A poll commissioned by patient watchdog Healthwatch England has revealed that almost one in five patients in England have misused Accident and Emergency departments. The survey of over 1,700 people found that 18% owned up to visiting A&E when they needed non-emergency care outside of normal GP opening hours.
The survey also showed a widespread lack of awareness about the other options available. About a third of those who responded said they did not know where their nearest minor injury unit or walk-in centre was, while just one in five said they had used the non-emergency number 111 and NHS Direct when in need. Nevertheless, the survey did show that two-thirds of patients were worried about the pressures on the system.
Anna Bradley, chair of Healthwatch England, said:
“A&E has become NHS Express. The problem is it was never designed to be a catch-all service and nor should it be allowed to become one. But blaming people for going to the ‘wrong place’ when we need care and support is the wrong way of looking at the problem.”
“I’m not absolving us of our responsibility not to clog A&E whenever we get the sniffles, but until the health and care sector offers a more consumer-friendly experience, things are unlikely to improve.”
Katherine Murphy, Chief Executive of the Patients Association, said:
“The NHS drastically needs to improve the out-of-hours care to ensure patients in acute emergencies are able to receive the high quality of care that A&E departments provide. Until then people will turn up at A&E in desperation with everyday medical problems.”
The release of the survey comes as MPs call for emergency care doctors to be paid more to work at struggling hospitals.
Sir David Nicholson, the outgoing Chief Executive of NHS England says he bitterly regrets not speaking to patients and their families who were caught up in the Stafford Hospital scandal.
Sir David described it as his “biggest mistake” during his 36 years of service in the NHS, saying he had avoided speaking to those affected for fear of becoming embroiled in a media circus.
He told delegates at the Health and Care Innovation Expo in Manchester:
“The biggest and most obvious mistake that I made was when it became clear, when the Health Care Commission reported on Mid Staffordshire, and I went to the hospital and I didn’t seek out the patients representatives and the people who were in Cure The NHS, and I didn’t do it because I made the wrong call.”
Sir David announced he was stepping down last year after facing repeated calls to resign over his role in the scandal. Campaigners and MPs had called for him to resign after publication of the Francis inquiry into the failings, which involved the neglect and abuse of vulnerable patients.
The report published a year ago said the system had “betrayed” the public by putting corporate self-interest ahead of patients.
Sir David initially said he was determined to carry on, but in a letter announcing his retirement in May he said: “Recent events continue to show that on occasion the NHS can still sometimes fail patients, their families and carers.”
The Parliamentary and Health Service Ombudsman investigated five complaints about University Hospitals of Morecambe Bay NHS Foundation Trust in relation to the way in which they handled a family’s complaint concerning the death of their baby.
They found that a lack of openness and honesty at the Hospital Trust caused unnecessary distress and further pain to a family who had already suffered from the tragic and avoidable death of their baby.
Julie Mellor, Parliamentary and Health Service Ombudsman, said:
“We are publishing these reports as they highlight the need for more openness and transparency in the way hospitals and the wider health and social care system deal with complaints.”
“When serious untoward incidents happen there needs to be an independent investigation which looks at the root cause of the complaint and the role of human factors such as people and the organisation’s culture. We expect all service providers to adopt this approach to help them understand why mistakes happen and help improve services for everyone.”
The Health Secretary, Jeremy Hunt, has agreed to dissolve the trust that runs the scandal-hit Stafford Hospital. The trust was heavily criticised in a public inquiry led by Robert Francis QC for causing the “suffering of hundreds of people” under its care between 2005 and 2008.
Mr Hunt said Mid Staffordshire NHS Trust would be scrapped and, while its two hospitals would remain open, many services would move to other hospitals. He said the changes would “secure the safe and high-quality services that the people of Stafford deserve having endured years of uncertainty and failures in care”.
He added: “I want Stafford to be a proper district hospital that continues to meet the needs of patients nearby, including for emergency care and births.”
However, campaigners who oppose the move said they may challenge the decision in the courts. Sue Hawkins, from the Save Stafford Hospital group, said:
“We were expecting the trust to dissolve. We understood from the outset that would be the case but we are a semi-rural area and people are going to have to travel long distances to receive care.”
