisation of the NHS - began in late December.

When it goes fully live it will give 50 million NHS patients an electronic record and link more than 30,000 GPs with 300 hospitals.

It is said to be the world's largest civil computer project.

South Norfolk MP and member of the Commons public accounts committee Richard Bacon has written to the National Audit Office asking it to investigate.

The Computer Weekly report claims papers it has seen revealed that: “Major configuration and software problems led to significant operational disruption, and potential risk to patient safety, business continuity, staff morale and public and patient confidence.”

The papers also showed the Oxford hospital filed a “serious untoward incident” report after it encountered problems as it began phasing the system in at the end of December.

Examples of serious untoward incidents can include events which have or may have caused death or serious injury, contributed to a pattern of reduced standard of care, or caused serious disruption to services.

Another document said there had not been enough time to test the system and that it would take the trust some months to address the issues which arose.

A spokeswoman for NHS Connecting for Health said patient safety was never compromised - but admitted implementation of the system caused inconvenience to patients and staff.

“A variety of mechanisms have ensured that functions have continued and patients' progress through the system has been monitored.”

“Reporting a serious untoward incident does not mean individual patients were at risk and they were not in this case. It was a general alert in line with proper NHS process.”

“The trust, NHS Connecting for Health and Fujitsu, the local service provider, are fully engaged in addressing the issues.”

“Intensive work by all parties has already resolved the vast majority of issues raised and we fully expect the remaining small number of concerns to be resolved in the near future.”

'Compromising'

She pointed to successful deployments at the Nuffield Orthopaedic Centre of other computerised systems which are bringing benefits to patients and clinicians.

She added: “In the coming year there will be more than 20 such installations in the NHS Connecting for Health Southern Cluster and we will ensure that lessons are learned from each deployment.”

However, Mr Bacon said: “Connecting for Health has many of the hallmarks of a classic IT fiasco,” he said.

“It is being foisted on clinicians with no proper consultation and there is over-rapid implementation without proper testing.”

“Now we are seeing reports that it is potentially compromising patient safety. Since the National Audit Office is already undertaking a study of Connecting for Health, it should also examine these incidents at the Nuffield.”

Computer Weekly's executive editor Tony Collins said: “These are systems that are fundamental to the running of the hospital. One hopes there haven't been patient safety implications but the fact is that these reports were written because of genuine concerns that there could be.”

Health Minister Lord Warner said no patient's care had suffered as a result of “glitches” in the system.

Health chiefs had been aware of the risks of pressing ahead with a new system but believed they were “worth taking”.

“We have been in touch with the Trust medical staff and they have confirmed that no individual patient's care has been adversely affected by the system's deployment but there have been some delays to some appointments.”

Source: BBC

Frontline hospital staff axed

Tuesday 14 March 2006

THEY were told it would only happen as a last resort, but today 180 staff at cash-strapped city hospitals learned they are to lose their jobs.

Frontline staff will be axed and an operating theatre will be closed as managers are staring at a £7.7 million black hole in the budget at Peterborough and Stamford Hospitals NHS Foundation Trust. As medical staff were facing the shock of losing their jobs, the trust announced it was looking for a new manager to promote the hospitals' facilities and attract new business from primary care trusts (PCTs) outside the Peterborough area. The salary will be between £50,000 and £60,000 a year.

Hospital staff, including nurses, were hoping job cuts would not be necessary, but an internal e-mail from chief executive Chris Banks, which was leaked to The Evening Telegraph, reveals some people, including clinical staff could go as early as this week. In the e-mail, Mr Banks said a consultation was held with staff about savings that had to be made.

He said: “With the results of the consultation in mind, we have taken the difficult decision to proceed with a reduction of about 180 posts from across the trust. Many of these reductions will be phased during the coming months and we expect to be able to reduce posts through natural wastage”.

“A relatively small number of posts will be affected immediately, and line managers will be speaking directly to the members of staff concerned from the beginning of next week.”

He said some members of staff would have to take on additional responsibilities, some services would be withdrawn and other services organised differently.

In the e-mail he added: “As I have said in previous letters we will do everything we can to keep hard-working and skilled members of staff at the trust — redundancy is always the last option.”

However, Mr Banks revealed: “As well as cost reductions, we are also anxious to protect our income and, where possible, to increase it by attracting patients from other areas. In order to do this we are creating the new post of head of business development. This person will work with GPs, PCTs and other organisations to market the trust's services. The more income we can attract, the less cost we have to save, and the more secure our services will be.”

The economy drive was launched in November to get the trust out of trouble caused partly by PCTs spending money on community care rather than hospital services.

Meanwhile, the Government has tightened the purse strings further by insisting trusts make a 2.5 per cent efficiency saving this year. Three wards have already been mothballed, there will be further cuts in bed numbers and one of the 19 theatres at the three hospitals will be shut. This will be bolstered by streamlining administrative support and cost savings on materials.

Today, Bill Stevenson, director of operations would only say: “All these initiatives are designed to maintain the financial and operational strength of the trust, and not end up in a position that other parts of the NHS have found themselves in.”

Source: Peterborough Today

NHS forced to fix bungled private sector hip replacement operations

Tuesday 14 March 2006

NHS hospitals are having to repair the damage done during botched operations on people who have been sent to private centres for hip and knee replacements to cut waiting lists, it is revealed today.

Drive to cut waiting lists resulting in poor surgery
Overseas staff asked to do unfamiliar procedures

NHS hospitals are having to repair the damage done during botched operations on people who have been sent to private centres for hip and knee replacements to cut waiting lists, it is revealed today.

Independent sector treatment centres (ISTCs) have been set up around the country using mainly surgeons from overseas to take the pressure off major NHS hospitals by fast-tracking the easiest cases.

But Angus Wallace, professor of orthopaedic and accident surgery at Nottingham University, writes in the British Medical Journal that “the number of patients we are seeing with problems resulting from poor surgery - incorrectly inserted prostheses, technical errors and infected joint replacements - is too great.”

Many overseas surgeons, he says, "have been asked to carry out joint replacement operations that they have never seen or done before". Many of the centres have contracts to buy just one type of artificial joint - but sometimes it is one that the surgeon has no experience in using.

“It is quite clear that this has occurred with inadequate training of both the surgeons and the operating theatre staff and as a consequence there have been several serious errors - joint replacements put in without bone cement when bone cement was essential for that joint replacement, the use of the incorrect size heads (ball) for a hip joint replacement, etc,” he writes.

It is hard to know how many operations are going wrong, Prof Wallace told the Guardian, but it is clear there are problems that ought to be investigated.

“We expect failures of hip replacements at approximately 1% a year and knees at about 1.5% a year. But we have got some of the ISTCs that are looking at 20% failure rates,” he said.

The British Orthopaedic Association has submitted two dossiers of cases to the Department of Health, its president, Ian Leslie, told the Guardian. The first went to then deputy chief medical officer Aidan Halligan about 16 months ago and the second was submitted nine months ago.

“Although they investigated, it hasn't made much difference to our concerns,” he said. “The difficulty is getting hold of the information from the ISTCs. We don't know how many patients are being done in the treatment centres.”

But in two centres where the figures have been examined the failure rate was significantly higher than in NHS hospitals - at a diagnostic and treatment centre in Weston-super-Mare it was three times the NHS rate and in Cheltenham it was something like 10 times the rate, he said.

At an inquiry by the Commons health select committee yesterday, Royal College of Surgeons president Bernard Ribeiro said the government policy in establishing the treatment centres was “to win elections and to get waiting lists down”.

Extra theatre time for hip and knee replacements had indeed been needed, he said. “The government gave us capacity through ISTC but somewhere down the line it lost the plot. In developing ISTC it is challenging the NHS.”

The BOA and the royal college strongly urged the need for an audit of success rates and revision rates (where the operation has to be redone).

“Let's find out whether the quality of work in ISTCs is equivalent to the work in the NHS,” said Mr Ribeiro. “Let us actually do a paper study. If it could be funded we would do it tomorrow.”

The treatment centres are also having a detrimental effect on the training of UK surgeons, they argue. Junior surgeons used to learn their craft on the simple operations - firstly by watching senior surgeons perform them and then by carrying them out under supervision.

“This time-honoured and soundly proved method of training has now, sadly, been denied," writes Prof Wallace in the BMJ. "Even if training were to be allowed in ISTCs, the supervising surgeons may not be fully competent themselves ... let alone competent as trainers. Consequently the competence of our next generation of surgeons is in jeopardy.”

