You can now find the full text of the Act on the government legislation website.
Friday, 30 March 2012
Immigration changes pose threat to nursing numbers, says RCN
Immigration changes pose threat to nursing numbers, says RCN: The Royal College of Nursing has expressed grave concerns about changes to UK immigration policy, which will see nursing staff from overseas being forced to leave Britain unless they’re earning more than £35,000 per year.
The Month: Special Issue 52, March 2012
The Month: Special Issue 52, March 2012:
This special issue of ‘the month’ carries a detailed letter from NHS Chief Executive Sir David Nicholson on the passing of the Health and Social Care Bill and what the new Act means to the NHS now and from 2013/14. Department of Health
Read the Special Issue of ‘the month’ – 29 March 2012 (PDF, 190KB)
This special issue of ‘the month’ carries a detailed letter from NHS Chief Executive Sir David Nicholson on the passing of the Health and Social Care Bill and what the new Act means to the NHS now and from 2013/14. Department of Health
Read the Special Issue of ‘the month’ – 29 March 2012 (PDF, 190KB)
the week: issue 241
the week: issue 241:
On the agenda this week: the Secretary of State writes to all NHS staff following the Royal Assent of the Health and Social Care Bill this week, the Prime Minister announces a new challenge on dementia and the NHS Institute for Innovation and Improvement introduces the NHS Patient Feedback Challenge. Department of Health
Download ‘the week’: issue 241, 23-29 March 2012 (RTF, 535KB)
On the agenda this week: the Secretary of State writes to all NHS staff following the Royal Assent of the Health and Social Care Bill this week, the Prime Minister announces a new challenge on dementia and the NHS Institute for Innovation and Improvement introduces the NHS Patient Feedback Challenge. Department of Health
Download ‘the week’: issue 241, 23-29 March 2012 (RTF, 535KB)
Transplant fluid 'contaminated'
Transplant fluid 'contaminated': The solution used to preserve some donor organs could be contaminated with bacteria, the government says. BBC News
CCGs face tough challenge despite PCT savings
CCGs face tough challenge despite PCT savings: Clinical commissioning groups (CCGs) stand to inherit a grim financial legacy from PCTs despite a report showing they are on track for efficiency savings worth £5.8bn in 2011/12, GP leaders have warned. GP Online
Obesity fuelling kidney cancer rise
Obesity fuelling kidney cancer rise: The number of kidney cancer cases diagnosed in Britain has risen sharply with obesity highlighted as a key factor.
Figures from Cancer Research UK have found that cases rose from about 2,300 in 1975 to almost 9,000 in 2009 and it is now the eighth most common cancer in this country.
With obesity increasing kidney cancer risk by about 70% - compared to smoking which increased it by about 50% - the charit... Healthcare Today
Figures from Cancer Research UK have found that cases rose from about 2,300 in 1975 to almost 9,000 in 2009 and it is now the eighth most common cancer in this country.
With obesity increasing kidney cancer risk by about 70% - compared to smoking which increased it by about 50% - the charit... Healthcare Today
Doctors face pension reforms ballot within weeks
Doctors face pension reforms ballot within weeks:
The first ballot of doctors on industrial action since 1975 will go ahead within weeks if the Government does not rethink the major changes it is making to NHS pensions, it has been warned. The Independent
The first ballot of doctors on industrial action since 1975 will go ahead within weeks if the Government does not rethink the major changes it is making to NHS pensions, it has been warned. The Independent
Letter from Secretary of State to NHS staff on Health and Social Care Act
Letter from Secretary of State to NHS staff on Health and Social Care Act:
Health Secretary Andrew Lansley has thanked NHS staff for their work over the last year and reassured them the Health and Social Care Act 'explicitly supports the core principles of the NHS'. These are: care provided free at the point of use, funded from general taxation, and based on need, not ability to pay.
Health Secretary Andrew Lansley has thanked NHS staff for their work over the last year and reassured them the Health and Social Care Act 'explicitly supports the core principles of the NHS'. These are: care provided free at the point of use, funded from general taxation, and based on need, not ability to pay.
Improving safety in maternity services: a toolkit for teams
Improving safety in maternity services: a toolkit for teams:
This toolkit is organised around five key areas for improvement in maternity care: teamworking; communication; training; information and guidance; and staffing and leadership. Each section begins with a brief explanation on how focusing on improvements in each area can contribute to improved safety. It then highlights some of the experiences of the maternity teams who focused on this issue and their key learning points. There are also short summaries of tools that can be used to improve safety.
Solution to preserve donor organs 'contaminated'
Solution to preserve donor organs 'contaminated': A major alert has been issued over the solution used to preserve some donor organs for transplant.
The government has said the solution used to preserve some donor organs - viaspan - could be contaminated with the bacteria Bacillus cereus.
Tests have found it in the solution that is used to test the sterility of viaspan and further investigations are now being carried out to see if viaspan is also conta... Healthcare Today
The government has said the solution used to preserve some donor organs - viaspan - could be contaminated with the bacteria Bacillus cereus.
Tests have found it in the solution that is used to test the sterility of viaspan and further investigations are now being carried out to see if viaspan is also conta... Healthcare Today
Sustainability action: top 10 tips for NHS trusts
Sustainability action: top 10 tips for NHS trusts:
To mark the first annual day of action for sustainability on 28 March we asked readers to let us know what their trusts are doing to contribute. Here are some of their best tips,
Raising patient awareness: We are getting members of the public to jump on a rower and bike machine in the entrance of our new Royal London Hospital to see how much energy it takes to power up an iPod for the day of action on sustainability. Hope the volunteers ate a good breakfast this morning! — Barts and the London NHS trust
Alice the Harris Hawk: Alice is a majestic bird with a wingspan of more than a metre. She's our secret weapon in the fight against pigeons as we were keen not to use harmful pesticides and chemicals. Patients love to see her in flight, and children on the Starlight ward look out for her. She's become a really important member of the UHSM team – Paul Featherstone, director of estates, University Hospital of South Manchester NHS foundation trust
Good work down the drain: Our food digesters use a bio-enzymatic formula to break food down into grey water, which then passes harmlessly through the system's filter and into the drainage system. This is much better for the environment than throwing food away, and will save us nearly £100,000 in water and electricity costs over the next five years — David Moss, deputy director of estates, Tameside and Glossop PCT
Food sourcing: All of our meat, milk and seasonal vegetables come from local farms within the East Midlands, reducing the carbon footprint of every meal we produce for our patients. We've also done this at no extra cost to the hospital — Nottingham Hospitals
Video conferencing: At NHS Medway video conferencing is just one of ways that the trust is reducing emissions. To celebrate NHS Sustainability Day of Action we have launched a video about how NHS Kent and Medway is helping to create a green and sustainable healthcare system. – NHS Medway
Savings can be made with water too: A tap dripping 2 drops of water per second would waste £7.50 per year. A 2mm drip stream costs £115 per year, and a 5mm drip stream costs £415 per year. Don't flush toilets unnecessarily, a single flush can use nine litres of water, and when boiling a kettle only fill with the amount of water needed – Martin Aizlewood, estates officer, energy and special Projects, Rotherham NHS foundation trust
Staff challenges: We can measure our electricity usage hour by hour. So we've set up an energy challenge for our staff. We've heavily promoted how they can help, with five simple top tips and encouraged engagement with a little competitive spirit – Barnsley Hospital
Loving cycling: The sustainability team has recently relaunched an "I Heart Cycling" free bike loan scheme with folding bicycles for staff to try cycling as part of their commute. We will soon launch an "I Heart Walking" pedometer loan scheme to encourage 2,012 staff to become more active in the runup to the Olympics – Rebecca Hall, sustainability co-ordinator, Imperial College Healthcare NHS Trust
Cake incentives: I work for a five-partner GP practice in Brighton. To mark sustainability day we permanently swapped to a green energy supplier, asked staff to come to work without using a car (with the incentive of homemade carrot cake for those that did!) and planted a plum tree which we registered with NHS forests — Comment from Mungomorris
Large-scale campaigns: We have an ongoing ecosmart energy and environment campaign to help staff save energy and money at work and at home. Every day is Sustainability Day in NHS Greater Glasgow and Clyde! – NHS Greater Glasgow and Clyde
• You can read the full comment thread online here. Guardian Professional.
Raising patient awareness: We are getting members of the public to jump on a rower and bike machine in the entrance of our new Royal London Hospital to see how much energy it takes to power up an iPod for the day of action on sustainability. Hope the volunteers ate a good breakfast this morning! — Barts and the London NHS trust
Alice the Harris Hawk: Alice is a majestic bird with a wingspan of more than a metre. She's our secret weapon in the fight against pigeons as we were keen not to use harmful pesticides and chemicals. Patients love to see her in flight, and children on the Starlight ward look out for her. She's become a really important member of the UHSM team – Paul Featherstone, director of estates, University Hospital of South Manchester NHS foundation trust
Good work down the drain: Our food digesters use a bio-enzymatic formula to break food down into grey water, which then passes harmlessly through the system's filter and into the drainage system. This is much better for the environment than throwing food away, and will save us nearly £100,000 in water and electricity costs over the next five years — David Moss, deputy director of estates, Tameside and Glossop PCT
Food sourcing: All of our meat, milk and seasonal vegetables come from local farms within the East Midlands, reducing the carbon footprint of every meal we produce for our patients. We've also done this at no extra cost to the hospital — Nottingham Hospitals
Video conferencing: At NHS Medway video conferencing is just one of ways that the trust is reducing emissions. To celebrate NHS Sustainability Day of Action we have launched a video about how NHS Kent and Medway is helping to create a green and sustainable healthcare system. – NHS Medway
Savings can be made with water too: A tap dripping 2 drops of water per second would waste £7.50 per year. A 2mm drip stream costs £115 per year, and a 5mm drip stream costs £415 per year. Don't flush toilets unnecessarily, a single flush can use nine litres of water, and when boiling a kettle only fill with the amount of water needed – Martin Aizlewood, estates officer, energy and special Projects, Rotherham NHS foundation trust
Staff challenges: We can measure our electricity usage hour by hour. So we've set up an energy challenge for our staff. We've heavily promoted how they can help, with five simple top tips and encouraged engagement with a little competitive spirit – Barnsley Hospital
Loving cycling: The sustainability team has recently relaunched an "I Heart Cycling" free bike loan scheme with folding bicycles for staff to try cycling as part of their commute. We will soon launch an "I Heart Walking" pedometer loan scheme to encourage 2,012 staff to become more active in the runup to the Olympics – Rebecca Hall, sustainability co-ordinator, Imperial College Healthcare NHS Trust
Cake incentives: I work for a five-partner GP practice in Brighton. To mark sustainability day we permanently swapped to a green energy supplier, asked staff to come to work without using a car (with the incentive of homemade carrot cake for those that did!) and planted a plum tree which we registered with NHS forests — Comment from Mungomorris
Large-scale campaigns: We have an ongoing ecosmart energy and environment campaign to help staff save energy and money at work and at home. Every day is Sustainability Day in NHS Greater Glasgow and Clyde! – NHS Greater Glasgow and Clyde
• You can read the full comment thread online here. Guardian Professional.
NHS reforms: what now for health service managers?
NHS reforms: what now for health service managers?:
NHS managers now have the task of implementing Andrew Lansley's reforms
The passing of the health and social care bill was trumpeted in some quarters (including, apparently, the Cabinet room) as a hard-won victory for Andrew Lansley and his plans to "liberate the NHS".
For the battalion of health service managers, however, the campaign has now begun in earnest. It is they who have to take the legislation, translate its complex clauses into practical plans, and determine how far Lansley's hopes will be realised and the fears of his detractors proven or not.
NHS managers have been here before. Reorganising the service forms a core part of the person specification for any NHS management post, because every four years or so, they can be pretty sure to find themselves charged with implementing the latest grand plan of their political masters.
However, the latest reforms are of a different order, entailing change at every level: Department of Health (splits to form a new NHS commissioning board); strategic health authorities (to be abolished in 2013); primary care trusts (again, abolished in 2013); hospitals (if not already a foundation trust, must be by 2016); public health (off into local government); and general practice (to be organised into 250 clinical commissioning groups by 2013).
The managers responsible for all this could be forgiven for feeling beleaguered. While waiting nearly two years to find out if the NHS white paper would be passed into legislation, they were instructed by the Department of Health to get on with implementing the reforms, which is why primary care trusts are already a thing of the past, clinical commissioning groups are up and running, the NHS commissioning board has a top team in place, and strategic health authorities are down from 10 to four.