“It’s been a very lengthy process. I wouldn’t wish this on any other hospital.”
Maggie Oldham, chief executive of the trust, said she wanted to “pay tribute” to staff at the hospitals:
“Mid Staffs has come a long way over the past few years and I am very proud of all of our staff and what they have achieved.”
Responding to this Katherine Murphy, Chief Executive of the Patients Association, said:
“The decision to close Stafford Hospital will no doubt be welcomed by those who have suffered or have seen relatives suffer at the hands of poor care at the hospital, and will allow the people of Mid Staffs to move on from the terrible reputation their local hospital has gained.
“The real issue though is the culture that still exists in the NHS that puts processes above patient care. The behaviour and culture that permeated Mid Staffordshire could well be found in other hospital wards around the country. The Government must act now to ensure that we are not talking about closing other hospitals in the future because their reputation has been sullied by poor patient care.”
The National Institute for Health and Care Excellence (NICE) is currently seeking community members to join the committee developing guidance on community activities or services which improve people’s health or wellbeing.
NICE produces guidance on the most effective ways to prevent, diagnose and treat disease and ill health, and provide social care support.
Community members are paid a fee to attend meetings, and travel and other expenses are covered.
The National Institute for Health and Care Excellence (NICE) has been accused of “playing fast and loose” with the lives of cancer sufferers following the announcement that thousands of men with prostate cancer could be denied life-extending treatment following a U-turn by the NHS rationing body.
Each year more than 40,000 British men are diagnosed with prostate cancer. More than 10,000 develop an advanced form of the disease which resists standard hormone treatment and chemotherapy and most will die within five years, making the disease the second most common cause of cancer death in men.
Trials found that the drug Xtandi® on average gave patients an extra five months of life – bringing their survival to 18 months. Three months ago NICE ruled that the drug would be made available to those with cancer which has spread beyond the prostate, and stopped responding to treatment, after the manufacturers agreed a discount on the £25,000 per patient price. But the watchdog has now issued new restrictions, which mean that the NHS will only fund the drug if men have not tried the only other drug available for such cases.
Owen Sharp, Chief Executive at Prostate Cancer UK, said Nice had acted in secrecy, and had given no explanation for a “blatant U-turn” which will cost lives. He said, “Nice is playing fast and loose with men with prostate cancer in the advanced stages of the disease who may become resistant to other treatments, and what’s worse without saying why.”
Last week Prof David Haslam, the chairman of Nice, said British patients should be more assertive in ensuring that they obtain drugs which the watchdog has backed, and learn from the attitudes of Americans, who were more likely to see themselves as equal partners with their doctors
Nice said it changed its recommendation because of responses to its consultation, and because trials on Xtandi® did not include patients who had previously received the standard treatment of abiraterone, leaving them unable to draw conclusions about its effectiveness in such cases.
The Health Service Ombudsman, the body with ultimate responsibility for complaints against the NHS, has been accused of failing thousands of patients and bereaved relatives after admitting it fully investigated less than 400 of 16,000 patient complaints made last year. The watchdog’s own records disclose that during the year 2012/13, less than 3% of complaints which came to them were fully investigated.
In the vast majority of cases, those seeking help were told that an investigation would not achieve anything, that there was no case to answer or that they should return to the organisation which they said had failed them to argue their case.
Professor Sir Brian Jarman, emiritus professor of Imperial College London, said:
“It’s an appalling situation. These complaints – which we should treat as ‘gold dust’, because they are the lessons we need to learn to prevent future tragedies – are being virtually ignored and thrown away.”
In response, a spokesman for the Ombudsman said:
“We changed our criteria for investigating complaints last year. We now always begin our consideration of a complaint about potentially avoidable death with the assumption that we will investigate. In fact, if any complaint meets some basic tests, we will usually investigate it. These changes were prompted by feedback from people whose complaints we had not investigated.”
A huge central database called Care.data due to be launched after April will enable experts to assess diseases, examine new drugs on the market and identify infection outbreaks as well as monitor the care patients get. Information is already available about what happens in hospitals, but to date it has been difficult to link those records with the information that was available about what is happening to patients when they are discharged back to the care of their GPs.