Source: Guardian unlimited

SIR NIGEL CRISP STEPS DOWN FROM DH

Tuesday 7 March 2006

Sir Nigel Crisp today announced that he is to step down from his post as Chief Executive of the NHS and Permanent Secretary at the Department of Health at the end of the month.

He is to take early retirement after more than five years in one of the most challenging jobs in Whitehall, during which he oversaw the implementation of the first half of the ten-year NHS Plan.

In a message to NHS and departmental staff, Sir Nigel said:

“I have been privileged to serve as Chief Executive of the NHS and Permanent Secretary of the Department of Health for more than five years. So it is with pride, as well as sadness, that I announce my retirement.”

“Looking back over the last five years, I am proud that the NHS has achieved or exceeded the challenging targets it has been set. Over this period, people have made enormous changes in the NHS.”

“Where it matters, at the front-line, the old hierarchies are breaking down and outdated practices are changing.”

“But not everything has gone well. I am particularly saddened by the difficulties we have had over the last few months and the financial problems we are grappling with. As Chief Executive, I wish to acknowledge my accountability for problems just as I may take some credit for achievements.”

“Looking forward, I have concluded that, despite these problems, the timing of my retirement is right for the NHS. We have built a good foundation but this is a very big moment of change. The NHS needs a Chief Executive who can give leadership over several more years. My departure will allow new leaders to be appointed at the same time in the Department, in Strategic Health Authorities and in Primary Care Trusts, to work together to continue reform and improvement.”

Sir Nigel, 54, joined the NHS in 1986, and held a variety of senior managerial positions, including Chief Executive of the Oxford Radcliffe Hospital and Regional Director for London. He was appointed to his current post in November 2000, and became the first civil servant to combine the previously separate roles of Head of a Government department and head of the NHS.

Following Sir Nigel's retirement, Sir Ian Carruthers will become Acting Chief Executive of the NHS, and Hugh Taylor will become Acting Permanent Secretary of the Department.

Patricia Hewitt, Health Secretary, said: “Sir Nigel has served the NHS and the Department of Health with great distinction. I have enjoyed working with him since I became Secretary of State, and I am very grateful to him for driving the huge improvements we have seen in patient care over the last five years.”

“He has successfully led the health service through the first half of the Government's ambitious programme of investment and reform. This has secured the shortest waiting times in a generation, with more beds, more hospitals, more doctors and more nurses than ever before. By putting patients first, and introducing more and more choice for consumers and users, we are changing the culture of the NHS for the better, for good.”

“As a result of Sir Nigel's efforts, the Department has become a role model for the successful delivery of public services. On a personal level I regret his decision announced today, but I respect his integrity and wish him well for the future.”

HEALTH ADVICE TO PEOPLE TRAVELLING TO COUNTRIES AFFECTED BY H5N1

Tuesday 7 March 2006

The Department of Health has published public health information for people travelling to countries that have been affected by bird flu.

Although there is no H5N1 currently in the UK, cases of avian influenza are now occurring in poultry and wild birds in some parts of the world. The leaflet provides guidance on how to reduce the risk of exposure to the virus in a country affected by an outbreak of H5N1 avian influenza, the symptoms of infection and what to do if a person thinks they may have been infected. Advice includes:

do not visit bird or poultry farms and markets,
avoid close contact with live or dead poultry,
do not eat raw or poorly-cooked poultry or poultry products, including blood,
wash your hands frequently with soap and water.

Sir Liam Donaldson, Chief Medical Officer said:
“The information we are distributing is to make sure that people travelling to countries affected by H5N1 have up-to-date health advice. H5N1 avian influenza is predominantly a disease of birds. The virus does not pass easily from birds to people and has not yet been shown to pass from person to person. Where people have been infected, it was as a result of close contact with infected poultry or birds. The virus has caused severe disease and a high proportion of people have died. H5N1 infections have not been reported in this country, but it is important that travellers from the UK have clear factual information to assist them.”

The leaflet will be available from GP surgeries, health centres, and English air and sea ports.

The severe form of H5N1 has now been diagnosed in birds in the following countries: Austria, France, Germany, Greece, Hungary, Italy, Slovakia, Slovenia, Turkey and across South East Asia.
Copies of the leaflet are available on the Department of Health website.

HOSPITAL HYGIENE WILL HELP NHS STOP MARCH OF MRSA AND OTHER DEADLY SUPER-BUGS

Wednesday 1 March 2006

Spurred to action by the rapid, and tragic, increase in the number of preventable MRSA-related deaths and the continuing surge in the other Healthcare Acquired Infections (HCAI's), Optimus Healthcare Events is offering NHS staff free entry to a major new national event focused on combating hospital super-bugs, which contribute to the deaths of around 5,000 people in the UK every year.

Believed to be for the first time ever, The Hospital Hygiene Exhibition (which takes place at ExCel, London from 16 to 17 March 2006) will feature A Ward At Work - an interactive seminar area where healthcare professionals can see and evaluate the latest hand hygiene and decontamination techniques in action. Entry is entirely free of charge.

Over 100 companies who have developed products and services specifically to combat the spread of bacteria and infections in the operating theatre, on the wards and throughout hospital environments will be exhibiting at Hospital Hygiene. Many of these will be launching break-through new products and showcasing prototypes for the first time.

This announcement comes in the wake of alarming new statistics showing the number of deaths linked to the super-bug MRSA has risen by 22% and a stark reminder from the British Medical Association that approximately 15 to 30 per cent of HCAIs are preventable.

“Hospital staff in the UK are clearly under enormous budgetary and time pressures to treat patients and meet targets, but a 15% reduction in the incidence of HCAIs would free up around £150 million every year for other NHS resources. We urge all NHS staff to take advantage of this entirely free opportunity to increase their knowledge and pick up practical hygiene tips which they can put in to practice when they return to the wards”, said event organiser, Martin Scott.

Hospital Hygiene, the first national event of its kind, is designed for everyone involved in keeping the UK's hospitals clean - from clinicians to hospital directors.

Products on display will include touch-free taps, alcohol wipes, protective clothing, steam cleaners, chemicals and detergents, while personnel from the Health Protection Agency, Hospital Infection Society, National Patient Safety Agency and British Institute of Cleaning Science will be available to talk to visitors about best practice.

Further information is available here.

REVIEW PUBLISHED ON INFECTED BLOOD PRODUCTS

Tuesday 28 February 2006

A review in to how patients were infected with Hepatitis C and HIV through contaminated blood in the 1970s and early 1980s, was published on 27 Fevruary 2006.

This review focussed on documents from 1973 to 1991 to produce a chronology of events and analysis of the key decisions which were taken at that time. The question of why England and Wales did not achieve a policy of self-sufficiency in blood products and whether this would have avoided infection rates, was given particular attention within the review.

The report concludes that:

Nobody acted wrongly in the light of the facts that were available to them at the time.
Every effort was made by the Government to pursue self sufficiency in blood products during the 1970s and early 1980s
The more serious consequences of Hepatitis C, only became apparent in 1989 and the development of reliable tests for its recognition in 1991.
Tests to devise a procedure to make the Hepatitis C virus inactive were developed and introduced as soon as practicable
Self sufficiency in blood products would not have prevented haemophiliacs from being infected with hepatitis C. Even if the UK had been self sufficient, the prevalence of hepatitis C in the donor population would have been enough to spread the virus throughout the pool.

Public Health Minister Caroline Flint said:
”We have great sympathy for those people, and their families, who were infected with hepatitis C and HIV from contaminated blood products in the 1970s and early 80s.”

“The review based on the available evidence, concludes that clinicians acted in the best interest of their patients in the light of the evidence available at the time. Donor screening for hepatitis C was introduced in the UK in 1991 and the development of this test marked a major advance in technology, which could not have been implemented before this time.”

The Review of Papers can be found here.

MRSA deaths up by nearly quarter

Thursday 23 February 2006

The number of deaths linked to the hospital superbug MRSA has risen by nearly a quarter, statistics show. The Office for National Statistics data revealed that between 2003 and 2004 the mentions of MRSA on death certificates increased by 22% to 1,168.

It does not necessarily mean the superbug was the cause of death, just that it contributed to it. Most of the deaths were in the older age groups and rates were higher among men than women. MRSA was mentioned on two out of every 1,000 deaths certificates in England and Wales, the statistics showed.

Despite the rise, Chief Nursing Officer Christine Beasley said: “It is important to put this in to context. These figures show that out of the 12m people that go in to hospital in a year about 360 of them probably die directly of MRSA, but it is unacceptable for anyone to die unnecessarily from infections.”