What is more, managers have obeyed orders, knowing that cuts to the administrative budget of 45% over four years are coming in the name of cutting bureaucracy, although the NHS is one of the most lightly managed – some would say under-managed – health systems in the world.
This structural change is, however, a sideshow. The biggest challenge is not the implementation of these legislative changes. What keeps senior NHS managers awake at night is how on earth they are going to make 4% efficiency savings each year until 2015 (and probably for several years beyond that) and make sure that local services stay safe and viable.
They know they need to make radical changes to how hospitals and general practice work in the future, and that mergers and other difficult decisions will be required. Managers are also painfully aware of the signs of strain in the NHS, as witnessed by reports of shockingly awful care of older people, cancelled operations and sub-optimal maternity and other services.
What managers want more than anything is for politicians to provide them with the equipment (ie, political leadership and support) with which to fight the most important battle facing the NHS: that of doing more with less.
The main salvo of 2012 has yet to be fired into the NHS. Robert Francis QC is busy writing his report of the public inquiry into the scandal of Stafford hospital. This is likely to provide shock and awe for NHS managers, doctors and nurses, asking how the NHS allowed itself to become enmeshed in such a complicated system of oversight and performance management that it could not see what mattered most: the suffering of frail and vulnerable patients.
As NHS managers concentrate on implementing this latest, and most complicated, reorganisation, they need to think hard about how the new system they create will look when the Francis report casts its piercing light over the service. Most critically, who will notice if there is a serious failing in a hospital or practice, and who will be responsible for taking action?
Judith Smith is head of policy at the Nuffield Trust, a healthcare thinktank Guardian Professional.
The passing of the health and social care bill was trumpeted in some quarters (including, apparently, the Cabinet room) as a hard-won victory for Andrew Lansley and his plans to "liberate the NHS".
For the battalion of health service managers, however, the campaign has now begun in earnest. It is they who have to take the legislation, translate its complex clauses into practical plans, and determine how far Lansley's hopes will be realised and the fears of his detractors proven or not.
NHS managers have been here before. Reorganising the service forms a core part of the person specification for any NHS management post, because every four years or so, they can be pretty sure to find themselves charged with implementing the latest grand plan of their political masters.
However, the latest reforms are of a different order, entailing change at every level: Department of Health (splits to form a new NHS commissioning board); strategic health authorities (to be abolished in 2013); primary care trusts (again, abolished in 2013); hospitals (if not already a foundation trust, must be by 2016); public health (off into local government); and general practice (to be organised into 250 clinical commissioning groups by 2013).
The managers responsible for all this could be forgiven for feeling beleaguered. While waiting nearly two years to find out if the NHS white paper would be passed into legislation, they were instructed by the Department of Health to get on with implementing the reforms, which is why primary care trusts are already a thing of the past, clinical commissioning groups are up and running, the NHS commissioning board has a top team in place, and strategic health authorities are down from 10 to four.
What is more, managers have obeyed orders, knowing that cuts to the administrative budget of 45% over four years are coming in the name of cutting bureaucracy, although the NHS is one of the most lightly managed – some would say under-managed – health systems in the world.
This structural change is, however, a sideshow. The biggest challenge is not the implementation of these legislative changes. What keeps senior NHS managers awake at night is how on earth they are going to make 4% efficiency savings each year until 2015 (and probably for several years beyond that) and make sure that local services stay safe and viable.
They know they need to make radical changes to how hospitals and general practice work in the future, and that mergers and other difficult decisions will be required. Managers are also painfully aware of the signs of strain in the NHS, as witnessed by reports of shockingly awful care of older people, cancelled operations and sub-optimal maternity and other services.
What managers want more than anything is for politicians to provide them with the equipment (ie, political leadership and support) with which to fight the most important battle facing the NHS: that of doing more with less.
The main salvo of 2012 has yet to be fired into the NHS. Robert Francis QC is busy writing his report of the public inquiry into the scandal of Stafford hospital. This is likely to provide shock and awe for NHS managers, doctors and nurses, asking how the NHS allowed itself to become enmeshed in such a complicated system of oversight and performance management that it could not see what mattered most: the suffering of frail and vulnerable patients.
As NHS managers concentrate on implementing this latest, and most complicated, reorganisation, they need to think hard about how the new system they create will look when the Francis report casts its piercing light over the service. Most critically, who will notice if there is a serious failing in a hospital or practice, and who will be responsible for taking action?
Judith Smith is head of policy at the Nuffield Trust, a healthcare thinktank Guardian Professional.
NHS watchdog not ready for new responsibilities, say MPs
NHS watchdog not ready for new responsibilities, say MPs:
Public accounts committee reports that Care Quality Commission is 'poorly governed and led' as shakeup looms
England's NHS regulator should not be allowed to take on new responsibilities planned under the government's health reforms, according to a damning report by MPs.
The Care Quality Commission (CQC) was described as "poorly governed and led" and is not ready for the challenges of the coalition's health bill or to take on the functions of the Human Fertilisation and Embryology Authority (HFEA), according to the public accounts committee.
The CQC has focused on administration whilst neglecting to inspect the level of care and failing to act on information from whistleblowers, MPs concluded.
Plans for the CQC to take over the functions of watchdogs which regulate fertility treatment and human tissue should not go ahead in 2015 as planned, said the cross-party committee.
Margaret Hodge, chair of the committee, said the commission has been struggling for some time while the Department for Health has not got to grips with a failing institution.
"We are far from convinced that the CQC is up to the major challenge of registering and assessing 10,000 GP practices this year.
"Registration will now be decided on the basis of information from GPs themselves and there is a risk that the CQC will simply become a postbox. Unless the assessment of GP practices is meaningful and robust the commission cannot be sure that basic standards of quality and safety are being met," she said.
The DH, which oversees the commission, was criticised for failing to take action quickly.
The report will be a further blow for Andrew Lansley, the health secretary, who inherited a failing commission but wanted it to take a leading role in assessing GP practices and take over the functions of the soon-to-be-abolished HFEA.
The report welcomed the DH's announcement of a "pause" for consultation on the proposed transfer of the responsibilities of the HFEA and the Human Tissue Authority to the commission.
It warned that plans to register 10,000 GP practices between September 2012 and April 2013 may reduce the watchdog to little more than a "postbox" role, as surgeries were being asked to assess for themselves whether they were compliant with quality and safety standards.
The MPs said it was "astonishing" that – almost three years after its creation in 2009 – the CQC had not even developed measures by which to judge quality.
It had carried out "far fewer" inspections than planned and the information it provided to the public on the quality of care was "inadequate and does not engender confidence in the care system", said the report.
There were "serious concerns about the leadership, governance and culture of the commission", which had given incorrect information to Parliament, claiming to have completed twice as many inspections and reviews as it really had.
The committee raised concerns about the commission's use of "gagging clauses" in severance deals with staff, which prevent them from speaking out in public. One former board member said she had been "ostracised and vilified" after challenging the commission's leadership.
The MPs called on the commission to re-establish a dedicated whistleblowers' hotline for staff to report concerns about standards in care homes and hospitals.
However the report has not called for Cynthia Bower, head of the CQC, to stand down from her post before her expected leaving date in the autumn.
Bower resigned last month in expectation of the report and two other major inquiries which are also expected to criticise her and the commission.
The DoH is reviewing how the commission handled the scandal of Winterbourne View, a private hospital near Bristol for people with learning disabilities.
But the most serious criticism of the CQC and Bower is likely to come from a public inquiry into how NHS bodies failed to prevent between 400 and 1,200 patient deaths due to poor care at Stafford hospital.
A CQC spokesman said that the MPs' report had failed to take on board recent improvements in performance, an increase in the number of inspections and a tightening of its whistleblowing policy.
"These improvements were noted in the Performance and Capability Review published by the DoH in February, which referred to CQC's 'considerable' achievements in setting the essential platform from which tougher regulatory action can be taken when needed," he said.
A source close to Lansley said that the failings of the CQC had developed under the last government, but are being dealt with by the current administration. "We are addressing a difficult legacy," he said. The Guardian
England's NHS regulator should not be allowed to take on new responsibilities planned under the government's health reforms, according to a damning report by MPs.
The Care Quality Commission (CQC) was described as "poorly governed and led" and is not ready for the challenges of the coalition's health bill or to take on the functions of the Human Fertilisation and Embryology Authority (HFEA), according to the public accounts committee.
The CQC has focused on administration whilst neglecting to inspect the level of care and failing to act on information from whistleblowers, MPs concluded.
Plans for the CQC to take over the functions of watchdogs which regulate fertility treatment and human tissue should not go ahead in 2015 as planned, said the cross-party committee.
Margaret Hodge, chair of the committee, said the commission has been struggling for some time while the Department for Health has not got to grips with a failing institution.
"We are far from convinced that the CQC is up to the major challenge of registering and assessing 10,000 GP practices this year.
"Registration will now be decided on the basis of information from GPs themselves and there is a risk that the CQC will simply become a postbox. Unless the assessment of GP practices is meaningful and robust the commission cannot be sure that basic standards of quality and safety are being met," she said.
The DH, which oversees the commission, was criticised for failing to take action quickly.
The report will be a further blow for Andrew Lansley, the health secretary, who inherited a failing commission but wanted it to take a leading role in assessing GP practices and take over the functions of the soon-to-be-abolished HFEA.
The report welcomed the DH's announcement of a "pause" for consultation on the proposed transfer of the responsibilities of the HFEA and the Human Tissue Authority to the commission.
It warned that plans to register 10,000 GP practices between September 2012 and April 2013 may reduce the watchdog to little more than a "postbox" role, as surgeries were being asked to assess for themselves whether they were compliant with quality and safety standards.
The MPs said it was "astonishing" that – almost three years after its creation in 2009 – the CQC had not even developed measures by which to judge quality.
It had carried out "far fewer" inspections than planned and the information it provided to the public on the quality of care was "inadequate and does not engender confidence in the care system", said the report.
There were "serious concerns about the leadership, governance and culture of the commission", which had given incorrect information to Parliament, claiming to have completed twice as many inspections and reviews as it really had.
The committee raised concerns about the commission's use of "gagging clauses" in severance deals with staff, which prevent them from speaking out in public. One former board member said she had been "ostracised and vilified" after challenging the commission's leadership.
The MPs called on the commission to re-establish a dedicated whistleblowers' hotline for staff to report concerns about standards in care homes and hospitals.
However the report has not called for Cynthia Bower, head of the CQC, to stand down from her post before her expected leaving date in the autumn.
Bower resigned last month in expectation of the report and two other major inquiries which are also expected to criticise her and the commission.
The DoH is reviewing how the commission handled the scandal of Winterbourne View, a private hospital near Bristol for people with learning disabilities.
But the most serious criticism of the CQC and Bower is likely to come from a public inquiry into how NHS bodies failed to prevent between 400 and 1,200 patient deaths due to poor care at Stafford hospital.
A CQC spokesman said that the MPs' report had failed to take on board recent improvements in performance, an increase in the number of inspections and a tightening of its whistleblowing policy.
"These improvements were noted in the Performance and Capability Review published by the DoH in February, which referred to CQC's 'considerable' achievements in setting the essential platform from which tougher regulatory action can be taken when needed," he said.
A source close to Lansley said that the failings of the CQC had developed under the last government, but are being dealt with by the current administration. "We are addressing a difficult legacy," he said. The Guardian
Health regulator 'still failing' in duty to protect patients
Health regulator 'still failing' in duty to protect patients: A senior board member at the health and social care watchdog has warned that despite a series of damning reports the regulator is still failing to protect patients from poor treatment in hospitals and care homes.
The Daily Telegraph
The Daily Telegraph
International Perspectives on Patient Engagement: Results from the 2011 Commonwealth Fund Survey
International Perspectives on Patient Engagement: Results from the 2011 Commonwealth Fund Survey: An international survey of adults with complex health care needs found wide variations in the degree to which patients are engaged in their own care, from self-managing a health condition to actively participating in treatment decisions.
