Whooping cough jabs to be made available to pregnant women in Northants

Whooping cough jabs to be made available to pregnant women in Northants: Pregnant women in Northamptonshire will be offered whooping cough vaccinations as part of a nationwide drive to protect their newborn babies following a rise in cases and deaths amongst young infants. Northampton Chornicle and Echo

Balancing liberation with accountability?

Balancing liberation with accountability?:How should a multi-billion pound quango be held to account? This is the challenge that faces the Department of Health in setting out a mandate for the NHS Commissioning Board which will take over responsibility for the majority of the NHS budget in April 2013. The Board will be responsible for directly commissioning services worth around £20 billion and for allocating more than £60 billion to more than 200 clinical commissioning groups.

We’re all whistleblowers now

We’re all whistleblowers now: Medicine and nursing are unique amongst professions in their capacity to do significant harm as well and a huge amount of good, and yet the culture of openly acknowledging the harm we do and measuring it to learn from and minimise it is still a long way off, says Dr Phil Hammond. The Health Foundation

VIDEO: Controversy over private NHS practices

VIDEO: Controversy over private NHS practices: The government's health service reforms in England have provoked huge controversy, particularly over the role of private companies. BBC News

Validity of NICE guidance for GPs questioned

Validity of NICE guidance for GPs questioned: Most studies used to develop NICE guidelines for general practice are not applicable to primary care, a UK study has found. GP Online

Peer support for people with long term conditions: guidance from the Mental Health Foundation

Peer support for people with long term conditions: guidance from the Mental Health Foundation: This brief new guidance will be of interest if you are involved in delivering or planning peer support for people with long term conditions. It’s the result of a research project carried out in Scotland during 2010-11, which reported that: Peer support activity for people with long term conditions across Scotland had a positive impact [read the full story...]

Leading the way to the new NHS

Leading the way to the new NHS: The Government is setting up a range of new organisations to run the NHS in future, with at least seven new bodies impacting on the NHS day-to-day. NHS Employers

Primary care for the 21st century: learning from New Zealand's independent practitioner associations (IPAs)

Primary care for the 21st century: learning from New Zealand's independent practitioner associations (IPAs): This report was supplemented by previous research on IPAs, and on an
analysis of documents related to the development, operation and
evaluation of organised general practice. Findings suggest several
lessons for NHS general practice including: the need for CCGs to form
wider networks to secure the active engagement of GPs; the
implementation of genuine independence for GPs ; and the offer of time
and support to allow GP groups to focus more on public health.

• Report
• Related blog
• The Nuffield Trust - publications

Medical appraisal guide pilot

Medical appraisal guide pilot: These five reports summarise the work of the Revalidation Support
Team's testing and piloting project in 2011-12. The project aimed to
inform the implementation of revalidation and to provide information to
inform the Department of Health’s business case for revalidation.

• Testing and piloting 2011-12: a summary of findings and learning
• Medical appraisal guide pilot: pilot results
• Public and Patient Involvement in revalidation
• Doctors in training: a summary of findings
• Colleague and patient feedback study: a summary of findings
• Revalidation Support Team - news

CCG staff numbers vary significantly

CCG staff numbers vary significantly:

A survey of the new clinical commissioning groups has revealed major variations in the number of staff they plan to employ.
The first analysis of the structure of the new groups has shown the number of internal staff and their reliance on independent support services will vary from on CCG to another.
CCGs in total are likely to employ significantly fewer people than the independent commissioning support... Healthcare Today

NHS hospitals urged to copy City takeovers - CITY A.M.

NHS hospitals urged to copy City takeovers - CITY A.M.:

The Guardian

NHS hospitals urged to copy City takeovers CITY A.M. Friday 28th September 2012, 2:21am. JAMES WATERSON. THE NHS should learn from the City takeover process and allow successful health providers to take full control of failing public hospitals, according to research released today by the think tank ... Takeovers of failing hospitals urgedFinancial Times Merging hospitals failed so let private firms take over, urges ex-Blair adviserThe Guardian Struggling hospitals 'should be taken over, not merged'Public Finance Health Service Journal -This is Bristol all 24 news articles »

Whooping cough jab to be offered during pregnancy

Whooping cough jab to be offered during pregnancy: Vaccine now available for women in 28th to 38th week of pregnancy in move to halt surge in baby deaths. All pregnant women will be offered vaccination against whooping cough from Friday in an urgent effort by the government to halt the surge in deaths of small babies.
Ten children from across the UK have died from whooping cough in the first eight months of this year – up from seven in the whole of 2011.