“Many people who have MRSA are very, very sick people prone to infection and not all infections are avoidable, but we are ensuring that the NHS has good hand hygiene and clinical procedures to prevent the ones that are.”

“We are now legislating to put a hygiene code and a tougher inspection regime into law, to drive up standards of hygiene and infection control, with ultimate sanctions for trusts who fail to deliver.”

But Patients Association chairman Michael Summers said: “We are disappointed by these new figures. "It is clear that MRSA and hospital infections are winning the war in many of our wards.”

He added simple hygiene measures, such as washing hands, could have a huge impact and should be taken by everyone in hospitals.

Source: BBC

Robot assisted surgery more accurate than conventional surgery

Thursday 09 February 2006

A new study from Imperial College London shows that robot assisted knee surgery is significantly more accurate than conventional surgery.

The team of surgeons tested whether Acrobot, a robotic assistant, could improve surgical outcomes for patients undergoing partial knee replacement. Acrobot works by helping the surgeon to line up the replacement knee parts with the existing bones.

The surgeons looked at 27 patients undergoing unicompartmental knee replacement. The patients were separated into two groups as part of a randomised controlled trial, with 14 having conventional surgery, and the remaining 13 having robot assisted surgery.

Although the operations took a few minutes longer using the robotic assistant, the replacement knee parts were more accurately lined up than in conventional surgery. All of the robotically assisted operations lined up the bones to within two degrees of the planned position, but only 40 percent of the conventionally performed cases achieved this level of accuracy.

The team found there were no additional side effects from using robot assisted surgery, and recovery from surgery was quicker in most cases.

Professor Justin Cobb, from Imperial College London, who led the research team, said: “These robots are designed to hold the surgeon's hand in the operating theatre, not take over the operation. This study shows they can be an enormous help, preventing surgeons from making mistakes. More importantly, by showing how the increased accuracy makes a difference to how well a knee works after surgery, we will be able to develop a new generation of less invasive procedures without the risks of error, providing faster recovery and better functional outcomes for patients.”

The study involved both surgeons and engineers from Imperial College, with medical robotics engineers designing the Acrobot prototype, and surgeons testing it.

Professor Cobb added: “This study could have important implications for not just surgery, but also for health economics. By improving the accuracy of surgery, and ultimately improving the outcome for patients, we can make sure the knee replacements work better and last longer, preventing the need for additional surgery.”

The study was funded by The Acrobot Co. Ltd. a spin out of Imperial College London.

Make no mistake, the NHS can kill

Thursday 09 February 2006

By Dr SARAH BURNETT, Daily Mail
After terrible medical errors were disclosed by 19 health authorities, Dr Sarah Burnett - who herself experienced an NHS mixup - explores why the health service is failing up to one million patients each year...

Some years ago, I was admitted to hospital for a cartilage operation on my knee. While waiting to be wheeled into theatre, a nurse approached with the consent form for me to sign.

“It's your left leg we're operating on, isn't it?” she said.

“No, it's my RIGHT leg,” I told her. She showed me the form with “left leg” written on it.

I refused to sign it, and I wouldn't allow the anaesthetist to come near me until I had seen the surgeon and made sure he knew exactly which leg to operate on.

Have you experienced an NHS mix-up?

The operation was a success, but if I'd been elderly or confused or unable to speak English, the story might have been very different.

True, it wasn't life-saving surgery - but there are risks attached to every operation and administration of an anaesthetic; not to mention the chances of infection following invasive surgery, the cost to the NHS of the procedure and time off work to recuperate.

Catalogue of blunders

My experience was not that unusual, as revealed by a report yesterday detailing a catalogue of NHS blunders putting lives at risk.

The errors disclosed by 19 health authorities under the Freedom of Information Act make for uncomfortable reading.

One patient died after air was allowed to enter a vein through a drip, one had forceps left inside, another received the wrong set of lungs during a transplant, while a man had the wrong testicle removed and a woman underwent an unnecessary hysterectomy.

These shock findings follow two stories that made headlines recently. Last week it was reported that more than a 1,000 patients may have been wrongly diagnosed with heart problems after a technician at a hospital in Bury, Lancashire, misinterpreted ultra-sound tests.

And in January, a consultant radiologist at Trafford General Hospital in Manchester was reported to have mistakenly given 22 breast cancer sufferers the all-clear.

One million incidents per year

The most recent survey of NHS standards shows that there are now almost one million incidents and lapses in hospital care annually.

And according to the National Audit Office, there are around 2,000 avoidable deaths every year in the NHS, while another 5,000 patients die annually from infections acquired in hospital.

This may be a conservative estimate. An official report last year said that up to 34,000 patients a year may die because of medical mistakes.

As a consultant radiologist who spent 15 years working in the NHS between 1985 to 2000, I was often dismayed at the ineptitude I had to contend with. Indeed, it was my frustration with the standards of care that drove me out of the health service.

I could not tolerate working in a system so disorganised and so over-stretched that it was harming patients while trying to heal them.

I was witness to many regrettable incidents. In one tragic case, a patient with severe pains in his arm was X-rayed, yet the cancer - clearly visible on his lungs and which had spread to his bones - was not spotted. His treatment was so delayed that he eventually died from the condition.

Sent home with a broken neck

I saw cases of patients with serious fractures - one even with a broken neck - being sent home because the X-rays had not been examined properly.

Sometimes, I saw the wrong patients being sent to the operating theatre because there were two people on the ward with the same or similar name, and no one had bothered to re-check the notes.

Equally aggravating was the failure to inform doctors that a certain patient might be a carrier of the so-called superbug, MRSA, and needed nursing in isolation. Such a patient might be sent to a ward where open wounds were being treated.

In addition, poor communication means that almost 10 per cent of all hospital prescriptions are written incorrectly, which can have damaging consequences for those reliant on life-saving drugs.

Medical errors generally fall into three categories. First, there are the sins of omission in which doctors fail to recognise the data in front of them.

Second, there are the misinterpretations, where doctors wrongly interpret tests and examinations - for instance, mistakenly telling a woman that a breast lump is benign.

The third category might be called the errors of commission, where procedures are incorrectly carried out because of a failure in the system. Classic examples include operating on the wrong patient or removing the wrong limb or organ.

We can never live in a medical Utopia, and mistakes will always be made. Human error means that perfection is never attainable.

And there can be no doubt that Britain's compensation culture has contributed to a growing awareness of medical negligence in our society.

Interestingly, around 40 per cent of all claims are abandoned because they are so weak. Another 43 per cent are settled out of court, while just two per cent are decided in favour of the patient.

But these figures cannot disguise the reality that incompetence is on the rise. There are a number of reasons for this.

NHS 'horribly overstretched'

One is the fact that, despite all the extra billions spent by the Government, the NHS remains horribly overstretched. Too much money has gone on bureaucracy rather than recruitment of front-line staff and technicians.

Hospital staff are overworked and exhausted. They do not have the time to carry out the necessary doublechecking to avoid errors.

Lack of time also contributes to a failure to communicate with patients. Yet so many mistakes could be avoided if patients were kept informed about their treatment.

Another difficulty is that crucial basics of medical and nursing practice, such as hygiene, are being neglected - hence the rise in MRSA. I used to be astonished at the neglect of essential tasks such as handwashing between each patient consultation.

The huge influx of overseas doctors and nurses to the NHS is also contributing to the lack of vital communication in our hospitals. Medical staff from the EU can work here without any proficiency in English.

We can never eliminate mistakes, but the tragedy of NHS induced death and injury in the 21st century is something we should be ashamed of. Our patients surely deserve better.

MRSA: “TRUSTS MUST DO BETTER” SAYS MINISTER

Monday 06 February 2006

Support teams to be sent into 20 trusts.

The latest national and trust-level figures on MRSA bloodstream infections are published today by the Health Protection Agency (HPA), showing 3580 MRSA bloodstream infections occurring in NHS Acute settings during April - September 2005.

MRSA bacteraemia reports from NHS acute Trusts in England, April 2001-September 2005

Date		Number of reports
April-Sept 2001		3616
Oct 2001-March 2002		3665
April-Sept 2002		3584
Oct 2002-March 2003		3806
April-Sept 2003		3749
Oct 2003-March 2004		3956
April-Sept 2004		3525
Oct 2004-March 2005		3689
April-Sept 2005		3580

Around half of trusts are currently on target and half of trusts are behind target to make a 50% reduction in MRSA infections by 2008. Of those who are behind on the target around twenty trusts face a significant challenge and these are the organisations the Department will be working with most closely in the coming months.

