![[Valid RSS]](images/valid-rss.gif "Validate my RSS feed"){kind=small}
NHS staff 'must wash hands more'
Friday 28 December 2007
An audit of NHS staff in Scottish hospitals suggests they wash their hands between 70% and 80% of the time.
Two audits were carried out, in February and September, with specially trained employees monitoring how frequently staff washed their hands.
The first showed an overall compliance rating of 68%. That rose to 79% in the second audit.
Health Secretary Nicola Sturgeon said health boards would be expected to have hygiene levels of 90% by next year.
Hand–washing is recognised as the single most important step that can be taken to reduce transmission of infection.
Compliance rates varied across health boards, with figures in the most recent audit ranging from 59% in NHS Highland to 94% in NHS Forth valley.
The September audit showed medical staff, such as doctors, dentists and consultants, achieved a compliance rate of 62%.
Ms Sturgeon said: "More needs to be done to ensure that hand hygiene standards are as rigorous as possible."
"Patients and the public rightly expect the highest possible standards of cleanliness and hand hygiene in our hospitals to prevent the spread of infections."
The health secretary added: "Monitoring hand hygiene practices in our hospitals is an important development in our fight against infections and will ensure that we know that all health staff are employing the highest possible standards of hand hygiene."
'Getting better'
Health boards are to be given funding for at least the next two years to help highlight the importance of good hand hygiene to health staff, patients and the public.
Claire Kilpatrick, nurse consultant infection control with Health Protection Scotland, said the improvement in compliance rates between the two audits was significant.
She said: "We are just starting to seriously address compliance as a country and overall it is already getting better."
"Many staff are working towards achieving the highest possible standards to reduce the spread of infections through good hand hygiene."
Tory health spokeswoman Mary Scanlon said the figures underlined the "urgent need for more action".
She added: "Many people will be astonished that after so much suffering, so much publicity and so many millions spent, this compliance rate is not higher."
Source: BBC NewsHeart unit suspends transplants
Friday 21 December 2007
Heart transplants in Scotland have been suspended after an increase in patient deaths.
Operations at the Scottish National Heart Transplant Unit at Glasgow Royal Infirmary have been stopped while independent experts carry out a review.
Four of the 11 patients who received transplants this year died within 30 days.
While the review is taking place Scottish patients will be switched to a waiting list in Newcastle–upon–Tyne.
Source: BBC NEWS£3 cap on hospital parking charge
Friday 21 December 2007
Car parking charges at hospitals across Scotland will be capped at £3 per day in the New Year, it has been announced.
Health Secretary Nicola Sturgeon decided on the cap after an independent review by a group of experts.
New guidance will be issued to health boards about the way they allocate staff permits.
The expert panel recommended that charges should only be introduced as a last resort to curb pressure on spaces. The cap will be reviewed later.
Source: BBC NEWSUS 'penis photo' doctor suspended
Friday 21 December 2007
A surgeon at a prestigious US hospital is facing a disciplinary hearing after he allegedly took a photo of a patient's penis during an operation.
Dr Adam Hansen, of Arizona's Mayo Clinic Hospital, is accused of taking the snap while conducting gallbladder surgery earlier in December.
The chief of general surgery allegedly showed the photo to fellow surgeons.
The patient is a strip club owner, Sean Dubowik, whose penis is tattooed with the words "Hot Rod".
A member of the surgical staff tipped off local newspaper The Arizona Republic about the incident in an anonymous call on Monday.
'Great outrage'
On the same day, Mr Dubowik, 37, learned about the photo when the Nobel Prize-winning clinic, based in Scottsdale, telephoned him.
The businessman said: "I got a strange call after my surgery from a doctor who said there was a problem. He said Hansen was on the phone and would explain."
Mr Dubowik said that the surgeon confessed to having used his mobile phone to take the picture while inserting a catheter into his penis.
The patient, who said the tattoo was done for a $1,000 (£500) bet, continued: "Now I feel violated, betrayed and disgusted."
"The longer I sit here the angrier I get."
The clinic said Dr Hansen, who is on administrative leave pending an investigation, could face the sack at a disciplinary hearing next week.
Chief executive of the hospital Denis Cortese said in a statement: "The insult to our reputation, our patients, and our staff is the greatest outrage. We are taking this extremely seriously."
Source: BBC NEWSIcy trips, snowy slips… and venomous centipedes
Monday 17 December 2007
Christmas is coming and the goose is getting fat. And here's The Information Centre with a few festive facts…
As you know, The IC produces a wide range of facts and figures throughout the year as England's independent and authoritative source of health and social care information. Just in time for carols, crackers and mince pies are the latest figures on Hospital Episode Statistics (HES) in England.
Deck the halls…
Just think about those boughs of holly before reaching for the shears – there were 238 admissions to hospital in 2006/7 after contact with plant thorns, spines and sharp leaves, while a further 6,002 were admitted after falling from or on a ladder.
And a word of caution for would–be chestnut roasters – there were 38 admissions to hospital after exposure to controlled fire in a building or structure.
Walking in a winter wonderland…
It may make lovely snowmen, but the white stuff has its dangers – there were a total of 1,328 admissions to hospital in 2006/7 after falling on ice or snow. And 4,235 were admitted after a fall involving ice skates, skis, rollerblades or skateboards.
Happy holidays…
Those escaping the cold weather may not avoid an unfortunate accident. In 2006/7, 53 were admitted after contact with venomous snakes and lizards and 22 after contact with venomous marine animals and plants.
And finally, a toast…
How are you holding that glass of mulled wine? A total of 1,638 people were admitted in 2006/7 for contact with hot drinks.
Other facts from the 2006/7 data for England showed there were:
- Six admissions for contact with scorpions
- 49 admissions for victims of lightning
- 4239 admissions from contact with a non–powered hand tool
Health Professions Council meeting summary
Thursday 13 December 2007
Monday 17 December 2007
Here follows a summary of the decisions made at the Council meeting held on Thursday 13 December.
Full minutes of the meeting will be published as part of the papers for the next Council meeting.
Counsellors and psychotherapists
The Council considered a recommendation from the Executive that a Professional Liaison Group should be established to consider the regulation of counsellors and psychotherapists. The Council agreed to work proactively to investigate and make recommendations to the Secretary of State for Health on the statutory regulation of counsellors and psychotherapists.
The Council agreed to establish a counsellors and psychotherapists Professional Liaison Group (a working party) in July 2008 to consider the structure of the register, professional titles, the standards of proficiency, standards of education and training, post registration standards and grandparenting arrangements. The Group's membership will include representatives of the profession.
Equality and diversity scheme
The Council approved its equality and diversity scheme.
Post-registration qualifications
The Council agreed further work on the annotation of the register to show post–registration qualifications.
Student fitness to practise
The Council agreed its response to the Department of Health on whether students should be registered. It was the Council's view that the need for student registration had not yet been demonstrated.
Fee changes
The Council agreed proposed increases to fees, to take effect in 2009. The proposed increases would be at, or below, the rate of inflation and would be subject to a consultation process.
Five year plan
The Council considered and agreed the assumptions and forecasts for its five year financial plan.
Council elections 2008
The Council appointed the returning officer for the 2008 Council elections and agreed that candidates' statements of expenditure should be published on the HPC website. The elections will be held if the Section 60 Order which will bring about the restructured Council is not enacted by July 2008.
The next meeting of the Council is on 27 March 2008.
The agenda and papers are available on the HPC website.Surgeons used 'dirty' instruments
Thursday 6 December 2007
Eight patients at hospitals in Surrey and south London have been operated on with potentially contaminated instruments, it has been revealed.
Washing and disinfection of the instruments was carried out, but the subsequent sterilisation process was not completed in its entirety.
They were then used in treatments at Epsom, St Helier and Sutton hospitals.
The NHS trust said affected patients had been spoken to, and the risk of cross-infection was "extremely low".
The sterilisation and disinfection unit is currently out of action and more than 100 routine operations have been cancelled in recent days as a result.
Epsom and St Helier University Hospitals NHS Trust said apparently faulty seals on some instrument packs were reported on 13 November.
Eight were found to have not been through the final part of the sterilisation process, which uses high–pressure steam.
Another six instrument packs were being checked.
A trust spokesman said: "The Health Protection Agency has confirmed the process was enough to destroy any blood–borne viruses like HIV and hepatitis, as well as infections like MRSA."
"However something like tetanus might not have been destroyed."
But medical director Dr Lindy Steven added: "Expert medical advice has confirmed that the risk to patients of any form of cross-infection is extremely low".
"We would like to extend our sincere apologies to those affected, and to those whose operations are being delayed."
The work of the sterilisation and disinfection unit was suspended on 29 November, but there were no faulty instrument batches from that date back to the beginning of the investigation.
A trust statement said checks would "make sure the remaining [six] packs will not be used", adding it was "highly unlikely that any other patients have been affected".
The eight patients operated on were offered appropriate blood tests and follow–up treatment.
Source: BBC NewsGovernment launches new Flu Pandemic plan
Sunday 25 November 2007
Health Secretary, Alan Johnson, published a new plan on Friday to increase preparedness and better protect the public against a possible flu pandemic.
A new clinical countermeasures strategy has been developed to offer increased protection against the effects of a flu pandemic if a 'worst case scenario' happened. Commenting on the plans, the WHO has again stated that the UK is in the vanguard of countries worldwide in preparing for a pandemic.
The Department has already signed agreements with two pharmaceutical companies to supply enough pandemic specific vaccine for the entire population once the pandemic strain has been identified.
The new countermeasures include plans to:
- Double the stock of antivirals to cover at least 50 per cent of the population
- Buy 14.7 million courses of antibiotics to cover at risk groups
- Purchase 350million surgical masks and 34m respirators for NHS and social care staff on the frontline.
The Government also has an existing stockpile of 3.3 million doses of H5N1 pre–pandemic vaccine for healthcare workers and will be considering all the latest scientific evidence in relation to future decisions on pre–pandemic vaccines.
Alan Johnson said:
"The threat of an influenza pandemic remains real. Whilst it is not possible to predict its timing or severity, the top priority for the Government is to do all we possibly can to protect the public. Our arrangements are kept constantly under review, ensuring we keep abreast of emerging expert evidence and advice."
"Our new plans provide the first national blueprint for the UK's response to a pandemic flu. We are strengthening our countermeasures to ensure we have the necessary vaccines, antibiotics and antivirals to protect the population if the worst were to happen."
"We know a pandemic would have significant social and economic impact as well as a serious effect on the health of the population. A thorough and integrated response is therefore critical to lessening its overall effect."
"We have spent several years developing and testing plans with front line service providers and listening to expert national and international advice on how best to prepare the country and will continue to do that as new evidence or medical advances emerge."
Alongside the countermeasures a new National Flu Pandemic Framework, which coordinates the responses of all government departments, regional assemblies and all public and private bodies, will set out how the UK will respond if a flu pandemic occurs.
The Framework will help public and private organisations to be as prepared as possible for a pandemic and make sure their arrangements are resilient enough to cope
Although previous pandemics during the last century have resulted in infection rates at or around 25 per cent, the new plans consider a possible 'reasonable worst case' scenario to ensure a robust response. This means considering an infection rate between 25 per cent and 50 per cent of the population.
Chief Medical Officer Sir Liam Donaldson said:
"We may not be able to prevent a pandemic, but with good planning we can reduce its impact on all aspects of society. This framework will enable organisations such as schools, businesses, transport, and the NHS to prepare for a pandemic in an integrated manner, with the full support of cross-government policy and planning."
"But many changes can be made now. Developing habits for respiratory hygiene – using tissues, disposing of them carefully, and cleaning hands – are all good practice even before a pandemic arrives."
"It is recognised internationally that the UK has already made significant progress in protecting the UK and we will continue to work closely with the World Health Organisation."
Dr David Heymann, the Assistant Director–General for Health Security and Environment at WHO said this week:
"The UK is still in the vanguard of countries worldwide in preparing for a pandemic, and is also one of the leading global players in addressing the cross-sectoral issues in their planning."
The Department of Health has also announced £2M to support the Global Pandemic Influenza Action Plan, to increase vaccine supply to help develop capacity to secure vaccine supply for the developing world.
The National Flu Pandemic FrameworkNurses' pay row a threat to ops
Friday 23 November 2007
A PAY dispute involving hundreds of nurses has broken out at Cardiff's University Hospital of Wales, sparking fears that operations will have to be called off.
Nurses are furious at the failure to resolve a long–running pay battle which could see top nurses losing more than £7 an hour and lowly–paid nurses £20 worse off per shift.
It will mean a nurse who currently earns a basic salary of around £20,000 losing out on several thousand pounds a year.
Patients are set to be caught up in the dispute with fears that operations will be called off as nursing staff have vowed from this Sunday to only work their set hours and to withdraw their traditional goodwill to do the extra shifts – often those covering weekends and nights.
The pay wrangle will have the most serious affect on nurses working in the intensive care units for adults and children and those looking after heart patients, operating theatres nurses and those in the operating theatre recovery areas.
Nurses are fuming that their pay will be cut and the Echo understands that all attempts by managers of the Cardiff and Vale NHS Trust to try to resolve the problem have been overruled by the National Assembly.
The dispute centres on the introduction of a new UK pay scheme for NHS staff which rules out the local agreements for extra shifts or extra hours which have, until now, been paid by the Cardiff and Vale NHS Trust.
One senior intensive care nurse told the Echo: "They need nurses working the extra hours to keep the hospital running. They are now planning to cut our pay for this work. It means they will have to employ private nurses on £60 a hour – if they can find them – to do the work."
Nurse Angela Gorman, a union official with Unison, said: "This dispute has been rumbling on for many months but there has been no resolution. It appears the Trust's hands are tied but it will impact on the hospital's ability to deliver their service to patients especially those coming in for elective surgery."
"Nurses of all grades will be affected, especially those on the lowest salaries who will have their rates cut for the extra hours they put in."
Patient watchdogs today voiced their worries over the dispute.
Martyn Jenkins, chief officer for Cardiff Community Health Council, said: "We are very concerned on the impact this will have on patients and patient care. If this dispute cannot be resolved or goes on for a prolonged period, then there is no doubt that patients will be seriously affected."
Source: South Wales Echo Greg TindleCockroaches 'killed on operating table'
Tuesday 20 November 2007
A FORMER senior doctor at Sydney's Royal North Shore Hospital (RNSH) says complaints that he had to kill cockroaches on operating theatre tables during surgery were ignored by management.
It has also been confirmed that an anaesthetist at the hospital was forced to catch an unconscious patient after an operating table broke in half.
The revelations are contained in a submission by Dr Jeffery Sleye Hughes, who worked at the hospital between 1981–86 and 1995–2007, to a parliamentary inquiry into the running of RNSH.
The inquiry heard the growing list of complaints about the hospital have been having an effect on staff, with reports of nurses being spat on and abused in the street.
Dr Sleye Hughes said he was forced to resign because of an "endless procession of events" that highlighted the "bureaucratic negligence" and "medical indifference" at the hospital.
His submission contains reports on nine incidents, which include instances of patients being lied to about the delay in their surgery and inadequate surgical instruments being used to undertake day–to–day surgery.
He said he had forwarded the complaints to administration, only to have them "ignored or shelved".
"(The incidents included) killing live cockroaches on operating theatre tables during operations and no response when I forwarded a written complaint and response requested," his submission said.
"High–pressure hoses exploding in theatre during use and injuring staff."
"Operating tables breaking in two due to age/fatigue failure off (sic) whilst the patient was anaesthetised. A spinal injury only being avoided due to the anaesthetist's catching the upper portion of the bed before the patient came to harm."
Health Minister Reba Meagher, who was among the first witnesses called for the inquiry's public hearings, said the cockroach incident was "unacceptable".
It is believed to have occurred between 1998 and 2002.
"That is why the new management has responded to concerns of staff at the hospital and ordered a complete clean of the hospital," Ms Meagher said.
Northern Sydney Central Coast Area Health Service chief executive Matthew Daly confirmed the incident with the operating table had taken place, but said maintenance had now resolved the issue.
"I was also aware there was no injury to the patient due to the good work of theatre staff," he told the committee.
The incidents join a list of concerns raised about the hospital in the seven weeks since Jana Horska miscarried in the emergency department toilet of the hospital.
Acting director of nursing at RNSH, Linda Davidson, said staff were receiving a lot of positive feedback from patients about the treatment they are getting.
She told the inquiry these stories were not getting out into the community.
"I have had it reported to me that some nursing staff in the community are actually undergoing similar situations that their colleagues at Camden and Campbelltown experienced, which was abuse in the streets and actual spitting episodes," Ms Davidson told the inquiry.
"So when that comes back within that environment the morale does tend to wane accordingly."
Nurses at Campbelltown and Camden Hospitals said they were verbally and physically abused in the streets when the two hospitals were at the centre of maltreatment allegations in 2004.
Source: news.com.au Nick RalstonAnetic Aid Newsletter
Monday 12 November 2007
Download the October 2007 Anetic Aid Newsletter
Modernising Nursing Careers Consultation Launched
Thursday 1 November 2007
Nurses and health practitioners were today invited by Health Secretary Alan Johnson to share their views on their career development.
Speaking at this year's Chief Nursing Officer's Conference, he launched a formal consultation to look at a new structure for nurses' careers.
The draft proposals reflect changing health needs and the new ways in which healthcare is being delivered by organising nursing careers around a series of 'patient pathways'.
Five broad pathways that reflect patient care categories emerged from listening to stakeholders' and nurses' views earlier this year. They include:
- Children, family and public health
- First contact, access and urgent care
- Supporting long term care
- Acute and critical care
- Mental health and psychosocial care
Health Secretary Alan Johnson said:
"The NHS cannot stand still in the face of profound changes in society and major challenges to health. We must design 21st Century healthcare systems to meet these challenges. This must be matched by a 21st century workforce and by launching this consultation on a new career framework nursing, has taken a major step in that direction."
"For the Health Service to reach its potential, we must ensure that every single member of staff reaches their potential. We are committed to delivering a rewarding and fulfilling career for today's and tomorrow's nurses which is why I'm delighted to launch our consultation on career planning for post-registration nurses."
"Everyone should have clear sight on where their career is heading. By linking these career paths with the patient pathways which are emerging in the Darzi Review we can ensure that professional development is linked with the transformation of the service."
Chief Nursing Officer Christine Beasley said:
"This national consultation is a great opportunity to shape the nursing careers of the future. The proposed new framework draws on the national and regional stakeholder events held over the last year and takes forward recommendations from Modernising Nursing Careers: setting the direction. It is so important that this consultation on post registration training is launched at the same time as the Nursing and Midwifery Council launch their consultation 'A framework for pre-registration nursing education'. We want to gather as many views as possible on the options proposed and to find out if you think the options proposed would work for nurses and equip them to provide the best care for patients and service users."