NHS on 'high alert' over reforms hitting patient care

NHS on 'high alert' over reforms hitting patient care: Sir David Nicholson, the NHS chief executive, said the health service is preparing itself in case of problems caused by the coming shake-up. The Daily Telegraph

NHS performing well but worries over tougher times ahead

NHS performing well but worries over tougher times ahead: NHS performance is continuing to hold up well, but there is concern that quality of care may suffer as financial pressures bite from next year, according to the latest quarterly monitoring report on NHS performance published by The King’s Fund.

Patient receiving treatment for novel coronavirus

Patient receiving treatment for novel coronavirus: The Department of Health has issued an alert to advise of a case of a novel coronavirus in a patient receiving treatment in a London hospital.
On 22 September 2012 a novel coronavirus was identified in lower respiratory tract specimens of a previously well, adult male Qatari national receiving treatment for a severe respiratory illness in London.
Please see the full alert from the Department of Health

NHS 'could get worse from 2013'

NHS 'could get worse from 2013': Fresh concerns are being raised about the NHS's ability to cope without front line cuts, with finance chiefs saying 2013 could be a turning point. BBC News

'Serious failure' over lost data

'Serious failure' over lost data: A review into why one of the UK's biggest NHS trusts, Imperial College Healthcare in London, lost data about patients has blamed "a serious management failure". BBC News

VIDEO: How NHS changes will affect GPs

VIDEO: How NHS changes will affect GPs: In sweeping NHS changes, GPs are being asked to group together, form a constitution for their area, and manage not just the care, but the budget for their community. BBC News

NHS staff seasonal flu campaign 2012/13 begins!

NHS staff seasonal flu campaign 2012/13 begins!: The NHS flu fighter campaign aims to continue boost in number of frontline staff receiving vaccinations NHS Employers

Childhood obesity has been underestimated

Childhood obesity has been underestimated: A review of studies has raised new concerns about childhood obesity.
The work by researchers at Oxford University suggests that children who are obese may have an even higher risk for heart disease, diabetes, and other weight-related diseases later in life than had earlier been thought.
Experts now fear that earlier studies may have underestimated the effect of obesity during childhood and adolescence o... Healthcare Today

Doctors accused of lacking compassion in survey of patients

Doctors accused of lacking compassion in survey of patients: Patients Association findings reveal growing concerns about attitudes and actions of GPs

Patients daren't complain about bad GPs

Patients daren't complain about bad GPs: Patients treated badly by their GPs are not complaining over fear of being banned from their local surgery, a report says. The Daily Telegraph

Social care services 'at risk'

Social care services 'at risk': Budget cuts of up to £85m would put severe pressure on Northamptonshire's adult and children's social care services, a report finds. BBC Northamptonshire

A mounting case for change, but will it drive change in a 'liberated NHS'?

A mounting case for change, but will it drive change in a 'liberated NHS'?: Less than two weeks ago, we said that the current health and social care system is not fit to meet current and future demands and requires radical reform.

Now the publication from the Royal College of Physicians, Hospitals on the edge? Time for action, – and hot on its heels, The state of medical education and practice in the UK, from the General Medical Council – provide further compelling evidence for the need for change. In essence both these reports describe a fundamental misalignment of the medical workforce, and the way in which care is organised, with the needs of the patients. The RCP report in particular makes salutary reading.

Dental mouth cancer checks urged

Dental mouth cancer checks urged: More dentists need to be checking their patients for mouth cancer, say experts. BBC News

Incapacity benefits appeals heap unpaid work upon GPs

Incapacity benefits appeals heap unpaid work upon GPs: Practices have faced a huge surge in unfunded work in the past 18 months as thousands of patients ask for help with benefits appeals, GP leaders say. GP Online

CCGs plan to limit private sector role

CCGs plan to limit private sector role: Clinical commissioning groups (CCGs) are planning to add clauses to their constitutions to limit the role of private providers, GP can reveal. GP Online

Care and support at home

Care and support at home: The Good Governance Institute has published a report into out of hospital care. 'Care and support at home: an audit of telecare services in England' examines how care services in the future need to be developed. It provides a number of recommendations aimed at Government and local authority officials about how telecare services and user outcomes can be improved. It is targeted at policy-makers, local authority councillors with an interest in adult social care, local authority directors of adult social services, and health and wellbeing board members. Its purpose is to encourage decision-makers to understand the current provision of telecare services in England and how services can be improved for the future.