Health Minister, Jane Kennedy, said:
“I am disappointed that, despite many trusts making significant reductions in infections, the overall figures do not reflect these improvements. These are early figures from the period at the very start of the comprehensive program of action we have put in place.”

“To reinforce the efforts at Trusts that are furthest from their target I am setting up teams of specialists to work with them through 2006. These teams will begin first wave work now at Sandwell, Northumbria and Aintree NHS Trusts who have volunteered for help, and then move on to around seventeen more Trusts through 2006.”

“While 7,269 infections is a tiny fraction of the 12 million patients admitted to hospital every year, and more cases are reported now due to better surveillance, any avoidable infection is one too many.”

The DH will now offer targeted support for trusts facing the biggest challenges. Targeted support has two main elements:

The first element is the MRSA/HCAI Improvement Programme, the objectives of which are to provide support teams to hospitals that have a significant MRSA problem, to help them:

Diagnose the issues currently preventing reduction in MRSA bacteraemia numbers
Develop practical action plans with realistic implementation timescales
Implement agreed plans and put in place management and support arrangements that facilitate sustained improvement
Act as a catalyst for other Trusts and demonstrate that by adopting best practice rates can be reduced to lower levels, and at faster rate than previously thought.

These teams will begin work now at Sandwell, Northumbria and Aintree NHS Trusts and then move on to around 20 Trusts in total through 2006.

The second element is the Performance Improvement Network (PIN), consisting of a national network of Trusts with a mixed track record of delivery against their Local Delivery Plans. These Trusts meet quarterly as an action learning set to share best practice and learn from each other. There are currently 21 Trusts that belong to the network.

The Department of Health and the Health Protection Agency also previewed their new enhanced data reporting system today. This is a new online reporting system allowing trusts and the Department and HPA to monitor:

Location where infection occurred
Location of patient
Stage of infection
Specialty

We will now publish this enhanced reporting data every six months, starting with the next six-month statistics.

We now have one of the best reporting and data systems for monitoring MRSA in the world, allowing us to get to the root of where infections occur most frequently. For example, the enhanced MRSA data collection has enabled us to quantify the risk of infection in Renal settings - as many as 1 in 10 of all MRSA bacteraemias may be arising during renal treatment. To prevent avoidable infections occuring in Renal settings we are:

Establishing Renal/HCAI Group led by Renal Tsar Donal O'Donahue
Improving vascular access so more 'permanent' lines can be fitted more quickly, reducing risk of infection
Developing a programme of activities to ensure good clinical practice on touch techniques when inserting both temporary and permanent lines

Chair of the Renal Advisory Group at DH, Donal O'Donahue, said
“We have known about the risk of incurring MRSA during renal treatment, particularly when using temporary lines, for some time. That is why we included a standard in the Renal National Service Framework covering access to vascular surgery for creation of fistulae, which reduces the risk.”

“The enhanced MRSA data collection has enabled us to quantify the risk suggesting that as many as 1 in 10 of all MRSA bacteraemias may be arising due to inadequate vascular access provision. This means this is now a high priority and that is why I have convened a national conference on 16th February to drive home the important messages about raising clinical standards.”

The national and trust-level data can be viewed here.

For further information on Saving Lives and other action the Department is taking to help reduce infection go here.

HPC In Focus

Monday 06 February 2006

The Health Professions Council latest newsletter is now available.

Amongst other things this latest issue discusses 'Advertising yourself as a Health Professional' and what you can and cannot call yourself.

Go Here

Antacids Cause Deadly Stomach Bug

Tuesday 31 January 2006

There's a new stomach bug that is proving fatal among our elderly — and it could be caused by over-the-counter antacids.

The campaigning health journal, “What Doctors Don't Tell You”, has reported that indigestion pills freely available in drug stores could be a cause of the stomach bug Clostridium difficile.

Cases of C difficile infection have already been reported in regions of the USA, and in the Canadian province of Quebec.

The bug seems to mainly affect people aged older than 65, and it can cause diarrhoea, serious illness, and it can even be fatal in extreme cases. The micro-organism is resistant to heat, alcohol and stomach acids.

The bug is also running rampant through hospitals, especially in the UK. More than 44,000 people were infected in UK hospitals last year, and its spread has been blamed on poor hygiene standards, and inappropriate therapies to treat it.

The situation could be even worse than reported. Researchers fear that hospitals are seriously under-reporting incidents of the bug because they are trying to restore public confidence following the outbreak of another killer bug, MRSA, in Britain's hospitals.

Despite an improvement in hygiene at hospitals, the MRSA bug still kills around 900 patients in British hospitals every year.

Doctors are also at a loss as to how to treat the new C difficile bug. Researchers say that antibiotics are being given inappropriately, and they are not proving to be effective against the new bug.

“It seems extraordinary that a major side effect to one of the most popular drug groups has only now come to light”, said What Doctors Don't Tell You spokesman Bryan Hubbard.

“This of course suggests that antacids have always allowed the bug to flourish, but the usual effects of diarrhoea have just been put down to general stomach problems the patient had already”, Hubbard said. Because of this, it may be impossible to prove a definitive link between the drug and the bug.

The possibility of a link was mooted by researchers, who published their findings before Christmas in the prestigious medical journal, “Journal of the American Medical Association (JAMA)”.

Source: WDDTY LTD

New diagnoses of HIV remain high

Thursday 26 January 2006

The rate of new diagnoses of HIV in the UK continued to rise in 2005, early figures suggest.

The Health Protection Agency (HPA) has recorded 5,560 new diagnoses for 2005 so far, but expects the figure evenutally to exceed 7,750.

The HPA said the rise was mainly due to an increase in new diagnoses among men who have sex with men.

However, overall there were more new diagnoses among people who had heterosexual sex.

To the same point in 2004, the HPA recorded 5,016 new cases of HIV. The current figure for the year is 7,328.

Currently, 1,712 new diagnoses have been recorded among men who have sex with men, although the figure could rise to around 2,453. The current figure for 2004 is 2,214.

So far, men who have sex with men account for 31% of the HIV diagnoses recorded for 2005.

To the same point in 2004, they accounted for 28% of the total.

2005 NEW DIAGNOSES SO FAR

Sex between men and women - 2,878 (52%)
Sex between men - 1,712 (31%)
Injecting drug use - 112 (2%)
Other routes - 79 (1%)
Route of infection yet to be determined - 14%

Dr Valerie Delpech, of the HPA HIV department said: “Sex between men remains the group in the UK at highest risk of acquiring HIV with evidence that transmission is continuing at a substantial rate.”

“The rise in the number of new diagnoses reported is likely to be due to more HIV testing among men who have sex with men and ongoing transmission of HIV.”

In comparison, the total number of new HIV diagnoses among heterosexual men and women is expected to remain high but relatively stable - with most cases being acquired outside the UK.

It is predicted that new HIV diagnoses for heterosexual men and women will reach 4,392 diagnoses for 2005, compared to 4,347 diagnoses currently reported for 2004.

However, diagnoses of injected drug users (IDUs) are expected to increase to an estimated 182 diagnoses compared to 131 diagnoses currently reported for 2004.

Priority needed

Public Health Minister Caroline Flint said: “We are continuing our efforts to encourage more HIV testing by offering tests to all first-time attenders of GUM clinics, testing all pregnant women and piloting HIV testing in community-based settings.”

“The rise in sexually transmitted infections, including HIV, is a serious problem that we are determined to tackle.”

“That is why we have committed over £300 million to modernise sexual health services as well as making sexual health one of the seven key national priorities for the NHS next year.”

Nick Partridge, chief executive of the HIV charity Terrence Higgins Trust, said: “We are delighted that the government has named sexual health as one of its seven key health priorities.”

“Now we are urging Primary Care Trusts to follow its lead, giving frontline sexual health services the attention, funding and resources they so desperately need.”

Professor Pete Borriello, director of the HPA's Centre for Infections said: “The earlier people are diagnosed the more effectively their health can be monitored and antiretroviral treatment can be started.”

“It is vital that anyone who thinks they have put themselves at risk of contracting HIV should contact their GP or a sexual health clinic at the earliest opportunity.”

Overall, there are over 58,000 people living with HIV in the UK, and an estimated 19,700 who remain unaware of their infection, and therefore undiagnosed.

