Monthly Archives: November 2013
The Care Quality Commission (CQC) has called for urgent action to stem the rise in avoidable emergency admissions among the elderly, after data collected by the regulator revealed that 530,000 over 65s were admitted to England as an emergency for a preventable cause last year, representing an increase of more than 40% since 2007/8.
The CQC report, its annual State of Care Review, also highlighted common themes found during the 35,000 inspections made in 2012/13. Evidence of poor care was found in one in ten hospitals, with half of cases judged to have had a moderate or major impact on patients, while those suffering from dementia continuing to have among the worst outcomes, with similar problems identified in social care.
The regulator’s inspectors were “alarmed” to see the way patients were being treated and found “unacceptable” failures to protect the most vulnerable, with a deterioration in standards from an already poor position. It concluded that hospitals had made “no improvement” in monitoring the quality of care or in ensuring that patients were safe or treated with dignity and respect, and warned that the NHS has still not learned the lessons from the Mid-Staffs scandal.
However, the findings in this report were based on an inspection regime that has being radically revamped.
Avoidable admissions are caused by conditions such as dehydration or infections which could have been prevented with better care.
Katherine Murphy, Chief Executive of the Patients Association, has said:
“Avoidable admissions drain much needed resources from the NHS, but more importantly, they cause huge amounts of distress and discomfort to those patients who would much prefer to be cared for at home.”
Secretary of State for Health Jeremy Hunt has this week outlined the Government’s response to the Francis Report into the deaths at Stafford Hospital, saying that the NHS needs to undergo a “profound transformation” to create an open, honest and learning culture that will give patients “the best and safest care…in the world”.
The Government has agreed to accept all but nine of the original 290 recommendations made by Robert Francis QC in his report, including
- Getting hospitals to publish details of whether they have enough nurses on wards, with the numbers to be put on a new national safety website
- Hospitals will have to produce quarterly reports on how they are handling complaints and clearly set out how patients can raise them.
- A legal duty of candour on organisations to be open and honest about mistakes.
- A criminal offence of willful neglect to hold staff to account.
- A “fit and proper person’s test” so managers who have failed in past will be barred from taking up posts.
- Care certificates to ensure healthcare assistants and social care workers have the right skills and training.
- Every patient should have the names of a responsible consultant and nurse listed above their bed.
The nine recommendations that the Government have chosen not to take forward include the call for the regulators Monitor and the Care Quality Commission to be merged, although the decision made recently to grant both organisations extra responsibilities made that unlikely.
But of the 281 accepted recommendations, one in four of them has not been met fully, for example the inquiry called for a system of registration for healthcare assistants, but the care certificate falls short of that. The inquiry also originally called for the duty of candour to apply to individuals, not just organisations.
However, Robert Francis QC, the chair of the Inquiry, has said he is happy, describing the Government’s response as a “comprehensible collection of measures”.
The Francis Inquiry, which was published at the start of February, was set up to tackle the wider cultural problems in the NHS after the discovery of widespread abuse and neglect at Stafford Hospital. The inquiry accused the NHS of putting corporate self-interest ahead of patients and concluded that the failings went from the top to the bottom of the system.
The Patients Association welcomes the commitment by the Secretary for State for Health to adopt most of the recommendations of the Francis Report. However, the organisation does warn that some vital recommendations have not being accepted and that patient care should suffer as a result.
In particular, the failure to adopt recommendations around the registration of Healthcare Assistants, has led to concerns that the safety of patients will be compromised. The organisation does believe however that the adoption of most of the recommendations will lead to considerable advances in patient safety. In particular, it strongly supports moves to provide more information on staffing numbers in hospitals, safety information on hospitals and closer monitoring of the complaints system.
Speaking about today’s announcement, Katherine Murphy, Chief Executive of the Patients Association, has said:
“We have said on many occasions in the past that the Francis recommendations represent a blueprint for an NHS that treats people in a safe environment, with dignity and respect.