Report: http://www.good-governance.org.uk/Product%20Menus/audit-of-telecare-services-in-england.htm 

Good Governance Institute

Atlas of Variation in healthcare for people with respiratory disease

Atlas of Variation in healthcare for people with respiratory disease: Right Care has produced a new themed Atlas which highlights variation in care for people with respiratory disease. The indicators presented in this document underline the substantial scope clinicians and commissioners have to improve outcomes by ensuring that all patients receive the quality of care that is delivered in the best-performing localities.

GMC trialling new system to improve how complaints against doctors are investigated

GMC trialling new system to improve how complaints against doctors are investigated: A new system to improve how complaints against doctors are investigated is to be trialled by the General Medical Council (GMC), it was announced today.

More support needed for smokeless tobacco cessation in South Asian communities, says new NICE guidance

More support needed for smokeless tobacco cessation in South Asian communities, says new NICE guidance: NICE has published final guidance on providing support for people in South Asian communities on stopping the use of  smokeless tobacco products, such as Paan, Gutka, Shupari, and Betel Quid.  Contrary to perceptions that these types of products are healthy or beneficial, they are in fact associated with serious health problems such as oral cancer, serious dental problems, heart attack and stroke, and problems in pregnancy.

New 'SARS-like' virus detected

New 'SARS-like' virus detected:

A new “SARS-like” virus has been detected in the UK, according to widespread media reports. The headlines are based on press releases from the UK’s Health Protection Agency (HPA) and the World Health Organization (WHO).

Coroners make record number of recommendations to NHS

Coroners make record number of recommendations to NHS: Coroners have issued a record numbers of recommendations to hospitals in order to prevent future patient deaths. The Daily Telegraph

Nurse and midwife total falls by 6,000

Nurse and midwife total falls by 6,000: The number of nurses and midwives working in the NHS has fallen by almost 6,000 in two years, figures show. The Independent

Cardiologist struck off for molesting young boys

Cardiologist struck off for molesting young boys:
An internationally renowned former Great Ormond Street cardiologist has been struck off the medical register after he was found guilty of molesting young boys. The Independent

New features to be added to mental health report following successful consultation

New features to be added to mental health report following successful consultation: The Health and Social Care Information Centre (HSCIC) is to further enhance one of its biggest annual mental health reports following a successful con... NHS Information Centre

NHS meeting to discuss plans for the future

NHS meeting to discuss plans for the future: A county NHS service will discuss its plans for the future at a public meeting this week. Evening Telegraph

Consultation on ambulance stations in Northamptonshire

Consultation on ambulance stations in Northamptonshire: People in Northamptonshire are being urged to have their say on the possible closure of ambulance stations. Northampton Chronicle and Echo

Patients value care over longer hospital journeys

Patients value care over longer hospital journeys: Most patients who have studied NHS proposals to move obstetrics and emergency surgery services around the region, ranked journey times as the least important factor. Northampton Chronicle and Echo

Patient-level costing: can it yield efficiency savings?

Patient-level costing: can it yield efficiency savings?: The report examines in depth the experience of one NHS trust with a patient-level information and costing system. These computerised information systems were introduced in the NHS in the mid-2000s, and are currently used in many other countries. NHS Networks

How threatening is the new coronavirus?