The consultation will finish on 15 February 2008.
The consultation documents are available on the Chief Nursing Officer's web site
Anaesthesia: Safety improvement through partnership
Friday 19 October 2007
A key programme of work to improve safety in anaesthetic services is announced today by the National Patient Safety Agency at a conference opened by HRH the Princess Royal.
The project will be outlined at Safety in Clinical Practice, a two day conference hosted jointly by the Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists of Great Britain and Ireland where speakers will include NPSA Chief Executive Martin Fletcher.
The Agency has embarked on four collaborative projects with differing Royal Colleges to improve patient safety in the relevant specialities. 'Anaesthesia: Improvement through Partnership' is a two year project led by the Royal College of Anaesthetists.
The project will focus on:
- Developing a speciality based reporting system to improve critical incident reporting by providing a single point of entry for data submission.
- Patient safety incidents arising from errors during the administration of injectable drugs
- The management of throat packs and in particular their retention following surgery.
Martin Fletcher said: "We aim to put patient safety at the top of the healthcare agenda. By working closely with the Royal College of Anaesthetists and other experts in the field we can pool our expertise to focus on the issues that really matter for the benefit of patients."
Charlie McLaughlan, Director of Professional Standards at the Royal College of Anaesthetists, said: –This project will be key to the advancement of safety improvements in anaesthesia in the UK. It will improve collaboration towards a safer anaesthesia environment for patients and the various elements of the project will grow to become key elements of ongoing safety focussed processes well into the future.–
The Royal College of Anaesthetists (RCoA), supported by the Agency, is forming an Anaesthesia Expert Consultative Group that currently includes representation from the Association of Anaesthetists of Great Britain and Ireland (AAGBI), the College of Operating Department Practitioners (CODP) and the Association for Perioperative Practice (AfPP).
The group is working in collaboration to identify patient safety issues within the field of anaesthesia and determine areas of activity where partnership working can improve safety.
For several years the RCoA has been interested in developing a national critical incident reporting system which allows for shared learning in anaesthesia. The NPSA is now working with the RCoA and the Association of Anaesthetists to develop a speciality based system which integrates the information required by anaesthetists with the NPSA's National Reporting and Learning System and allows the RCoA access to data so that clinicians can have a role in analysis and subsequent action.
Two areas of concern have already been identified by the group as issues for further work. The first relates to patient safety incidents arising from errors during the administration of injectable drugs. Next steps of this major piece of work will include the examination of the role of double–checking and technologies such as bar–coding to help reduce such errors. The programme of work will include the formation of pilot sites.
The second more specific issue is the management of throat packs and in particular their retention following surgery. The group will be reviewing a variety of solutions and working to promote awareness to improve safety in this area.
The outcomes of the RCoA 3rd national audit of major complications of spinal and epidural anaesthesia which is nearly complete, and the 4th national audit on airway management, will be incorporated into this partnership project and may suggest possible future areas of work.
UK MUST LEARN FROM OTHER EU MEMBER STATES IN FIGHT AGAINST SUPERBUGS
Friday 19 October 2007
The UK must learn from other EU Member States and support a Europe–wide code of practice if the fight against super bugs is to be won, according to a Liberal Democrat MEP.
The subject has once again attracted attention after a shocking survey released by the Healthcare Commission today found that a quarter of hospital trusts in England are failing to meet new standards on infection control.
Liz Lynne MEP, who is Vice President of the European Parliament's Employment and Social Affairs Committee, yesterday hosted a seminar attended by MEPs and European experts at the European Parliament to discuss how countries who are losing the battle against super bugs, such as the UK, can learn from other Member States. The UK has consistently come towards the bottom of EU super bug tables.
Commenting from Brussels Liz said:
"Today's shocking new report shows the Government is losing the battle against hospital infections and yet there is no need to reinvent the wheel; in many countries such as the Netherlands, Sweden and Denmark, the MRSA infection rate is less than 1%, ten times lower than in the UK and yet unbelievably exchange of best practice is practically non-existent."
"EU legislation is not necessary, but today's figures show that the Government is unable to act and I believe an EU Code of Practice could be a vital tool in sharing experiences to help ensure that patients, visitors and staff alike are better protected."
"Hospitals should be safe, reassuring places; action is needed now if further unnecessary loss of life is to be avoided. People may lose their jobs as a result of these outrages but it will not bring back the loved ones lost through poor hygiene."
Sedated patients can hear speech
Friday 12 October 2007
Research into the brain's response to speech when under sedation has revealed reduced activity in areas critical for memory and understanding language.
Cambridge University scientists used brain imaging to find evidence which may influence the amount of anaesthetic given to patients undergoing surgery.
It may also affect attitudes to patients in a coma or vegetative state.
Researchers said: "The brain processes speech when sedated but it appears not to fully comprehend or remember it."
Using a scanning technique called functional magnetic resonance imaging (fMRI) that registers brain activity, Dr Matt Davis, a cognitive neuroscientist at Cambridge University, and his colleagues mapped speech-related brain activity in volunteers at varying levels of sedation.
'Return of consciousness'
Their aim was to show how the brain's response to speech changed as people became more sedated and whether understanding of speech might continue even while consciousness and memory were impaired.
Professor David Menon, professor of anaesthesia at the University of Cambridge, said the research has important parallels in two clinical situations.
"A small proportion of anaesthetised patients report memories of events that occurred in the operating theatre, implying an inadvertent return of consciousness."
"It is possible that even more patients may have some awareness of events during anaesthesia, but this may fail to be detected because patients have no memories of the event afterwards."
"This implies that these patients, although unable to respond, are not sufficiently anaesthetised. There are good clinical reasons to use only as much anaesthetic as is needed, since this increases patient safety."
"However, this needs to be balanced against the risk of inadvertent return of consciousness during general anaesthesia."
"Our research will help develop techniques to measure how deep anaesthesia needs to be to prevent awareness."
"Secondly, there is an emerging consensus that some severely brain–injured patients in a coma or vegetative state might understand but not be able to respond to speech."
Source: BBC NewsHealthcare watchdog to give voice to NHS staff in world's biggest staff survey
Friday 12 October 2007
Published: 2nd October 2007
The Healthcare Commission is encouraging NHS employees to provide feedback on their experiences at work by participating in what is believed to be the largest survey of staff in the world.
In the fifth annual survey, more than 250,000 NHS staff will be asked their views. Between 600 and 850 staff at each NHS trust will be chosen randomly and data will be collected between October and December.
The Healthcare Commission, the Department of Health and NHS Trusts use the information gathered in the survey to inform local and national changes in working conditions, which will lead to improvements in the quality of care for patients.
Dr Jonathan Boyce, head of surveys at the Healthcare Commission, said: "We want to give a voice to NHS staff. We need to know their views on key issues such as safety, violence towards frontline workers and their experience of work–related stress."
"The annual staff survey is a vital tool in our efforts to improve the NHS for both patients and staff. This year we hope to have a record response rate. Staff attitudes, experiences and working environment naturally affect organisational outcomes – and in the NHS this includes the quality of care patients receive."
"Results from the survey are used by trusts to deliver local improvements in working conditions and practices. I hope that NHS staff will seize this opportunity to shape their own future."
The Commission encourages staff in all sectors and roles in the NHS to take the opportunity to give their views. In 2006, 38,188 nurses, 8,123 doctors, 13,355 allied health professionals (for example clinical psychologists, occupational therapists, physiotherapists), 2,795 managers, 3794 ambulance staff and 5875 ancillary staff took part in the survey.
More information on NHS surveys is also availableNHS to speed up technology use
Friday 12 October 2007
A scheme to speed up the introduction of cutting–edge technology in the NHS has been launched.
The NHS has long been criticised for being slow to adopt new gadgets.
Around 15 life–saving technologies will be introduced over three years, including a blood flow monitor which could save the NHS £500m a year.
The NHS Technology Adoption Hub, based in Manchester, was set up after an advisory group found innovations were not reaching patients.
The Healthcare Industries Task Force, set up to promote better use of medical technology within the NHS, concluded three years ago that better promotion was needed for new ideas.
In 2005, the Health Select Committee warned the NHS was lagging behind many other countries in the take–up of modern equipment and spent less than the European average on medical technology.
One of the devices to be looked at under the new programme – the CardioQ Oesophageal Doppler machine – monitors the amount of blood circulating in patients undergoing major surgery.
It tells doctors if the patient needs additional fluid, helping them to recover much more quickly after the operation.
The Hub is also looking at a machine to diagnose whether men with an enlarged prostate would benefit from surgery.
An ECG machine which can be used by GPs in their practice and the results read remotely by experts, reducing the need for patients to attend hospital clinics, is also being introduced.
Barriers
Each technology will be implemented in three trusts before adoption is encouraged across the whole of the NHS.
Margaret Parton, head of the National Technology Adoption Hub said all the technologies chosen had been proven to be effective but for some reason most people did not have access to them.
"It is vital that new life-saving, cost-effective technologies are adopted as quickly as possible through the NHS."
"The National Technology Adoption Hub will streamline and speed up the process."
She said individual trusts were nervous about taking the "risk" of buying expensive equipment that wouldn't be used.
"One of the biggest issues is that adopting new technology is very disruptive – what we're doing is breaking down those barriers and supporting trusts."
Health minister Lord Ara Darzi, who is also a practising surgeon, said: "It is encouraging to see the NHS continually striving to find the best standards of care, using the latest available techniques, for its patients."
Richard Phillips, a spokesman for the Medical Technology Group, a campaign body, said he hoped the Hub would speed up the process.
"Medical technologies are going through several different appraisal channels, including the National Institute for Health and Clinical Excellence, yet even when approved they are not being widely used in the NHS."
"It simply takes too long for new developments to be taken up for use in the NHS. This Hub has the potential to change that."
He added there were some "serious challenges" in getting already approved technologies implemented more quickly and consistently across the NHS.
Source: BBC NEWSHPC In Focus – Issue 13
Monday 8 October 2007
Issue 13 of 'HPC In Focus' is available to download
THE ROYAL COLLEGE OF ANAESTHETISTS ANNOUNCES 'SAFETY IN CLINICAL PRACTICE' CONFERENCE, 18–19 0CTOBER, 2007, OPENED BY HRH THE PRINCESS ROYAL
Sunday 23 September 2007
The Royal College of Anaesthetists, the professional body representing anaesthesia in the UK – together with the Association of Anaesthetists of Great Britain and Ireland – will present a two day 'Safety in Clinical Practice' conference on 18–19 October, 2007, to be opened by HRH The Princess Royal.
The two day conference will be a major departure from the traditional style of educational meetings, incorporating many practical elements and a wealth of interactive, hands–on content. The event is designed to stimulate discussion on increasing anaesthesia safety. It features a series of short presentations, after which attendees can meet several anaesthetic equipment manufacturers, medical device regulatory bodies and a selection of other groups which have a major interest in anaesthesia safety.
The afternoon sessions involve hands–on workshops that show attendees how new equipment and critical incident simulation can improve the safety of the delivery of anaesthetics.
The conference will also launch 'National Audit Project 4', involving anaesthetists and other healthcare professionals in improving airway management for increased patient safety.
Dr Judith Hulf, president of the Royal College of Anaesthetists and Dr David Whitaker, president of the Association of Anaesthetists of Great Britain and Ireland, have stated their delight that HRH The Princess Royal has kindly agreed to attend this prestigious event. Together, both organisations represent their members for all aspects of anaesthesia practice, and royal patronage of the conference strongly reinforces the drive toward continuing the focus on patient safety as the principal concern for all anaesthetists.
The 'Safety in Clinical Practice' conference will take place at Churchill House, Red Lion Square, London, from 9am to 5pm on Thursday 18 and Friday 19 October. Application forms for attendance at the conference can be obtained on the College website by accessing the Meetings and Events area.
International expert to speak on patient safety in anaesthetic services
Wednesday 19 September 2007
Professor Bill Runciman, President of the Australian Patient Safety Agency, will be the key–note speaker at a joint workshop being held tomorrow by the National Patient Safety Agency (NPSA) and the Royal College of Anaesthetists (RCoA).
The workshop will focus on setting up an enhanced speciality based incident reporting system for patient safety incidents occurring during anaesthesia. This will allow RCoA to directly access relevant data from the NPSA's National Reporting and Learning System (NRLS), allowing more detailed analysis and shared learning.
Drawing on the expertise of a project team that includes anaesthetists, human factors specialists and design experts, issues under discussion will include how and when anaesthetists are likely to report incidents, and learning from critical incident reports.
Lord Naren Patel, Chairman of the NPSA, said: "This collaboration with the Royal College of Anaesthetists to develop a speciality–based reporting system will give us better information on incidents related to anaesthetics, and help us to identify risk areas."
"We're delighted that Professor Runciman will be joining us from Australia to share his experience of setting up a ground–breaking anaesthetic incident monitoring system. By learning from international partners and colleagues, we're working together to deliver the safest care possible for patients."
Professor Runciman will be speaking about his experience of developing and implementing the Anaesthetic Incident Monitoring System (AIMS) in Australia, which pioneered the speciality based model of incident reporting.
He said: "Sharing our knowledge and expertise is the way forward – that's why I'm so pleased to be working with the NPSA and the Royal College of Anaesthetists to improve patient safety in anaesthetic services."
"When I founded the Australian Patient Safety Foundation in 1988, patient safety was a relatively new area. Today, it's incredibly encouraging to see how rapidly progress is being made across the world, with organisations like the National Patient Safety Agency using incident data collaboratively to improve safety and reduce risk."
Mr Charlie McLaughlan, Director of Professional Standards, Royal College of Anaesthetists said: "The College is delighted to be a partner in taking forward this important aspect of sourcing and investigating anaesthesia related critical incidents with the NPSA."
"We have benefited from past collaborative working with colleagues to produce a safer patient environment and this initiative presents an excellent opportunity to work with international experts for further shared learning."
The development of this reporting system will be a key component of a two year project led by the RCoA, with the support of the NPSA, to introduce new ways of working that improve patient safety in anaesthetic services.
The National Patient Safety Agency (NPSA)Health Professions Council launches fourth FTP annual report
Monday 17 September 2007
The Health Professions Council (HPC) has launched its fourth fitness to practise annual report that details all aspects of its FTP function over the financial year 1 April 2006 to 31 March 2007.
The report provides detailed information about the HPC's work in considering allegations about the fitness to practise of its registrants. It also presents the ways in which practice committee panels have handled the cases brought before them, as well as information about the number and type of cases and their outcomes.
This year has seen an increase in the number and complexity of hearings. In HPC's first year of operation (April 2002 to March 2003) the HPC received 70 allegations, this financial year allegations totalled 322 which is an increase of 460%. The increase has been steady across the last five years. This report provides more information on the types of cases that have been considered, including the types of allegations received, cases where the panels have determined that there is a 'case to answer' and cases where a sanction has been imposed. The report also looks into trends in the allegations received, detailing the types of allegations by profession and the location trends of allegations across the UK.
When asked to comment about the increase of cases, Kelly Johnson, Director of Fitness to Practise said "Although there has been an increase in the number of cases considered by panels in 2006–2007, the overall number of registrants who appear before our panels is still less than 1%. We attribute this increase to a better awareness of the HPC's function and powers, particularly amongst the public and employers. The increase does not reflect a drop in the standard of care provided by the professionals registered with us. The vast majority of registrants are still acting in a safe, lawful and effective manner".
The Health Professions Council is an independent, UK–wide health regulator set up by the Health Professions Order (2001). The HPC keeps a register for thirteen different health professions and only registers people who meet the standards it sets for their training, professional skills, behaviour and health. The HPC will take action against people who do not meet these standards or who use a protected title illegally.
Copies of the report can be downloaded or hard copies can be requested by email or by phoning 020 7840 9806.World Health Organization and its partners call for intensified research to improve patient safety
Monday 17 September 2007
Up to 1–in–10 patients across the globe may be subject to a medical error when hospitalised1
Many of these errors could be avoided
Porto, Portugal, 24 – 26 September 2007. Patient Safety Research – Shaping The European Agenda
Adverse events in health care and medical errors harm millions of patients worldwide each year. This risk can be reduced by studying instances of adverse events and using this evidence to improve the delivery of health care. Patient safety research is central in every aspect of patient care and should be encouraged globally, delegates at a conference in Porto, Portugal, will hear.
The World Health Organization (WHO) World Alliance for Patient Safety, University College London (UCL) and the UK's Faculty of Public Health (FPH) are hosting the first ever pan-European conference dedicated to patient safety research.
Patient Safety Research – Shaping The European Agenda will facilitate greater collaboration between 400 academics, policy makers and funding institutions, with the aim of agreeing priorities for patient safety research in developed and developing countries.
The conference is supported by the European Commission Sixth Framework Programme for Research and the Portuguese Ministry of Health during Portugal's Presidency of the European Union.
As well as facilitating research developments, the event will enable policy makers to understand, and utilise, patient safety research. Improving healthcare systems based on this data may reduce patient safety risk and the associated impact on patients, families and healthcare providers.
"Collaboration required to produce quality research that improves patient care"
Mark McCarthy, Professor of Public Health and Honorary Consultant in public health medicine at University College London, says, "Patient safety is a growing and exciting area of research. We want to encourage European and global collaboration to ensure that the right kind of research happens and that evidence is shared. This international conference represents a huge first step in establishing the key priorities for the successful implementation of research programmes in Europe and beyond."
He adds, "Medical and public health practice will only adapt according to the effectiveness of interventions. It is critical that high quality research is conducted to establish why and how medical errors occur and that the evidence is then used in policy development. This is the only sensible way to introduce changes in medical practice that will improve clinical care."
"Innovative research to be translated into life saving actions"
Sir Liam Donaldson, Chief Medical Officer for England, who chairs the WHO World Alliance for Patient Safety, reinforces the importance of patient safety research, "Patient safety research is an invaluable resource for ensuring that health care reduces patient suffering and does not contribute to it. It is vital that research findings are translated into tangible actions that can actually save lives."
"Health improvements through shared learning, not blame"
Professor Alan Maryon Davis, President of the FPH and Director of Public Health, indicates that we all have a role to play in facilitating patient safety research, "Today's blame culture threatens public health because patients blame healthcare systems and doctors blame policy makers, meaning people are reluctant to report medical errors. By working collectively with many healthcare providers, and patients themselves, in a culture of shared learning rather than blame, patient safety researchers can help to identify and address these medical errors. We need to understand what is happening today in order to improve patient safety in the future."
Conference programme
Conference attendees will hear speeches from David Bates, Leader of the Patient Safety Research programme of the World Alliance for Patient Safety and renowned world expert in the field of patient safety, as well as Sir Liam Donaldson, Chair of the WHO World Alliance for Patient Safety and Chief Medical Officer for England.