The Commonwealth Fund
Thursday, 29 March 2012
The Health and Social Care Act: what next for the NHS? | Anna Dixon
The Health and Social Care Act: what next for the NHS? | Anna Dixon: How does the Health and Social Care Act differ from Lansley's original plans? And what challenges will the NHS face now as the Act is implemented? (Blog, 28 Mar 2012) Kings Fund
NHS savings progress questioned
NHS savings progress questioned: Doubts are being raised over government claims that the NHS in England is making good progress on its savings target. BBC News
Beyond consultation: a guide for health commissioners - how staff and service users can work together to improve health services
Beyond consultation: a guide for health commissioners - how staff and service users can work together to improve health services:
This guide draws on lessons and practices from the Beyond Consultation project. They are included to illustrate how an effective engagement process can be put into practice. It details a series of steps designed to encourage genuine participation and engagement between staff and service users. For each step there are questions to guide decisions, useful practical methods and tools, expected outcomes and potential challenges.
This guide draws on lessons and practices from the Beyond Consultation project. They are included to illustrate how an effective engagement process can be put into practice. It details a series of steps designed to encourage genuine participation and engagement between staff and service users. For each step there are questions to guide decisions, useful practical methods and tools, expected outcomes and potential challenges.
Effective pathways for long term conditions
Effective pathways for long term conditions:
This publication looks at taking a pathway approach to care delivery in four key areas where patients and carers want improvements: stabilising the condition to get patients back to living their lives; supporting patients to live their lives through monitoring and review; timely intervention to the appropriate service when things go wrong; and providing choice and support towards the end of life.
This publication looks at taking a pathway approach to care delivery in four key areas where patients and carers want improvements: stabilising the condition to get patients back to living their lives; supporting patients to live their lives through monitoring and review; timely intervention to the appropriate service when things go wrong; and providing choice and support towards the end of life.
Profit-seeking GPs: not the end of the NHS, but business as usual
Profit-seeking GPs: not the end of the NHS, but business as usual:
Commissioning doctors having stakes in non-NHS providers may present a conflict of interest – but this kind of thing isn't new
When Andrew Lansley's over-ambitious health and social care bill first saw the light of day early last year I was among those scornful of such a distraction at a time when the NHS was under Labour-initiated pressure to produce £20bn of efficiency savings – ie higher output for the same money – over a brisk five years.
Like most people I depend on the NHS and unlike most people I'm reaching an age where I'm starting to get my taxes back from the service. Most of the time it treats me, my friends and family pretty well – and we're grateful.
But as the bill progressed and attacks on it became ever-more hysterical, the contrarian in me obliged me to stand up for bits of it. The wretched thing won't be either as good or as bad as the warring camps say.
Whatever the politicians say now, every health secretary for the past 30 years – except Old Labour's gallant Frank Dobson – has been pushing the NHS in the same direction as the hapless Lansley, towards greater patient choice and faster, more responsive treatments in a more competitive, less monolithic environment than has existed since the great Nye Bevan's bold nationalisation in 1946-8.
Even Dobbo once admitted in my hearing: "If all my hospitals were as good as my best ones we wouldn't have a problem." That says it all really. Dobson thought the issue was all about money and capacity constraints, but it wasn't and it still isn't.
I don't subscribe to the Tories' pre-election claims that the Brown-Blair billions saw NHS productivity plummet – there is plenty of evidence to the contrary available now in terms of better cancer and heart outcomes and much else.
But we still heard too much about careless and callous behaviour, the result of poor attitudes by individual staff and systems towards patients and the taxpayer.
As for co-operation, allegedly threatened by the insertion of a highly regulated quasi-market, steady on, chaps. Co-operation between primary and hospital care, between health and social care, or mental care – they've hardly been a triumph these past 60 years.
So we may learn something from greater private and voluntary sector involvement, just as they will learn something from the values and virtues of the dear old NHS. Thus, those much-abused independent sector treatment centres (ISTCs), another Labour initiative, had a miraculous effect on the slothful performance of some NHS hospitals in the cataract, hip and knee business. I have heard NHS consultants admit it.
So I can't get as excited as the TUC-funded False Economy research group is, as reported by the Guardian on Wednesday, though I understand their concerns and am glad they are holding what is now the H&SC Act – the Queen signed off on it this week – to account. We all benefit from openness, though it's hard work.
Society's getting older, treatments (brilliant ones too) cost more, lifestyle choices wreck lives in countless avoidable ways. All advanced healthcare systems the world over (no one actually copied ours) face similar problems. There's no time to lose. Here's a smart, sceptical health website I always enjoy.
Of course, some GPs with an eye to the main financial chance, are going to take shares in private health care firms sniffing around the NHS or running out-of-hours services. They are the entrepreneurial types of medic who will always be at the fore of chances to expand their take-home pay. Plenty of doctors aren't like that, the NHS ethos is different, so that many of the cash-motivated types will long since have gone to the private sector or to fleece the old in Arizona.
It creates fresh opportunities for financial conflicts of interests, which the clinical commissioning groups (CCGs) set to handle £60bn of NHS taxpayers' cash – yours and mine – and Monitor, the economic regulator, will have to watch carefully.
The Guardian, the Sunday Times and Private Eye will all have a field day with whatever rogue-ish practice emerges from the new system, much as they did with Bevan's model.
I'll let you into a secret: GPs and hospital docs have always had a conflict of interest of this kind. Part of Bevan's compromise with the BMA (usually wrong in these battles) in the 1946-8 negotiations was to allow the GPs to remain self-employed private professionals rather than NHS state-employed staff. Hospital consultants were allowed to retain the right to do private practice on the side – using NHS hospitals, kit and even staff, if memory serves.
"I stuffed their mouths with gold," the great man explained.
There has always been tension as a result of Bevan's deal, it's been a shifting frontier, but as long as we assume that most doctors are decent people – as most of the rest of us are – then we will muddle through. There will be scandals involving those private sector sharks who are circling the NHS pool and smell blood. Some are already at it and we all hope they get blown out of the water.
But the scandal at Mid-Staffs hospital, patients neglected unto death, whistleblowers silenced and the rest, all took place in an NHS context. So do the fraudulent "ghost patient" rackets that occasionally get GPs jailed and the Harold Shipman mass murder in Hyde. That's life, it happens and the Guardian's energetic health team and live blog forum will be following it tenaciously.
Contrary to routine assertions, I have never met a British politician, however rightwing, who wants us to go down the route to the US healthcare model, though plenty think we can learn from the French, Swedes, Kiwis, Bruces and others. Lansley himself says "if there's one thing worse than a public monopoly, it's private monopoly" – not a phrase you'd catch on Rupert Murdoch's lips.
So let's not panic and say the NHS is finished. No government hoping to be re-elected could ever sanction its destruction. But times change and those elderly and sick people who staggered into the new NHS's hospitals and clinics carrying their hernias and other neglected ailments would be astonished at what we expect from the service in 2012, pampered as we are.
I leave you with a thought I picked up from Dr Donald Berwick, a champion of US public healthcare and of Obama healthcare – whose very constitutionality is being challenged in the US supreme court this week.
The American "fee-for-service" model of paying doctors for what they specifically do has almost wrecked the system. But long service and study had taught him – he sounded saintly and wise as I heard him praise the NHS – that the future lies not in salaried doctors either, but in "gain-sharing" for patient and medical staff. Here's one explanation of the concept (pdf).
It's not a panacea, nothing is, though Berwick says transparency is "almost" one. But change is unavoidable. I think that's what clunky Lansley is trying to say, he just can't get the words in the right order. The Guardian
When Andrew Lansley's over-ambitious health and social care bill first saw the light of day early last year I was among those scornful of such a distraction at a time when the NHS was under Labour-initiated pressure to produce £20bn of efficiency savings – ie higher output for the same money – over a brisk five years.
Like most people I depend on the NHS and unlike most people I'm reaching an age where I'm starting to get my taxes back from the service. Most of the time it treats me, my friends and family pretty well – and we're grateful.
But as the bill progressed and attacks on it became ever-more hysterical, the contrarian in me obliged me to stand up for bits of it. The wretched thing won't be either as good or as bad as the warring camps say.
Whatever the politicians say now, every health secretary for the past 30 years – except Old Labour's gallant Frank Dobson – has been pushing the NHS in the same direction as the hapless Lansley, towards greater patient choice and faster, more responsive treatments in a more competitive, less monolithic environment than has existed since the great Nye Bevan's bold nationalisation in 1946-8.
Even Dobbo once admitted in my hearing: "If all my hospitals were as good as my best ones we wouldn't have a problem." That says it all really. Dobson thought the issue was all about money and capacity constraints, but it wasn't and it still isn't.
I don't subscribe to the Tories' pre-election claims that the Brown-Blair billions saw NHS productivity plummet – there is plenty of evidence to the contrary available now in terms of better cancer and heart outcomes and much else.
But we still heard too much about careless and callous behaviour, the result of poor attitudes by individual staff and systems towards patients and the taxpayer.
As for co-operation, allegedly threatened by the insertion of a highly regulated quasi-market, steady on, chaps. Co-operation between primary and hospital care, between health and social care, or mental care – they've hardly been a triumph these past 60 years.
So we may learn something from greater private and voluntary sector involvement, just as they will learn something from the values and virtues of the dear old NHS. Thus, those much-abused independent sector treatment centres (ISTCs), another Labour initiative, had a miraculous effect on the slothful performance of some NHS hospitals in the cataract, hip and knee business. I have heard NHS consultants admit it.
So I can't get as excited as the TUC-funded False Economy research group is, as reported by the Guardian on Wednesday, though I understand their concerns and am glad they are holding what is now the H&SC Act – the Queen signed off on it this week – to account. We all benefit from openness, though it's hard work.
Society's getting older, treatments (brilliant ones too) cost more, lifestyle choices wreck lives in countless avoidable ways. All advanced healthcare systems the world over (no one actually copied ours) face similar problems. There's no time to lose. Here's a smart, sceptical health website I always enjoy.
Of course, some GPs with an eye to the main financial chance, are going to take shares in private health care firms sniffing around the NHS or running out-of-hours services. They are the entrepreneurial types of medic who will always be at the fore of chances to expand their take-home pay. Plenty of doctors aren't like that, the NHS ethos is different, so that many of the cash-motivated types will long since have gone to the private sector or to fleece the old in Arizona.
It creates fresh opportunities for financial conflicts of interests, which the clinical commissioning groups (CCGs) set to handle £60bn of NHS taxpayers' cash – yours and mine – and Monitor, the economic regulator, will have to watch carefully.
The Guardian, the Sunday Times and Private Eye will all have a field day with whatever rogue-ish practice emerges from the new system, much as they did with Bevan's model.
I'll let you into a secret: GPs and hospital docs have always had a conflict of interest of this kind. Part of Bevan's compromise with the BMA (usually wrong in these battles) in the 1946-8 negotiations was to allow the GPs to remain self-employed private professionals rather than NHS state-employed staff. Hospital consultants were allowed to retain the right to do private practice on the side – using NHS hospitals, kit and even staff, if memory serves.
"I stuffed their mouths with gold," the great man explained.
There has always been tension as a result of Bevan's deal, it's been a shifting frontier, but as long as we assume that most doctors are decent people – as most of the rest of us are – then we will muddle through. There will be scandals involving those private sector sharks who are circling the NHS pool and smell blood. Some are already at it and we all hope they get blown out of the water.
But the scandal at Mid-Staffs hospital, patients neglected unto death, whistleblowers silenced and the rest, all took place in an NHS context. So do the fraudulent "ghost patient" rackets that occasionally get GPs jailed and the Harold Shipman mass murder in Hyde. That's life, it happens and the Guardian's energetic health team and live blog forum will be following it tenaciously.
Contrary to routine assertions, I have never met a British politician, however rightwing, who wants us to go down the route to the US healthcare model, though plenty think we can learn from the French, Swedes, Kiwis, Bruces and others. Lansley himself says "if there's one thing worse than a public monopoly, it's private monopoly" – not a phrase you'd catch on Rupert Murdoch's lips.
So let's not panic and say the NHS is finished. No government hoping to be re-elected could ever sanction its destruction. But times change and those elderly and sick people who staggered into the new NHS's hospitals and clinics carrying their hernias and other neglected ailments would be astonished at what we expect from the service in 2012, pampered as we are.
I leave you with a thought I picked up from Dr Donald Berwick, a champion of US public healthcare and of Obama healthcare – whose very constitutionality is being challenged in the US supreme court this week.
The American "fee-for-service" model of paying doctors for what they specifically do has almost wrecked the system. But long service and study had taught him – he sounded saintly and wise as I heard him praise the NHS – that the future lies not in salaried doctors either, but in "gain-sharing" for patient and medical staff. Here's one explanation of the concept (pdf).