How threatening is the new coronavirus?: How worried should we be by new Sars-like bug? BBC News

'Convenience should not compromise confidentiality'

'Convenience should not compromise confidentiality': Medical Protection Society (MPS) raises concerns over the use of tablet computers for patient data Public Service

NHS rationing 'forcing patients to go private'

NHS rationing 'forcing patients to go private': More patients are going private because the NHS is increasingly cutting back on providing a range of treatments. The Daily Telegraph

Eye clinics 'can't cope with demand' for sight-saving drugs

Eye clinics 'can't cope with demand' for sight-saving drugs: Elderly patients with a common eye condition are needlessly losing their sight because doctors are not treating them in time, campaigners have warned. The Daily Telegraph

Cancer deaths 'to fall 17% by 2030'

Cancer deaths 'to fall 17% by 2030':
Cancer death rates in the UK are set to fall by almost 17 per cent by 2030, experts predict. The Independent

County consultation on health and well-being

County consultation on health and well-being: Residents are being urged to have their say on what health and well-being means to them as part of a public consultation launched this week. Evening Telegraph

NHS Northamptonshire failing heart, stroke and kidney failure patients

NHS Northamptonshire failing heart, stroke and kidney failure patients: Diabetes, heart stroke and kidney failure patients are being failed by a lack of important health checks being carried out by NHS Northamptonshire according to a new report from Diabetes UK. Northampton Chronicle and Echo

Guidance published on sharing information to tackle violence

Guidance published on sharing information to tackle violence:
This Guidance highlights how Community Safety Partnerships  (CSPs) made up of local authorities, the Police and other local agencies can reduce violence in their community by encouraging A&Es to collect and share information on time, type and location of assault, as part of the Government’s commitment to deliver on Information Sharing to Tackle Violence.
Information can be anonymised, aggregated and shared with local CSPs to identify where violence is happening and inform local interventions to tackle it. Interventions such as restricting alcohol licensing and targeting policing can have a big impact on community safety.
This guidance should also support CSP partners to understand better ways of engaging with their health partners at a local level.
This guidance includes:

• advice and tools to support CSPs to share information to reduce violence
• advice on data collection, use and feedback
• information on how to engage with health partners effectively
• relevant information on NHS and Public Health reform

Read the guidance on Information Sharing to Tackle Violence Department of Health

GMC must investigate rationing and quality premium, says GPC

GMC must investigate rationing and quality premium, says GPC: Proposed quality premium payments for commissioning groups and rationing of NHS care are 'appallingly unethical' and should be investigated by the GMC, GP leaders have said. GP Online

Papering over the cracks: the impact of social care funding on the NHS

Papering over the cracks: the impact of social care funding on the NHS: Demand for both NHS and social care services is increasing rapidly, due to growing demographic pressure from an ageing population and an increasing number of people living with complex care needs. Funding is not keeping pace with demand. NHS Confederation

Carers and telecare

Carers and telecare:

According
to Carers UK, despite huge potential benefits of using telecare and
telehealth, families caring for ill, frail and disabled loved ones are
still facing barriers to accessing the service.

• Report
• Carers UK - press release

Delivering quality care for drug and alcohol users: the roles and competencies of doctors

Delivering quality care for drug and alcohol users: the roles and competencies of doctors:
This
guidance, published by the Royal College of General Practitioners and
the Royal College of Psychiatrists, highlights the need for services to
employ teams with the right mix of skills and clinical expertise to
support the recovery of people with drug and alcohol problems. It is
also intended as timely assistance in the transition towards new
commissioning arrangements for drug and alcohol services next year.

• Guidance
• Royal College of Psychiatrists - press release

Jeremy Hunt in new row over bid to hire adviser from private health sector

Jeremy Hunt in new row over bid to hire adviser from private health sector: New health secretary accused of privatisation agenda
Jeremy Hunt has again been accused of having too close links to private healthcare after it emerged that he is in talks to hire a personal adviser from the sector as one of his first moves as health secretary.

Closing one in three hospitals would improve patient care – leading doctor

Closing one in three hospitals would improve patient care – leading doctor: Centralisation of NHS services would put more doctors in one place, says Professor Tim Evans of Royal College of Physicians
Shutting a third of hospitals would improve quality of care and should be part of changes to the NHS that would let patients see their GP or have surgery at the weekend, a leading doctor has claimed.