Plenary sessions will address research approaches to patient safety, explore research networks, and will enable the European patient safety research community to move this important agenda forward.
Workshops will focus on research and policy issues. Research themes will include; the value of national reporting systems, understanding human action in preventing or causing adverse events, the role of the patient, controlling hospital infections, and effective methods to ensure accurate medication. WHO–lead policy workshops will focus on various elements of research commissioning including; building infrastructures and capacity, and developing partnerships.
To view the latest conference programme and identify specific topics of interest, please visit Patient Safety Research
1. Patient Safety, The Public Health Portal of the European Union.Europe's First Professional Training Programme in Integrated Medicine is Launched for Medical Doctors & Nurse Practitioners
Wednesday 12 September 2007
This month sees the official launch of a 2 year professional training programme in integrated medicine for medical doctors and nurse practitioners.
Developed by The British College of Integrated Medicine, and inspired by Dr Andrew Weil's highly successful Integrated Medicine Training Programme based at the University of Arizona in America, this pioneering training programme aims to facilitate the emergence of a new generation of doctors and nurse practitioners who are committed to the practice and philosophy of integrated medicine.
Dr Mark Atkinson, Founder of The British College of Integrated Medicine defines integrated medicine as a proactive, patient–centred, whole–person approach to health, healing and human flourishing. It involves the co–ordinated and integrated provision of individually tailored health and wellbeing programmes which are designed to:
- empower the patient to take an active and informed role in their own healing and recovery
- address and resolve the underlying barriers to optimum health and healing
- provide the knowledge, skills, resources and support so that individuals can take better care of their physical, emotional, psychological and spiritual health.
Rather than limiting treatments and recommendations to a specific specialty, integrated medicine uses the safest and most effective combination of approaches and treatments from allopathic and complementary medicine. These are selected according to a combination of evidence–based practice, and the expertise, experience and insight of the individuals and team members caring for the patient
The practice and provision of integrated medicine is well established in the USA, where there are more than 500 trained integrated medical doctors and numerous specialist integrated medical centres throughout the US. Most medical schools in the USA have integrated medicine incorporated into their curriculum. The focus is now very much on repeating the US in Europe, and the launch of The British College of Integrated Medicine is very much seen within medical circles as a significant step towards achieving that.
The arrival of the college and its training courses, have been hailed as an important step forward for the medical profession.
"I am delighted to be supporting The British College of Integrated Medicine and their post-graduate training courses", said Professor Karol Sikora – Professor of Cancer Medicine, Hammersmith Hospital, London. "The integrated medical approach to health and healing combines evidence–based practices, with the expertise, experience and insight of healthcare practitioners in a way that is designed to provide patients with an individually tailored health and wellbeing programme. It is an empowering and innovative form of medicine that will have a significant and positive influence in British healthcare in the years to come."
The college also offers one of the world's most comprehensive training programmes in mind-body medicine. This 1 year programme has been designed to provide healthcare professionals with a high level of training in an eclectic mix of psychological and emotional skills and techniques for facilitating health, healing and personal growth.
Full details about the college and all courses and workshops can be found by visiting their website.National Patient Safety Agency issues warning on dealing with haemorrhage
Wednesday 12 September 2007
Following the death of a patient, the National Patient Safety Agency is warning that surgery should not be commissioned or delivered in facilities which lack the systems and equipment to manage emergencies safely.
In a recent incident a patient died following routine laparoscopic surgery exacerbated by no blood being available, a lack of critical resuscitation devices such as central venous catheters and an absence of surgical equipment such as abdominal packs and vascular sutures.
Poor communication, lack of back–up surgical assistance in the facility and a lack of basic communication devices made the situation worse. In addition there was no telephone available in the operating theatre.
Dr Kevin Cleary, Medical Director at the National Patient Safety Agency said: "Routine elective surgery including laparoscopic surgery has serious but well recognised risks such as severe haemorrhage. All units need to have robust co-ordinated systems in place and equipment which can respond immediately to these emergencies."
"That's why the Agency is advising that these systems need regular review, testing and updating, and must ensure adequate supply of blood, resuscitation equipment and the necessary surgical equipment in case of the occurrence of a recognised complication such as haemorrhage. These recommendations to the NHS and the independent sector, if implemented, will reduce risk to patients."
The NPSA is advising the NHS and the independent sector that:
- A co-ordinated system for the urgent supply of blood products must be established and maintained.
- Blood must be available quickly for all operations, including the ability to communicate directly and immediately with the transfusion laboratory and for blood products to be transported between the laboratory and the unit without delay.
- All units must have access to emergency equipment that may be required to deal with a haemorrhage, such as the appropriate sutures and packs. This emergency surgical and resuscitation equipment will need to reflect the range of surgery undertaken in the unit and the distance from other healthcare services.
- A formal check should be carried out before every procedure.
- A formal backup system for surgeons and anaesthetists is essential so that consultants have a system for summoning help in emergency situations.
Seeking ex Royal Army Medical Corps
Wednesday 12 September 2007
Come and join OTT Reunited
Seeking ex Royal Army Medical Corps Operating Theatre Technicians (OTT), Operating Department Assistants (ODA) and Operating Department Practitioners (ODP).
Come and join OTT Reunited. Data base (135 members worldwide), Newsletter and Reunion.
Contact Ken Hannah 01733 453462 for detailsSafety fears over explosion in nurse prescribing
Wednesday 22 August 2007
The number of potentially risky medicines prescribed by nurses has increased hugely in the last year since controversial changes to prescribing regulations, Pulse can reveal.
Use of some drugs by nurse prescribers has leapt by over 200% in the year since they were handed access to the entire drug formulary, according to data obtained by Pulse under the Freedom of Information Act.
Among the growing number of drugs prescribed by nurses are many whose use requires high–level clinical skills, such as the antidepressant paroxetine, the diabetes drug rosiglitazone and the heart drug amiodarone.
Overall numbers of prescriptions by independent nurse prescribers have leapt by 49% in the year since the Government amended prescribing regulations in May 2006.
But use of medicines requiring complex clinical judgment, including antibiotics and antidepressants, has increased far more rapidly. Use of ciprofloxacin is up 218%, paroxetine by 262% and rosiglitazone by 245%, according to the latest data, for May this year.
Professor Hugh McGavock, visiting professor of prescribing science at the University of Ulster and a former member of the Committee on Safety of Medicines, said he had 'serious concerns' over the issue. "'Nurses' knowledge of diagnosis is pathetically poor. It takes medical students five years to be competent to make a differential diagnosis. Only a country with not enough doctors would go down this cheapy line."
After examining the data, he identified particular concerns over nurses' prescribing of the cardiac drugs amiodarone and digoxin, plus antibiotics, antivirals and blood pressure medication.
An editorial in this week's BMJ called for an improvement in prescribing training for nurses to deal with concerns over the current training courses. Under the new regulations, independent nurse prescribers gain access to the entire British National Formulary after just 26 days of theory and 12 days of mentored practice.
Jo Haynes, editor of Pulse, said: "Nurse prescribers now in theory get access to almost exactly the same set of drugs as doctors do, but with the proviso that nurses are supposed to limit themselves only to those drugs they feel competent to prescribe. I'm sure most will do just that, but it seems incredible that it has been left to individual nurses to assess and police their own competence."
"The whole nurse prescribing scheme has been rushed through with only the bare minimum of piloting and evaluation, and it won't be until academics start analysing the rates of adverse events and prescribing errors that we will know whether it has been a good or bad thing."
Pulse is the market–leading magazine for GPs in the UK. It has a controlled circulation of 43,000 and is consistently the best read medical paper in the UK.Launched in 1960, Pulse is published by CMP Information.
HemoCue Glucose Meters Alert, UK
Tuesday 21 August 2007
Users of HemoCue Glucose 201+ and HemoCue Glucose 201 RT blood glucose meters purchased or supplied before January 2007 should contact HemoCue for a software upgrade.
Users are warned that some devices may display a zero reading for blood samples above 22.2mmol/l, if the measurement is taken directly after a measurement with an empty cuvette holder.
If a zero reading is obtained, the meter should be turned off and on again. The reading should then be repeated.
HemoCue can be contacted on 01246 292955.
Diabetes UK'Faulty' hip replacements removed
Friday 17 August 2007
Two UK patients have had their hip implants replaced after a packaging error meant they were given the wrong size, it has emerged.
Around half of the 185 implants involved, which have since been recalled by manufacturer Smith & Nephew, had been distributed in the UK.
It is not clear how many more patients may have received one of these.
The company said hospitals were being instructed not to fit any more and to monitor any patients at risk.
The Medicines and Healthcare products Regulatory Agency has issued an alert to UK professionals about the Birmingham Hip Resurfacing implants.
The MHRA said about 83 affected devices may have been in circulation in the UK, but some have since been returned unused.
A spokesman urged patients not to be alarmed by the news.
"We do not want people to panic. The vast majority of people who have received a hip replacement will not be affected."
"But, clearly, anyone in doubt should contact their surgeon."
Recall
The manufacturer recalled some affected products in March 2007 and then extended the recall in June and again in July, he added.
Heath professionals have been advised to review the post operative X-rays of patients already implanted with affected devices to identify any mismatch of head and cup size.
A mismatch may not cause the patient any immediate symptoms or problems, but could with time.
A spokesman for Smith & Nephew said some patients were also having their blood monitored for any unusual wear that could be happening from a possible mismatch.
"Where patients may have been given these hips they are already being monitored."
He said the implants were incorrectly packaged by a subcontractor and, as a result, different sizes of acetabular cup were mixed together.
Some 50,000 patients have been fitted with Birmingham Hip Resurfacing implants over recent years.
Source: BBC NEWSOperating department practitioner suspended for stealing drugs
Friday 17 August 2007
Duncan R Nixon has been suspended from working for one year following several criminal convictions at Norwich Crown Court on the 3 July 2006. The convictions related to theft and possession of drugs and the falsification of patient records in the drugs register. Mr Nixon was given an eight month suspended sentence and 150 hours of community service.
A HPC conduct and competence panel found that while employed at Norwich University Hospital NHS Trust, Mr Nixon entered patients into the drugs register who did not exist and forged the signatures of colleagues. When interviewed by police, following an investigation, Mr Nixon stated that he had started doing this because of domestic problems.
Panel Chair, Martin Ryder commented: "Although the Panel has no evidence that any patient has been harmed or put at risk by Mr Nixon, his misconduct has damaged the reputation of his profession. Mr Nixon's dishonesty continued over a number of weeks and included theft and the fraudulent making of drug records."
"The Panel considers that a suspension order is necessary in order to protect the public in this case."
The Health Professions Council is an independent, UK–wide health regulator set up by the Health Professions Order (2001). The HPC keeps a register for thirteen different health professions and only registers people who meet the standards it sets for their training, professional skills, behaviour and health. The HPC will take action against health professionals who do not meet these standards or who use a protected title illegally.
HPC currently regulate the following thirteen professions. Each of these professions has one or more 'protected titles'. Anyone who uses one of these titles must register with the HPC. The full list of protected titles is here.
- Arts therapists
- Biomedical scientists
- Chiropodists / podiatrists
- Clinical scientists
- Dietitians
- Occupational therapists
- Operating department practitioners
- Orthoptists
- Paramedics
- Physiotherapists
- Prosthetists / orthotists
- Radiographers
- Speech and language therapists
Mother died after 'starved of oxygen during dental surgery'
Friday 17 August 2007
A mother–of–three died during routine dental surgery after an oxygen supply tube pumped air to her stomach instead of her lungs, a medical tribunal heard.
Patsy Bryan, 39, suffered fatal brain damage after being starved of oxygen when her ventilation tube was incorrectly inserted into her throat.
Mrs Bryan, who was having a tooth abscess drained in hospital, essentially suffocated on the operating table as oxygen was pumped into her stomach.
Yesterday Dr Neil Collighan, 35, an anaesthetist, appeared before the General Medical Council to answer accused of ignoring vital warnings which could have saved her life.
The panel heard how monitoring machines warned the doctor she was not breathing properly after two attempts at passing the tube into her windpipe.
Daryl Allen, for the GMC, said that during the procedure in 2002 there had been problems in anaesthetising the patient and inserting an endotracheal tube to deliver oxygen to the lungs.
He said: "During this first attempt the patient bit on the tube and Dr Collighan abandoned this first attempt. This reflected the fact that at the time she was insufficiently anaesthetised. No criticism is made of Dr Collighan for that."
"Dr Collighan then made a second attempt to intubate the patient. During or shortly after this the patient coughed and bucked and had to be physically restrained by other members of staff in the anaesthetic room."
Mr Allen said: "During or shortly after this second attempt to insert the tube, it was misplaced into the patients oesophagus, as opposed to her trachea. The significance of the tube being misplaced is that, in this instance, oxygen and other gases would be delivered to the stomach rather than to the lungs where they are required."
Although she was attached to a capnograph machine – which indicates whether a patient is exhaling carbon dioxide and therefore receiving oxygen – Dr Collighan still failed to notice the misplaced tube.
Mr Allen said: "The capnograph was indicating that the patient was not expiring carbon dioxide. The alarm on the capnograph sounded to alert Dr Collighan to the fact."
"The GMC's case is that a lack of carbon dioxide caught on capnograph indicated that the patient was not receiving oxygen to the lungs via the endotracheal tube."
"The most obvious cause for that was a misplaced tube, which is a plainly serious and dangerous situation which had to be remedied."
The panel heard how Collighan failed to take any of a number of steps to assess whether the tube was correctly sited, instead connecting her to a second machine in the operating theatre.
Mr Allen said: "Again the capnograph showed that no carbon dioxide was being expired by the patient. It was the only logical conclusion from the information given by the capnograph that the patient was not breathing adequately and was not receiving oxygen to the lungs and that the endotracheal tube was misplaced."
"Dr Collighan did not perform any of the checks to assess whether the tube was misplaced. What he should have done immediately but did not was to remove the endotracheal tube to reinsert it and to ensure that it was appropriately sited in the trachea. At this stage he did not summon senior help and did not initialise a crash call."
Eventually it was found Mrs Bryan, a hotel housekeeper, was not breathing and Dr Collighan called senior colleagues at Leeds General Infirmary who reinserted the tube and resuscitated her.
Mrs Bryan, of Chapeltown, Leeds was transferred to intensive care where it was found she had suffered serious brain damage from oxygen starvation and she died the following day.
A police investigation was conducted into her death and a jury at her inquest returned a verdict of unlawful killing. But after examining the evidence the Crown Prosecution Service decided no criminal charges should be brought against the doctor. Collighan denies misconduct. The hearing continues.
Source: Daily MailAnaesthetic switch 'may cut risk'
Friday 10 August 2007
A gas commonly used in anaesthetics might not be safe as many people think, Australian scientists have warned.
In a study of over 2,000 people, they found avoiding using nitrous oxide cut the risk of surgery complications like wound infections.
The research, in Anaesthesiology, also found a possible link between nitrous oxide and the risk of heart attacks.
But experts have warned that in many cases the use of nitrous oxide remains safe and has other advantages.
In the UK, around 6 million anaesthetics are given every year, and a significant proportion of these include nitrous oxide.
The gas is included in the mixture which patients breathe during surgery, as a supplement to the anaesthetic drugs used.
Improved outcomes
Some evidence suggesting potential side–effects from nitrous oxide use already existed, but in the latest study, the first on such a large–scale, the researchers looked at the outcomes of operations performed in 19 hospitals around the World, including in the UK.
They compared the effects of using a mixture of 70% nitrous oxide and 30% oxygen as part of the anaesthetic cocktail, with an alternative mixture of approximately 80% oxygen and 20% nitrogen.
They found patients given the oxygen–nitrogen mix suffered half as many cases of severe nausea and vomiting, and on average a 30% reduction in serious complications such as wound infections and pneumonia.
They also found patients recovered from their anaesthetics just as well as those given nitrous oxide.
Lead researcher Professor Paul Myles, from the Alfred Hospital in Melbourne, Australia, said nitrous oxide could interfere with the metabolism of some vitamins, and with DNA synthesis, which is important in wound healing.
Serious implications
The study also found there could be a link between nitrous oxide and heart attacks after surgery, but this effect was too small to be confirmed, and is now being investigated in more detail.
Harriet Hopf, of the University of Utah, said in an editorial article: "This study is not the last word on nitrous oxide, but it is an important one that is likely to have a major impact on clinical practice in anaesthesia."
But other experts have warned that the use of nitrous oxide in certain cases, such as many operations on children, women in labour, and minor surgery, could still be appropriate – mainly because the gas itself can help to kill pain, and is fast–acting.
Dr Keith Myerson, a member of the Royal College of Anaesthesiologists, said: "The Australian study suggests that there may be benefits in eliminating the use of nitrous oxide in patients having major surgery."
"With the publication of this article, the use of nitrous oxide will undoubtedly diminish."
"However, it is not clear from the study whether or not the benefits were due to the elimination of nitrous oxide or the use of high concentrations of oxygen."
But he added that more work was needed to pin down the exact effect of high concentrations of oxygen administered during anaesthesia.
Source: BBC NEWSNATIONAL FIRST AID AWARENESS DAY – 2nd August 2007
Friday 24 July 2007
The UK's leading first aid providers – St John Ambulance, St Andrew's Ambulance Association and the British Red Cross – are urging the British public to equip themselves with life–saving skills on National First Aid Awareness Day (2nd August 2007).
- 1 in 3 people consider themselves capable of performing the simplest of first aid techniques or treating minor household injuries
- 1 in 10 are not confident of treating a burn effectively
- 1 in 3 people would not know the correct practice if faced with a broken bone
- 1 in 5 would be clueless as to what to do if someone was choking
- Two thirds of British people would stop if they saw someone in need of first aid
- The majority would not be comfortable with one of the fundamentals of first aid, CPR
- A third of people say they could resuscitate someone
- 1 in 4 people admit they would panic when giving first aid
Recent research commissioned by the three voluntary organisations and publishers Dorling Kindersley suggests millions of Britons lack the knowledge to undertake basic first aid procedures as featured in DK's First Aid Manual, which offers a comprehensive guide to treating casualties in emergency situations. This lack of knowledge means that people are ill equipped to deal with real–life emergency situations and is not surprising considering that people are more likely to own a DIY manual than DK's First Aid Manual!
National First Aid Awareness Day is taking place on 2nd August 2007.
The Day is a national campaign in association with the UK's leading First Aid providers, St John Ambulance, St. Andrew's Ambulance Association and the British Red Cross, and publishers Dorling Kindersley. Its aim is to raise awareness of the importance of first aid and keeping a copy of the First Aid Manual in the home.