Whilst we should recognise the considerable step forward taken today, we need to remember that it simply isn’t enough to commit to implementing the reforms. In relation to staffing numbers, for example, it is about getting the right staff as well as simply ensuring that the ratio is correct. There is also real concern about where the nurses need to meet the ratio will be found.
In relation to complaints, we need to see tough action taken against those trusts that are consistently underperforming.
For many years the Patients Association has raised concerns about care in hospital, especially for the elderly, and has published a number of reports on the subject. It is therefore extremely welcome that the Government will make it a criminal offence to willfully neglect patients, all of whom will have had complete faith in those that mistreated them.
We will be monitoring the implementation of these proposals closely, but we really do believe that today is a move towards restoring the faith patients have in the NHS.”
The College of Emergency Medicine has published a ten point action aimed at resolving the crisis in emergency departments. It calls for other NHS services to provide “effective alternatives to A&E for patients without acute severe illness or serious injury seven days a week”.
The College calls for GP services, social care services and NHS walk-in centers to open longer to take the pressure off casualty wards, as well as action to resolve a “massive staffing shortage ”by making work on casualty wards more attractive with increased incentives for doctors working nights and weekends.
The College’s Vice President, Dr Chris Moulton, said that GP out of hour’s services were not always comprehensive and A&E was the only 24 hour service.
But GPC out of hours lead Dr Peter Holden said general practice was, alongside A&E, the only part of the new NHS which runs a 24/7 service.
Figures from the Health and Social Care Information Centre (HSCIC) have revealed that the number of patients admitted to hospital has risen by 12.7% between 2007/8 to 2012/13, amid increasing concerns from senior doctors that the NHS is facing its worst winter yet due to a combination of soaring demand, a shortage of doctors and “toxic overcrowding” on hospital wards.
Dr Bernadette Garrihy, from the College of Emergency Medicine, said government measures to ease the pressure on A&E amounted to “a drop in the ocean” and warned that doctors were concerned about their ability to provide a safe service this winter, due to the pressures of “severe weather problems” and “winter vomiting bugs” coming together to put “our departments under huge pressure”.
Dr Garrihy also said that increasing attendances at A&E during out of hours was due to many patients feeling that they were unable “to access any other sources of care”, saying that patients should only attend casualty departments “as a last resort”.
Meanwhile, hospitals were suffering from urgent staffing crises, she said, especially with shortages of senior doctors in A&E.
Official figures show a vacancy rate of 61 per cent among senior emergency doctors, up from 48 per cent in 2011
Police are investigating allegations that hospital staff were “pressurised or bullied” into falsifying data after the Care Quality Commission found inaccuracies with waiting time data for cancer treatment at Colchester Hospital University NHS Foundation Trust, with the CQC’s Chief Inspector of Hospitals suggesting that the trust wanted to give the impression it was meeting its waiting list targets, which may have put lives at risk.
Out of 61 care records examined, 22 showed that patients had been put at “risk of receiving care that was unsafe or not effective, due to delays in receiving appointments or treatment”, according to the CQC. Staff had told the inspectors that they were pressured and bullied to change data about patient’s treatment to make it seem like people were being treated in line with the national guidelines, meaning that some patients did not get their treatment within the national target of two months, with some patients having to wait more than three months to receive treatment.
The CQC has now asked Monitor, the regulator for foundation trusts, to put the trust into special measures.
Dr Sean MacDonnell, medical director of the trust, has said “On behalf of the trust, I apologise to the patients, relatives and carers who we have let down. We are very sorry for the worry, distress and concerns that have been raised by the publication of the CQC report…our priority is to focus on the safety and welfare of call cancer patients”.
However, Karen Webb, regional director for the eastern region at the Royal College of Nursing (RCN), has claimed that she raised concerns about the “bullying culture, the secrecy of the management culture” at Colchester Hospital a year ago but her and fellow RCN members were dismissed as “fantasists” and the board of the hospital had tried to bully them into “shutting up”.
“I think there were a few things that smell rather unpleasant about Colchester General and the way that it is being led,” Ms Webb said.