Primary care holds the key to raising quality of dementia patients' lives

Primary care holds the key to raising quality of dementia patients' lives: New campaign launches to tackle dementia stigma and drive concerned people to consult their GP

NHS 'heading for disaster' over lack of nurses

NHS 'heading for disaster' over lack of nurses: The NHS is heading for "disaster" because nursing training places are being cut even though record numbers of nurses are set to retire, David Cameron warned. The Daily Telegraph

Storm of protest over 'don't act too gay' advice to trainee doctors

Storm of protest over 'don't act too gay' advice to trainee doctors:
Controversial advice by a senior GP to would-be family doctors to act "less overtly gay " if they wanted to pass exams provoked a storm of protest yesterday as the Royal College of General Practitioners (RCGP) started its inquiry into the affair. The Independent

NHS chiefs: don't take £2bn to patch up social care

NHS chiefs: don't take £2bn to patch up social care:
The NHS will "buckle under the pressure" unless the Government stops using it to plug the funding gap in social care, health leaders warn today. The Independent

Acute respiratory illness associated with a new virus identified in the UK

Acute respiratory illness associated with a new virus identified in the UK: The Health Protection Agency (HPA) can confirm the diagnosis of one laboratory confirmed case of severe respiratory illness associated with a new type of coronavirus. The patient, who is from the Middle East and recently arrived in the UK, is receiving intensive care treatment in a London hospital. Health Protection Agency

Patients take part in health budget pilot

Patients take part in health budget pilot: County patients have been involved in a trial designed to give them more choice and control over their healthcare which may now be replicated in other areas. Evening Telegraph

Computer virus in monitoring equipment sees appointments cancelled at Northampton General Hospital

Computer virus in monitoring equipment sees appointments cancelled at Northampton General Hospital:
Appointments were cancelled at NGH “in the interests of patient safety” after a computer problem affected medical monitoring equipment. Northampton Chronicle and Echo

Health staff urged to get flu jab

Health staff urged to get flu jab:
Health staff are being urged to get vaccinated against flu to cut the risk of it spreading to patients and colleagues this winter.

NHS must have 'brave and honest' debate about rationing, RCGP says

NHS must have 'brave and honest' debate about rationing, RCGP says: The NHS needs to have a 'brave and honest' debate about rationing and whether it should continue to fund medicines available OTC, RCGP chairwoman Professor Clare Gerada has argued. GP Online

NHS mixed-sex breaches ''at all-time low''

NHS mixed-sex breaches ''at all-time low'': Mixed-sex accommodation breaches for hospitals in England have fallen by 99 per cent in two years Public Service

40m SCRs by 2014

40m SCRs by 2014: The Summary Care Record programme is on track to reach 40m people by early 2014. E-Health Insider

Criminal record and barring checks - new decision tree tool

Criminal record and barring checks - new decision tree tool: To support employers in making the assessment of when criminal record checks are required and eligibility for the level of check, the NHS Employers organisation has produced a new decision tree tool. NHS Employers

Home truths: how dysfunctional relationships between GPs and social care staff are driving demand for adult social care

Home truths: how dysfunctional relationships between GPs and social care staff are driving demand for adult social care:
According
to research by iMPOWER, GPs inflate demand for residential care by at
least 60,000 older people every year because they don’t understand the
alternatives. The study, based on interviews with older people, social
care professionals, GPs and directors of adult social care reveals a
bold consensus that by not addressing this, local authorities are
failing to manage demand for residential care.

• Report
• iMPOWER - news

Patient-level costing: can it yield efficiency savings?

Patient-level costing: can it yield efficiency savings?:
According
to the Nuffield Trust many hospitals in England are still unable to
track costs because they are using outdated IT systems. This report
examines in depth the experience of one NHS Trust which is more advanced
than most, in that it has a ‘patient-level information and costing
system’. These computerised information systems were introduced in the
NHS in the mid-2000s, and are currently used in many other countries.

• Report
• Research summary
• Nuffield Trust - press release

Serco gave NHS false data about its GP service 252 times

Serco gave NHS false data about its GP service 252 times: Private firm admits altering data about out-of-hours doctor service in Cornwall, prompting call for review of contract
Serco, the leading private contractor to the government, has admitted that it presented false data to the NHS 252 times on the performance of its out-of-hours GP service in Cornwall.

A quarter of cancer patients only diagnosed in casualty

A quarter of cancer patients only diagnosed in casualty: Research raises fresh questions about the NHS's ability to spot the disease early enough.
One in four cancer patients is diagnosed only after they end up in casualty, according to research that raises fresh questions about the NHS's ability to spot the disease early enough.