It's not a panacea, nothing is, though Berwick says transparency is "almost" one. But change is unavoidable. I think that's what clunky Lansley is trying to say, he just can't get the words in the right order. The Guardian
Health experts warn of hidden spread of Lyme disease
Health experts warn of hidden spread of Lyme disease: The number of Lyme disease cases in England and Wales has almost trebled since 2002 with experts warning the true number of people affected by the infection from ticks could be much higher.
The Daily Telegraph
The Daily Telegraph
Discrimination 'denying care home residents hospital access', study suggests
Discrimination 'denying care home residents hospital access', study suggests: Elderly people in care homes are being denied access to basic NHS services available to everyone because of discrimination, a major study suggests.
The Daily Telegraph
The Daily Telegraph
‘Infection prevention and control in community and primary care settings’ guideline updated
‘Infection prevention and control in community and primary care settings’ guideline updated:
NICE have today (28 March 2012) published an update to the guideline on prevention and control of healthcare–associated infections (HCAI’s) in primary and community care. This update was produced by the National Clinical Guideline Centre (NCGC), hosted at the RCP.
It is estimated that 300,000 patients a year in England acquire a HCAI as a result of care within the NHS. Against this backdrop, rapid turnover of patients in acute care settings means that more complex care is now being delivered in community settings.
read more
NICE have today (28 March 2012) published an update to the guideline on prevention and control of healthcare–associated infections (HCAI’s) in primary and community care. This update was produced by the National Clinical Guideline Centre (NCGC), hosted at the RCP.
It is estimated that 300,000 patients a year in England acquire a HCAI as a result of care within the NHS. Against this backdrop, rapid turnover of patients in acute care settings means that more complex care is now being delivered in community settings.
read more
Wednesday, 28 March 2012
Rise in hospital payout packages
Rise in hospital payout packages: The cost of exit packages paid out by hospitals in the East of England in a bid to cut staff numbers increases significantly, the BBC has learned. BBC Northamptonshire
Self-management of diabetes in Hospital
Self-management of diabetes in Hospital:
The aim of the document is to improve the safety of the in hospital management of diabetes.
Diabetes care is very individualised, especially if that person is using insulin. It follows that the person with the greatest expertise in managing diabetes is commonly the individual themselves. Allowing patients to self manage their diabetes in hospital should significantly improve patient safety. The correct support structures need to be provided to ensure that this is properly monitored but this must be done without creating unnecessary bureaucracy. NHS Networks
The aim of the document is to improve the safety of the in hospital management of diabetes.
Diabetes care is very individualised, especially if that person is using insulin. It follows that the person with the greatest expertise in managing diabetes is commonly the individual themselves. Allowing patients to self manage their diabetes in hospital should significantly improve patient safety. The correct support structures need to be provided to ensure that this is properly monitored but this must be done without creating unnecessary bureaucracy. NHS Networks
Sustainable health and social care, the environment and finance
Sustainable health and social care, the environment and finance:
A key finding is that improving efficiency at the operational level is unlikely to be sufficient. A more fundamental transformation in service models will be needed, with a greater emphasis on prevention, shifting care upstream, better integration and co-ordination of care, and an ongoing focus on maximising value for patients. NHS Networks
A key finding is that improving efficiency at the operational level is unlikely to be sufficient. A more fundamental transformation in service models will be needed, with a greater emphasis on prevention, shifting care upstream, better integration and co-ordination of care, and an ongoing focus on maximising value for patients. NHS Networks
Leaked document warns of NHS risk
Leaked document warns of NHS risk: Costs of GP care may rise and health emergencies could be harder to manage following the NHS shake-up, a leaked document warns. BBC News
MPs attack breast implant stance
MPs attack breast implant stance: The stance taken in England on replacing PIP breast implants - at the centre of a health scare - "flies in the face of common sense", MPs say. BBC News
News analysis: What the squeeze on GP prescribing means for the NHS
News analysis: What the squeeze on GP prescribing means for the NHS: As the NHS struggles with a burdensome efficiency drive, GPs are increasingly concerned about how the squeeze on prescribing will affect patients, clinical freedom and workload. GP Online
The care of frail older people with complex needs: time for a revolution
The care of frail older people with complex needs: time for a revolution:
The Sir Roger Bannister Health Summit, held at Leeds Castle, Kent in November 2011, offered The King’s Fund an opportunity to invite academics, practitioners, policy-makers and representatives from patient and voluntary organisations to discuss the care of frail older people with complex health problems. This briefing summarises the discussions.
The Sir Roger Bannister Health Summit, held at Leeds Castle, Kent in November 2011, offered The King’s Fund an opportunity to invite academics, practitioners, policy-makers and representatives from patient and voluntary organisations to discuss the care of frail older people with complex health problems. This briefing summarises the discussions.
Dementia 2012: a national challenge
Dementia 2012: a national challenge:
This report describes how well people are living with dementia in 2012 in England, Wales and Northern Ireland. Alzheimer’s Society will provide an annual report on how well people are living with dementia to help chart progress and opportunities for action, year on year.
This report describes how well people are living with dementia in 2012 in England, Wales and Northern Ireland. Alzheimer’s Society will provide an annual report on how well people are living with dementia to help chart progress and opportunities for action, year on year.
Deprivation of Liberty Safeguards 2010/11
Deprivation of Liberty Safeguards 2010/11:
The CQC have published their second annual report on the use of the Deprivation of Liberty Safeguards in care homes and hospitals throughout 2010/11.
The CQC have published their second annual report on the use of the Deprivation of Liberty Safeguards in care homes and hospitals throughout 2010/11.
Putting people first through shared decision-making and collective involvement
Putting people first through shared decision-making and collective involvement:
This paper argues that everyone who provides or receives healthcare services needs to play a role in greater decision-making. It explores what it means to put people first when commissioning and providing services, and sets out what is known about the benefits.
This paper argues that everyone who provides or receives healthcare services needs to play a role in greater decision-making. It explores what it means to put people first when commissioning and providing services, and sets out what is known about the benefits.
Government proposes 40p minimum price per unit of alcohol
Government proposes 40p minimum price per unit of alcohol:
According to data analysed by the Guardian, if the government sets the minimum price for alcohol at 40p it could increase the price of a fifth of supermarket drink offers.The paper said more than 1,000 offers were priced under 40p per unit and would not be able to be sold after 2014, when the new laws come into effect. It quotes government analysis which says: "the cost of the minimum price for the average drinker ... Healthcare Today
According to data analysed by the Guardian, if the government sets the minimum price for alcohol at 40p it could increase the price of a fifth of supermarket drink offers.The paper said more than 1,000 offers were priced under 40p per unit and would not be able to be sold after 2014, when the new laws come into effect. It quotes government analysis which says: "the cost of the minimum price for the average drinker ... Healthcare Today
Report reveals stark dangers in opening up NHS services
Report reveals stark dangers in opening up NHS services: Patients denied treatment, forced to pay for care and faced worsening health after changes to physiotherapy provision
A controversial example of private companies being allowed to provide NHS services has resulted in patients in pain being denied treatment, forced to go private and enduring "extended suffering".
Those are the findings of an internal NHS report into how patients fared when physiotherapy services in Rushcliffe, Nottinghamshire were opened up to "any willing provider" – a version of which will start affecting a range of NHS community and mental health services in England from Sunday.
The report is a secret internal "review" conducted by practice-based commissioner Principia Rushcliffe, a social enterprise that in 2009 used the Labour government's opening up of NHS community services to replace the NHS as the sole local provider of musculoskeletal services for people with neck and back pain with nine private providers. But a massive overspend in the planned £55,000 treatment budget in 2010 led to Principia last year bringing in drastic restrictions on patients' ability to access the care they needed.The Guardian
A controversial example of private companies being allowed to provide NHS services has resulted in patients in pain being denied treatment, forced to go private and enduring "extended suffering".
Those are the findings of an internal NHS report into how patients fared when physiotherapy services in Rushcliffe, Nottinghamshire were opened up to "any willing provider" – a version of which will start affecting a range of NHS community and mental health services in England from Sunday.
The report is a secret internal "review" conducted by practice-based commissioner Principia Rushcliffe, a social enterprise that in 2009 used the Labour government's opening up of NHS community services to replace the NHS as the sole local provider of musculoskeletal services for people with neck and back pain with nine private providers. But a massive overspend in the planned £55,000 treatment budget in 2010 led to Principia last year bringing in drastic restrictions on patients' ability to access the care they needed.The Guardian
It's time to talk about quality of death
It's time to talk about quality of death: Too often we forget that health care should be about providing a good quality of death as well as a good quality of life, says Chris Skidmore.
The Daily Telegraph
The Daily TelegraphHundreds of EU doctors have 'not undergone language tests'
Hundreds of EU doctors have 'not undergone language tests': Eight out of ten EU doctors working as GPs in the NHS have never had their language skills tested despite being ordered to by ministers.
The Daily Telegraph
The Daily Telegraph
'Inadequate and slow' regulator criticised over faulty breast implant scandal
'Inadequate and slow' regulator criticised over faulty breast implant scandal:
The medicines regulator failed to exercise proper vigilance over cosmetic surgery in the PIP breast implant scandal which has left thousands of women fearing for their safety, a parliamentary committee will say today. The Independent
The medicines regulator failed to exercise proper vigilance over cosmetic surgery in the PIP breast implant scandal which has left thousands of women fearing for their safety, a parliamentary committee will say today. The Independent
GPs' shares in private firms raise alarm
GPs' shares in private firms raise alarm:
Swathes of senior GPs stand to profit from the Government's contentious NHS reforms through shares they hold in private medical companies, research has found, raising further concerns about potential conflicts of interest within the health system. The Indepdendent
Swathes of senior GPs stand to profit from the Government's contentious NHS reforms through shares they hold in private medical companies, research has found, raising further concerns about potential conflicts of interest within the health system. The Indepdendent
Why are dementia patients being 'locked up'?
Why are dementia patients being 'locked up'?:
Elderly patients with dementia “are being illegally locked in their rooms” to make them easier to manage, according to The Daily Telegraph.
The claim is based on a new report looking at how well hospitals and care homes safeguard the human rights of people who cannot make decisions about their own care. It focused on the legal obligations around confining and securing individuals who may be at risk of harming themselves, such as some people with dementia, brain injuries or severe learning difficulties.
In its second annual report on the subject, the Care Quality Commission, England’s regulator of the quality of health and social care, analysed a sample of 1,212 inspection reports on care homes, NHS hospitals and independent hospitals. The CQC said that although many homes and hospitals have developed good practice around implementing legally-required safeguards, some are not meeting their obligations in this area. For example, some homes and hospitals are still confused about the safeguards and when they apply, and many staff have never received any training about them. In practice, this could mean that people’s liberty is removed – for example, they may be made to stay in their rooms – without the legal safeguards being in place.
The Commission also noted that applications to confine people rose to 8,982 in 2011, compared with 7,157 the previous year. Fifty-five per cent of these applications were authorised, compared with 46% the previous year. However, this does not necessarily mean that more people are being deprived of their liberty overall, as implied in some papers. It means that when considering depriving someone of their liberty, more homes and hospitals adhere to legal guidelines than previously.
Depriving someone of their liberty means taking away their freedom to do or live as they wish. For example, this includes:
The legal safeguards are there to ensure that these kinds of measures are considered only when it is in the best interests of the person and there is no other less-restrictive way to make sure they get the care and treatment they need.
The safeguards can be used for adults aged 18 or over in hospitals and care homes. People who may need this protection include those with severe learning disabilities, people suffering from dementia and those with brain injuries.
The authors of the report also say they found several instances where doors were locked to make it easier to manage residents’ behaviour when short-staffed without any consideration of the legal framework for the deprivation of liberty.
In less than half of NHS hospitals, reference was also made to the use of restrictions or restraints such as bedrails and locked rooms and “rapid tranquillisation”. Most of these had been used without considering legal safeguards.
The CQC also notes that although the number of applications for authorisation rose significantly in 2010/11, the 9,000 applications put forward were still far lower than the 18,600 that the Department of Health had predicted.
Cynthia Bower, CQC chief executive said: “The safeguards are vital to ensure that a person’s best interests are carefully considered, their needs fully understood, their wishes taken into account and their human rights properly respected.”