Drawing on hundreds of years of combined experience, the Voluntary Aid Societies are the acknowledged experts in training and practising first aid. Each Society offers distinct charitable, voluntary and training services, but all work together to raise standards in first aid. St John Ambulance, St Andrew's Ambulance Association and the British Red Cross all run regular courses in first aid. These courses are literally life saving. The courses teach procedures for everyone to follow at home, in the workplace or on holiday, and give the confidence to provide effective first aid treatment anywhere, at anytime – whether it's cuts and bruises, a nosebleed or a heart attack.
The three Voluntary Aid Societies run First Aid courses.
For further details please contact the relevant organisation:St John Ambulance, 08700 10 49 50
St. Andrew's Ambulance Association, 0141 332 4031
British Red Cross, 0870 170 9222
Children's surgery overhaul call
Friday 24 July 2007
Children's surgery in England and Wales is being undermined by lack of funding and training, warn medics.
The Royal College of Surgeons says "strong action" is needed to make sure routine operations can be done locally.
At the same time, complex procedures, such as heart and brain surgery, should be carried out in specialist centres to ensure the best results, they add.
It is expected the number of consultant surgeons will need to more than double over the next few years to meet demand.
The Children's Surgical Forum last reported on the state of services seven years ago but say much has changed since then.
Low take up of training in general paediatric surgery means fewer routine operations are being done in local district general hospitals.
And although it is important that various difficult operations, such as removal of tumours, are done in specialist centres, children need to have access to services near to home when it is safe to do so, the report states.
There are currently only 104 consultant paediatric surgeons – significantly lower than the 256 predicted to be needed by 2010 – and many general surgeons who also have expertise in children will soon retire leaving nothing to fill the gap.
Recent health reforms may have a further detrimental effect as hospitals are encouraged to compete against each other rather than work together to develop the best services.
Funding may have to be increased in order to keep local services running, the report concludes.
Best practice
Across the country there is variation in best practice in children's surgery.
The report rules that children should normally be treated on dedicated paediatric theatre lists and surgeons must have life support training specific to children.
Procedures for giving anaesthesia and sedation to children need to be standardised.
And where possible children undergoing elective surgery should be admitted to a children's surgical ward as their inclusion on general paediatric wards can lead to cancellation of operations and increased risk of cross–infection.
Mr David Jones, consultant in paediatric orthopaedics at Great Ormond Street Hospital and chair of the Forum said: "Surgery for children has changed beyond recognition."
"Techniques have improved and more can be done for sick children, but fewer hospitals are able to provide these services."
"We have reached a point where there are now major challenges facing surgical care for children."
"While routine surgery should be available locally, there is a need to centralise specialist services to achieve the best outcomes."
He added: "Current health policy reforms that introduce competition can provide a disincentive for trusts to collaborate in the interests of the patient."
"The report recommends that children's surgical services be protected from competition and commissioned separately."
A spokesperson for the Royal College of Paediatrics and Child Health said they welcomed the standards set out in the report. "In particular RCPCH supports the need for a network of children's surgical services, so that care is delivered safely as close to home as possible."
Government children's tsar, Dr Sheila Shribman said: "We have already said that children's surgical services being delivered as part of a clinical network is the way forward and we are already looking at the issues around the surgical workforce and specialist training as part of our ongoing work programmes."
Source: BBCRSPCA Furious As Animal Experiments Break Through Three Million Mark
Tuesday 24 July 2007
Government statistics reveal highest number of experiments in 15 years.
The RSPCA is outraged after statistics released by the Home Office show that last year the highest number of scientific procedures was carried out on animals since 1991.
The UK is seeing unwelcome year on year increases in the numbers of procedures being carried out on animals, with this year's figures representing a shocking fifth consecutive annual rise. In 2006, 3.01 million procedures were carried out, up from 2.90 million in 2005 (a further rise of 4%).
RSPCA senior scientist Barney Reed said: "The RSPCA is furious that the numbers have risen yet again and have broken the three million mark."
"Scientists and pro"animal use campaigning groups are falling over themselves to persuade the public that everything possible is done to avoid using animals in experiments – but clearly something is not working. The number of animals used in 2006 was higher than at any time over the past 15 years!"
"Everyone involved in the use of animals in research and testing must significantly raise their game to better explore every opportunity for replacing or avoiding animal use, reducing their suffering and improving their welfare – there is simply no excuse not to."
Mr Reed added: "Numbers alone can never convey the ways in which animals can suffer and it is important that the nature and level of animal suffering is also made clear."
"The Home Office statistics should enable people to understand how much suffering animals experience and for what purposes, but the figures do not do this. For example, what does it mean when 10,000 mice are used in a scientific procedure entitled 'neoplasms', and what actually happens to a rabbit used in 'psychology', or a rat in 'anatomy'?"
"The RSPCA, the Animal Procedures Committee, and a House of Lords Select Committee have all called for these Home Office figures to be made more meaningful – yet staggeringly the Government is currently considering reducing the information collected and made available in future – this is simply not acceptable."
Porn probe at children's hospital
Saturday 21 July 2007
A member of staff at a children's hospital has been suspended after pornographic material was found on a computer.
The material was found during routine computer security monitoring at the Royal Hospital for Sick Children in Edinburgh.
The worker has now been told to stay away from work until a health board investigation has been completed.
Lothian and Borders Police said it was also investigating.
Jim McCaffery, director of acute services and workforce at NHS Lothian, said: "A member of staff has been suspended from work at the Royal Hospital for Sick Children following routine computer security monitoring carried out by NHS Lothian."
Further comment
"NHS Lothian is co-operating fully with the resulting police investigation."
"As part of this process and as a standard measure I can confirm that a member of NHS Lothian staff has been excluded from work to allow a full and thorough examination of the allegations made."
Mr McCaffery said it would be "inappropriate" to make any further comment while the investigation was continuing.
A spokesman for Lothian and Borders Police said: "An allegation has been made which we are investigating."
Source: BBC NEWSCHIEF MEDICAL OFFICER LAUNCHES ANNUAL REPORT
Saturday 21 July 2007
The Chief Medical Officer, Sir Liam Donaldson, on the 17th of July published his Annual Report for 2006, On the State of Public Health, in which he reviews key health problems and developments.
He calls for action in five key areas:
- improving levels of hand hygiene in hospitals (a key factor in infections such as MRSA) by giving patients the power to establish whether healthcare professionals have cleaned their hands and giving patients a personal supply of alcohol-based handrub
- tackling the present crisis in organ shortages for transplantation by introduction of an opt–out system for donors, as is done successfully in some other countries
- reducing the risk of radiation overdoses during cancer treatment by extending the use of monitoring devices to all radiotherapy machines in the country
- conducting more research to establish the reasons why 500 babies die each year despite starting the process of birth apparently healthy ('intrapartum–related deaths')
- taking steps to increase the number of women in the most senior positions in medicine.
The Chief Medical Officer is the UK Government's principal medical adviser. His Annual Reports have championed the need for action on key public health issues such as smoke–free enclosed public places. The Chief Medical Officer also highlights the work in each of the nine public health regions.
The report in more detail: hand hygiene
Sir Liam calls for action on the unacceptably low levels of hand hygiene in hospitals. Poor hand hygiene is strongly linked to healthcare infection and incidence of superbugs like MRSA and Clostridium difficile. Despite improvements, such as the more widespread use of alcohol–based handrubs, levels of compliance by healthcare staff with hand cleaning protocols seldom rise above 60%, and are often lower. Experience in some other countries – notably Switzerland – shows that high standards of hand hygiene cuts infection rates and saves lives. Studies show that patients are reluctant to challenge doctors and nurses even when they know that they have not cleaned their hands.
To tackle this, the Chief Medical Officer proposes that:
- patients should be empowered to work with healthcare professionals and ask them if they would like to clean their hands before treating them
- patients will be provided with alcohbol–based handrubs to offer staff
Sir Liam Donaldson said:
"Good hand hygiene should be a natural reflex for healthcare professionals, yet it no longer has the status it once had. Every time a patient is touched, several thousand bacteria can be passed between the clinician and a patient. Yet patients do not feel able to ask their doctor or nurse if they have washed their hands before touching them. I believe that by empowering patients to work with healthcare professionals on this issue we can improve hand cleaning rates amongst healthcare staff and reduce the number of infections."
The report in more detail: shortage of organs for transplantation
The report also addresses the grave shortage of organs for transplantation – on average one patient a day is dying on the transplant waiting list.
The current organ donor system is based on an 'opt–in' approach whereby people enrol on the NHS Organ Donor Register to give permission for their organs to be used in the event of their death. Recent legislative changes to strengthen this wish – overriding that of their relatives – has done little to increase the number of organs for donation. The Chief Medical Officer therefore proposes an 'opt–out' system be introduced, similar to that in some other European countries which has helped improve their supply of organs. An opt–out system would mean people would register to say they specifically do not want to be donors rather than they do. Safeguards would be built in to any new system of donation.
Sir Liam added:
"There are simply not enough organs donated to meet the need for transplants, with one person dying every day while waiting for a transplant. Compounding this are issues surrounding consent, which often reduce this number further. To meet current demand for organs the number of people on the NHS Organ Donor Register would need to approximately treble. I believe we can only do this through changing the legislation to an opt–out system with proper regulation and safeguards."
The report in more detail: other topics
Launching his 2006 Annual Report On the State of Public Health, Sir Liam Donaldson also draws attention to:
Preventing harm from radiotherapy
Radiotherapy saves lives in the treatment of cancer and other conditions. Giving the wrong dose of radiation by mistake can harm and kill patients. Such errors do occur. The Chief Medical Officer recommends that the use of in–vivo dosimetry radiation checks (this is where after a first dose of radiation, it is measured to ensure it is correct) should be mandatory. He also recommends that a full analysis of all past serious incidents be carried out by the National Patient Safety Agency, working with the NHS Litigation Authority and the Royal College of Radiologists, to identify common causes and the scope for reducing risk.
Newborn baby deaths
Approximately 500 babies a year start labour apparently healthy and then die (intrapartum–related deaths), a figure that has remained unchanged since 2000. It is of concern that the current national survey on maternal and infant deaths no longer reviews the causes of intrapartum-related deaths in detail. The Chief Medical Officer calls for further review of deaths, research and education to avert these deaths.
Women in medicine
Two–thirds of new medical students are women, yet less than 30% of consultants, 11% of professors and 36% of senior lecturers are female. Studies of women doctors' attitudes and experience show that many regret entering the profession because of the barriers to career progression that they encounter. Sir Liam calls for improved flexible working patterns and increased childcare facilities for NHS staff.
A copy of the Chief Medical Officer's Annual Report 2006 On the State of Public Health can be downloaded from the Department of Health website.New mandatory surgical curriculum and web-based training system goes live
Friday 13 July 2007
From 1 August 2007 it will become mandatory for all new surgical trainees in ST1, ST2, ST3 and FTSTA posts to follow the PMETB approved, competence-based Surgical Curriculum for all nine surgical specialties embodied in the Intercollegiate Surgical Curriculum Programme (ISCP). Surgical trainees already in training posts are encouraged to become familiar with the new Curriculum and Assessment methods.
Developed by the Surgical Colleges of Great Britain and Ireland and the nine surgical Specialty Associations, the new Surgical Curriculum can be accessed via the ISCP website. The open access area of the website allows professionals and the public to view all aspects of the Curriculum: syllabus, levels of competence at each stage, standards and assessment tools.
The ISCP website also provides a comprehensive interactive Training Management Information System for use by Surgical Trainees, Trainers (Assigned Educational Supervisors) and Programme Directors.
The password protected interactive area of the site allows trainees and their training supervisors to view global objectives, develop learning agreements, agree assessment methods and record the evidence required to allow progression from one training placement to the next.
Trainees will use the website to store the evidence from work–place based assessments during their training posts. Security and system integrity are key priorities. Backed up every half–hour, the ISCP website is password protected at all levels with strict permissions in place. This means that no user can see particular details without first being given specific access.
The ISCP website has been piloted over the last two years in five deaneries with over 500 surgeons at all levels actively contributing to its development. More than 4,000 trainees and trainers are currently registered users of the ISCP site.
http://www.iscp.ac.ukwww.jcst.org.uk
www.pmetb.org.uk
Source: NHS Networks
INDEPENDENT REVIEW MAKES MAJOR PROPOSALS FOR RESHAPING LONDON'S HEALTHCARE
Thursday 12 July 2007
A network of 'polyclinics' throughout London could provide up to 50 per cent of the outpatient treatment currently carried out in hospital by 2017, if proposals in a report by a top London surgeon are adopted.
And hospitals would take on different roles, from local hospitals doing the bulk of the routine work to major acute hospitals undertaking complex and specialist work, with three trauma units taking seriously injured patients.
The report, Healthcare for London, by Sir Ara Darzi, Professor of Surgery at Imperial College, was commissioned by NHS London, the Strategic Health Authority for the capital, and was published on Wednesday, 11 July.
Professor Darzi points out that health services have improved for Londoners, in particular waiting times in A&E and for routine operations. But many aspects of NHS services are not as good as they should be for a major world city.
Millions of Londoners have non life–threatening short–term illnesses for which they need prompt and convenient treatment. A much smaller number suffer from more serious illness, such as stroke or heart attack, or have a major injury. The NHS is not serving either of these groups as well as it could.
He points out that best care for stroke patients means rapid access to a CT scan to determine the cause of the stroke and to provide clot busting drugs if the cause is a blockage in the blood vessel. These drugs should ideally be given within three hours. Yet, at present, many people are not even having the initial scan within 24 hours.
If stroke patients were seen by specialist teams many more could live and still more be saved from disability. Over 6000 Londoners suffered a stroke in 2005/06. A stroke strategy is a priority, the report says.
Twenty seven per cent of Londoners are dissatisfied with the running of the NHS, compared to 18 per cent nationally. Around 60 per cent of 7000 Londoners questioned said improvement was needed in waiting times to see consultants, cleanliness in hospitals, waiting in A&E and for routine operations. People are particularly unhappy with access to GP services outside normal working hours.
Medical advances mean that more care than ever before can be provided locally.
Day surgery can be provided in local hospitals, outpatients can be seen in the community and people with long–term conditions like diabetes can be supported to stay at home.
Services in the community need improvement, but GP practices in London are smaller than the England average – 54 per cent in London have only one or two GPs, compared to 40 per cent nationally, without the support and equipment to undertake treatments close to people's homes.
Professor Darzi's report recommends a network of polyclinics across the capital that would provide many of the treatments currently provided in hospital, giving patients more care closer to home. A polyclinic would include GP surgeries, diagnostics such as x–ray and pathology, outpatient clinics, urgent care, minor procedures and associated services such as pharmacies.
Professor Darzi said: "Londoners face a stark divide between primary care and hospital care, and we believe the polyclinic will fill that gap. Most GPs provide an excellent and well–regarded service, but they do not have the facilities to undertake even quite simple diagnostics on site, which means patients face multiple trips to hospital for quite straightforward procedures."
Hospitals would not be all the same – local hospitals would continue to provide the majority of treatments, but patients needing specialist treatment, complex surgery or treatment for serious injury would be sent to a major acute hospital with medical and surgical teams seeing sufficient numbers of patients to keep their skills up to date. Elective centres for routine planned surgery would not treat emergency patients, to achieve better results for patients and lower the risk of infection.
Ruth Carnall, Chief Executive of NHS London, which commissioned the report, said: "London has been the subject of a number of major reviews in recent years, but not enough has actually changed as a result of these reports. We do not want Ara Darzi's report to sit on the shelf, because its arguments and its proposals are both radical and persuasive. They also reflect very much what Londoners have been telling us."
"This report must not simply generate unproductive debate about which organisation is better than another, because the report is not about institutions but the needs of patients. It is clear we are not providing the quality of healthcare to Londoners that we could and should be, given the huge investment we have been making in our skills and resources. Ara Darzi's excellent report will be a spur to action that will ensure Londoners receive the world–class healthcare that they deserve."
Televised heart op to provide healthy insight
Wednesday 4 July 2007
OPEN heart surgery at Papworth Hospital will be shown live in a ground-breaking broadcast.
Heart surgeon Francis Wells and a theatre team will perform the operation tomorrow. It will be the first time a UK hospital operation has been broadcast to a public audience.
The operation will be watched by 220 people at the Wellcome Collection in London. A satellite link will allow viewers to question the surgical team as they carry out the complex reconstruction of a heart valve.
It will provide insight into the impact surgery will have on a patient's life, and why preserving the heart valve, rather than replacing it with an artificial one, allows the heart to function more efficiently.
Mr Wells said: "This interactive broadcast is an opportunity to demystify surgery and encourage more people to understand the magnitude of what the heart is about and what it does for us."
"It is the first organ to work at conception and the last to die, yet how much do we really know about its function? The heart is a labyrinth of beauty, and I believe the more people know about it, the more they will appreciate what it takes to maintain good health."
Papworth Hospital is the UK's largest provider of specialist heart and lung services. It performed the first UK heart transplant in 1979 and pioneered the first transplant of a "beating heart" in 2006.
The public viewing of the heart surgery at 7pm tomorrow (Thursday, 05 July) is part of the Wellcome Collection's new heart exhibition and public event programme, and is taking place in conjunction with Papworth Hospital NHS Foundation Trust.
Lisa Jamieson, events manager at the Wellcome Collection, part of the Wellcome Trust which funds innovative biomedical research, said: "This is a first for the UK and for Wellcome Collection. The broadcast will be a fascinating opportunity to observe a major surgical procedure and hear directly from experts whilst they are working."
"It will give unparalleled insight into an operating theatre and the skill and expertise of those involved. It also encapsulates the Wellcome Trust's vision of engaging the public with medicine and its applications."
Source: Cambridge Evening NewsCPDConference.org – CPD resources for health professionals.
Wednesday 4 July 2007
www.CPDConference.org is an innovative website for healthcare professionals, which focuses on providing continuing professional development (CPD) help and resources for UK-based practitioners.
The Internet resources and members benefits at CPDConference.org are proving to be a popular and timely solution for private individuals and NHS staff and their CPD commitments.
Full membership to CPDConference.org offers the following benefits:
- CPD & e-learning activities
- Easy to use CPD Portfolio & Diary
- Dedicated HPC CPD profile area with detailed guidance for audit preparation
- Incorporate NHS Knowledge and Skills Framework dimensions with your CPD activities
- Printable CPD certificates & portfolio summaries
- Discounted CPD events & special offers
- Telephone & email support and CPD advice
The website is also designed to act as an archive for articles, scientific posters and presentations, which can be shared internationally. CPDConference.org aims to showcase group and individual projects and provides information on activities available to healthcare professionals that contribute to their CPD. It acts as a complementary service to those offered by the international community of professional bodies and health organisations.
CPDConference.org is based on an idea conceived by Conference Manager Neil Spence, a HPC registered professional.