Maternity units must be closed to make childbirth safer, report says

Maternity units must be closed to make childbirth safer, report says: Maternity units must be shut and merged into new 'super-units' to help women give birth safely, experts say. The Daily Telegraph

Male suicide rate is 'not acceptable'

Male suicide rate is 'not acceptable': As a report is released revealing that middle-aged men from disadvantaged backgrounds are 10 times more likely to commit suicide than more affluent men, Professor Stephen Platt from the University of Edinburgh explains some of the reasons behind the high male suicide rate. The Daily Telegraph

UK hospital has 40 per cent death rate after abdominal ops

UK hospital has 40 per cent death rate after abdominal ops: More than four in 10 patients undergoing abdominal surgery at one hospital in the UK die within 30 days, according to figures described as "shocking" yesterday. The Independent

Ousted minister Paul Burstow attacks George Osborne over elderly care

Ousted minister Paul Burstow attacks George Osborne over elderly care: Former Health Minister Paul Burstow has urged the Coalition leaders to "take on the Treasury" to stop George Osborne blocking plans for funding elderly care. The Independent

NHS encourages smokers to give up next month

NHS encourages smokers to give up next month: Throughout October, NHS Northamptonshire is launching a ‘Stoptober’ campaign in an effort to help people give up smoking. Evening Telegraph

New health guide for older people being launched in Corby

New health guide for older people being launched in Corby: A new health guide is being launched for Corby aimed at older people in the town. Evening Telegraph

A mounting case for change, but will it drive change in a 'liberated NHS'?

A mounting case for change, but will it drive change in a 'liberated NHS'?: In the light of two new reports, Candace Imison reflects on the impact of staff provision during out-of-hours on the quality of care. King's Fund

NHS must deal with risk posed by SME suppliers

NHS must deal with risk posed by SME suppliers: Government must consider challenges of opening NHS procurement to smaller suppliers, Intellect official warns Public Service

NHS Confederation calls for bold action and investment by commissioners to improve sustainability of NHS services

NHS Confederation calls for bold action and investment by commissioners to improve sustainability of NHS services: NHS Confederation chief executive Mike Farrar calls on NHS Commissioning Board, due to take the reins in October, to be bolder in releasing the cash in the system to help providers transform their service

Half of medical reporting 'is subject to spin'

Half of medical reporting 'is subject to spin':

A study that you probably won’t be reading in your daily paper or favourite news website anytime soon casts serious doubts on the reliability of mainstream medical and health journalism.
The study found that 51% of news items reporting on medical trials – specifically on randomised controlled trials (RCTs), which are seen as the gold standard in judging whether a treatment is effective or safe – were subject to “spin”.

The right to live

The right to live: Jill Davies, Research Programme Manager talks about the shocking case of a man with Down's syndrome suing East Kent Hospitals University NHS Foundation Trust over a hospital's decision to issue a DNR order. Foundation for People with Learning Disabilities

NHS has cash reserves of £4bn, report shows

NHS has cash reserves of £4bn, report shows:

Disclosure raises questions over tight health budgets and draws criticism from Unison

The NHS has built up cash reserves of almost £4bn even as rationing has increased, the number of nurses has fallen and the service has had to make unprecedented savings, an Audit Commission report reveals.

NHS under pressure with more trusts in the red

NHS under pressure with more trusts in the red: Number of NHS trusts in financial difficulty has more than doubled in a year, an Audit Commission report warns. The Daily Telegraph

NHS faces £8bn cuts 'after next election'

NHS faces £8bn cuts 'after next election':
The National Health Service could face cuts of almost £8bn immediately after the next general election, according to the first analysis of the Government's own figures as it draws up another round of spending reductions. The |Independent

Hunt paves way for U-turn on casualty unit closures

Hunt paves way for U-turn on casualty unit closures: Jeremy Hunt has ordered a fresh political assessment of controversial plans to shut hospital casualty units as one of his first acts as Health Secretary. The Independent

Personal health budgets: the 10 features of an effective process

Personal health budgets: the 10 features of an effective process: It draws on the learning of pilot sites in the region and nationally to outline the 10 features of an effective personal health budget process within NHS continuing healthcare. NHS Networks

Painkillers 'cause' of headaches

Painkillers 'cause' of headaches: Up to a million people in the UK are giving themselves severe headaches by taking too many painkillers, doctors have warned. BBC News