Just last month NHS England started a mass mail-out to every household explaining the project and giving people the chance to opt out. However, people were struggling to understand what it was about and there have been cases where GPs have decided to opt out all their patients themselves.
Concerns have been raised about the prospect of keeping all of the information in one place, with campaigners saying that it could lead to privacy problems and data breaches. There is a proposal, to be discussed next month, which could give access to non-NHS bodies, including private firms.
Dawn Monaghan, of the Information Commissioner’s office, also said she had concerns:
“At the moment, we don’t think it is clear enough on the website or in the information that has been sent out exactly what data is going to go and what is not going to go.”
But Tim Kelsey, NHS England’s national director for patients and information, said patients need not have concerns as the information would not be “identifiable”.
It is exactly 12 months since the report of the full public inquiry into the failings at the Mid Staffordshire Foundation Trust was published on 6th February 2013. The inquiry, led by Robert Francis QC, looked at the role of commissioning, supervisory and regulatory bodies and why serious problems at the trust were not identified and acted on sooner.
In all, 290 recommendations were made by the Francis inquiry which set out a clear blueprint for the creation of a care system which ensures that the safety, dignity and well-being of patients is paramount. The Patients Association made it very clear at the time that it was vital that the recommendations were implemented swiftly and comprehensively; indeed, we are the only organisation that has been consistent in our arguments that the recommendations made by the Francis Inquiry should be implemented in full.
In response to the Francis inquiry, the Government set about implementing a series of further reviews which covered three key areas of concern: patient safety, patient experience and regulation
Whilst we welcome the findings of the various reviews and reports, it is now time for action. It is becoming increasingly apparent that those who run the NHS are reluctant to take the radical steps demanded by the Francis inquiry. We all know what needs to happen: regulation of healthcare assistants, a reformed complaints system, improved training and a properly funded and structured regulatory system. It is time for the government and NHS England to deliver action. We have been saying for many years now that the need to listen to patients, involve them in their care, value staff and for trusts to work together rather than in isolation are all key elements to ensure that standards improve and unnecessary deaths are avoided.
There is still a lot to change. There is a culture in the NHS where processes precede patient care. For years we have tried to highlight concern about poor care despite often being seen as a nuisance for highlighting these issues. The behaviour and culture that permeated in Mid Staffordshire could well be found in many trusts in many parts of the country today.
Ultimately, we believe that patients who use health and care services have the right to be treated with respect, dignity and compassion by staff who have the skills and time to care for them. We must:
1. Put patients (and their carers) first in decisions about their care
2. Help staff to be competent and provide care with dignity and compassion
3. Keep patients and service users safe; encourage whistle blowing where
unsafe care is being practiced
4. Have easy and accessible mechanisms for ensuring patient feedback
through complaints – lessons to be learnt
5. Create open and transparent cultures which are free of blame
A copy of our full response to the first anniversary of the Francis Report can be found here.
Do patients really have a choice?
The British Medical Association (BMA) held an event this week to celebrate the 10th anniversary of their Patient Liaison Group. The event brought together past and present members of the group, along with BMA committee Chairs, representatives from external patient groups and senior BMA staff.
The meeting aimed to provide the BMA with informed and independent advice on the issue of patient choice in the NHS. Dr Mike Smith of the Patients Association was invited to speak at the event along with a representative from Healthwatch England.
Dr Smith highlighted some of the problems that patients have in making an informed choice about their care, and the barriers to obtaining the health care that they want. Patients today expect, and deserve, a variety of choices when it comes to accessing health care from the NHS, and the “Choose and Book” website was set up to enable patients to make this a reality. However, many patients find that there isn’t actually a great deal of choice available (and sometimes none). Furthermore, even when choices are available, patients are finding it difficult to make an informed decision.
Last year The Patients Association ran a survey to gauge the public’s awareness of the NHS constitution and the rights that it contains.
The results showed that awareness was extremely low.
They are running the survey again this year, to assess whether the public are now more aware of the constitution and would be grateful if you could take the time to fill it out. It’s a short questionnaire that shouldn’t take more than thirty minutes to complete.
It will remain open until Friday 6th December 2013.
You can take the survey here.