Neil states, "The key point about the website is that it is created by health professionals for health professionals. We always welcome CPD contributions; they help develop the importance of this project and they help us all to fulfil our CPD commitments. Full details are available on the website."
Professional, educational and health information organisations have provided guidance for the development of this website but CPDConference.org is an independent service and not directly linked to or controlled by any third party organisation. The CPD Conference resources and activities are peer-reviewed by the Speciality and Professions Committee Members who are from a practical, academic and industrial background.
For further information please visit www.CPDConference.orgor contact:
Neil Spence, Conference Manager
Email neil.spence@kosmos.co.uk
Tel. 01525 873942
Dirty hospitals must clean up, says Brown
Tuesday 3 July 2007
A drive to slash the rates of MRSA and other hospital infections is being masterminded by Gordon Brown, who is convinced that the public's perception of the NHS has been swayed by concerns over cleanliness on the wards.
Brown has told close colleagues that they will never win 'hearts and minds' over the health service reforms until they can demonstrate that the wards really are cleaner, and that they are cutting the numbers of patients being infected.
The Prime Minister and his aides have become alarmed that one in four hospitals is still not meeting the hygiene targets imposed in November 2004 by the then Health Secretary John Reid. Hospital-acquired infections (HAI) now affect some 300,000 people a year, and despite better control measures appear to be epidemic in some areas. The government is unlikely to meet the target it has set itself, of halving the numbers diagnosed with MRSA by next April.
Brown chose to highlight the issue of hospital cleanliness yesterday, on his first visit to a hospital - Kingston, in south-west London - as Prime Minister. A team of experts is being set up within the Department of Health to look at new measures to deal with the problem. The new health minister, the surgeon Professor Ara Darzi, will be asked to devise a new strategy to combat the infections.
Since MRSA first hit British hospitals 10 years ago, it has spread across the country, as an increasing number of people became resistant to antibiotics, coupled with poor cleaning on the wards and the fast turnover of patients.
In recent weeks, Brown has been touring the country listening to Labour supporters and the public. One aide told The Observer that the Prime Minister had been dismayed by the numbers who put MRSA top of their priorities for the NHS. 'We've been thinking that tackling the waiting lists is the number one issue, along with better access to the GP, but we know that dirty hospitals are in the public mind,' the aide said.
The new Health Secretary, Alan Johnson, visited Kingston hospital with Brown yesterday, where they learnt how the hospital had managed to reduce its MRSA rate by 47 per cent.
The hospital imposed a stringent system of hand hygiene compliance and general cleanliness. Posters have been put up urging visitors and staff to wash their hands, and a team goes around the hospital every week and observes staff to give them a hygiene compliance score.
Other hospitals are also tackling the superbug. In the final quarter of last year, 1,542 patients had MRSA infecting their bloodstream, seven per cent fewer than in the previous quarter.
Source: The ObserverSpecialist care cuts heart deaths
Tuesday 5 June 2007
Swift treatment to re–open the arteries at a specialist centre significantly increases the chances of surviving a heart attack, a study has found.
Doctors at Harefield Hospital found under 3% of patients treated with angioplasty at the specialist heart centre had died after 30 days.
But of those patients taken first to a general hospital before referral to the centre, more than 10% died.
The study was presented at a British Cardiovascular Society Conference.
The British Heart Foundation estimates that 230,000 people in the UK have a heart attack each year, and that about 30% of these are fatal.
Dr Miles Dalby, a consultant cardiologist at Harefield Hospital, and colleagues looked at 180 patients who received direct primary angioplasty at their hospital.
Fast treatment
The patients were taken there directly by ambulance staff trained to identify patients who would benefit from the treatment.
Dr Dalby says patients at the hospital's heart attack centre receive treatment and have their blood flow restored within an average of 24 minutes after arrival.
They compared these with 181 patients who had received the treatment after being referred to the centre from a general hospital.
Cardiologists perform primary angioplasty to clear blockages in the heart's arteries – the artery is unblocked using a thin tube, then opened by inflating a small balloon, and held open with a metal tube, or stent.
In non-specialist centres treatment is often by thrombolysis drugs which dissolve the blood clots, but the study found in patients treated with thrombolysis in the preceding two years, around 9% died.
Dr Dalby said prompt treatment is vital for effective primary angioplasty, and that taking patients directly to heart attacks centres could reduce the number of deaths "significantly".
He said: "During a heart attack, blood flow to the heart muscle is blocked which damages it."
"The sooner the patient receives treatment enabling the blood flow to return to the coronary arteries, the less damage occurs."
"This gives better long-term results – time is muscle."
More detail needed
Dr Clive Weston, associate director of Royal College of Physician's Myocardial Infarction National Audit Project, which collects data on heart attack patients, said the results were "quite remarkable".
However he warned that in rural areas, where it make take some time to travel to a specialist centre, methods such as delivering thrombolytic treatments in ambulances could be more effective.
And he said the data needed to be explored in more detail to check there were no biases.
Thrombolysis is very effective if delivered soon after heart attack symptoms develop.
However, as time passes, angioplasty becomes the more effective treatment.
And Dr Weston said another benefit of primary angioplasty was that it allowed to doctors to see more of the coronary anatomy so they could see what had caused the heart attack and help prevent future attacks.
Judy O'Sullivan, cardiac nurse at the British Heart Foundation, said: "The study published by the Harefield team shows promising results for recent advances in the treatment of heart attacks at such specialist centres."
She said in the future angioplasty was likely to supercede thrombolysis as the treatment of choice for heart attacks,and added that patients' speed of response in dialling 999 could also affect their survival chances.
Source: BBC NEWSINFECTION CONTROL IS EVERYONE'S BUSINESS SAYS IHM
Tuesday 5 June 2007
Commenting on the Healthcare Commission's plan to carry out unannounced inspections at 120 NHS trusts over the coming year, Sue Hodgetts, Chief Executive of the Institute of Healthcare Commission said:
"The fight against diseases such MRSA and Clostridium difficile is the business of everyone that works in the NHS, whether they are directly treating patients or supporting clinical staff as managers and administrators. The Institute welcomes the announcement of the Healthcare Commission, which it believes will provide a boost in confidence for patients, their families and their carers that controlling these potentially deadly infections is being treated with the utmost seriousness."
"The Institute also believes that, while those working in the NHS have a duty to ensure that our hospitals are safe environments for patients, a public awareness campaign aimed at everyone that visits a hospital also needs to be mounted. Unwittingly, infections can be brought in by patients' families and friends and, until the public are made aware that they too can play their part in defeating MRSA and C difficile, we will never completely eradicate it from the system."
HPC launches consultations on the Standards of conduct, performance and ethics and guidance for registrants on confidentiality
Tuesday 5 June 2007
The Health Professions Council (HPC) has launched consultations on the Standards of conduct, performance and ethics (SCPE) and guidance for registrants on confidentiality. Both consultations run for three months until 7 September.
The HPC publish the Standards of conduct, performance and ethics which explain their expectations of registrants in terms of their behaviour. The standards are also used to consider cases of misconduct as part of the HPC's fitness to practise process.
The review of the standards was undertaken to ensure that they continued to be relevant to registrants and conformed to public expectations.
Standard two of the Standards of conduct, performance and ethics requires registrants to 'respect the confidentiality of service users'. The proposed guidance offers more information to registrants about how to ensure their practise adheres to the above standard.
Rachel Tripp, Director of Policy & Standards said "We are looking forward to listening to registrant and stakeholder views on both the confidentiality guidance and SCPE consultations."
"We have produced the confidentiality guidance in order to provide registrants with additional information and advice on how to handle issues around confidentiality. We hope that the document provides more information about our expectations of health professionals in this important area."
"Anyone who wishes to take part in the consultations 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 over the coming months and I would encourage anyone who wants to get involved to send their thoughts and ideas to us."
The consultations will put the Council's guidance and standards before a wide range of stakeholders including professional bodies, employers and education providers. We would like to invite any individual or organisation with an interest in these issues to respond to the consultations. They will both run until 7 September 2007 and further copies of the consultation documents will be available on our website to download.
If stakeholders would like to respond to the consultations, they can send their response to:
Confidentiality guidance consultation / Standards of conduct, performance and ethics consultation
Policy and Standards Department
Health Professions Council
Park House
184 Kennington Park Road
London
SE11 4BU
E-mail: consultation@hpc-uk.org
Phone: 020 7840 9815
Website
If stakeholders would prefer their response not be made public, this must be indicated when you respond. We will publish on our website a summary of the responses we receive, and the decisions we have taken as a result.
The full documents are available on-line and a copy can be downloaded from the HPC website
You can access copies of the existing standards on the HPC website
NHS 'is heading for underspend'
Wednesday 30 May 2007
The NHS looks like it has underspent by nearly £500m last year after making cuts amid intense political pressure to avoid a deficit, early data shows.
Unions suggested the NHS had gone too far in making cuts and harmed care. But the government said any surplus would be re–invested.
Health Secretary Patricia Hewitt has staked her job on the NHS balancing.
Figures compiled by the Guardian newspaper revealed the under spend was estimated to be £456.8m in England.
The Guardian analysed data from England's 10 strategic health authorities, regional NHS bodies which oversee hospitals and local NHS trusts.
They showed that only two regions failed to balance its books – the east of England and the south–east coast. The north west on its own ran up a £161m surplus.
The figures include the £450m contingency fund – built up over the year by making cuts to training and public health budgets – which was redistributed to NHS trusts in March.
But the data shows a large increase on the three-quarter year point, when the NHS was predicting a small £13m surplus.
It is unclear how such a big surplus has been amassed in the final three months of 2006–7. There have been reports of trusts imposing minimum waits for operations in a bid to avoid paying for treatment until the new financial year.
The NHS had also not had the full £5.4bn increase in its budget passed on for 2006–7. Some of this went to pay off last year's debt of over £500m, but it that still left several hundred million pounds left over.
The Department of Health is due to publish the final figures next week.
'Impacted adversely'
But Dr Sam Everington, acting chairman of the British Medical Association, said: "If these figures are right, we know that some trusts must have unnecessarily cut back on services to patients such as reducing operating lists and clinics, closing wards, cutting education and training budgets, and making staff redundant".
"All of these things will have impacted adversely on patient care."
Other unions also questioned the fairness of staggering a 2.5% pay award for nurses and other health workers when there was so much money left in the system.
But a spokeswoman for the Department of Health said the final figures would be published shortly.
But she added: "The NHS ended last year [2005-6] with a deficit of over £500m".
"This was unacceptable, and we introduced new rigour and discipline in order to put the NHS on a sound financial footing for the future."
Source: BBC NEWSBird flu checks reach hospitals
Wednesday 30 May 2007
Hospital patients and staff are being offered anti-viral treatment by health officials fighting a bird flu outbreak in north Wales.
Nearly 80 at Ysbyty Glan Clwyd at Bodelwyddan are being offered tamiflu because of contact with a health worker who is being treated for the H7 virus.
About another 70 patients and staff at Ysbyty Gwynedd in Bangor are being contacted to see that they are well.
Twelve people with flu–like symptoms or conjunctivitis have been identified.
The National Public Health Service for Wales (NPHS) stressed that no-one has been seriously ill and the risk to the health of the general public is low.
So far the service has found a total of 221 people who may have come into contact with the virus, which is not as serious as the H5NI strand of the disease.
The first confirmed case of the avian flu was confirmed last Thursday among chickens on a smallholding near Corwen in Denbighshire.
The Rhode Island chickens first affected were bought at a Chelford Market in Macclesfield, Cheshire on 7 May.
On Saturday a second possible case emerged at a farm on the outskirts of Pwllheli although results of tests on birds there have not been finalised.
Some year five children at Ysgol Henllan in Denbighshire are being offered anti–viral treatment after one pupil was linked to the first smallholding.
The NPHS said 79 patients and staff from ward six at Glan Clwyd Hospital were now being offered tamiflu as a precaution.
A further 69 patients and staff from the A&E unit, Tryfan and Gogarth wards at Ysbyty Gwynedd in Bangor have been contacted because a patient, who has now been discharged, has also had treatment for the virus.
Marion Lyons, NPHS's communicable disease control consultant, said: "We have assessed the risk to others and can confirm that the healthcare worker was working at Ysbyty Glan Clwyd during the time when she may have been infectious, between 21 and 23 May."
"The patient at Ysbyty Gwynedd may also have been infectious while at Ysbyty Gwynedd."
"However, as the patient was discharged on 18 May, and the incubation period is eight days, anyone would have had symptoms by 26 May."
The NPHS stressed that experience of this particular bird flu virus in humans was limited, so it was "actively managing" the response.
Person–to–person spread would be very unusual, it said, but limited spread has been seen elsewhere in the past.
Dr Lyons added: "We are looking for people who have had flu-like symptoms or conjunctivitis. It is the symptoms which are important to identify. It is reassuring that so few of the large number of contacts have had symptoms".
"People can also be confident that, the more remote the contact with infected birds, the less likely that symptoms that we have defined would really be H7 flu".
Source: BBC NEWSPolice probe hospital tampering
Monday 21 May 2007
Police say they are investigating a number of lines of inquiry into how three hospital oxygen cylinders were deliberately tampered with.
Tubes on one cylinder at Sandwell Hospital, West Bromwich, were found to have been blocked, restricting the flow of oxygen to a patient.
Later checks revealed two other cylinders had been interfered with.
West Midlands Police said the items that caused the blockages were being forensically examined.
Patient unharmed
In a statement on Sunday the trust said an unidentifiable substance had been blocking the oxygen flow.
The trust said the substance could only have been added deliberately.
The tank was full and staff could hear oxygen flowing from the cylinder, but it quickly became apparent the oxygen was not getting through to the mask.
The patient was not hurt in the incident, which took place two weeks ago.
The hospital immediately checked all 500 of its portable cylinders which showed two others, which were not in use, had been disabled.
A police spokesman said the force was keeping an open mind and was investigating the incidents with the Health and Safety Executive (HSE) and Sandwell and West Birmingham Hospital NHS Trust.
Source: BBC NEWS150 medical staff at risk of sack in A&E closure plan
Monday 21 May 2007
UP TO 150 medical jobs are under threat after health chiefs announced on 17th May they had recommended the scaling back of services at Vale of Leven Hospital in Alexandria.
Up to 10,000 emergency patients a year would instead be treated at a hospital 15 miles away.
Three groups of experts were set up by NHS Greater Glasgow to look at anaesthetics, unscheduled medical care and rehabilitation at the Dunbartonshire hospital.
They found that the anaesthetic services department "was not sustainable" and recommended that emergency patients should go to the Royal Alexandra Hospital in Paisley. Rehabilitation services would also move.
Local politicians Jackie Baillie MSP and John McFall MP, hit out at the move which they claimed would cost 150 jobs and 60 beds.
Jackie Baillie, the MSP for Dumbarton, said: "The board's decision is a disaster for the Vale of Leven. This is not only devastating news for patients. It is bad for staff, from consultants to nurses to ancillary staff, who face losing their jobs."
Source: The ScotsmanHospital theatre staff on strike
Monday 21 May 2007
Operating theatre nurses at Barnsley hospital are staging a 24-hour strike over changes to their jobs.
Managers want to reduce cover at night and plan to downgrade some theatre staff as they seek to cut the annual wages bill by £1.5m.
They said the nursing structure was "top-heavy" but the GMB union described the plans as "an insult" to staff.
Hopes of a deal evaporated at the weekend as talks between managers and GMB union officials stalled.
Joan Keane, the regional organiser of the GMB union for health workers, said: "GMB members employed at Barnsley Hospital are at the point where they can't take any more and recently, over the past couple of years, we've had new pay and conditions imposed."
"These people are now effectively being asked to take a pay cut, but do the same job."
Contingency plans
Ms Keane said 85% of the theatre staff, including nurses and operating department practitioners, had voted to take action.
Another 70 GMB members in support roles voted to impose a work-to-rule but stopped short of endorsing strike action.
Barnsley Hospital said the proposed changes to its staff structure applied across the hospital and the majority of employees had accepted them.
A spokesman said Monday's industrial action involved a small number of staff and the hospital was confident contingency plans would mean it could carry out business as usual.
Source: BBC NEWSEUROPEAN COMMISSION MUST NOW ACT TO SAVE EUROPE'S MRI SCANNERS
Friday 4 May 2007
Liz Lynne MEP, Vice President of the European Parliament's Employment and Social affairs Committee has today welcomed a presentation given by Commissioner Spidla to the European Parliament's Employment and Social Affairs Committee, explaining the action the European Commission is taking to review the scientific evidence used to justify the Electro–Magnetic Fields Directive.
However, Liz Lynne, who has long warned of the dangers of the directive, today called for an amendment to the directive, highlighting the problems that will be caused to the operation and development of MRI scanners throughout the EU if comes into force as currently drafted.
Speaking today from Brussels Liz said;
"The European Commission's announcement that is looking again at this directive is a welcome step and shows nervousness about the evidence used to force through this legislation, but we urgently need further action in the form of an amendment directive to exclude MRI scanners, the use of which are covered by the medical devices directive."
"I hope the Commission has acknowledged the risk this directive poses to MRI scanners' rather than committing to a consultation solely to cover their own back."
For years the Commission has denied there were any problems with the directive.
"The future use of MRI scanners is at risk and the European Commission must do more if we are to protect patients and manufacturers alike."
"The current guidelines imposed by the directive are unnecessary and overcautious. MRI scanners pose no known health risks, and medical staff are already protected under the Medical Devices Directive."
Source: Liberal Democrat MEPs in the European ParliamentBurnham – New patient champ to drive action to end waiting
Friday 4 May 2007
New patient champion to help end waiting announced as new figures show waiting at record low
A new champion to put patient views at the heart of efforts to transform the NHS and deliver the Government's target to reduce waiting times by 2008 was announced by Andy Burnham, Health Minister today.
As the Patient and Public Champion, Neil Betteridge, Chief Executive of Arthritis Care, will have an important role understanding and reflecting patient views as policy is implemented across the NHS. He will work closely with local NHS, key stakeholders and patient groups.
The announcement coincides with new figures published today that show ongoing reductions in outpatient and inpatient waiting times, putting the NHS firmly on track to deliver a maximum wait of 18 weeks from referral to start of treatment by the end of 2008.
These figures show that:
- 701,000 patients are waiting for surgery – a decrease of 457,000 since March 1997 and the lowest figure since data was first collected on this basis in September 1987;
- The NHS continues to deliver the 13–week outpatient and 26–week inpatient maximum waiting time standards established in December 2005;
- Over 99% of patients are waiting less that 11 weeks for their first outpatient appointment and 98% of patients who need surgery are waiting less than 20 weeks.
These improvements are the result of a combination of record investment, the hard work of NHS staff and changes in the way the NHS works.