In total, 76,850 people have been diagnosed with HIV in the UK since 1982.

To date, 21,898 people have been diagnosed with AIDS, of whom 13,346 (61%) have died.

Source: BBC News

Awareness Under Anaesthesia-Findings From Research By University Of Leicester Professor

Tuesday 24 January 2006

It is the stuff of nightmares - you are under anaesthetic during an operation but you are fully conscious. Aware of every incision -yet unable to communicate that fact.

Now a leading Professor of Clinical Psychology at the University of Leicester is to reveal his views and findings on awareness in anaesthesia during his inaugural lecture on Tuesday 24 January.

Professor Michael Wang, of the School of Psychology at the University of Leicester, will give the lecture, Dissecting Consciousness on the Operating Theatre Table, at 5.30pm in Lecture Theatre 1, Ken Edwards Building.

He said: “My research has important implications for understanding the human psyche from a clinical point of view, by casting light on how some types of psychological disturbance may be caused, not just in the operating theatre, but in other circumstances as well.”

“Psychologists have made, and continue to make, significant contributions to the study and practice of anaesthesia. Moreover the induction of general anaesthesia provides opportunity to investigate the nature of consciousness using experimental methods and systematic observation in the operating theatre.”

Professor Wang said episodes of full awareness with explicit recall during operations with general anaesthesia are more common than many realise.

He added: “The common reason for failure to identify intra-operative awareness is the paralyzing effects of muscle relaxants. Contrary to traditional belief there are no reliable clinical signs to enable the identification of wakefulness.”

Studies conducted by Prof Wang and Dr Ian Russell (Hull Royal Infirmary) have made use of the isolated forearm technique to determine levels of consciousness during general anaesthesia, which allows communication despite the muscle paralysis.

The isolated forearm technique simply involves applying a tourniquet to the forearm just before the paralysing drug is administered. This allows the patients to move his/her hand when asked to if he/she is sufficiently conscious to do so. The technique has been pioneered by Dr Russell and Prof Wang.

“Often patients will demonstrate high levels of consciousness during an operation but without conscious recall afterwards. This is because many anaesthetic drugs interfere with memory. I and colleagues have also investigated benzodiazepine sedation as another clinical circumstance in which there may be dissociation between unconscious and conscious recall. There is an intriguing literature in which patients have developed psychological disturbance following operations with general anaesthesia in which the patient has no conscious recall, but the nature of the disturbance is indicative of inadequate anaesthesia. Experimental studies that attempt to investigate the mechanisms by which this may occur are reviewed.”

Biography

Prof Wang was born in Sheffield, Yorkshire. After attending Rowlinson School he went to Manchester University for both undergraduate and postgraduate clinical training in the late 1970s. He then spent eight years working as an NHS Clinical Psychologist at Withington Hospital initially treating patients with substance misuse followed by work with general and acute psychiatric patients. During this time he completed a part-time PhD which investigated the aetiology of phobias in alcohol-dependent patients. In 1988 he was appointed Clinical Co-Director and Honorary NHS Consultant on the integrated Clinical Psychology Course at the University of Hull. In 1997 he became Head of Department, and then in 2000 was made Honorary Clinical Professor in the Postgraduate Medical Institute, University of Hull. He was awarded the Fellowship of the British Psychological Society in 1999 in recognition of his research into psychological aspects of anaesthesia and his contributions to clinical psychology training.

Prof Wang has a commitment to his profession as well as to training, and in 2001 began a three-year stint in the Chair role of the Division of Clinical Psychology of the British Psychological Society. He is a registered clinical psychologist, neuropsychologist, health psychologist and cognitive-behavioural psychotherapist.

Prof Wang was appointed Professor of Clinical Psychology, Head of Clinical Section and Course Director at the University in May 2005.

Research Topic

Prof Wang has a longstanding research interest in psychological aspects of anaesthesia and in particular, the problem of anaesthetic awareness, which he is pursuing in Leicester alongside colleagues in the Academic Department of Anaesthesia, in addition to his work as Director of the Postgraduate Clinical Psychology Training Course.

University of Leicester
www.le.ac.uk
University Road
Leicester
UK

Source: www.medicalnewstoday.com

Boy badly burned on legs after having his tonsils out

Tuesday 24 January 2006

A SIMPLE tonsillectomy on a nine-year-old boy at Grey Hospital in King William's Town last week turned into a nightmare ordeal after the young patient emerged from theatre with horrific burns behind his knees.

The burns are so bad that a top East London plastic surgeon said it could be up to a year before the boy's injuries were fully healed.

He would need repeated surgery and other medical care totalling over R25000.

Plastic surgeon Brian Ritchie, who examined Shanolyn Govender at the weekend, said the burns had come from a diathermy machine, which is used to cauterise or close off blood vessels during operations.

“How this happened is a mystery to all of us,” he said.

“I've come across diathermy burns maybe once or twice in 28 years of surgery.”

He said theatre staff were supposed to check that equipment was working properly and that all safety precautions were in place.

The provincial Health Department is to launch a full investigation into the incident.

“If there was any wrongdoing we will not run away from our responsibility,” said MEC Bevan Goqwana.

Spokesman Sizwe Kupelo concurred.

“No stone will be left unturned in the investigation. And if it shows we were at fault, the patient will be assisted with whatever he needs.”

The nightmare began when little Shanolyn came out of surgery last Tuesday and his sister, 11-year-old Pavisha, noticed the wounds.

“We couldn't believe our eyes,” said his mother, Vino Govender.

“My poor little boy - he was so excited about starting Grade 4 and signing up for all kinds of new sports. Now he's got to miss out on all of that.”

Ritchie said there would definitely be no sport for Shanolyn this term.

The first of his operations is scheduled for Wednesday.

“First we have to cut away all the dead tissue. Only then will we know how deep the damage is.”

About a week later Shanolyn will return to the operating theatre to have skin from his thighs grafted over the wounds.

He will then need four to six months of physiotherapy and healing before Ritchie removes the grafts and tries to join the outer edges of the wounds so that Shanolyn ends up with linear scars instead of round ones.

“We may have to do this third stage in several phases,* he said. "It depends on how he heals.”

He said he was deeply concerned about the family, who were not on a medical aid scheme.

“Because of that, they have to pay the hospital R5000 to R6000 in cash up front, every time he is admitted. That's not counting the anaesthetists, surgeons and other medical care he'll need.”

Ritchie said the burns could have happened in any of several ways.

“The machine itself is separate from the operating table, but an earthing pad is connected to a large surface area of the patient's body, such as the thigh or stomach.”

“The surgeon activates the current with a foot pedal, and it travels to the forceps in his or her hand via the earthing pad.”

“If the earthing pad is faulty or not connected properly, the current will look for another exit point - and if the patient's skin is damp and in contact with the metal of the operating table it will choose that.”

He said another possibility was that the machine itself was malfunctioning.

“It could have been pushing out a stronger current than necessary.”

Grey Hospital was not available for comment.

Source: Dispatch Online SA. By ALISON STENT

Cash crisis 'to hit patient care'

Thursday 19 January 2006

Three-quarters of NHS bosses say patient care will suffer because of the current cash crisis, a survey suggests.

Two-thirds of acute trusts had had to close wards, the survey of 117 acute, primary care and mental health trusts in the Health Service Journal said.

The government predicts a £620m deficit in the NHS for the 2005-6 financial year, and the Royal College of Nursing says 400 nursing posts could be lost.

The Department of Health says there is more money in the NHS than ever before.

The Royal College of Nursing (RCN) says the NHS financial deficit could go as high as £1 billion.

Earlier this week Treasury officials warned the Health Secretary to prepare for a spending squeeze.

Treasury papers suggest the NHS is likely to see real term growth of less than 4% after 2007-8 - this compares with the 7% increase it has enjoyed since 1999.

Despite the huge year-on-year increases in funding, health trust managers told the Health Service Journal they were resorting to desperate measures to save money in this financial year.

Many laid the blame for the cash flow problems firmly at the door of the government.

Operations cancelled

Seven out of 10 said the NHS would not be facing such problems if it were not for “inflexible government targets”.

And 99% said NHS reforms and changes to consultants' and GPs' contracts had had a big impact as they had not been costed effectively.

One in four of all trusts said they had made staff redundant, while 75% had brought in recruitment freezes.

The Department of Health said improving financial management did not mean compromising patient care and that clinical needs were always paramount.

A spokesman said spending had only outstripped resources in a quarter of trusts and that 'turnaround teams' were helping them balance the books.