Locked up and sedated: Huge rise in number of dementia patients being 'restrained' by hospital staff and carers. Daily Mail, March 27 2012
NHS Choices
The claim is based on a new report looking at how well hospitals and care homes safeguard the human rights of people who cannot make decisions about their own care. It focused on the legal obligations around confining and securing individuals who may be at risk of harming themselves, such as some people with dementia, brain injuries or severe learning difficulties.
In its second annual report on the subject, the Care Quality Commission, England’s regulator of the quality of health and social care, analysed a sample of 1,212 inspection reports on care homes, NHS hospitals and independent hospitals. The CQC said that although many homes and hospitals have developed good practice around implementing legally-required safeguards, some are not meeting their obligations in this area. For example, some homes and hospitals are still confused about the safeguards and when they apply, and many staff have never received any training about them. In practice, this could mean that people’s liberty is removed – for example, they may be made to stay in their rooms – without the legal safeguards being in place.
The Commission also noted that applications to confine people rose to 8,982 in 2011, compared with 7,157 the previous year. Fifty-five per cent of these applications were authorised, compared with 46% the previous year. However, this does not necessarily mean that more people are being deprived of their liberty overall, as implied in some papers. It means that when considering depriving someone of their liberty, more homes and hospitals adhere to legal guidelines than previously.
What are the legal safeguards?
The Deprivation of Liberty Safeguards (often referred to as “the safeguards”) came into effect in 2009 as part of a legal framework set out in the Mental Capacity Act 2005. Their aim is to ensure that people who are mentally incapacitated, and therefore unable to make decisions for themselves, have their human rights protected when they are deprived of their liberty.Depriving someone of their liberty means taking away their freedom to do or live as they wish. For example, this includes:
- making someone stay in their room and not allowing them to leave or make visits home or see family and friends when they want to
- giving someone medicines against their will
- staff making all decisions about someone’s treatment, including choices about care options
The legal safeguards are there to ensure that these kinds of measures are considered only when it is in the best interests of the person and there is no other less-restrictive way to make sure they get the care and treatment they need.
The safeguards can be used for adults aged 18 or over in hospitals and care homes. People who may need this protection include those with severe learning disabilities, people suffering from dementia and those with brain injuries.
How do these safeguards work?
For a person to be deprived of their liberty, the care home or hospital must apply for authorisation to their “supervisory body” (an NHS care trust or a local authority). The supervisory body has to undertake six different assessments, including one specifically looking at whether deprivation of liberty would be in a person’s best interests. It then makes a decision on whether or not to approve the application. In England only primary care trusts or local councils can give permission to take away someone’s liberty, so they need to understand how the law works.What does the CQC report say?
The report has several key findings, outlined below:- Many care homes and hospitals have developed “positive practice” around the process, notably involving people and their carers in the decision-making process relating to deprivation of liberty.
- However, there appears to be some confusion about what constitutes deprivation of liberty, which can cause “inconsistent practice” between homes and hospitals.
- Some providers have still not trained their staff in the safeguards, two years after their introduction. Between a quarter and a third of care homes have not provided their staff with training on the safeguards and, in some cases, only the manager has received training.
- There is a “gap in information” on the role of the “supervisory bodies”, which needs to be addressed.
- While the number of applications for authorisations under the safeguards has risen, there continue to be areas that need to be addressed.
- The CQC also says there are concerns about the complexity of the safeguards, which it intends to discuss with the Department of Health.
How often are people "locked in their rooms"?
The report does not answer this question, but it notes that about a tenth of care homes in their sample mentioned the use of restrictions or restraints, mostly involving doors being locked or the use of bedrails. In some care homes, it says, these practices are in operation without any consideration of whether they might constitute a deprivation of liberty.The authors of the report also say they found several instances where doors were locked to make it easier to manage residents’ behaviour when short-staffed without any consideration of the legal framework for the deprivation of liberty.
In less than half of NHS hospitals, reference was also made to the use of restrictions or restraints such as bedrails and locked rooms and “rapid tranquillisation”. Most of these had been used without considering legal safeguards.
Why are so many deprivation of liberty applications being rejected?
Not all applications for safeguards are approved, and the CQC says there were a number of reasons why authorisation was not granted for nearly half the applications. In the vast majority (81%) of the cases that were turned down this was because the requirement that deprivation of liberty be in the best interests of the person was not satisfied. In the rest of these cases, other requirements – such as the “mental capacity requirement” - were not met.The CQC also notes that although the number of applications for authorisation rose significantly in 2010/11, the 9,000 applications put forward were still far lower than the 18,600 that the Department of Health had predicted.
What does the CQC conclude?
The CQC says that tackling the problem is a high priority and it plans to ask councils, healthcare trusts and other organisations to contribute to a pilot study that is being developed to improve the collection of information.Cynthia Bower, CQC chief executive said: “The safeguards are vital to ensure that a person’s best interests are carefully considered, their needs fully understood, their wishes taken into account and their human rights properly respected.”
Links To The Headlines
Dementia patients locked in rooms to make them, easier to manage. The Daily Telegraph, March 27 2012Locked up and sedated: Huge rise in number of dementia patients being 'restrained' by hospital staff and carers. Daily Mail, March 27 2012
NHS Choices
Caring for our future: what service users say
Caring for our future: what service users say:
What do service users think about adult social care and what are their fears for the future?
This report shares the results of a consultation held in November 2011 on social care reform. The consultation was carried out by Shaping Our Lives in association with the Centre for Citizen Participation at Brunel University, and was supported by the Joseph Rowntree Foundation
The study: read more
What do service users think about adult social care and what are their fears for the future?
This report shares the results of a consultation held in November 2011 on social care reform. The consultation was carried out by Shaping Our Lives in association with the Centre for Citizen Participation at Brunel University, and was supported by the Joseph Rowntree Foundation
The study: read more
Tuesday, 27 March 2012
Northampton six-year-old starved of oxygen during birth to receive £1 million NHS payout for future care
Northampton six-year-old starved of oxygen during birth to receive £1 million NHS payout for future care:
A YOUNG girl left severely brain damaged after being starved of oxygen during her difficult birth is to receive a £1 million NHS payout. Northampton Chronicle and Echo
A YOUNG girl left severely brain damaged after being starved of oxygen during her difficult birth is to receive a £1 million NHS payout. Northampton Chronicle and Echo
Survey reveals staff saw potentially harmful mistakes made at Northampton General Hospital
Survey reveals staff saw potentially harmful mistakes made at Northampton General Hospital:
FOUR in 10 Northampton General Hospital staff saw potentially harmful mistakes in the space of a month, new figures suggest. Northampton Chronicle and Echo
FOUR in 10 Northampton General Hospital staff saw potentially harmful mistakes in the space of a month, new figures suggest. Northampton Chronicle and Echo
Why continuity of care is crucial for patients | Lara Sonola
Why continuity of care is crucial for patients | Lara Sonola: Continuity and co-ordination is essential for safe, effective and high quality care and it matters to everyone. However, for older patients it has fundamental importance. (Blog, 23 Mar 2012) Kings Fund
Partnership working for child health programme
Partnership working for child health programme:
The documents include guidance, health visiting attributes, health visiting factsheets and questions and answers. NHS Networks
The documents include guidance, health visiting attributes, health visiting factsheets and questions and answers. NHS Networks
Third of babies 'to live to 100'
Third of babies 'to live to 100': A third of babies born in 2012 in the UK are expected to live to 100, according to a new report. BBC News
NHS ageism 'harming elderly care'
NHS ageism 'harming elderly care': The elderly are being passed around hospitals in England like parcels, often going without treatment because of ageist attitudes, a report suggests. BBC News
Health Bill now set for royal assent by Easter
Health Bill now set for royal assent by Easter: The Health Bill is set to receive royal assent and become law by Easter after completing its passage through parliament last week. GP Online
Choose and Book use on downward slope
Choose and Book use on downward slope: Usage of Choose and Book has fallen from a high of 57% to 50%, with some areas almost halving their use of the Department of Health's e-booking system. E-Health Insider
Seven-day NHS 'unaffordable' says BMA
Seven-day NHS 'unaffordable' says BMA: Attempts to make hospitals work seven days a week are unaffordable because the move will cost the NHS billions of pounds a year, the British Medical Association has warned. Daily Telegraph
Co-codamol recalled
Co-codamol recalled: The Medicines and Healthcare products Regulatory Agency (MHRA) has warned that some batches of co-codamol could contain incorrect strengths of the painkiller.The MHRA said a problem in manufacturing the pills could have resulted in the mistake, which meant some packets of batch LL1701, which expires in September 2014, contain 30mg instead of 8mg of co-codamol per tablet.While the 8mg tablets can be bought from ... Healthcare Today
Health reforms could damage NHS, warns draft risk register
Health reforms could damage NHS, warns draft risk register:
Document points to danger of emergencies being less well managed and increased use of private sector driving up costs
Emergencies in the NHS could be less well managed under the government's controversial health reforms, according to a draft version of a risk register on the bill (PDF) which has been leaked.
Labour claimed the register served as a "damning indictment" of the health reforms which recently passed into law after a bruising parliamentary battle.
The warnings about the threat posed by the bill were issued in a draft version of the risk register, dated 28 September 2010, which was leaked to the health writer Roy Lilley.
The government has been criticised for refusing to comply with a ruling by the information commissioner to publish the Transition Risk Register, drawn up on 10 November 2010, after an FOI request by the former shadow health secretary, John Healey.
The register sets out the risks posed by the health and social care bill which will devolve 60% of the NHS's £100bn budget to new GP-led consortia. The draft version of the register warned of:
• A longer term danger to the NHS's ability to cope with emergencies. It said: "The NHS role in emergency preparedness/responsiveness is more difficult to manage through a more devolved organisation, and so emergencies are less well managed/ mitigated."
• Greater costs if new GP-led consortiums make greater use of the private sector. "One example of area where system could be more costly is if GP Consortia makes use of private sector organisations/staff which adds costs to the overall system."
• A danger that the new system is set up too quickly, threatening the running of the NHS.
• A loss of financial control. "Financial control is lost due to the restructuring of budgets distributed between or allocated to organisations within the system [to be clarified]," it said.
• Unfavourable media coverage. "Public reputation. There is a risk that the transition will be presented in a negative light via the media. Two of the biggest risks which have already surfaced in the media are i) that the reforms will continue to be characterised through the prism of privatisation and ii) financial cuts."
Health secretary Andrew Lansley's reforms were built on demolishing a layer of management – the primary care trusts which currently purchase care on behalf of patients. But the document highlights the risk that the reforms would sow confusion between rival bodies on the ground during the transition to Lansley's new look NHS. Civil servants also rate highly the danger that the £20bn savings may not materialise as managers lose focus and that the quality of patient care suffers.
The Department of Health said that it did not comment on leaks. But it is understood that the leaked document looked familiar to officials. Ministers are likely to argue that the document is an early draft drawn up four months before the publication of the health and social care bill. Since then the bill has undergone two major changes during the government's "listening exercise" last spring and in a series of parliamentary amendments. Ministers will also say that a report to be published on Tuesday shows that the NHS is on course to meet the so called "Nicholson challenge" to save £20bn over the course of this parliament.
But Labour seized on the document. Liz Kendall, the shadow social care minister, said: "This is a damning indictment of the health bill – forced through by the Tories with cover from the Lib Dems. It shows beyond doubt the high risks the bill poses to patients and taxpayers. The government has repeatedly tried to hide these risks, but its own assessment of the bill makes them devastatingly clear. Patients and the public will not forget or forgive David Cameron for his reckless NHS gamble."
Andy Burnham, shadow health secretary, said: "Now we know why David Cameron refused to publish the risk register before the bill was through parliament – it's because civil servants were telling him his reorganisation was likely to cause major damage to the NHS. David Cameron will never be forgiven for knowingly taking these risks with the country's best-loved institution."
Clare Gerada, chair of the Royal College of General Practitioners and a critic of the reforms, tweeted that the risk register was "very scary reading & should have been disclosed long ago".
Healey said: "This is exactly the type of information that the public and parliament lacked while the bill was being debated. This shows how unprepared the NHS and civil service were for this huge NHS reorganisation."
A Department of Health spokesperson said: "We have always been open about risk and have published all relevant information in the impact assessments alongside the bill. As the latest performance figures show we are dealing with those risks, performance is improving – waiting times are down and mixed sex wards are at an all time low - and we are on course to make the efficiency savings that the NHS needs to safeguard it for the future." The Guardian
Emergencies in the NHS could be less well managed under the government's controversial health reforms, according to a draft version of a risk register on the bill (PDF) which has been leaked.