Andy Burnham said:
"Our commitment to improving the NHS means that by 2008 all patients will be assured of faster treatment. Not simply another target, 18 weeks captures the whole patient journey – from referral to start of treatment – with many patients seen even more quickly than that."
"This will be a major achievement for the NHS – making it more streamlined and productive as well as leading to a much better experience for patients – and helps change people's lives by improving care and cutting unnecessary delays."
"I'm delighted to appoint Neil Betteridge as patient champion for this important policy. He has an outstanding track record of speaking up for patients and his appointment underlines how we want the NHS transformed into a truly patient led service."
Neil Betteridge said:
"I'm delighted to be asked to take up this important role on behalf of all patients. This is a once in a lifetime opportunity for patients and the public to help shape the future delivery of services."
"As the NHS changes, it is crucial that patients are right at the heart of any improvements. My role will be to keep the target focused on people."
"Currently many people with long term conditions, such as arthritis, are in long queues and the wrong queues – that's why the Government has set the 18 weeks target. For the first time in nearly 60 years, this initiative will I hope bring an end to waiting in the NHS."
HPC publishes fees consultation key decisions
Friday 4 May 2007
The Health Professions Council (HPC) has announced the publication of its key decisions document following the consultation about its fee structure. The consultation asked registrants and stakeholders for their views on the proposed changes to the Council's fees.
The HPC consulted for three months between November 2006 and February 2007 on proposals to raise the fees and a copy of the consultation document was sent to all registrants and to a large number of stakeholders. The HPC received 1,153 responses to the consultation, the majority coming from individual registrants. The Council consulted with a variety of stakeholders, including professional bodies, employers, higher education institutions and others with an interest in the HPC's work.
The responses were extremely varied and ranged from positive "Your reasoning about this seems fair and sensible and we would be happy with any of the options suggested" to highly critical "This is nothing more than a tax on caring staff". The document contains detailed analysis of the responses received and the HPC's decisions made as a result of these responses.
Anna van der Gaag, HPC President said "I would like to thank everyone who responded to the consultation, the views of our registrants and stakeholders are vital in shaping our future activities. I believe we have reached a compromise based on the responses we received and the new fee structure will allow us to continue to operate at the highest standard of regulation."
"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."
The document contains 12 key decisions and includes reasoning and explanations for our decisions. The main points are:
- The renewal fee will go up to £72 per annum.
- Registrants who wish to come back onto the Register (e.g. returning to work after maternity leave) will pay a 'readmission' fee of £182; this includes the first year of registration. (This will only be charged one month after being off the Register to allow for late renewals).
- Applicants who complete an approved course will pay a scrutiny fee of £50 and a renewal fee of £36 per annum for the first two years of registration.
- There will be no additional fee for students who graduate from an approved course but who delay applying for registration for more than two years.
- International and grandparenting scrutiny fees will rise to £400.
- The HPC will keep cross–subsidisation across the organisation to a minimum.
The changes to the fees will be effective from 1 June 2007. Existing registrants will pay the new renewal fee when their profession next renews its registration. The proposed changes will be laid before the Privy Council with the expectation that the rules will be changed by 1 June 2007.
Download the full documents (key decisions and consultation).
Surgical drill feels its way through tissue
Friday 4 May 2007
A medical drill being tested in the UK simplifies delicate surgical procedures by sensing the properties of surrounding tissue. It has already been used to give profoundly deaf patients cochlear implants – a process that requires extreme caution to avoid damaging delicate tissues inside the ear.
The device was developed by Peter Brett and colleagues at the University of Aston and David Proops, a surgeon at University Hospital Birmingham, both in the UK. Proops has tested it on three patients so far.
The drill is used to bore a small hole in the side of a patient's head, so that a surgeon can install an implant. Unlike conventional hand–powered surgical drills, it can sound an alert or shut down before piercing a delicate membrane in the inner ear. The researchers say this unique ability could prove useful for other small–scale surgical procedures.
Proops used the drill to create a hole less than a millimetre wide into his patients' ears. Wires connected to an external microphone and electronics can then be fed to the cochlear – the spiral shaped organ in the inner ear that senses sound and transmits the corresponding electrical signals to the brain. The wires are pushed through the hole into the cochlear itself.
Torque and force
A surgeon normally uses a hand–drill to make this hole, but drilling to the right depth is difficult. "If you're not careful, the drill bursts through the membrane and into the ear cavity, introducing debris like bone dust," says Brett. The pressure wave created by such a mishap can cause other trauma, he adds, perhaps even destroying any residual hearing.
So far, the new drill has got it right every time. "By monitoring the torque and force on the drill it can interpret the changing state of the tissue around the drill tip," says Brett. "It can detect when the drill has passed through the bone of the skull and reached the membrane surrounding the cavity of the ear", he says.
"It's a bit like when you use a hand drill on a piece or wood – you can feel when the wood is getting thin," says Brett. "But it is near impossible for a person to do the same when drilling so small a hole, so the new drill could help make the procedure less problematic and more consistent", he says.
Automated surgical devices usually rely on scans of the patient taken before an operation. "That's OK for a lot of procedures," Brett explains, "but at the very small scale things move about – there are lots of procedures around the head where greater accuracy is needed. The solution is probably to combine the two approaches," Brett says.
Source: NewScientist.comSurgical instruments left inside patients
Friday 4 May 2007
Since 2004, 283 claims have been made against NHS trusts after surgical instruments or other foreign bodies were left inside patients following surgery.
The health service has paid over £4 million in compensation for such cases, amounting to almost two affected patients a week.
Speaking to the Daily Mail on the 10th of April 2007, Peter Walsh of Action Against Medical Accidents said: "It is almost certain that there are a lot more incidents of this nature that are unknown because people never find out about it. Also there will be a great number of people who even when this happens decide not to take legal action."
"What is so tragic is that these are such basic errors – they are so easily avoidable through routine checks."
Implements found inside patients over this period include swabs, a catheter and cutting instruments.
According to The Department of Health there are approximately 850,000 medical accidents in English hospitals alone each year, half of which should have been avoided.
Figures from the NHS Litigation Authority for the year 2005–2006 show that the cost of clinical negligence in England alone was £560 million.
Source: Legal & MedicalBetter information for hospitals in the fight against C difficile
Friday 4 May 2007
New web based system to monitor Clostridium difficile
A new web based system to enhance monitoring of Clostridium difficile (C difficile) is being introduced this month, enabling trusts and PCTs to monitor progress on local C. difficile targets and to identify and focus on 'infection hotspots' in the future.
Accurate surveillance is essential in any strategy to reduce infections and the new system, modelled on the MRSA data collection system, will provide an improved national picture on the incidence of C. difficile associated diarrhoea by collecting data on nearly all cases rather than just those over 65.
Chief Nursing Officer Christine Beasley said
"The MRSA surveillance system is widely regarded as one of the best in the world and our experience has allowed us to learn much more about sources of infection and specialties where MRSA bacteraemia occur most often. This knowledge has helped hospitals to target these areas and drive MRSA infection rates down and we want to replicate this for C difficile."
In a letter to the NHS, Christine Beasley and the Chief Medical Officer Sir Liam Donaldson explained the benefits of the changes for local Trusts, highlighting barriers to accurate national monitoring of C difficile.
Under the current system, C difficile cases are reported from Trust laboratories and a case is assigned to the reporting laboratory's Trust, regardless of where the patient came from. This means that if a Trust laboratory carries out work for other Trusts, community hospitals and primary care, their published infection rate will include these other patients, making their rate higher than it really is. Consequently, patients, their families and medical advisers may be misled over the scale of C difficile in the Trust.
The new system will show where cases occur rather than just assigning all cases to the reporting laboratory's Trust, giving the public and NHS access to more accurate data. This is the first stage of the surveillance system and a group of NHS professionals are working on a risk factor page that Trusts will be able to use to identify 'hot spots' i.e. the places where they should be targeting interventions to reduce infection rates.
All PCTs are now required to agree local targets with their Trusts for reducing Clostridium difficile infections. This new surveillance system will allow them to monitor progress against these targets on a monthly basis. As this system is based on the one currently used to monitor MRSA, there will be minimal training needs for NHS staff avoiding any unnecessary burdens on the NHS.
The letter also highlighted the importance of local surveillance, stressing that Trusts and SHAs must continue to have systems that provide early warning of outbreaks and allow early implementation of control measures when necessary, as well as monitoring progress toward local reduction targets.
All central data collections must go through the Review of Central Returns (ROCR) process and are subject to Review of Central Returns (ROCR) approval. An application for this new C difficile system has been submitted and we expect a response by the summer.
Read the letter from the Chief Medical Officer and the Chief Nursing Officer 'Changes to the mandatory healthcare associated infection surveillance system for Clostridium difficile associated diarrhoea from April 2007'.
Local targets for C. difficile were introduced in the NHS operating framework for 2007/08.
Image–guided Robot Called A Surgical "milestone"
Friday 4 May 2007
The NeuroArm, a surgical robot that provides magnetic resonance images of the brain was unveiled in Calgary recently, where researchers called it a "milestone in medical technology." The technology works in conjunction with real–time MRI to provide surgeons with unprecedented detail and the control to manipulate tools at a microscopic scale for operations ranging from repairs of blood vessels to removal of a brain tumor. A surgeon controls the robot using levers at a computer workstation in a room next to the surgery. The robot's two mechanical hands mimic the movements of the surgeon with incredible precision, while sensors and microphones recreate the sights, sounds and touch of surgery, said Dr. Garnette Sutherland, a professor of neurosurgery at the University of Calgary who led the team that designed the device.
Microsurgical techniques that evolved in 1960s have pushed surgeons to the limits of their precision, accuracy, dexterity and stamina, Sutherland said, with the world's best surgeons working at tolerances within three millimetres. The robotic technology makes it possible for surgeons to work accurately within the width of a hair, said philanthropist Doc Seaman, whose family provided $2 million for the planning of NeuroArm. The arm was designed and built in collaboration with engineers at MacDonald, Dettwiler and Associates, known for creating Canadarm and Canadarm2 for NASA. Funding for the $27 million device also came Western Economic Diversification Canada, Canada Foundation for Innovation, the National Research Council of Canada, Alberta Advanced Education and Technology, Alberta Heritage Foundation for Medical Research and other philanthropists.
The NeuroArm is now moving out of development, and the first human surgery testing with the device is expected in two the three months. There is already interest in adapting the technology for a wider variety of surgeries.
Source: vashNYCPRECAUTIONARY ADVICE GIVEN TO DENTISTS ON RE-USE OF INSTRUMENTS
Friday 4 May 2007
As a precautionary measure the Chief Dental Officer, Dr Barry Cockcroft issued new guidance on the 19th of April 2007 to all dentists in England regarding single use of reamers and files, instruments used only in the root filling of teeth.
The guidance to dentists follows on from precautionary advice from the Spongiform Encephalopathy Advisory Committee to the Department of Health and early results from ongoing research conducted by the Health Protection Agency, indicating a potential risk of vCJD associated with endodontic procedures.
Dr Barry Cockcroft said:
"There are no reported definite or suspected cases of vCJD transmission arising from dental procedures – this new guidance to dentists is purely an extra precaution. The public should continue to attend their dentist as normal."
Scientists to test portable surgical robot
Friday 4 May 2007
Doctors and scientists from the University of Washington will get a glimpse of what it would be like to do remote surgery in space when a portable medical robot they created will be tested next month in an underwater environment designed by NASA to simulate zero gravity.
The portable robot, which can be controlled over the internet by a human surgeon many kilometres away, is being developed with money from the U.S. Defence Department to be used to treat wounded soldiers on a battlefield, to perform complicated surgery on patients in remote areas of the developing world and to help sick astronauts in space.
The difference between the robot surgeon demonstrated at the University of Washington on Wednesday and others that are being used today in some hospitals involves portability and communications, said Prof. Blake Hannaford, co-director of the UW BioRobotics Lab.
All the portable parts of this device weigh about 23 kilograms and can be transported and reconstructed by non-engineers at remote sites. Robot surgeons currently being used in hospitals weigh several thousand kilograms, are not portable and can't be easily broken down and reconstructed.
Current medical robots also were not designed to be controlled from kilometres away.
Undersea tests
When the mobile surgical robot called Raven is in the Aquarius Undersea Laboratory off the coast of Florida, its robotic arms holding surgical instruments will be operated by doctors in Seattle sitting in front of a computer screen and holding on to moveable metal arms.
The experiment will involve sewing up a tear in a rubber tube that is being used as a simulated blood vessel. The surgeons will also do a skill test used to judge student doctors.
The surgeons' digital instructions will travel over a commercial internet connection from Seattle to Key Largo, Fla., and then through a wireless connection to a buoy, which is connected by cable to the submarine-like research pod about 20 metres underwater. Two NASA astronauts and a NASA flight surgeon will be in the underwater pod with the robot.
Mitchell Lum, a research assistant and electrical engineering PhD candidate, said an expected time delay of up to a second – between the surgeon's digital instructions and movement of the robot's arms – should be the most challenging part of the experiment.
"We think they will take longer to complete the tasks", Lum said.
The researchers said a major goal of the underwater experiment is to show that the robot can be dismantled, transported and set up by non–engineers in the zero gravity environment. NASA is paying for the underwater testing, scheduled for May 7 to 18, but the rest of the project is being paid for by the Defence Department.
The robot underwent an earlier series of tests last summer in California's Simi Valley, using an unmanned aircraft with a wireless transmitter for communications.
Source: cbc.caOne in 30 aborted foetuses lives
Friday 4 May 2007
One in 30 foetuses aborted for medical reasons is born alive, a 10–year study at 20 UK hospitals has found.
Most of these babies with disabilities were born between 20 and 24 weeks of pregnancy and all lived for no more than a few hours.
Anti-abortion campaigners said the figures in the British Journal of Obstetrics and Gynaecology study were likely to be the tip of the iceberg.
But abortion experts said such incidents were extremely rare.
Abortion rates
About 190,000 abortions take place annually in England and Wales. This is nearly a quarter of all pregnancies.
Most abortions are carried out on "healthy" foetuses for social reasons.
The study, however, looked at the outcomes of 3,189 abortions performed between 1995 and 2004 because the foetus had a disability of some kind.
It showed that 102 – or around one in 30 – were born alive.
Julia Millington of the pro-life group Alive and Kicking Campaign said the rates found at West Midlands hospitals studied were likely to be mirrored elsewhere in the UK.
She explained: "If 102 out of 3,189 babies aborted for reasons of impairment are born alive, then how many healthy babies must be surviving?"
"It is difficult to comprehend the number of babies, throughout the country, left fighting for their lives."
Abortion is allowed in Britain up to the 24th week of pregnancy. Beyond this, a termination is only sanctioned if the foetus has a severe disability or if the mother's life is at risk.
Safeguards
Usually, the foetus will not survive the procedure.
The Royal College of Obstetricians and Gynaecologists said it had "very strong" guidelines on terminations of pregnancy after 22 weeks.
According to the guidelines, after 22 weeks and beyond, if there are signs of major foetal abnormality and the patient has requested an abortion, the patient should be offered feticide, where a lethal injection is administered.
The patient has every right to refuse this course of action. If the baby is born alive, palliative care should be provided till the baby dies.
Theoretically, such an event could result in a doctor being accused of murder if a "deliberate act" – that is, legal abortion – were to be followed by a live birth and the subsequent death of the child because of immaturity.
An RCOG spokesman said an expert group was examining the management of cases when babies are born before 21 weeks 6 days and will produce a report with guidelines in due course.
Ann Furedi, chief executive of the British Pregnancy Advisory Service, stressed that termination due to a diagnosis of a severe or life-threatening disability in the foetus was rare.
"It would be wrong to imply from this retrospective study, that if women undergo a medical induction abortion at under 24 weeks' gestation for reasons aside from foetal abnormality, that this is at all likely to result in a live birth."
"Doctors working in abortion care have for some years now followed the Royal College of Obstetricians and Gynaecologist's guidance, that the foetal heart is stopped before a medical induction abortion around 22 weeks' gestation."
She added: "To end a wanted pregnancy because of severe foetal impairment is, understandably, a very difficult choice for women and couples."
A spokeswoman from the charity Antenatal results and Choices said: "Feticide is technically demanding and stressful for parents and professionals alike."
"Enforcing the procedure in cases where death is the inevitable outcome either as a means to reduce apparent perinatal mortality figures or to satisfy those who do not support the legal availability of abortion will not benefit anyone."
The charity has a helpline for people who need support around issues of antenatal testing and diagnosis of foetal abnormality – 020 7631 0285.
Source: BBC NEWSDoctors use magnets to perform surgery
Friday 4 May 2007
It sounds like the stuff of science fiction, but doctors have made a remarkable medical breakthrough by using magnets outside the body to control surgical instruments inside it.
The experts say they were inspired to devise the revolutionary technique after seeing how teenagers use magnets inside their mouths to hold jewellery studs on their lips without piercings.
The method can significantly reduce the need for surgical incisions, meaning far less scarring and shorter recovery times.
The technique involves putting tiny instruments and a camera into the body through a single incision or natural opening and then using magnets placed on the patient's skin to drag them to the right place.
Source: Daily MailOral and surgical dentistry to merge
Friday 4 May 2007
The General Dental Council has closed the specialist list in Surgical Dentistry and transferred those dentists to a reconfigured Oral Surgery list.
The move brings UK arrangements for oral surgery in line with other countries in Europe and elsewhere, and will mean greater clarity for patients and practitioners about the specialty.
The merger is one of a package of changes recommended by a special group set up by the GDC to review the arrangements for the training and listing of dental specialists. A new Specialist Dental Education Board is being introduced to take forward the other recommendations. The Council has recently appointed Professor Kevin O'Brien as chair of this Board.
GDC president Hew Mathewson, said: "The General Dental Council's specialist lists enable patients and dental professionals to identify dentists who have specialist training and are entitled to use a specialist title."
"We have recently set up the Specialist Dental Education Board to advise the Council on amending the arrangements for the training and listing of dental specialties following the recommendations of the Specialist Lists Review Group."
The Council has written to all dentists on the Surgical Dentistry and Oral Surgery lists to inform them of the new arrangements.
Dental professionals and members of the public can search the specialist lists on the GDC website.Quarter of GPs refuse to refer for abortion
Friday 4 May 2007
As many as one in four GPs are refusing to sign abortion referral forms, according to a Pulse survey revealing the extent of opposition to abortion among doctors.
Experts in women's health expressed concern at the findings, warning women faced a "lottery" in attempting to access abortion services.
Some 19 per cent of the 309 GPs surveyed said they did not believe abortion should be legal, with 24 per cent saying they would not sign abortion referral forms.
GPs also expressed concern over the current 24–week limit, with 55 per cent wanting it to be reduced. They were responding to a survey asking a broad range of questions about medical ethics.