The cuts at Lewisham Hospital by Health Secretary Jeremy Hunt had been challenged by Save Lewisham Hospital and the London Borough of Lewisham. During the summer, the High Court ruled Mr. Hunt did not have power to implement cuts at Lewisham Hospital, south-east London.
The government turned to the Court of Appeal on Monday in an attempt to overrule the decision. The decision made by Lord Dyson, Lord Justice Sullivan and Lord Justice Underhill, ruled Mr Hunt acted outside his powers. They ruled Mr Hunt had breached the National Health Services Act 2006, when he decided the emergency and maternity units at Lewisham Hospital should be cut back.
Rosa Curling, who represented the Save Lewisham Hospital campaign group, said: “This expensive waste of time for the government should serve as a wakeup call that they cannot ride roughshod over the needs of the people.
The Hunt had said “I completely understand why the residents of Lewisham did not want any change in their A&E services, but my job as health secretary is to protect patients across south London – and doctors said these proposals would save lives.’’
Mr Justice Silber said at the High Court in July, the cuts would mean local people having ‘’to travel a long, long way further to get access to vital services’’. The government turned to the Court of Appeal on Monday in an attempt to get the decision overruled.
Mr Hunt had previously claimed the move would improve patient care after appointing a trust special administrator (TSA) to the South London Healthcare Trust, which went into administration after losing more than £1m a week. The TSA had recommended cuts at the Hospital.
Mayor of Lewisham Sir Steve Bullock said: “This is a great result. I was confident of our case but I am still very relieved.’’
“This is another victory for each and every individual who signed a petition, who wrote to the secretary of state and who marched through the streets of Lewisham.”
A review carried out by the National Audit Office has revealed that the NHS spends nearly £700 on clinical negligence cover for every live birth in England, £500 million overall and accounting for nearly a fifth of all spending on maternity.
The number of births has increased by nearly a quarter in the last decade, reaching nearly 700,000 live births.
The public spending watchdog said maternity services were generally good for women and babies, but there was still a lot of scope for improvement. Its report highlighted “wide unexplained variations” between trusts in rates of complications such as readmissions, injuries and infections.
Public Accounts Committee Chairwoman Margaret Hodge said the figure was “absolutely scandalous”.
Katherine Murphy, Chief Executive of the Patients Association, has said:
“Whilst we are pleased that this report finds that NHS maternity units provide a good service for most women, we are greatly troubled by the news of variations in performance around the country. The NHS is meant to provide top quality care to all the patients that it serves, and this should not be determined by where someone lives.
When giving birth, women need to know that they and their new born baby are going to be looked after to the highest possible standard, wherever they live. The Department of Health needs to rethink its Maternity Matters strategy in order to close the gap between the varying levels of quality of care that exist in the UK”.
The National Audit Office has reported 5.3m emergency admissions to hospitals in England – a 47% rise in 15 years.
The NAO report defined emergency hospital admissions as unplanned admissions at short notice, due to the apparent clinical need. The report found an increased number of patients who attended major A&E departments, were admitted over the past decade.
The NAO report estimated at least a fifth of patients admitted as emergencies, could be better managed in the community by the patient, their GP or another member of the primary care team. People particularly those who live close to an acute hospital, were more likely to use A&E departments as the first place to seek treatment. The report concluded hospital admissions to A&E and then being admitted had become the ‘’default route’ for urgent and emergency care.
Once admitted, the report highlighted there were delays in discharging patients once they are fit to leave hospital. The National Audit Office reported ‘Improving the flow of patients will be critical to the NHS’s ability to cope with future winter pressures on urgent and emergency care services.’’
Health Secretary Jeremy Hunt said: “We know demand for A&E services is increasing as the population ages, with more people needing more healthcare.’’
“That’s why we are tackling both the short and long-term problems: transforming out of hospital care by reversing the disastrous changes to the 2004 GP contract, joining up the health and social care system, and backing A&Es with £250 million to prepare for this winter.