Labour claimed the register served as a "damning indictment" of the health reforms which recently passed into law after a bruising parliamentary battle.
The warnings about the threat posed by the bill were issued in a draft version of the risk register, dated 28 September 2010, which was leaked to the health writer Roy Lilley.
The government has been criticised for refusing to comply with a ruling by the information commissioner to publish the Transition Risk Register, drawn up on 10 November 2010, after an FOI request by the former shadow health secretary, John Healey.
The register sets out the risks posed by the health and social care bill which will devolve 60% of the NHS's £100bn budget to new GP-led consortia. The draft version of the register warned of:
• A longer term danger to the NHS's ability to cope with emergencies. It said: "The NHS role in emergency preparedness/responsiveness is more difficult to manage through a more devolved organisation, and so emergencies are less well managed/ mitigated."
• Greater costs if new GP-led consortiums make greater use of the private sector. "One example of area where system could be more costly is if GP Consortia makes use of private sector organisations/staff which adds costs to the overall system."
• A danger that the new system is set up too quickly, threatening the running of the NHS.
• A loss of financial control. "Financial control is lost due to the restructuring of budgets distributed between or allocated to organisations within the system [to be clarified]," it said.
• Unfavourable media coverage. "Public reputation. There is a risk that the transition will be presented in a negative light via the media. Two of the biggest risks which have already surfaced in the media are i) that the reforms will continue to be characterised through the prism of privatisation and ii) financial cuts."
Health secretary Andrew Lansley's reforms were built on demolishing a layer of management – the primary care trusts which currently purchase care on behalf of patients. But the document highlights the risk that the reforms would sow confusion between rival bodies on the ground during the transition to Lansley's new look NHS. Civil servants also rate highly the danger that the £20bn savings may not materialise as managers lose focus and that the quality of patient care suffers.
The Department of Health said that it did not comment on leaks. But it is understood that the leaked document looked familiar to officials. Ministers are likely to argue that the document is an early draft drawn up four months before the publication of the health and social care bill. Since then the bill has undergone two major changes during the government's "listening exercise" last spring and in a series of parliamentary amendments. Ministers will also say that a report to be published on Tuesday shows that the NHS is on course to meet the so called "Nicholson challenge" to save £20bn over the course of this parliament.
But Labour seized on the document. Liz Kendall, the shadow social care minister, said: "This is a damning indictment of the health bill – forced through by the Tories with cover from the Lib Dems. It shows beyond doubt the high risks the bill poses to patients and taxpayers. The government has repeatedly tried to hide these risks, but its own assessment of the bill makes them devastatingly clear. Patients and the public will not forget or forgive David Cameron for his reckless NHS gamble."
Andy Burnham, shadow health secretary, said: "Now we know why David Cameron refused to publish the risk register before the bill was through parliament – it's because civil servants were telling him his reorganisation was likely to cause major damage to the NHS. David Cameron will never be forgiven for knowingly taking these risks with the country's best-loved institution."
Clare Gerada, chair of the Royal College of General Practitioners and a critic of the reforms, tweeted that the risk register was "very scary reading & should have been disclosed long ago".
Healey said: "This is exactly the type of information that the public and parliament lacked while the bill was being debated. This shows how unprepared the NHS and civil service were for this huge NHS reorganisation."
A Department of Health spokesperson said: "We have always been open about risk and have published all relevant information in the impact assessments alongside the bill. As the latest performance figures show we are dealing with those risks, performance is improving – waiting times are down and mixed sex wards are at an all time low - and we are on course to make the efficiency savings that the NHS needs to safeguard it for the future." The Guardian
Dementia patients locked in rooms to make them 'easier to manage'
Dementia patients locked in rooms to make them 'easier to manage': Staff in care homes and hospitals are routinely ignoring patients' human rights over restraint techniques, official report warns.
The Daily Telegraph
The Daily TelegraphMonday, 26 March 2012
Evaluation of integrated care pilots
Evaluation of integrated care pilots:
The evaluation which commenced in 2009 looked at 16 sites across England who undertook different ways of integrating care, for example, between general practices, community nurses, hospitals and social services.
The report also provides information on evalution methods, data collection and analysis. NHS Networks
The evaluation which commenced in 2009 looked at 16 sites across England who undertook different ways of integrating care, for example, between general practices, community nurses, hospitals and social services.
The report also provides information on evalution methods, data collection and analysis. NHS Networks
Diabetes issues 'at record high'
Diabetes issues 'at record high': Rates of stroke and kidney failure in people with diabetes have reached record levels in England, according to new analysis by Diabetes UK. BBC News
VIDEO: Dementia to be 'national priority'
VIDEO: Dementia to be 'national priority': Care Services Minister Paul Burstow says working towards an earlier diagnosis for dementia must be a priority, as funding for research is to be more than doubled to £66m by 2015. BBC News
Reducing migrant nurses ''will harm care''
Reducing migrant nurses ''will harm care'': The move could have a ''significant impact'' on the quality of healthcare, the government has admitted Public Service
Industrial action update
Industrial action update from Dean Royles: Our director, Dean Royles, has written to HR directors in the NHS with an update on the decisions being made by the various trade unions, in response to the NHS Pension Scheme reforms. NHS Employers
Identifying and managing tuberculosis (TB) among hard-to-reach groups
Identifying and managing tuberculosis (TB) among hard-to-reach groups:
This guidance sets out how commissioners and providers of TB services and other statutory and voluntary organisations that work with hard-to-reach groups can achieve better outcomes through targeted action to find patients early, and by providing intensive clinical and social support to help them complete TB treatment.
This guidance sets out how commissioners and providers of TB services and other statutory and voluntary organisations that work with hard-to-reach groups can achieve better outcomes through targeted action to find patients early, and by providing intensive clinical and social support to help them complete TB treatment.
Alcohol strategy
Alcohol strategy:
This strategy sets out Government proposals to crack down on binge drinking culture, cut down on alcohol fuelled violence and disorder and slash the number of people drinking to damaging levels. It includes commitments to introduce a minimum unit price for alcohol; consult on a ban on the sale of multi-buy alcohol discounting; introduce stronger powers for local areas to control the density of licensed premises; and pilot innovative sobriety schemes to challenge alcohol-related offending.
This strategy sets out Government proposals to crack down on binge drinking culture, cut down on alcohol fuelled violence and disorder and slash the number of people drinking to damaging levels. It includes commitments to introduce a minimum unit price for alcohol; consult on a ban on the sale of multi-buy alcohol discounting; introduce stronger powers for local areas to control the density of licensed premises; and pilot innovative sobriety schemes to challenge alcohol-related offending.
How GPs are set to make a killing out of NHS reform
How GPs are set to make a killing out of NHS reform:
He is arguably the medical profession's highest-profile cheerleader for the most radical reorganisation of the NHS the UK has seen. And, as one of Britain's most senior GPs, he holds our trust. But Dr Shane Gordon is also one of a number of GPs backing Andrew Lansley's reforms who stand to profit personally. And that, critics claim, is the embodiment of a fundamental flaw in the new Bill which could dangerously erode public trust in the NHS – the potentially volatile mix of money and medicine. The Independent
He is arguably the medical profession's highest-profile cheerleader for the most radical reorganisation of the NHS the UK has seen. And, as one of Britain's most senior GPs, he holds our trust. But Dr Shane Gordon is also one of a number of GPs backing Andrew Lansley's reforms who stand to profit personally. And that, critics claim, is the embodiment of a fundamental flaw in the new Bill which could dangerously erode public trust in the NHS – the potentially volatile mix of money and medicine. The Independent
What the NHS can learn from accountable care organisations
What the NHS can learn from accountable care organisations:
The new health models being used in the US are similar to those coming to Britain: the aim is to cut costs while improving the service, says Mark Zezza
Among all the health reform activities in the United States, the arrival of accountable care organisations is considered one of the more promising for bending the health care cost curve while improving patient outcomes.
Accountable care organisations are providers that are held accountable for the cost and quality of care for a defined population of patients. The successful ones are expected to manage costs by aligning incentives for hospitals, physicians and other providers to encourage better co-ordination and to promote continuous quality improvement efforts. Those that are able to keep costs below specified amounts can share in the savings, contingent upon meeting performance standards.
The organisational model is still relatively new and untested. In fact, the results for the Medicare physician group practice demonstration, one of the largest such efforts to date, has been mixed at best: only half of the 10 participants have achieved cost-reduction targets by the end of the fifth year.
However, providers and payers remain committed to the concept. Over the next year, the number is expected to grow substantially, as a new Medicare programme designed specifically for accountable care organisations is set to begin in April. Interestingly, the model bears a strong resemblance to the basis of proposed reforms being introduced in the NHS in the United Kingdom – ie, the clinical commissioning groups. These will also be provider-led and be responsible for managing the health of a defined population of patients under a budget.
At the recent Nuffield Trust Summit, I had the chance to meet several NHS delegates and other UK stakeholders. Three key issues were raised, which I have outlined in more detail below.
Flexibility in design
A key feature of the accountable care organisations framework is its inherent flexibility. For example, participating provider organisations can range from integrated delivery systems to loosely affiliated physician groups that may be linked together through a regional health information exchange.
In addition, payment models can range from one-sided approaches that reward providers for reducing costs, but do not hold them at risk of any excess costs, to two-sided approaches, in which providers can achieve even larger rewards, but are held accountable for excess costs.
Since the US programme is voluntary, this flexibility can help encourage broad participation. However, too low a barrier for entry could lead to the enrolment of providers not ready to co-ordinate and manage care effectively, potentially resulting in wasted investments.
Hospital participation
One suggested cost-reduction strategy is to avoid high-cost hospital services. However, those services represent revenue to hospitals, which calls into question the value proposition for a hospital to participate in the new model.
On the other hand, hospitals can be considered logical leaders for the new model organisations. For example, they already have a management structure and are likely to have a data sharing infrastructure in place, as well as the capital available for the upfront investments needed.
In addition, hospitals may be motivated to protect their market share, realising that change may be inevitable as current payment rates are unsustainable and physician groups and competing hospitals may already be getting a head start in reform efforts.
Engaging patients
The new organisational model does not require any insurance benefit design changes. For example, patients assigned to an ACO under the Medicare program would still have access to other Medicare providers. While this helps ensure that patients retain choice, it also makes it harder for ACOs to manage the care of their patients. Ideally, they will retain their patients by providing high-quality care associated with positive patient experiences.
Conclusions
As can be gathered from this sampling of issues, the new model is certainly not a sure fix to the problems in the United States health care system. It represents a sharp change from the current health care environment in which most providers are not well-equipped to co-ordinate care and have little financial incentive to do so because of the predominant fee-for-service payment system which rewards inefficiency by paying more for more care, regardless of the impact on patient health.
Thus, it would likely take years and many modifications from lessons learned, to foster the type of change that can permanently bend the cost curve. Given that similar issues are being faced by the NHS, ideally that process can be accelerated by sharing lessons learned across health systems on both sides of the Atlantic.
Dr Mark Zezza is a senior policy analyst at The Commonwealth Fund in the United States. He presented at the Nuffield Trust's Health Policy Summit 2012. Guardian Professional.
Among all the health reform activities in the United States, the arrival of accountable care organisations is considered one of the more promising for bending the health care cost curve while improving patient outcomes.
Accountable care organisations are providers that are held accountable for the cost and quality of care for a defined population of patients. The successful ones are expected to manage costs by aligning incentives for hospitals, physicians and other providers to encourage better co-ordination and to promote continuous quality improvement efforts. Those that are able to keep costs below specified amounts can share in the savings, contingent upon meeting performance standards.
The organisational model is still relatively new and untested. In fact, the results for the Medicare physician group practice demonstration, one of the largest such efforts to date, has been mixed at best: only half of the 10 participants have achieved cost-reduction targets by the end of the fifth year.
However, providers and payers remain committed to the concept. Over the next year, the number is expected to grow substantially, as a new Medicare programme designed specifically for accountable care organisations is set to begin in April. Interestingly, the model bears a strong resemblance to the basis of proposed reforms being introduced in the NHS in the United Kingdom – ie, the clinical commissioning groups. These will also be provider-led and be responsible for managing the health of a defined population of patients under a budget.
At the recent Nuffield Trust Summit, I had the chance to meet several NHS delegates and other UK stakeholders. Three key issues were raised, which I have outlined in more detail below.