Dr Rob Hardie left his Wiltshire practice in 2004 after refusing to sign the new GP contract, partly because of the guidelines on abortion. He told Pulse: "With abortion, there's the ethical problem of destroying a life, and even if you have different beliefs, there's surely an ethical problem in doctors being forced to do something that they do not believe in. It's immoral and unjust. So it's fantastic to see young doctors making a stand against this – not just Catholics but other Christians and Muslims too."
But experts in women's health said GP reluctance to refer caused problems for women attempting to access abortion services. Dr Robbie Foy, clinical senior lecturer at Newcastle University, who has conducted research on abortion, described current access as "a lottery for women".
"We must provide reliable, secure and non–judgemental care. Many women are still not getting this at present and face unacceptable delays which increase the risks of complications as well as causing additional anxiety. Any sort of trend towards more doctors refusing to partipicipate in induced abortion will risk marginalising this essential service."
Jo Haynes, editor of Pulse, said: "This is an extremely difficult issue, and it's essential to strike the correct balance between providing timely access for women to abortion services, and allowing doctors the right to object on ethical grounds."
"GPs must of course have the right to take an ethical stance on abortion, but equally it is essential that they provide women with alternative routes to abortion services."
A Department of Health spokesperson said: "If GPs feel their beliefs might affect the treatment, this must be explained to the patient who should be told of their right to see another doctor."
Source: Pulse, the leading newspaper for General PractitionersArmed Forces in dire need of 1,700 medics
Friday 4 May 2007
The Armed Forces are suffering a desperate shortage of frontline medics, with more than one in five posts laying vacant.
Fewer than half the required number of surgeons, anaesthetists and emergency nurses are available to treat troops who are badly injured in war zones.
There are also severe shortfalls in the numbers of GPs, physicians, and psychiatrists to care for wounded personnel.
Ministry of Defence figures reveal that the Armed Forces have 6,497 medics – 1,754 fewer than is needed.
The scale of understaffing emerges at a time when ministers are accused of failing in their duty of care to injured personnel.
Critics warn that the hardest hit are wounded soldiers returning from Iraq and Afghanistan.
The MoD recently revealed that 203 troops have been seriously wounded in the conflicts.
But campaigners warn that these figures are only the tip of the iceberg and that the real numbers of wounded run into the thousands.
The Ministry of Defence has resorted to offering 'golden hellos' to NHS staff in an attempt to enlist them. It must also rely on reservists to make up the numbers.
Tory defence spokesman Liam Fox said the shortfall is far higher than figures suggest because ministers have downgraded their estimates on numbers of staff needed.
The Strategic Defence Review published eight years ago stated that the Armed Forces required a minimum 8,970 frontline medical staff – 719 more than the current requirement of 8,251.
But these figures were produced before the Iraq and Afghanistan conflicts – when the need was far lower. Dr Fox said: "Despite the cuts in the Government's target numbers there will still be a shortfall of over 1,700 medical staff. The Government has not been able to say how they plan to fill this gap."
"As Gordon Brown's defence cuts bite he must tell us what he is going to do about this. Servicemen need to be assured that the necessary medical care is available. This is part of the MoD's duty of care."
MPs on the Commons defence select committee have launched an inquiry into the state of medical care in the Armed Forces. They have called for injured troops to give evidence about their treatment.
There is growing anger at the way some soldiers have been treated, including Jamie Cooper, a 19–year–old Royal Green Jackets rifleman who suffered stomach wounds in a mortar attack.
He was admitted to the Queen Elizabeth Hospital in Birmingham, where he was allegedly left lying in his own faeces after his colostomy bag was allowed to overflow. Dr Brendan McKeating, chairman of the BMA's armed forces committee, said: "There are particular shortfalls in the numbers of medical officers including those working in surgery, psychiatry and anaesthetics."
Over the past decade, the Government has shut down the network of dedicated military hospitals. The last, at Haslar in Hampshire, will close at the end of this month.
Defence Minister Derek Twigg said: "Our priority is to ensure that the level of care which our medics provide is sustained in the future".
Source: This is London.co.ukTransfusion Awareness Week - 23-27 April
Saturday 14 April 2007
Patients and the public in England and Wales are set to benefit from a new campaign aimed at increasing awareness about blood transfusion.
The Chief Medical Officer's National Blood Transfusion Committee (NBTC), in partnership with the National Patient Safety Agency (NPSA), is launching a campaign on Wednesday 18th April 2007 before the start of Transfusion Awareness Week (23rd – 27th April 2007). The aims of this campaign are to better inform patients and the public about the relative risks and benefits of blood transfusion, about alternatives to donor blood and to involve patients in transfusion safety issues such as correct identification.
Dr Adrian Copplestone, Chairman of the National Blood Transfusion Committee said: "Receiving a blood transfusion can be lifesaving, but as with any medical treatment there are risks as well as benefits. This campaign aims to increase patient and public involvement and promote greater awareness about blood transfusion. We want patients to feel empowered to ask questions like 'do I definitely need blood?', 'are there any alternatives to receiving a transfusion?', and if a transfusion is necessary, 'what can be done to ensure that I get the right blood?'."
This initiative informs patients about the importance of wearing an identification band whilst they are in hospital and how it is used to correctly identify patients before a blood transfusion is given.
There are sometimes alternatives to blood transfusion, such as treating a shortage of iron before an operation and during pregnancy, or cell salvage whereby the patient's own blood lost during surgery can be collected and returned to the patient. This campaign encourages patients or relatives to ask whether there are suitable alternatives for them and also helps inform patients about the importance of getting an adequate amount of iron in the diet.
Warning over surgery kit cleaning
Saturday 14 April 2007
A plan to move the sterilisation of surgical equipment out of hospitals is "a recipe for chaos", a group of surgeons has said.
The government wants instruments to be cleaned at about 50 new "super centres" across England and Wales, each serving all hospitals in a region.
But the British Orthopaedic Association (BOA) says this could delay operations.
Ministers insist centralisation is needed to ensure hospitals meet new standards for cleanliness.
Some NHS Trusts have already closed older sterilisation units and moved cleaning to new purpose–built sites.
But surgeon Andrew Thomas, spokesman for the BOA, told BBC Radio 4's Today programme that he fears the policy is "a recipe for chaos".
And he said the BOA has contacted the National Audit Office to query whether centralising sterilisation services represented value for money for the NHS.
In January, new figures obtained by Conservative MP Grant Shapps showed there had been a big increase in the number of operations cancelled due to a lack of sterile surgical instruments.
A total of 1,765 operations were cancelled in 2005/06 – up 40% from 1,252 in 2002/03.
Source: BBC NEWSIssue 10 of HPC In Focus is now available
Tuesday 10 April 2007
Download all issues from here.
'No need' for hospital mobile ban
Monday 19 March 2007
Hospitals in England which currently ban doctors and patients from using mobile phones have no reason to do so, the government has said.
Restrictions have been in place in many trusts because of concerns phones could interfere with medical equipment.
But an NHS regulator said last year phones could safely be used in some areas away from sensitive equipment.
Health minister Andy Burnham said on Wednesday there was now "no reason" for an outright ban on mobiles.
The advice published by the Medicines and Healthcare Products Regulatory Agency (MHRA) said mobile use should be restricted only where specialist equipment was used, as in intensive care and specialist baby units.
But many hospitals still have complete bans.
In evidence to the Commons Health Committee last year, Ofcom suggested some had kept the outright ban because of pressure from the companies operating their bedside phone services.
'Keeping in touch'
Mr Burnham said: "As technology has moved on it is right that we update our guidance on mobile phones to reflect that."
"We recognise that patients and staff should be able to use mobile phones, where it is appropriate to do so and subject to medical and privacy considerations."
He added: "I see no reason for trusts to have an outright ban on mobile phones – especially in communal areas – and our updated guidance will make that clear, although, NHS Trusts are responsible for formulating their own policy on mobile phone usage."
Sharon Hodgson, Labour MP for Gateshead and Washington, who led a campaign to lift the mobile phone ban said she was "delighted" it would be easier for patients to use their phones in hospital, rather than having to rely on expensive bedside systems.
She added: "People who are in hospital, especially for long periods, desperately need to keep in touch with their friends and loved ones. Anything that cheers them up is also medically useful."
Potential disturbance
Dr Gill Morgan, chief executive of the NHS Confederation, which represents over 90% of NHS organisations, said: "It is up to each individual NHS trust to draw up their own policy in relation to the use of mobile phones on their premises."
"I'm sure updated guidance from the Department of Health on this area will be welcomed."
She added: "When drawing up their mobile phone policy, trusts also consider potential noise disturbance caused by the use of mobile phones in hospitals."
"Mobile phones can often be intrusive and technological advances mean that increasingly phones have cameras and recording devices."
Barbara Wood, chair of the British Medical Association's Patient Liaison Group, said: "Research has clearly demonstrated that mobiles pose little or no risk to hospital equipment."
"We welcome the fact that trusts are being encouraged to allow patients and staff to use them, although this needs to be done in a way that does not affect other patients' right to peace and quiet."
Source BBC NEWSAmicus on Scottish NHS Pay settlement
Monday 19 March 2007
Amicus reaction to news that the Scottish Executive has agreed to implement the NHS Pay Review Body recommendation in full and make a pay award of 2.5%. NHS workers in England will now be subject to a less than inflation 1.9% pay settlement.
"The Scottish Executive have made a pay award based on the recommendation of the independent NHS Pay Review Body. Their counterparts in England will receive much less thanks to the unfounded interference of the Treasury."
"The resulting pay discrepancy is an absurdity and an insult to every NHS worker in England. Does this mean that if your Scottish and working for the NHS in England you should earn more?"
Amicus says it expects the Welsh Assembly to follow the example of the Scottish Executive and award a pay rise in line with the 2.5% guideline set by the NHS Pay Review Body.
Lack of bodies for medic training
Monday 19 March 2007
A shortage of donor bodies is putting medical teaching at risk, the Royal College of Surgeons has warned.
About 1,000 bodies are needed every year to teach anatomy to medical students, it is estimated.
But the college predicted a 30% national shortfall in the number of bodies needed by medics in the current academic year.
London is faring the worst, with a 40% shortfall expected among the capital's five medical schools and the college.
Last year the Chief Medical Officer wrote to doctors asking them to encourage patients to leave their bodies to medical research.
By law, medical schools may only accept bodies from individuals who have made a specific request for their bodies to be bequeathed for medical study.
And the Human Tissue Act now requires a witness be present.
The college said that while many people carry donor consent cards, they may not be aware of – or are reluctant to undertake – the necessary procedures for donating their bodies to medical schools.
It added that the problem may get worse in the future as many of the bodies which are donated are unsuitable, because of the effect of hospital infections such as MRSA and increased levels of surgical intervention as people live longer.
Teaching
Undergraduates already receive much less teaching in anatomy than they used to, and several medical schools have abandoned dissection-based teaching altogether.
Other schools rely on giving students demonstrations using pre"dissected specimens rather than allowing them to perform their own dissections.
Dick Rainsbury, the RCS director of education, said: "The college currently receives about 60 cadavers a year."
"They are hugely important to us in the teaching of anatomy."
He added that trainees who had only watched operations rather than personal experience may not have the same degree of competence or confidence.
"Visual demonstration is not enough. If the UK is to produce high–quality surgeons, the teaching of anatomy has to be of the highest standard."
Pat Honeysett, who lives in South London, has made the necessary arrangements for her body to be donated to medical training after her mother did the same, and would urge others to follow her example.
"Once you die the body is of no use and the medical profession need to be able to practice in readiness for when they are faced with the real thing."
Emily Rigby, chair of the British Medical Association students committee, said medical students were worried about the drop in donor bodies.
"Students very much value the use of cadavers."
"It will have an impact on their understanding of anatomy and we hope to encourage the number of people donating bodies."
Source BBC NEWSRoutine oxygen therapy may put heart attack patients at greater risk
Monday 19 March 2007
The routine use of oxygen therapy in the treatment of heart attack is not supported by clinical evidence, according to a paper published in the Journal of the Royal Society of Medicine.
The review, led by Professor Richard Beasley of New Zealand's Medical Research Institute, shows there is little evidence to support the routine use of oxygen in myocardial infarction and urges further studies be undertaken.
"Use of oxygen to relieve angina has been available for 100 years. However, as far back as 1950, researchers have been cautioning about its routine use in myocardial infarction," said Professor Beasley.
"Research in this area is scarce but cardiologists should be concerned as the balance of evidence suggests that its routine use in this clinical situation may cause harm."
The only randomised, double–blind and controlled trial of oxygen therapy in the first 24 hours of myocardial infarction in 1976 showed that patients receiving routine oxygen therapy ended up having a greater amount of heart damage than those receiving room air.
The likely reason for this observation was provided in the 2005 study in which the administration of high flow oxygen was shown to reduce coronary artery blood flow in stable patients with heart disease.
"For over 50 years and especially in the 1980s and 1990s, research has focused on the pharmacological agents in myocardial infarction and we have ignored the impact of routine oxygen use, despite earlier warnings," said Professor Beasley. "Oxygen therapy should only be given if the oxygen level is significantly reduced, which is uncommon in the situation of a heart attack."
"We need to challenge clinical dogma because the routine use of oxygen in myocardial infarction is not supported by the evidence."
Professor Beasley's paper calls for urgent research into the current practice of oxygen administration in myocardial infarction.
'Oxygen therapy in myocardial infarction: an historical perspective' by R Beasley, S Aldington, M Weatherall, G Robinson and D McHaffie is published in the March 2007 issue (Vol. 100) of the Journal of the Royal Society of Medicine.
JRSM is the flagship journal of the Royal Society of Medicine. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.
A copy of the article is also available free at www.jrsm.org.uk
Founded in 1805, the Royal Society of Medicine is an independent organisation that promotes the exchange of knowledge, information and ideas in medical science and continued improvement in human health.Government announces pay cut for nurses
Friday 2 March 2007
Dr Peter Carter, General Secretary of the Royal College of Nursing (RCN), said: "Having worked closely with the government to modernise the NHS, bring down waiting times and improve patient care, this is the thanks hard–working nurses get – a cut in pay."
"It is regrettable that the government plans to impose this award in stages. This is unfair and it is undeserved."
"Nurses are only too aware of the precarious state of NHS finances and the effect it is having on patient care. This was reinforced today by the results of a survey of NHS chief executives, 75% of whom stated that patient care will 'suffer as a result of short–term decisions to cut deficits.'"
"This news will leave nurses feeling angry, frustrated and let down. The RCN is committed to working with the government on the difficult agenda that lies ahead but they should also understand that today's announcement makes this harder."
Hewitt - sensible and fair pay awards will benefit staff, the NHS and the economy
Friday 2 March 2007
Government accepts pay review body recommendations
Health Secretary Patricia Hewitt today announced that the Government is accepting the 2007 pay review body recommendations for NHS staff and GPs. In line with the rest of the public sector, the implementation of awards over 1.5 per cent will be staged, with 1.5 per cent paid from 1 April and the remainder being paid from 1 November.
The main recommendations are:
- 2.5 per cent for nurses and other healthcare professionals;
- a flat rate of £1000 pa for hospital doctors and £650 pa for hospital doctors and dentists in training – giving an average of 2 per cent across all groups;
- 2 per cent for general dental practitioners; and,
- 0 per cent for general medical practitioners.
Health Secretary Patricia Hewitt said:
"These are sensible increases, fair for staff, consistent with the Government's inflation target and affordable for the NHS."
"We are therefore accepting the recommendations of the NHS pay review bodies, but have decided to stage the increase in line with the consistent approach across Government to the workforce covered by the pay review bodies."
"We appreciate that nurses will be disappointed by the staging of their award. However, overall earnings growth in the NHS will be around 4.5 per cent in 2007/08 as a result of this pay award, the Government's pay reforms and opportunities for career progression."
"For nurses in particular, I expect the average earnings of nurses to rise by 4.9 per cent next year, above the national average."
"It is also expected that inflation across the year will be much lower than it is now."
"We will be working with the NHS, employers and unions to implement these pay increases while continuing to improve services and job security."
The decision means that, for the following examples:
- the minimum starting pay for a basic grade, newly–qualified nurse will be over £19,600 from 1 November – an increase of £479 on current rates and a 59 per cent increase on 1997 rates;
- typical pay for doctors in their first post will be £31,578 from 1 April and £32,087 from 1 November – an increase of 3.1 per cent on current rates and a 48 per cent increase since 1997;
- a consultant on the minimum pay scale will get £71,822 from 1 April 2007 - a 64 per cent increase in cash terms from 1997; and,
- modern matrons will start on around £35,700 from 1 April (and £36,112 from 1 November) with the potential to earn up to around £43,000 a year.
Patricia Hewitt added:
"GP profits are estimated to have increased by more than 50 per cent since the introduction of the new GMS contract. This has come with significant improvements in the quality and range of services for patients, but I welcome that the review body has recognised that GPs are well-rewarded for the work they do."
She concluded:
"I have asked the NHS Employers organisation today to make a similar offer to NHS staff outside the review body process. As last year, I also propose to increase the pay of very senior managers' in line with the average percentage increase given to consultants."
THE NEW MÖLNLYCKE HEALTH CARE SCIENTIFIC AWARD
Friday 2 March 2007
Mölnlycke Health Care is relaunching the Klinidrape EORNA Perioperative Nursing Foundation Award as the new Mölnlycke Health Care Scientific Award.
The objective of this updated award is to raise the level of research within perioperative nursing and this award hopes to achieve this by providing the winner with the means to conduct research into the subject of their choice.
The deadline for submitting applications for this award is March 31st, 2007 and the winner will be notified by May 10th, 2007. The topic for research will be: 'How can a knowledgeable and competent OR nurse help reduce stressful situations in the perioperative environment?'
The winner will receive 30,000 euros to support their research, with the first half awarded when the winner is selected and the second half at the award ceremony at the EORNA Congresses in Copenhagen in 2009, where the winner will also present their paper.
For an application form or for more information on the Mölnlycke Health Care Scientific Award, please visit www.eorna.eu/award.
Ministers warned over NHS schemes
Wednesday 31 January 2007
Ministers must keep a closer eye on big NHS building projects after incompetent local health chiefs caused the collapse of a £900m scheme, MPs have said.
The public accounts committee said the government had left the Paddington Health Campus project to local managers who were "out of their depth".
The project, designed to merge three north–west London hospitals, was abandoned after costs rose by £300m.
The government said it had already introduced tighter checks on schemes.
The health complex in Paddington, which would have merged St Mary's, the Royal Brompton and Harefield hospitals, was approved in October 2001.
Health bosses thought it would be finished by 2006 but the projected costs more than doubled and the completion date slipped to 2013.