“There is more money than ever before in the NHS, and within two years, we will have brought NHS finances back into balance,” he said.

“All the changes that are being made in the NHS are designed to achieve even better NHS services for patients.”

The RCN, which has been tracking the level of NHS trust deficits and their impact on staff during 2005, said evidence from this year showed operations were being cancelled, beds closed and redundancies planned.

The chairwoman of the RCN Public Policy Committee, Barbara Tassa, said it was not acceptable that patients were suffering and nursing posts being lost because of the deficits.

She urged the government to step in now to address the problem.

“In October 2005 the RCN predicted that NHS deficits would hit £1 billion with up to three-thousand NHS posts lost.”

“These predictions were dismissed by the government, yet we are now seeing a situation that is deteriorating. We have real concerns about the stability of NHS finances, especially in view of the roll-out of reforms such as Patient Choice and Payment by Results.”

But the Department of Health dismissed the RCN figures as “back-of-an envelope” calculations.

Dr Gill Morgan, chief executive of the NHS Confederation which represents more than 90 per cent of NHS organisations, said the HSJ survey gave a crude picture of the overall situation.

'In denial'

“We must get this in proportion. The overall deficit is less than one per cent of the overall NHS budget.”

“Over one million patients are treated in the NHS every single day and patients are now being seen and treated quicker than ever.”

Shadow health secretary Andrew Lansley said Patricia Hewitt was in denial over the consequences of NHS financial deficits.

“It is time for her to take responsibility for the consequence of the government's polices.”, he insisted.

INDEPENDENT PRESCRIBING COMING TO WALES

Thursday 19 January 2006

Health Minister Dr Brian Gibbons today supported the introduction of independent prescribing for pharmacists and nurses in Wales. During a visit to Boots the Chemists in Cardiff Dr Gibbons spoke of the important role pharmacists can play in improving the health of their local population.

Dr Gibbons said: “Independent prescribing will mean that suitably qualified nurses and pharmacists will not only be able to offer advice on health promotion and management of chronic conditions but also be able to prescribe independently for their patients in hospital and community settings.”

“This will provide new ways for patients to access the right person, at the right time to provide the most appropriate service. This is exactly the way forward outlined in the 10-year strategy Designed for Life.”

“This is an important change to the way we deliver healthcare services and will build on the foundations already in place where nurse and pharmacist supplementary prescribers are already running for example diabetes and coronary heart disease clinics.”

“A project board will now be set up to take this forward. They will advise and support the implementation of this exciting initiative.”

Pradip Patel, Pharmacy Superintendent for Boots The Chemist said: “This announcement is great news for pharmacists in Wales in extending their role which can only bring enormous benefits for patients with pharmacists being able to prescribe their medicines. We look forward to discussions to agree the training programme that will be provided for pharmacists and supporting this initiative.” Peter Haydn Jones, Chief Executive, Community Pharmacy Wales gave his support adding: “CPW welcomes the Welsh Assembly Government's support of the introduction of independent prescribing for nurses and pharmacists in Wales. The introduction of independent prescribing for community pharmacists in Wales will provide increased opportunities to utilise the skills and knowledge of pharmacists and to deliver convenient and accessible patient care within community pharmacy settings in line with the principles of Designed for Life. CPW looks forward to participating in and working with the project board in order to see this key policy delivered across Wales.”

Dr Andrew Dearden from GPC Wales welcomed the announcement. He said: “GPC Wales welcomes the statement of the Minister today on the introduction of nurse and pharmacist prescribing in Wales. Doctors are highly trained professionals who should be able to spend more time with those ill patients who need their levels of diagnostic, investigative and treatment skills. We can, of course, never replace doctors with other health professions but, each has their role and areas of expertise. Just as a GP could never fulfil the role of a Health Visitor for example, a nurse or a pharmacist can never replace the GP as the patients doctor and first point of medical contact for most people. We can however see many roles that can be fulfilled by nurses and pharmacists that are able to independently prescribe. Many minor self-limiting illnesses or ailments that do not really need to see a GP could be seen and treated quite appropriately by this new extended role. With the introduction of cheaper, and finally free prescriptions, the request for those medications that would otherwise have needed a visit to the GP to obtain the prescription, could be obtained from for example, the pharmacist, and release a needed GP appointment for someone who truly needed it. "We of course will wait to see the training criteria for those who wish to take up this new skill. We would expect those who do so to have a level of training equal to the responsibility that they would be taking on. To do anything less would be to put the health of the people of Wales at risk.”

Tina Donnelly, Director of the Royal College of Nurses, Wales added: “Dr Brian Gibbons has announced an important development in healthcare and nursing practice in Wales. Nurses are key to the new ways of working that are likely to develop under Designed for Life and have always had an important role to play in improving patient care and pushing back the boundaries of clinical practice. We very much look forward to working with the project board on this important initiative.”

Doctors Angry at Pay Interference

Thursday 19 January 2006

Doctors have accused the government of meddling with the independence of the review body that decides their pay.

The British Medical Association is angry that Health Secretary Patricia Hewitt and Chancellor Gordon Brown both wrote to the Pay Review Body.

Mrs Hewitt recommended a pay rise of no more than 1%, while the chancellor said pay increases should be based on the government's 2% inflation target.

The Department of Health dismissed accusations of interference.

But the BMA said ministers' intervention was unacceptable and incompatible with the review body system.

The Department of Health had already submitted its formal evidence to the Doctors' and Dentists' Pay Review Body (DDRB) in October 2005. This recommended rises of no greater than 2.5%.

Formal complaint

Mr James Johnson, the BMA chairman, has complained to Michael Blair QC, the DDRB chairman.

Mr Johnson said government interference “seeks to undermine the established process by which evidence is considered, and will provoke anger and further disenchantment among [BMA] members.”

The BMA is concerned that the government is trying to blame doctors for current NHS deficits - and to minimise their pay increase as one way to tackle the problem.

It is calling on the DDRB not to be influenced by government pressure and to base its decisions in the usual way on the evidence submitted by doctors and the Department of Health.

Mr Johnson said: “These government recommendations are a kick in the teeth for doctors who have worked tirelessly to improve the quality of patient care and bring waiting times for operations down to record low levels.”

“Doctors are as frustrated as patients by financial instability in the NHS; we're the ones struggling with limited resources to keep services running.”

“Yet for all our hard work, the government is effectively saying that we should be punished for the failure of NHS managers to balance the books.”

Mr Johnson added that as a result of European legislation, many junior doctors were already working more intensely for lower take home pay.

In addition, the government's old argument that juniors were guaranteed a job for life was no longer valid.

Government response

A Department of Health spokeswoman said it was “ridiculous” to describe the move as interference.

“The Treasury and Health Departments routinely give evidence to the DDRB.”

“Following the submission of written evidence to the Pay Review Body, the Review Body invites each party to give oral evidence.”

“The Secretary of State gave oral evidence on 12 December - her letter of 19 December was written at the request of the DDRB.”

“As evidence to the DDRB, the letter was shared with the BMA and the DDRB invited the BMA to comment.”

“Doctors have benefited hugely from our extra investment in NHS pay - earnings for hospital doctors have grown by 6.1% in 2004/05 which is considerably higher than the national whole economy average of around 4.0%.”

New Spinal Repair Unit Opens

Wednesday 11 January 2006

An imminent medical breakthrough in the treatment of paralysis (paraplegia and tetraplegia) is anticipated in Professor Geoffrey Raisman's lecture: Repairing the Spinal Cord: Ripples of an Oncoming Tide. This inaugural lecture will be given at 5.30 pm on Wednesday 11th January at the Wolfson Lecture Theatre, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N. This is also the official opening of the UCL Spinal Repair Unit.

The Lecture has proven to be very popular, and all tickets for it have now been allocated.

Professor Raisman's team recently moved into the new Spinal Repair Unit at the Institute of Neurology, UCL. Their work with adult stem cells harvested from the brain's olfactory system (which gives us our sense of taste and smell) holds out hope for the 40,000 people in the UK who are paralysed by spinal cord injury. In laboratory work the cells have repaired damage in the brain and spinal cord restoring some degree of function.

These specialised stem cells will be used in pre-clinical safety trials on a number of paralysed volunteers during 2006. At the moment plans are to operate on partially paralysed people. This will be a group who have lost movement and sensation in one arm and shoulder because the peripheral nerves have been torn from their roots in the spinal cord (usually through motorbike accidents). If there is success with re-implanting the nerves along with these cells so that the patients have some restoration of sensation, the operation will have given some idea of effectiveness as well as safety.