Flexibility in design
A key feature of the accountable care organisations framework is its inherent flexibility. For example, participating provider organisations can range from integrated delivery systems to loosely affiliated physician groups that may be linked together through a regional health information exchange.
In addition, payment models can range from one-sided approaches that reward providers for reducing costs, but do not hold them at risk of any excess costs, to two-sided approaches, in which providers can achieve even larger rewards, but are held accountable for excess costs.
Since the US programme is voluntary, this flexibility can help encourage broad participation. However, too low a barrier for entry could lead to the enrolment of providers not ready to co-ordinate and manage care effectively, potentially resulting in wasted investments.
Hospital participation
One suggested cost-reduction strategy is to avoid high-cost hospital services. However, those services represent revenue to hospitals, which calls into question the value proposition for a hospital to participate in the new model.
On the other hand, hospitals can be considered logical leaders for the new model organisations. For example, they already have a management structure and are likely to have a data sharing infrastructure in place, as well as the capital available for the upfront investments needed.
In addition, hospitals may be motivated to protect their market share, realising that change may be inevitable as current payment rates are unsustainable and physician groups and competing hospitals may already be getting a head start in reform efforts.
Engaging patients
The new organisational model does not require any insurance benefit design changes. For example, patients assigned to an ACO under the Medicare program would still have access to other Medicare providers. While this helps ensure that patients retain choice, it also makes it harder for ACOs to manage the care of their patients. Ideally, they will retain their patients by providing high-quality care associated with positive patient experiences.
Conclusions
As can be gathered from this sampling of issues, the new model is certainly not a sure fix to the problems in the United States health care system. It represents a sharp change from the current health care environment in which most providers are not well-equipped to co-ordinate care and have little financial incentive to do so because of the predominant fee-for-service payment system which rewards inefficiency by paying more for more care, regardless of the impact on patient health.
Thus, it would likely take years and many modifications from lessons learned, to foster the type of change that can permanently bend the cost curve. Given that similar issues are being faced by the NHS, ideally that process can be accelerated by sharing lessons learned across health systems on both sides of the Atlantic.
Dr Mark Zezza is a senior policy analyst at The Commonwealth Fund in the United States. He presented at the Nuffield Trust's Health Policy Summit 2012. Guardian Professional.
NHS shakeup spells 'unprecedented chaos', warns Lancet editor
NHS shakeup spells 'unprecedented chaos', warns Lancet editor:
Dr Richard Horton predicts patients will die as a result of health and social care bill's focus on competition over quality
The NHS will be thrown into chaos by the government's shakeup and patients will die as a result, the editor of a medical journal has written.
Dr Richard Horton, the editor of the Lancet, called for a concerted campaign to overturn the health and social care bill which finally completed its parliamentary passage this week.
Horton also complained about a "failure" of leadership by professional medical bodies which did not prevent the coalition proceeding with its plans.
"We are about to see a phase of unprecedented chaos in our health services," he wrote on the Red Pepper website.
"Those of us who opposed the bill should not gloat as this confusion takes hold.
"People will die thanks to the government's decision to focus on competition rather than quality in healthcare.
"The coming disaster puts even greater responsibility on us to overturn this destructive legislation."
Horton accused Labour of being "slow to respond" to the government's "assault" on the NHS and said an inquest was needed into "the abysmal failure of medical 'leadership'.
"Early and united opposition would have seen off the Bill long ago. Instead our leaders, in trade unions and professional bodies, saw 'opportunities' and decided they could work with it on our behalf.
"When they were finally persuaded to see the dangers, their policy changed to seeking 'significant amendments', despite the fact that the government showed no sign of conceding any."
The bitter 14-month parliamentary battle over the coalition's NHS changes finally came to an end this week after the government comfortably fended off a desperate 11th-hour attempt by Labour to delay the legislation.
MPs then approved the last amendments – leaving the way clear for royal assent to be granted before parliament starts its Easter recess next week.
The NHS shakeup has threatened to drive a wedge between the coalition partners ever since it was announced by the Tory health secretary, Andrew Lansley.
It is intended to give GPs greater control over NHS budgets, reduce bureaucracy and increase patient choice.
But furious opposition from professional bodies and Lib Dem activists led the prime minister, David Cameron, and the deputy prime minister, Nick Clegg, to take the highly unusual step of "pausing" the legislation last year.
Despite accepting more than a thousand amendments – including limits on competition and private-sector involvement – the government has failed to win over many health workers. The Guardian
The NHS will be thrown into chaos by the government's shakeup and patients will die as a result, the editor of a medical journal has written.
Dr Richard Horton, the editor of the Lancet, called for a concerted campaign to overturn the health and social care bill which finally completed its parliamentary passage this week.
Horton also complained about a "failure" of leadership by professional medical bodies which did not prevent the coalition proceeding with its plans.
"We are about to see a phase of unprecedented chaos in our health services," he wrote on the Red Pepper website.
"Those of us who opposed the bill should not gloat as this confusion takes hold.
"People will die thanks to the government's decision to focus on competition rather than quality in healthcare.
"The coming disaster puts even greater responsibility on us to overturn this destructive legislation."
Horton accused Labour of being "slow to respond" to the government's "assault" on the NHS and said an inquest was needed into "the abysmal failure of medical 'leadership'.
"Early and united opposition would have seen off the Bill long ago. Instead our leaders, in trade unions and professional bodies, saw 'opportunities' and decided they could work with it on our behalf.
"When they were finally persuaded to see the dangers, their policy changed to seeking 'significant amendments', despite the fact that the government showed no sign of conceding any."
The bitter 14-month parliamentary battle over the coalition's NHS changes finally came to an end this week after the government comfortably fended off a desperate 11th-hour attempt by Labour to delay the legislation.
MPs then approved the last amendments – leaving the way clear for royal assent to be granted before parliament starts its Easter recess next week.
The NHS shakeup has threatened to drive a wedge between the coalition partners ever since it was announced by the Tory health secretary, Andrew Lansley.
It is intended to give GPs greater control over NHS budgets, reduce bureaucracy and increase patient choice.
But furious opposition from professional bodies and Lib Dem activists led the prime minister, David Cameron, and the deputy prime minister, Nick Clegg, to take the highly unusual step of "pausing" the legislation last year.
Despite accepting more than a thousand amendments – including limits on competition and private-sector involvement – the government has failed to win over many health workers. The Guardian
Britain is failing to care for older people with cancer | Ciarán Devane
Britain is failing to care for older people with cancer | Ciarán Devane:
Older people diagnosed with cancer are being under treated because of their age. This is discrimination and must stop
For some, age is just a number. But for older cancer patients it can be a very serious barrier to the best – and most appropriate – treatment. While cancer mortality rates are improving significantly for people under 75, the rate is much slower in the older population. In fact cancer mortality is actually getting worse for people aged 85 and over – as a result, there are about 14,000 avoidable cancer deaths in patients over 75 in the UK each year.
There is mounting evidence to show that older people are being under treated. They are less likely to receive surgery, radiotherapy and chemotherapy than young people and Macmillan Cancer Support is concerned that treatment decisions are too often based on age, not on a patient's overall fitness. A recent Department of Health study for instance found that age was a significant factor in determining treatment recommendations. People are being looked at just as a number, rather than an individual. We would not allow people to be refused treatment for a life-threatening disease just based on their gender. Or their race. Why should age be your one determining factor?
Macmillan's own research highlights examples when patients have been told their age is the reason for them not receiving treatment. I have heard from a 67-year-old man who was told, when offered treatment options, that if he were 70 or over, it would be unlikely his doctor would offer surgery. There was no assessment of his health or fitness levels – his age was the only thing the doctor took into account.
Similarly, I know of a lady who wasn't encouraged to have chemotherapy purely because she was "60, not 30". People are still running marathons aged 60 and beyond – should they not be given the best chance against a fatal disease?
This situation isn't unique to the UK. But countries such as France and the US have been tackling this issue for more than a decade. We're only just waking up to it.
Older people can often tolerate and benefit from the same treatments as younger patients, but in many cases they simply aren't offered it. Cancer treatments can have unpleasant side-effects at any age. Yet there is a reason for this – it is killing off the cancer inside their bodies. We can't make assumptions about how well someone will cope with a particular treatment just because of their age. Is it because we assume that because someone is 70, 80 or 90, they're not going to live much longer? One 70-year-old may have another 10 years of good quality life ahead of them, another just a few years. This is why we need to treat older people as individuals.
The problem is, the current method of assessing older people for treatment is simply not right. Treating patients where there is no long-term gain is just as undesirable. What we need are fuller assessments of older patients to ensure they get the most appropriate treatment for their cancer.
Admittedly, there are other things affecting older people that can contribute to poor survival rates among this age group – by the time people are in their 80s, for instance, they can be suffering from several conditions. Yet co-existing health problems are often not understood by cancer specialists and are not effectively managed. On some occasions, people could be made well enough for treatment but aren't.
A side-effect of a drug for a different condition is sometimes seen as a reason to deny an older patient chemotherapy. But just a simple conversation between a patient and a specialist would have avoided the mistake.
Another obstacle older people face is that they are not represented enough on clinical trials. Clinicians, therefore, just don't know what impact a treatment will have – whether it will save or risk the patient's life. We want older cancer patients to be better represented on these trials.
Sometimes it's not that older patients are denied treatment – often they reject it, thinking it's not possible. They may have a spouse to care for at home or not be able to get to the hospital on their own. These things can be easily solved but elderly patients often don't know they can ask for practical support.
This issue has been brushed under the carpet for long enough. Our population is aging and, as the number of people diagnosed with cancer is creeping up, it is vital we ensure everyone gets the correct treatment.
The last decade has seen dramatic improvements in cancer treatment and services, but we must not ignore the fact that older people with cancer are not being treated fairly. They still have the worst chance of beating this disease. It simply isn't fair and is an act of discrimination that would not be allowed in any other sector of society.
This is why Macmillan has launched its Age Old Excuse campaign – someone needs to bring these issues to light. The NHS and social care providers must wake up to the specific issues older people face and ensure treatment decisions are based on their overall health – not their date of birth. The Guardian
For some, age is just a number. But for older cancer patients it can be a very serious barrier to the best – and most appropriate – treatment. While cancer mortality rates are improving significantly for people under 75, the rate is much slower in the older population. In fact cancer mortality is actually getting worse for people aged 85 and over – as a result, there are about 14,000 avoidable cancer deaths in patients over 75 in the UK each year.
There is mounting evidence to show that older people are being under treated. They are less likely to receive surgery, radiotherapy and chemotherapy than young people and Macmillan Cancer Support is concerned that treatment decisions are too often based on age, not on a patient's overall fitness. A recent Department of Health study for instance found that age was a significant factor in determining treatment recommendations. People are being looked at just as a number, rather than an individual. We would not allow people to be refused treatment for a life-threatening disease just based on their gender. Or their race. Why should age be your one determining factor?
Macmillan's own research highlights examples when patients have been told their age is the reason for them not receiving treatment. I have heard from a 67-year-old man who was told, when offered treatment options, that if he were 70 or over, it would be unlikely his doctor would offer surgery. There was no assessment of his health or fitness levels – his age was the only thing the doctor took into account.
Similarly, I know of a lady who wasn't encouraged to have chemotherapy purely because she was "60, not 30". People are still running marathons aged 60 and beyond – should they not be given the best chance against a fatal disease?
This situation isn't unique to the UK. But countries such as France and the US have been tackling this issue for more than a decade. We're only just waking up to it.
Older people can often tolerate and benefit from the same treatments as younger patients, but in many cases they simply aren't offered it. Cancer treatments can have unpleasant side-effects at any age. Yet there is a reason for this – it is killing off the cancer inside their bodies. We can't make assumptions about how well someone will cope with a particular treatment just because of their age. Is it because we assume that because someone is 70, 80 or 90, they're not going to live much longer? One 70-year-old may have another 10 years of good quality life ahead of them, another just a few years. This is why we need to treat older people as individuals.
The problem is, the current method of assessing older people for treatment is simply not right. Treating patients where there is no long-term gain is just as undesirable. What we need are fuller assessments of older patients to ensure they get the most appropriate treatment for their cancer.
Admittedly, there are other things affecting older people that can contribute to poor survival rates among this age group – by the time people are in their 80s, for instance, they can be suffering from several conditions. Yet co-existing health problems are often not understood by cancer specialists and are not effectively managed. On some occasions, people could be made well enough for treatment but aren't.