The North West London Strategic Health Authority withdrew the plans in June 2005 but only after £15m costs had been run up.
The MPs found that the Campus partners, overseen by the SHA which has now been scrapped, were imprudent in submitting a business case in 2000 which was "manifestly inadequate".
They said at that stage, health chiefs had not even consulted their own doctors and nurses and were thus unable to determine with any degree of accuracy the land requirements and likely costs.
Collapse
The eventual collapse of the scheme can be traced directly to the ill-informed decisions taken at the outset by the NHS in north west London, the MPs said.
But the committee also said the Department of Health was to blame because it was "not adequately aware of the state of the Campus scheme" because it viewed it as a local issue.
MPs said this "hands–off" attitude must change with the other big projects in the pipeline.
Committee chairman Edward Leigh said: "The collapse of the ambitious Paddington Health Campus project after five years was the direct result of appalling planning and forecasting of costs by the NHS Trust partners, rows between them over the way forward and uncertainty over the Department of Health's degree of support for the scheme, which was lukewarm at best."
On the NHS managers in charge of the scheme, he said: "Their amateurism and incompetence in this field compounded the consequences of bad decisions made at the outset."
And he added: "The department's hands–off attitude towards large-scale capital investment projects must be abandoned in favour of closer and sustained scrutiny."
He said the government must order reappraisals of the current schemes which have risen in cost by more than 10%.
An spokesman for NHS London, which has replaced the individual strategic health authorities in the capital, said: "We welcome the PAC report and are keen to learn lessons from it."
And a Department of Health spokesman added: "The department takes seriously the points raised by the PAC and has already taken action to learn the lessons of Paddington and ensure that every penny of extra investment in new NHS hospitals is spent wisely."
"The department now formally approves expensive schemes at outline stage, which should prevent such cases arising in future."
"We have tightened up checks on governance and project management, introducing an independent assessment of project risks and leadership arrangements, as well as tighter criteria for outline business cases to ensure tender costs are realistic."
Source BBC NEWSCall to reform NHS charge system
Monday 29 January 2007
Most NHS prescription charges in England should be scrapped and applied to "ineffective treatments" instead, NHS public health chiefs say.
The Association of Directors of Public Health said rising demands on the NHS will lead to more rationing.
Their president, Dr Tim Crayford, said: "If NHS charges should be applied at all, they should be applied to relatively ineffective treatments."
He gave tonsil removal and varicose vein surgery as examples.
But he also speculated about the feasibility of allowing more serious procedures, such as cataract surgery and hip replacement operations, to remain free in all cases.
"Medicine and treatment that people need for health reasons should be free. But where there's little proof of clinical benefit, the use of such treatments would reduce more quickly if they had a price tag attached," Dr Crayford added.
Doctors' representatives said more NHS care should be rationed, but they were against charging.
Dr Crayford, president of the association, which represents NHS trust public health directors across the UK, said since 1998 spending on cataracts had increased by 40% to £200m, while the cost of hip operations had risen a third to £300m.
"What is wrong with asking people to contribute for some care which is not life–saving – much as we do with dentistry?"
"For operations such as cataracts and hip operations we need to decide at what point in people's lives these operations should be done."
"The association is calling for a debate on issues such as this to allow the public to decide how the NHS's limited resources are spent."
"If the public agree a threshold what about people below the threshold? Our argument would be that below that threshold they should be allowed to contribute towards the cost as they would with a filling."
"The thing with hip and cataract ops is that they have become more common as waiting lists have fallen and surgery improved, so we have to ask ourselves is it better if patients are asked to wait until their level of pain or blurred vision is more acute."
"The NHS will not be able to do everything in the future."
Benefit
Dr Crayford also said the health service was currently carrying out a small proportion of care which had little medical benefit.
He said procedures such as certain types of plastic surgery, orthodontic surgery, and varicose vein surgery should not be widely available in the future.
"As the elderly population grows and more medical breakthroughs are made, it is clear we are going to have to think about what the NHS is there for and what it is providing."
The British Medical Association is currently drawing up proposals about what the NHS should be providing and will discuss the issue at its annual conference later in the year.
Jonathan Fielden, chairman of the BMA's consultants committee, said it was an important debate.
"The NHS is already rationing procedures – cosmetic surgery is not carried out on the NHS, and the drugs which are used are restricted."
"There needs to be a public debate about what a comprehensive NHS means, which services are available, and which aren't. For example, should the NHS be doing work which is purely cosmetic, or of little clinical value?"
"But the question is how far do you go? If you include hips and eyes I think you are breaking with the traditional values of the NHS, I wouldn't agree with that."
But Professor John Appleby, chief economist at the King's Fund health think tank, said: "I do not buy into these doomsday scenarios. How much extra demand is there going to be on the NHS?"
"I don't think there are any miracle drugs in the pipeline and as for the people living longer, what matters most is how close you are to death, not how old you are."
"We consume the most health resources in the last year of life whether that is at 50 or 80."
Professor Appleby also said it was likely there would be public appetite to increase the amount spent on health to keep pace with increasing demands.
Nigel Edwards, director of policy at the NHS Confederation, said: "The issue is quite rational; after all, care is already rationed and we already make a contribution to dentistry, but it is a very emotive and political subject."
"In the end it is going to have to be decided by a public debate and it will be the public which should decide what the NHS does."
Stressed doctor cuts off patient's penis
Sunday 28 January 2007
A Romanian doctor who hacked off a patient's penis during surgery before slicing it into pieces has claimed he was suffering from stress.
Naum Ciomu, 58, was operating on the man to correct a testicular malformation when he lost his temper. Grabbing a scalpel, he sliced off the penis in front of amazed nursing staff, then cut it into three pieces before storming out of the operating theatre at the Panduri Urology Hospital in Bucharest.
A Romanian court has ordered Prof Ciomu to pay "100,000 damages and "20,000 costs to the victim, Nelu Radonescu, a 36–year–old builder.
"The trauma has left a deep mark both physically and psychologically," said Mr Radonescu. "It is hard for a man who wants to have sex, yet lacks the organ. My wife is the best thing I have."
The medical costs will be covered by the hospital's insurer, but doctors' unions have criticised the court's decision to make Prof Ciomu pay the damages personally. The unions claim the case could set a dangerous precedent, and doctors may refuse to carry out operations for fear of making a mistake. They said Prof Ciomu, a urologist and lecturer in anatomy, had been punished enough by having his medical licence suspended.
Dr Braticevici Bogdan, a former colleague of the disgraced doctor, said: "The amount of the damages is disproportionate compared with the doctors' salaries and the living standards in Romania." Senior hospital doctors may earn no more than £500 a month.
The surgeon told a court he lost his temper after he accidentally cut the patient's urinary channel. He said it was a loss of judgement due to personal problems.
Mr Radonescu will use the compensation to pay for an operation to rebuild his penis, using tissue from his arm. "It will never be the same, but if I am even a quarter of the man I was, I will still be very content," he said.
Source: Sunday Telegraph, Michael Leidig in Bucharest.AMs vote for free prescriptions
Wednesday 24 January 2007
Free prescriptions for everyone are to be introduced in Wales from 1 April following a vote in the Welsh assembly.
AMs voted by 39 to none to abolish the charges. Labour and Plaid Cymru supported the move while Conservatives and Liberal Democrats abstained.
The move was approved despite manufacturers earlier warning it could lead to drugs going to waste and funding for new medicines being lost.
It fulfils an assembly government pledge of free prescriptions by 2007.
Last year the price of prescriptions in Wales dropped from £4 to £3, while it rose to £6.65 in England.
The Welsh Assembly Government has said the scheme, while is expected to cost £29.5m in the first year, will reduce patient inequality.
Quality of life
Welsh Health Minister Brian Gibbons said that free prescriptions would particularly benefit those people with chronic illnesses or on low incomes.
He said: "The main reason for providing free prescriptions was to ensure people are not put off getting medication they need due to cost."
"This will therefore enable those people who need medication to get it to improve their health and ultimately their quality of life."
Dr Gibbons said the scheme would remove unfairness surrounding the currently–used 1968 exemption system where a diabetes patient automatically gets all prescriptions free while a cystic fibrosis sufferer does not.
Patients registered with a Welsh GP or Welsh patients who have an English GP with an accompanying entitlement card who get their prescriptions from a Welsh pharmacist will not have to pay for their drugs from April.
'Detrimental impact'
Dr Gibbons stressed the free prescription policy only applies to prescribed drugs.
"Where patients already buy non-prescription medication over the counter they should continue to do so in the normal way," he said.
"If patients change their behaviour radically this could have a detrimental impact on the NHS as a whole and indirectly on those patients who are in most need of the free prescriptions."
Before Tuesday's vote the Association of the British Pharmaceutical Industry (ABPI) said that if free prescriptions were introduced, demand for medicines may increase.
It also warned that there was a risk of drugs going to waste.
Director Richard Greville said: "Increasing demand on the medicines budget will mean newer, more innovative medicines will be even more difficult to access for patients in Wales."
"We do hope that the government will ensure that there'll be appropriate funding for this new policy," he added.
Source: BBCTories aim to scrap NHS targets
Sunday 21 January 2007
David Cameron is to announce plans to scrap many of the government's health targets including those on waiting times.
The Tory leader is to unveil the first details of his health policy on Monday.
He will outline plans to set new objectives to measure the effectiveness of treatments and the health of patients afterwards.
He also wants to give doctors greater responsibility for their own budgets and priorities.
'Health results'
The Conservatives say the problem with many of the government's targets is that they simply measure whether patients are treated quickly enough.
They want to set new objectives on survival or recovery rates for serious illnesses.
Former Health Secretary Stephen Dorrell, who heads the group which helped draw up the policy, said patients would benefit from the new targets.
"We have endless forms about process and insufficient focus on the health results that the NHS exists to deliver and it is that focus that we are seeking to shift away from process towards health outcomes," he said.
Dr Hamish Meldrum of the British Medical Association's GPs committee said he would welcome measures to assess how well patients are treated but added he wanted to know more about how the Conservative policy would work.
Source: BBCMP angry at £243,000 NHS pay-off
Sunday 14 January 2007
An MP has criticised a £243,000 pay–off to an NHS director who worked for a debt–ridden trust for three weeks.
The settlement was revealed in East Sussex Downs and Weald Primary Care Trust's annual report for 2005–2006.
The payment included a confidentiality clause, but Norman Baker, Liberal Democrat MP for Lewes, said the recipient was a Dr Iheadi Onwukwe.
The NHS trust said the legal settlement was properly agreed by its own board and the Department of Health.
The MP said Dr Onwukwe was put on gardening leave for two–and–a–half years, after working for just three weeks as director of public health at Eastbourne Downs Primary Care Trust (now merged into the new East Sussex Downs and Weald PCT).
He said there had been a dispute with a senior colleague, and the doctor eventually left his post in May 2005.
'Loss of office'
Mr Baker said the payout, at a time when Eastbourne Downs PCT was £4.6m in debt, was a "grotesque waste of money".
"It's unbelievable that someone who was only in a post for three weeks should be paid nearly a quarter of a million pounds to go away," he said.
The East Sussex Downs and Weald annual report stated: "The PCT paid (in 2005) a former executive director compensation for loss of office totalling £243,000 through an agreed legal settlement."
A spokesman added: "The payment was agreed by the board in accordance with NHS guidance."
"The PCT took advice from the Department of Health and its own solicitors through the process."
In July last year, East Sussex Hospitals NHS Trust was criticised for making a £231,000 "termination payment" to former chief executive Annette Sergeant.
Source: BBCDoctors: 'One year left to save NHS'
Friday 12 January 2007
The government must work more closely with doctors and clinicians in order to sort out the significant problems facing the NHS, or else risk wasting millions of pounds of public money, the leader of Britain's doctors has warned.
James Johnson, chairman of the British Medical Association, said that there was much less time than he had previously thought to save the health service before the "huge sums" of additional investment dried up.
"Despite the extra money, NHS trusts all over the country are in deficit, clinics cancelled, wards closed, operating theatre being under–used and staff made redundant or posts not advertised," he added.
Last week a leaked Department of Health document predicted a surplus of more than 3,000 consultants in the NHS by 2010/11.
Johnson added: "At the same time we hear that the government believes that by 2010/11 we will have an excess of 3,200 consultants alongside a shortage of 1,200 GPs, and 1,100 too few junior and staff grade doctors. Not to mention a shortage of 15,000 nurses and 16,000 allied health professionals. To add to the problems we know there will shortly be a huge bulge in the number of junior doctors chasing training jobs due to the abolition of the Senior House Officer Grade. In time, that bulge will feed through to fully trained doctors looking for work as consultants or GPs. The whole situation demonstrates an appalling lack of workforce planning."
The BMA believed in a consultant-led hospital service to make sure patients got the best possible care, and that anything less than that was short changing the public, Johnson said. Similarly, he added that primary care had to be led by GPs.
MRSA target 'likely to be missed'
Thursday 11 January 2007
The NHS is not on track to meet its MRSA target and perhaps never will, a leaked government memo says.
In November 2004, then health secretary John Reid pledged MRSA rates would be halved by April 2008.
But the memo, sent to ministers by a Department of Health official, said it would only be cut by a third by then.
And it warned another bug, Clostridium difficile, is endemic in hospitals and has overtaken MRSA. The government pledged to get on top of the problem.
Health Minister Andy Burnham said: "The decision that we took after the memo that was prepared for us was that we will stay the course, that we will hold for the target, that there's no complacency."
Targets
The Health Service Journal reported the document recommended delaying or dropping the target, as a way of dealing with media interest.
The memo, written by the Department of Health's director of health protection Liz Woodeson and circulated in October, said: "We have a three–year target to halve the number of MRSA bloodstream infection by April 2008."
"Although the numbers are coming down, we are not on course to hit that target and there is some doubt about whether it is in fact achievable."
"The opinion of DH infection experts is that we will succeed in reducing MRSA bloodstream infections by a third, rather than a half – and even if we had a longer period of time, it may not be possible to get down to a half."
But it said the NHS was now "light years ahead" of where it had been a few years ago.
Dr Mark Enright, an infections expert at Imperial College, said the target was "unrealistic".
He said: "I think the target was set really out of a lack of any knowledge of how difficult these things were going to be to put right."
Action
Much of the document focuses on the "handling" of the target.
The memo said: "Although the MRSA target is regarded as one of our highest priorities by the Prime Minister's Delivery Unit, it is not a Public Service Agreement target so there is theoretically scope to change it."
&But it has been publicly announced by ministers, including to Parliament, on many occasions so handling would be an issue."
The document goes on to discuss six options for "handling" the target.
Of the six, just one recommends simply trying to meet the current target - the other five discuss ways of changing the target or timescale, or dropping the target altogether.
The memo also warns that another bug, Clostridium difficile, is now "endemic throughout the health service, with virtually all trusts reporting cases" and shows that 2004 saw twice as many deaths from the infection as were related to MRSA.
And it warns that efforts to combat MRSA, such as alcohol handrubs, have had no impact on C. difficile, which it describes as a "far bigger problem".
C. difficile forms spores which means it can survive for long periods in the environment, such as on floors and around toilets, and spread in the air.
Rigorous cleaning with warm water and detergent is the most effective means of removing spores from the contaminated environment and the hands of staff, say experts.
Dr Peter Carter, general secretary of the Royal College of Nursing, said: "NHS deficits are forcing Trusts to reduce staff and cut services, so it comes as no surprise that priorities such as MRSA have been allowed to slip."
And shadow health secretary Andrew Lansley called on the government to "get a grip on these infections".
He told News 24 the government should follow the example of other European countries, such as Denmark and the Netherlands where employ a "search and destroy" policy is tackling the bug more successfully.
"You have got to have hand hygiene that is really effective," he said.
"Hard-working NHS staff have been set a target which the Department of Health privately admits is unachievable."
And Liberal Democrat health spokesman Norman Lamb said: "It is time that infection control became a top priority in the NHS rather than just another item on a long shopping list of targets."
"The government seems to spend more time worrying about how to bury bad news rather than stopping the rise of deadly infections."
But the Department of Health spokesman said: "We deplore this leak. This paper confirms that from the Prime Minister and Health Secretary downwards, the government is determined that the NHS should get on top of the problem of MRSA and other infections."
"Only last month we made an additional £50m available for infection busting measures."
Source BBC NEWSExperts warn against organ trade
Monday 08 January 2007
A transplant surgeon has warned against selling body parts, after a report suggested organs are for sale online.
The Sun newspaper claims people are selling organs such as kidneys, parts of their liver, and the corneas from their eyes, online to raise money.
Although there is a shortage of organs available for transplantation, the sale of organs in the UK is illegal.
Mr Keith Rigg condemned the practice and warned of a definite risk of death for transplant donors.
Mr Rigg, a consultant transplant surgeon at Nottingham University Hospitals NHS Trust, said: "I know there are people advertising their organs for sale online, but in this country it is illegal."
He said some patients had travelled abroad, such as to Pakistan or China to buy organs, but in those cases the purchases had been made over the internet but through previous connections.
Dangers
He also warned of the potential dangers involved for donors.
In the UK there is a one in 3,000 chance of a person donating a kidney dying after the operation, and a one in 200 chance after donating a section of liver.
He said the sale of corneas, which would blind donors in the eye from which the cornea was taken showed the lengths that some people were prepared to go to for money.
He also warned that other complications could occur after donations keeping people in hospital for longer, and that this occurred in about 20–25% of cases of liver donations.
He said: "We would not support anyone doing this although we do recognise that there is a shortage of organs [in the UK]."
He said the trade could be fuelled by the large number of people waiting for organ donations in the UK.
Unethical
The British Transplantation Society said it considered donation of organs for any kind of personal gain to be unethical.
Mr John Forsythe, BTS president, said: "We would completely condemn the sale of organs."
He said in all cases of live donation, they would try to ensure no coercion was involved at all, and that the selling of organs, often by people in desperate need of money would be "abhorrent" to many people.
Investigation
The Sun newspaper claims though that an undercover reporter met Umer Maqbool, a 24–year–old waiter who had advertised his organs online.
Mr Maqbool apparently told the reporter he wanted money to buy a house for his family in Pakistan and to start a business.
He said: "I'm ready to sell my kidney, a section of liver and maybe after three months do the cornea in my eye."
"I'm ready to do it today. I want £100,000 for all three."
TRANSPLANT FIGURES FOR THE YEAR TO APRIL 2006 FROM UK TRANSPLANTOrgans from 764 people who died were used in 2,195 transplants
1,914 patients received a kidney transplant, 31% of which came from a friend or relative
610 patients received a liver transplant
At the end of the year 6,698 patients were listed as actively waiting for a transplant
At the end of the year 13,122,056 people were registered on the NHS Organ Donor Register Source BBC NEWS