Katherine Murphy, Patients Association Chief Executive has said ‘’Demand on A&E services increases as patients continue to struggle to get an appointment with their GP and trust in out-of-hour services is at an all-time low. The A&E crisis is not new and it is unacceptable for patients’ safety to continue to be compromised.
Urgent and emergency care must be a key priority for the government alongside appropriate, properly funded, primary care services. When patients are ill they need access to appropriate, safe, high quality care. Immediate action needs to be taken.’’
A new report co-authored by MP Ann Clwyd and NHS chief executive Professor Tricia Hart, calls for urgent action into how complaints by patients and relatives have been handled in the NHS. The report has commitments from key NHS organisations in England, including the Royal College of Nursing, the General Medical Council, Care Quality Commission and Monitor.
The review was commissioned by David Cameron and follows the Francis report into the failings at Mid Staffordshire NHS Trust. Robert Francis QC reported problems could have been spotted earlier if staff had listen to the concerns of patients and relatives, who were often neglected and ignored.
The Health Secretary, Jeremy Hunt has supported the findings of the report and has said ‘’it is incredibly important to make sure we have a structure where people learn from mistakes and hospitals and care providers have a culture where there is openness and transparency’’.
The report concluded that:
- The attitude of the NHS to complaints must change, complaints should be welcomed, not ignored
- Patient advocacy must be improved
- The Department of Health must fund patient groups to work to support patients and improve the complaints system
- There should be a conversation between the complainant and the provider at the outset of a complaint, not just a letter
- PALS and complaints managers to be completely independent from NHS trusts
- Commissioners and regulators should establish clear standards for complaints handling
The review looked at 2500 accounts of poor care and lack of compassion. One read ‘When visiting my wife… after an operation to mend her broken hip, I asked a nurse for help as she was being very, very sick. She announced, ‘I am a graduate. I don’t do sick’ and left me to deal with the situation.’’ The staff was often described as offhand, rude and callous.
The Patients Association has today said that reform of the complaints system cannot wait any longer after the release of yet another report which suggests that failings in the system are continuing to hinder the ability of the NHS to listen to complaints and improve their services as a result.
NHS trusts often see complaints as a problem to be managed rather than an opportunity to learn and improve. Complainants are given responses that are inadequate and fail to answer key questions. They also frequently face lengthy delays in obtaining answers to the most simple of questions. The Patients Association also recognises the concerns raised in the report about the Parliamentary Ombudsman. Patients who contact its Helpline often express frustration that the Ombudsman does not accept many cases for investigation.
Speaking about the report, Katherine Murphy, Chief Executive of the Patients Association said “We fully agree that the NHS must change its culture and ensure that in future it welcomes complaints, rather than automatically becoming dismissive and defensive. Patient advocacy and support must improve and we are keen to play our part in that through our Helpline. The complaint process should be one based on conversation rather than simply letter writing.
We hope that more work will not be carried out to produce standards for complaints handling. Our work in Mid-Staffordshire has already established those standards, as was recognised by the Francis Inquiry.
There cannot now be any more reports into what is wrong with the system. We need to focus on what needs to happen to make things right. We would urge the Government to create the complaints commission as a matter of urgency, and we look forward to working as part of that process to improve the system.
However this process must be swift. The problems with the complaints system have been clear for many years. The NHS cannot further fail patients by wasting this opportunity to resolve them”.
Every person in England loses a week of their lives to illnesses which could otherwise have been treated successfully, a study by the Health and Social Care Information Centre has shown.
Conditions such as heart disease, breast cancer, hepatitis C, tuberculosis and asthma claim thousands of lives, with more than one million years of life in total are lost prematurely across the whole of England.
The figures also showed a striking north-south divide, with people who live in the south of England less likely to die prematurely than people who live in the north, as well as indicating that men are more likely to die prematurely than women.
Secretary of State for Health Jeremy Hunt said that: “There is a shocking variation in early and unnecessary deaths across the country which I am determined to start putting right as part of my ambition to save 30,000 lives a year by 2020. Local authorities have been given the power and budget to tackle the needs of their local population”.