A side-effect of a drug for a different condition is sometimes seen as a reason to deny an older patient chemotherapy. But just a simple conversation between a patient and a specialist would have avoided the mistake.
Another obstacle older people face is that they are not represented enough on clinical trials. Clinicians, therefore, just don't know what impact a treatment will have – whether it will save or risk the patient's life. We want older cancer patients to be better represented on these trials.
Sometimes it's not that older patients are denied treatment – often they reject it, thinking it's not possible. They may have a spouse to care for at home or not be able to get to the hospital on their own. These things can be easily solved but elderly patients often don't know they can ask for practical support.
This issue has been brushed under the carpet for long enough. Our population is aging and, as the number of people diagnosed with cancer is creeping up, it is vital we ensure everyone gets the correct treatment.
The last decade has seen dramatic improvements in cancer treatment and services, but we must not ignore the fact that older people with cancer are not being treated fairly. They still have the worst chance of beating this disease. It simply isn't fair and is an act of discrimination that would not be allowed in any other sector of society.
This is why Macmillan has launched its Age Old Excuse campaign – someone needs to bring these issues to light. The NHS and social care providers must wake up to the specific issues older people face and ensure treatment decisions are based on their overall health – not their date of birth. The Guardian
Agencies make millions from £120-an-hour doctors
Agencies make millions from £120-an-hour doctors: Dozens of medical "temping agencies" are making millions of pounds in commission providing part-time doctors for the NHS.
The Daily Telegraph
The Daily Telegraph
Nationwide dementia screening to tackle 'crisis' among elderly
Nationwide dementia screening to tackle 'crisis' among elderly: The first nationwide NHS screening programme to identify dementia patients earlier is to be launched to battle Britain's "crisis" among the elderly.
The Daily Telegraph
The Daily Telegraph
Funding doubled in effort to defeat dementia crisis
Funding doubled in effort to defeat dementia crisis:
Funding for dementia research will be more than doubled by 2015 to tackle "one of the greatest challenges of our time" and make Britain a world leader in the field, David Cameron will announce today. The Independent
Funding for dementia research will be more than doubled by 2015 to tackle "one of the greatest challenges of our time" and make Britain a world leader in the field, David Cameron will announce today. The Independent
More than 9,000 TB cases reported in 2011
More than 9,000 TB cases reported in 2011: Provisional figures released today by the Health Protection Agency (HPA) show there were 9,042 new cases of tuberculosis (TB) in the UK in 2011. Compared to provisional numbers reported in 2010 (8,587), this is a five per cent increase. Health Protection Agency
Friday, 23 March 2012
Severe constipation killed schizophrenic patient at Northampton mental healthcare unit
Severe constipation killed schizophrenic patient at Northampton mental healthcare unit:
A PATIENT at a mental healthcare facility in Northampton died after suffering from severe constipation believed to be caused by a drug he had been prescribed to treat his schizophrenia, an inquest heard. Northampton Chronicle and Echo
A PATIENT at a mental healthcare facility in Northampton died after suffering from severe constipation believed to be caused by a drug he had been prescribed to treat his schizophrenia, an inquest heard. Northampton Chronicle and Echo
Is patient engagement important in leadership? | Angela Coulter
Is patient engagement important in leadership? | Angela Coulter: If only NHS staff could be persuaded to do a better job of engaging individual patients in their own care, the effect on health outcomes could be far more dramatic than the sum total of all those extra meetings, consultations and service reviews that HealthWatch will be expected to endorse. (Blog, 22 Mar 2012) Kings Fund
the week: issue 240
the week: issue 240:
On the agenda this week: the 2011 NHS Staff Survey results are published with a summary plus full report for all trusts, the Department confirms £10 million of funding for children’s hospices, and the first national lung cancer campaign is announced, aiming to encourage people with a persistent cough to visit their GP and raise public awareness of the symptoms of lung cancer. Department of Health
Download ‘the week’: issue 240 16 – 22 March 2012 (RTF, 523KB)
On the agenda this week: the 2011 NHS Staff Survey results are published with a summary plus full report for all trusts, the Department confirms £10 million of funding for children’s hospices, and the first national lung cancer campaign is announced, aiming to encourage people with a persistent cough to visit their GP and raise public awareness of the symptoms of lung cancer. Department of Health
Download ‘the week’: issue 240 16 – 22 March 2012 (RTF, 523KB)
Abortion clinics get spot-checks
Abortion clinics get spot-checks: Inspectors have been ordered into abortion clinics across England to carry out spot-checks on how they work. BBC News
Extra smoking help 'doesn't work'
Extra smoking help 'doesn't work': Offering free nicotine patches or intensive counselling to smokers calling the English NHS helpline does not help them quit, a study in the BMJ says. BBC News
More health integration ''improved care''
More health integration ''improved care'': Greater integration in the NHS has led to more satisfied staff and reduced the use of hospitals, says study Public Service
National evaluation of Department of Health's integrated care pilots
National evaluation of Department of Health's integrated care pilots:
This evaluation, which commenced in 2009, looked at 16 sites across England which undertook different ways of integrating care, for example, between general practices, community nurses, hospitals and social services. It also provides information on evalution methods, data collection and analysis.
This evaluation, which commenced in 2009, looked at 16 sites across England which undertook different ways of integrating care, for example, between general practices, community nurses, hospitals and social services. It also provides information on evalution methods, data collection and analysis.
Sustainable health and social care: connecting environmental and financial performance
Sustainable health and social care: connecting environmental and financial performance:
This report is based on a literature review and stakeholder consultation carried out by The King’s Fund on behalf of the National Institute for Health Research and the Social Care Institute for Excellence. It provides an overview of current knowledge about the environmental impacts of health and social care and examines the evidence for a connection between sustainability, productivity and other system objectives.
This report is based on a literature review and stakeholder consultation carried out by The King’s Fund on behalf of the National Institute for Health Research and the Social Care Institute for Excellence. It provides an overview of current knowledge about the environmental impacts of health and social care and examines the evidence for a connection between sustainability, productivity and other system objectives.
Trust still overspends on wages despite pay freeze
Trust still overspends on wages despite pay freeze: NHS trusts are still overspending on wage bills, despite a pay freeze being in place.
An investigation by HSJ showed that acute hospitals have run up an estimated £300m overspend on wage bills so far this year.
In addition, while the number of pay increments withheld from staff has doubled in 2011-12 compared with 2010-11, many employees are automatically being handed incremental rises worth on average... Healthcare Today
An investigation by HSJ showed that acute hospitals have run up an estimated £300m overspend on wage bills so far this year.
In addition, while the number of pay increments withheld from staff has doubled in 2011-12 compared with 2010-11, many employees are automatically being handed incremental rises worth on average... Healthcare Today
New guidance points the way to tackling tuberculosis among hard-to-reach groups
New guidance points the way to tackling tuberculosis among hard-to-reach groups: New public health guidance from NICE provides a blueprint for improving the way tuberculosis (TB) is identified and managed among groups of people who are hard to reach through traditional health care services. NICE
NHS employers warn George Osborne against imposing local pay rates
NHS employers warn George Osborne against imposing local pay rates:
Health managers say reforms could lead to staff shortages, low morale and worse patient care
The government faces another bruising dispute with the NHS if it pushes ahead with full-blown local pay bargaining for millions of public sector workers, after health employers warned it could lead to staff shortages, low morale and worse patient care.
Chancellor George Osborne confirmed in his budget statement on Wednesday that he wants to see public sector pay "more responsive to local pay rates", to help the private sector recruit and expand.
Unions have also criticised the proposals, but criticism from the biggest public sector employer group will be harder to brush aside.
In its submission to the official consultation on the scheme, the NHS Employers group, which represents more than 2,500 hospitals and other health service bodies employing more than 1 million NHS workers who would be affected by the changes, said that it did not support localised pay rates, but would like more flexibility to help recruit and retain staff in areas with higher costs of living, for example.
Among the problems highlighted by NHS Employers were difficulties hiring or keeping staff who could earn more in nearby areas. It said the changes could also lead to the NHS paying much more for staff in some areas, so increasing the total wage bill, and would add greatly to bureaucracy and administration, with hundreds if not thousands of different wage negotiations.
"Getting rewards wrong could have a significant impact on the quality of patient care and safety," the group said.
Instead, the organisation said that existing flexible terms, such as premiums for recruitment and retention in difficult areas and London weighting payments to compensate for higher housing costs in the capital, should be extended.
The National Union of Teachers, the country's largest teaching union, also warned that the plans would lead to "real teacher shortages" in areas where pay is dragged down.
The chancellor sent evidence to pay review bodies on Wednesday to make the case for moving to local pay rates. The document suggests a pay "premium" of about 8% currently exists for those working in the public sector compared with similar jobs in the private sector, and that the public sector "pays more than is necessary" to recruit, retain and motivate staff.
It goes on to say: "The evidence suggests that the quality of public services would directly benefit if public sector pay became more responsive to local labour markets. In places where private sector firms have to compete for workers with public sector employers offering a large pay premium, the introduction of more local, market facing pay could help private businesses, particularly in some sectors become more competitive and expand."
The Local Government Association, whose members represent another major segment of public sector employers, abandoned national pay bargaining 15 years ago.
The move was taken because some councils in south-east England were finding it hard to recruit staff in areas with relatively high costs of living. However it is understood that before the recession some councils had the opposite problem, of hiring or keeping hard-to-recruit groups like social workers in areas with lower pay scales. The Guardian
The government faces another bruising dispute with the NHS if it pushes ahead with full-blown local pay bargaining for millions of public sector workers, after health employers warned it could lead to staff shortages, low morale and worse patient care.
Chancellor George Osborne confirmed in his budget statement on Wednesday that he wants to see public sector pay "more responsive to local pay rates", to help the private sector recruit and expand.
Unions have also criticised the proposals, but criticism from the biggest public sector employer group will be harder to brush aside.
In its submission to the official consultation on the scheme, the NHS Employers group, which represents more than 2,500 hospitals and other health service bodies employing more than 1 million NHS workers who would be affected by the changes, said that it did not support localised pay rates, but would like more flexibility to help recruit and retain staff in areas with higher costs of living, for example.
Among the problems highlighted by NHS Employers were difficulties hiring or keeping staff who could earn more in nearby areas. It said the changes could also lead to the NHS paying much more for staff in some areas, so increasing the total wage bill, and would add greatly to bureaucracy and administration, with hundreds if not thousands of different wage negotiations.
"Getting rewards wrong could have a significant impact on the quality of patient care and safety," the group said.
Instead, the organisation said that existing flexible terms, such as premiums for recruitment and retention in difficult areas and London weighting payments to compensate for higher housing costs in the capital, should be extended.
The National Union of Teachers, the country's largest teaching union, also warned that the plans would lead to "real teacher shortages" in areas where pay is dragged down.
The chancellor sent evidence to pay review bodies on Wednesday to make the case for moving to local pay rates. The document suggests a pay "premium" of about 8% currently exists for those working in the public sector compared with similar jobs in the private sector, and that the public sector "pays more than is necessary" to recruit, retain and motivate staff.
It goes on to say: "The evidence suggests that the quality of public services would directly benefit if public sector pay became more responsive to local labour markets. In places where private sector firms have to compete for workers with public sector employers offering a large pay premium, the introduction of more local, market facing pay could help private businesses, particularly in some sectors become more competitive and expand."
The Local Government Association, whose members represent another major segment of public sector employers, abandoned national pay bargaining 15 years ago.
The move was taken because some councils in south-east England were finding it hard to recruit staff in areas with relatively high costs of living. However it is understood that before the recession some councils had the opposite problem, of hiring or keeping hard-to-recruit groups like social workers in areas with lower pay scales. The Guardian
Number of children with autism soars by more than 50 per cent in five years
Number of children with autism soars by more than 50 per cent in five years: The number of schoolchildren who are classified as being autistic has soared by 56 per cent in the last five years.
The Daily Telegraph
The Daily Telegraph
Health workers to vote on pensions
Health workers to vote on pensions:
Almost half a million health workers are to vote on the Government's controversial public sector pension reforms, with rejection leading to the prospect of fresh industrial action. The Independent
Almost half a million health workers are to vote on the Government's controversial public sector pension reforms, with rejection leading to the prospect of fresh industrial action. The Independent
Subscribe to:
Posts (Atom)