The work at the Spinal Repair Unit is entirely supported by charitable donations and Spinal Research is one of the leading funders. Professor Raisman has held grants from Spinal Research since 1986 and the charity is delighted that its long-term support has helped him progress to the present position on the verge of clinical trials for spinal cord repair therapies that will revolutionise the lives of those paralysed now and in the future.

Professor Roger Lemon, Director of the Institute of Neurology and Chairman of the Spinal Research Scientific Committee said “This is an important day for Spinal Research, and represents the culmination of many years of basic research that has now led to the beginnings of a clinical treatment for spinal injury. It is also a tribute to the hard work of the many spinal injured patients and their supporters who have raised the funds that supported this research and the new UCL Unit at the Institute of Neurology.”

Army's assault on NHS waiting lists

Monday 09 January 2006

Surgical unit to carry out Ulster operations
HUNDREDS of 'guaranteed' operations are to be carried out this year at a newly-renovated Army surgical unit which is due to open next week to help tackle Ulster's extensive NHS waiting lists.

It is hoped that around 500 cases will be taken off the elective surgery waiting list at Belfast City Hospital, with patients being treated at the operating theatre within the Army's Duke of Connaught Unit at Musgrave Park Hospital.

The unit is the only permanently operational military hospital left in existence and its spare capacity is now used by civilians waiting for day case surgery.

There has been constant concern over Northern Ireland's waiting lists. Recent health figures showed that in November 46,944 people were waiting for inpatient treatment and 187,025 were on the outpatient waiting list.

In 2002 waiting lists hit an all-time high with nearly 59,000 people waiting to be admitted to hospitals across the province and, in 2004, an Audit Office report revealed that Northern Ireland had the worst waiting lists in the UK.

In partnership with the Eastern Health Board and Belfast City Hospital Trust the Army has offered theatre time, theatre staff and ward beds to the Board and Trust to help reduce waiting lists in a number of disciplines including general surgery, vascular, renal, dental and fractures.

Commanding officer Colonel David Bates said patients who were booked for a surgical procedure could be admitted knowing that their operation would not be cancelled.

He said: “As we are not an acute unit patients can be admitted safe in the knowledge that their priority for a bed is not going to be gazumped through a trauma patient having a greater need. The only time a procedure would be cancelled is if the surgeon is ill.”

“At the moment we are the only 21st century compliant operating theatre in Northern Ireland. When we were working at peak last year waiting times fell to below six months. It shows what can be done with that bit of extra capability.”

The new operating theatre will open to civilian patients on January 11 to provide elective surgery on a day case or short stay basis under an agreement with Belfast City Hospital Trust and will compliment the assistance previously to Musgrave Park Hospital's orthopaedic cases.

Source: The Belfast Telegraph. By Deborah McAleese

Australia: Hospital staff at risk of electrocution, WorkCover says

Thursday 05 January 2006

A WorkCover investigation has found that conditions are so bad in the operating theatre of Bega Hospital on the New South Wales south coast, that nurses and doctors are at risk of being electrocuted.

WorkCover has issued improvement notices to the Greater Southern Area Health Service identifying nine health and safety concerns within the operating theatre that require immediate action.

Two of the notices point to the risk of staff being injured as they trip over electrical leads lying around the operating theatre floor.

Other notices refer to electrical installations not being repaired, slippery floors and the failure of the theatre's air-conditioning system.

The hospital has been given until January 19 to rectify the problems.

Source: ABC News Online

Are we on the brink of a global catastrophe?
Leading experts reveal the threat of a bird flu pandemic at the Dana Centre in London

Thursday 05 January 2006

The public will have the rare chance to question Dr David Salisbury, Director of Immunisation at the Department of Health and Dr Maria Zambon, Head of the National Influenza Laboratory, at a free public debate on the threat of a bird flu outbreak.

As the British government carefully stockpiles over 14 million doses of avian flu antiviral drugs, the Dana Centre — the Science Museum's bar and café for adults to discuss contemporary science — will find out the real risk posed to the UK in debate on Tuesday 17 January.

Visitors will also be able to look at the similarities and differences between today's situation and the famous flu outbreak of 1918 with medical historian, Robert Brown from the Wellcome Trust

H5N1, is a form of avian flu, or, as it has been labelled, 'bird flu'. Although, on a global scale there have been a relatively small number of deaths from bird flu — 100 worldwide — some scientists argue we may be teetering on the brink of a global catastrophe.

Many countries are already banning the importation of live poultry, ordering in large quantities of antiviral drugs and culling flocks of birds. Some are ordering facemasks for their population and they are even on sale through the Sunday papers.

But just how dangerous and likely is a human epidemic? What are the consequences for the UK if bird flu turns into a human-to-human transmissible disease? And is the UK prepared for it?

Global Pandemics: Should we panic?

Date: Tuesday 17 January
Time: 19.00-20.30
Venue: The Science Museum's Dana Centre, 165 Queens Gate, London, SW7 5HE
Tube: Gloucester Road
Also webcast live: www.danacentre.org.uk
Events are open to anyone over the age of 18. Tickets are FREE but must be pre-booked on: 020 7942 4040 or tickets@danacentre.org.uk

The Dana Centre has brought together a panel of eminent experts who will be probed by the Dana Centre audience.

Panellists include:

Dr David Salisbury, Principal Medical Officer, Director of Immunisation, Monitoring and Surveillance, Department of Health will be talking about how prepared the UK is for a possible bird flu outbreak and the national immunisation programme which he manages.
Dr Maria Zambon, Head of the Health Protection Agency's Influenza Laboratory will argue that the risk of a pandemic is low. She will also discuss the international cooperation to develop a vaccine.
Robert Brown, Research Associate, Wellcome Centre for the History of Medicine, London, will be talking about the historical pandemic of 1918 and the lessons we can learn about it for future pandemics. He will highlight the potential similarities between 1918 and a pandemic situation today, as well as stress the significant differences such as the availability of vaccines and anti-viral drugs to mitigate an influenza outbreak in 2006.

Gaetan Lee, Programme Developer at the Dana Centre said, “The Dana Centre aims to give people the chance to have their say about science and issues that matter to them. We really wanted to address the topic of bird flu, as there does seem to be such confusion around it. We hope this event will allow the audience the chance to lead the discussion and ask the questions that matter to them.”

Government to Introduce Aneurysm Screening

Thursday 05 January 2006

The Government is planning to introduce a national screening programme for abdominal aortic aneurysm, Pulse has learned.

The National Screening Committee has agreed routine screening should be introduced for patients over the age of 65 - but only for men.

Doctors have welcomed the move, but questioned the committee's decision not to screen women.

The committee's decision follows a number of recent studies finding ultrasound screening for abdominal aortic aneurysms could be effective. Surgery will be recommended for aneurysms over 5 cm in diameter.

The committee has justified its decision to screen only men by their much higher death rate from the disease. Abdominal aortic aneurysms account for 1.36 per cent of deaths in men and 0.45 per cent in women among over 65s, according to British Heart Foundation figures for England and Wales.

Dr Surendra Kumar, a GP in Widnes and member of the National Screening Committee, told Pulse: 'It is going to happen in men over the age of 65 and be based on the size of the aneurysm.'

Sir Muir Gray, director of the National Screening Programmes, confirmed the committee's decision. He said: 'We are recommending screening for aortic aneurysm, but there is an issue over lack of treatment services. It looks good but there's a lot of work needed.'

Dr Terry McCormack, chair of the Primary Care Cardiovascular Society, told Pulse: 'If you can put an evidence-based argument forward, it's a worthwhile thing to do. Although the incidence will be lower in women there will still be a significant number and we have to be very careful about excluding women from the cardiovascular picture.'

Phil Johnson, editor of Pulse, said: 'The committee may well be justified it its decision to screen men only, but it will have to be prepared to communicate its reasons effectively, because there are bound to be concerns. Women are routinely less well treated for cardiovascular disease than men, and it would be a shame if a new and important innovation exacerbated that problem.'

Source: Pulse, the leading newspaper for General Practitioners

PATIENT CHOICE BECOMES A REALITY ACROSS THE NHS

Thursday 05 January 2006

From the New Year, for the first time in the history of the NHS, all eligible patients across England will have the right to exercise choice over where and when they get hospital treatment.

In one of the most fundamental reforms of NHS services, patients have the right to be offered the choice of at least four hospitals or clinics when they need to see a specialist for further treatment.

This new way of using the NHS means that patients are given the power to choose faster and better treatment - driving up standards across the NHS.

Health Secretary Patricia Hewitt said:
“Choice is now a reality in the NHS. Patients have new rights over their own healthcare. These rights will allow patients to choose services which best meet their individual needs and preferences.”

“Throughout the history of the NHS, good quality healthcare has been available on the NHS but not necessarily immediately, nor in some local areas. We have started to change this.”

“As well as setting challenging targets for the NHS, we have also been introducing more choice into the service to help speed up access to certain operations.”

“We are now building on this to ensure that all patients experience a service that is convenient to them while delivering the highest quality care possible. We want efficient health services delivering personalised care to everyone - patient choice is central to making this happen across the NHS.”

These changes mark a new way of accessing secondary care. When a patient is referred to a specialist for further treatment, they will be provided with the information they need to make a choice about which hospital or clinic appointment is best for them. They can then book the appointment there and then but patients also have the option to take away information about their local hospitals and make their choice later.

Patricia Hewitt said:
“There are a range of ways in which patients will access information and book their appointment - including through the new Choose and Book computer system, over the phone, or using the internet. Either way, when a patient leaves the GP surgery they will have either made their choice or know exactly what the next step will be to do so.”

“NHS staff have been working hard to make sure this new system is up and running. But we need to remember that choice will only work to the full if patients exercise their new rights to choose. It will take some time for everybody to get used to this new system, but I am confident that the benefits will be worth it. We will continue to listen to patients and clinicians and to learn from them as this exciting reform starts to have real impact right across the NHS.”

New booklets have been introduced to help patients make their choice.
The booklets contain comparative information about local hospitals.
Using these, patients will base their choice on a range of indicators including waiting times, MRSA rates, access and cancelled operations.

Choice menus will be made up of at least four hospitals or clinics.
During 2006 choice will be further extended, and by 2008 patients will be able to choose from any hospital or provider which meets NHS standards at NHS costs.

Also published on the 2nd January were the findings of a survey into attitudes towards choice. The survey was carried out by MORI on behalf of the Department of Health. Findings include:

Sixty-eight per cent of people aged 40 and over would choose a non-local NHS hospital within their Strategic Health Authority if it could deliver treatment in half the time of their nearest NHS provider;
Most are happy to go to either an NHS or a private provider so long as assurances are met over minimum standards of care and the provider is within reasonably easy reach of home;
Waiting times and cleanliness are important factors in deciding where to go for treatment.

News Roundup:

Calls to halt England NHS patient database development

Operating Theatre Lighting

NHS patients to get new legal rights

£4 million private hospital in Carlisle empty for two years

Briefing re suspension of paediatric cardiac surgery at the Oxford Radcliffe Hospitals

Cleanliness warning for hospital

News

Archived News Pages:

In The Event Of Death

Nurses, paramedics and care home staff from across the country, and in particular across the East Midlands, are to be offered training from coroners, police officials and undertakers to help deal with one of the most harrowing aspects of their job – dealing with death.

Outbreak of PVL–positive community–associated MRSA

Eight cases of Panton–Valentine Leukocidin (PVL)–positive community–associated MRSA have been identified among individuals in a hospital and their close household contacts in the West Midlands region. Four of these individuals developed an infection, two of whom subsequently died.

Drive to improve patient safety

The government has announced a shake-up of systems to improve patient safety as a study finds current safeguards are failing.

Most incidents 'missed'

Awareness of, and testing for, Hepatitis C is increasing

A life–saving technique dubbed a "brain bypass" has been carried out for the first time in the UK.

UK 'brain bypass' op breakthrough

A life–saving technique dubbed a "brain bypass" has been carried out for the first time in the UK.

Cut

More mystery deaths than thought

The rate of sudden unexplained deaths in England is around eight times higher than previously thought, warn experts.

Genetic link

'NHS-wide faults' led to deficits

Mismanagement at all levels of the NHS in England has led to the current multimillion pound deficit, a committee of MPs has found.

Shifting targets

Trusts criticised

More funding

Woman has double hand transplant

A Spaniard has become the first woman in the world to receive a double hand transplant.

Arms matched

HPC In Focus – Issue 8

Issue 8 of HPC In Focus is available to download online (along with previous issues)

Top clinicians argue case for NHS reform

Two of the top clinicians in the country today publish reports on the need to change how emergency care and heart and stroke services are delivered to ensure that patients get the best care in the right place.

Leaked paper reveals Labour fears on NHS

Government must be smarter, health secretary says at private briefing

Consult staff on smoke breaks, DWF tells employers

Employers should bring smoking and non-smoking workers together to agree an acceptable policy on smoking before the ban is introduced on 1 July 2007, says law firm DWF.

£10m burns centre to 'give hope'

A burns research centre which a charity says offers "hope to thousands" is to be set up in both Cardiff and Swansea.

'Prestigious'

'Great news'

National Cot Locator for critically ill babies

A new system to find intensive care cots for sick and premature babies was launched today by Health Minister, Ivan Lewis.

New NICE guidance to reduce the risk of transmission of Creutzfeldt–Jakob disease (CJD) via surgical procedures

The National Institute for Health and Clinical Excellence (NICE) has issued guidance to the NHS on reducing the risk of transmission of Creutzfeldt–Jakob disease (CJD) via surgical procedures.

Inquiry launched after woman dies and four fall ill in operating theatre

Police and managers at Britain's largest hospital have begun an investigation after it emerged that one patient had died and four others had fallen ill during surgery in the same operating theatre.

ROYAL COLLEGE OF SURGEONS' PRESIDENT CALLS FOR JOINT MULTI–PROFESSIONAL TEAM TRAINING ACROSS ALL ROYAL MEDICAL COLLEGES

ROYAL COLLEGE OF SURGEONS' PRESIDENT CALLS FOR JOINT MULTI–PROFESSIONAL TEAM TRAINING ACROSS ALL ROYAL MEDICAL COLLEGES

NHS's new computer system 'useless'

Health workers lack confidence in a new NHS computer system and few believe it will help them do their jobs better, according to a new survey.

Joint RCN and Unison march through Leeds on Saturday 11 November, 2006

Around 2,000 nurses, cleaners, porters, along with other clinical and hospital staff will march through the centre of Leeds on Saturday 11 November, 2006, protesting against the impact of budget deficits on NHS services at the Leeds Teaching Hospitals Trust and other hospitals in the region.

Timetable

NHS Supply Chain Announces Two New Supplier Conferences

NHS Supply Chain, incorporating the former NHS Logistics and some of the scope of NHS Purchasing and Supply Agency, announces that it is hosting two supplier conferences, for current and potential suppliers.

HPC launches fees consultation

The Health Professions Council (HPC) has launched a three month consultation to ask registrants and stakeholders for their views on the level of increase in fees.

Warning over privacy of 50m patient files

Call for boycott of medical database accessible by up to 250,000 NHS staff

HPC cautions Operating Department Practitioner

Maggots drop into hospital: Major clean-up after accident

Maggots have been falling from air vents near operating theatres in Barnet Hospital, it was revealed this week by hospital staff.

Veils Banned to Muslim medicos in Birmingham Hospital

Adding fuel to the already raging controversy in Britain, Birmingham city hospitals have banned Muslim medicos from donning full−face veils.

NHS pay rise plans prompt anger

Doctors' leaders have voiced anger over proposals for pay rises below the rate of inflation for NHS staff.

Balancing the books

Give up or we won't operate, smokers told

Smokers will be denied life-changing operations unless they agree to kick the habit, it was revealed today.

Launceston hospital set to feel industrial unrest impact

Patients undergoing elective surgery at Launceston General Hospital may be affected by industrial action today.

Revolutionary Adhesive for Prostheses Saves the NHS Money!

Professor Alan Roberts OBE, has made a major break through for the plastic and reconstructive surgery field by masterminding and developing − Zeflosil, a prosthetic adhesive, which is used to attach devices to the skin.

Man died from massive blood loss after surgery

A coroner has ordered further investigations into how a patient died from massive blood loss after an operation at Bradford Royal Infirmary.

Man needed surgery after sex with hedgehog

Maggots drop into hospital:
Major clean-up after accident

SOMETHING'S OP
Patient facing ear surgery is horrified when nurses start shaving … his chest

30 June 2006
Statement by Patricia Hewitt, Health Secretary

Social Market Foundation
Ann Rossiter's response to outsourcing NHS commissioning