Health ministers' portfolios revealed by DH

Health ministers' portfolios revealed by DH: Conservative peer Lord Howe will remain the health minister responsible for primary care and clinical commissioning groups (CCGs) following the cabinet reshuffle. GP Online

Hospitals on the Edge

Hospitals on the Edge: The Royal College of Physicians has published 'Hospitals on the edge: the time for action?' This report sets out the magnitude of the challenges facing acute care services. It is a call for action for all involved in the design and delivery of health services. The report suggests it is increasingly clear that the organisation of hospital care must be radically reviewed if the health service is to meet the needs of patients. Royal College of Physicians

Shake-up to employment law

Shake-up to employment law: The Coalition Government started a systematic review of employment law in 2010. This is the update. NHS Employers

Safe staffing for older people: RCN full report and recommendations

Safe staffing for older people: RCN full report and recommendations: This report, from the Royal College of Nursing (RCN), sets out guidance and recommendations for the provision of good quality, compassionate and
safe nursing care for older people in hospital.

• Report 
• RCN - publications

Caring Conversations: Half a Million Voices: improving support for BAME (Black, Asian and Minority Ethnic) carers – one year on

Caring Conversations: Half a Million Voices: improving support for BAME (Black, Asian and Minority Ethnic) carers – one year on: As part of a series of Caring Conversations policy and practice papers focussing on carers, Carers UK and the Association of Directors of Adult Social Services (ADASS) have jointly produced a briefing looking at improving recognition, responsiveness and outcomes for BAME carers, to mark the first anniversary of the publication of the research Half a Million Voices.

• Briefing
• Carers UK - policy briefings

British Social Attitudes 29

British Social Attitudes 29: The National Centre for Social Research has released the latest British Social Attitudes report, a study of how people's lives are changing and their views on how Britain is run. It draws on three decades of data, and spans three recessions and seven elections. The results for health show a decrease in the public's satisfaction with the way the NHS is run.

• Full report
• Health
• National Cenre for Social Attitudes - press release

Cancer support offered by libraries

Cancer support offered by libraries:


Macmillan Cancer Support and Glasgow Life are collaborating in order to offer cancer support and information at libraries across the city.The new project, which is believed to be the first of its kind in the UK, wants to ensure that people with cancer are able to get support from their local community.A Macmillan Service Delivery Manager will lead a team of volunteers at 25 libraries around Glasgow.The... Healthcare Today

Complaints about doctors at 'record high'

Complaints about doctors at 'record high':

The number of complaints against doctors in the UK is on the rise, according to widespread media coverage. The Daily Telegraph has reported that complaints have reached a “record high”, while the Daily Mail says that GPs are “rude, dishonest and hard to understand”.

Eleven NHS foundation trusts have serious financial problems, MPs told

Eleven NHS foundation trusts have serious financial problems, MPs told: Provision of services to change at struggling south London trust, and finances of 13 other trusts under scrutiny. Key services are set to end at hospitals operated by a debt-ridden NHS trust in south London as part of efforts to rescue it, and a growing number of NHS organisations are getting into financial trouble, MPs have been told.

Hundreds of patients dying of thirst in Britain's hospitals

Hundreds of patients dying of thirst in Britain's hospitals: Hundreds of hospital patients are dying of dehydration each year, official figures show. The Daily Telegraph

Drug giants give up on Alzheimer's cure

Drug giants give up on Alzheimer's cure:
The world's leading pharmaceutical companies are downgrading the search for new treatments for Alzheimer's disease after the failure of a series of high-profile drugs trials. The Independent

Poisons experts issue warning about wild mushroom foraging

Poisons experts issue warning about wild mushroom foraging: Wild food enthusiasts are being urged to take extra care when foraging for mushrooms because of the risk of picking toxic varieties, says the Health Protection Agency's poisons experts. Health Protection Agency

Community mental health survey 2012

Community mental health survey 2012: This survey of over 15,000 people on their experiences of community mental health services found that they are treated with dignity and respect by the health or social care worker they had seen most recently. However, some would have liked more support in getting help with aspects of day-to-day living. Care Quality Commission

Release of Organisation Patient Safety Incident reports

Release of Organisation Patient Safety Incident reports: The NHS Commissioning Board Authority has published the latest set of Organisation Patient Safety Incident data.
The figures show that the number of patient safety incidents in England that occurred between 1 October 2011 and 31 March 2012 and were submitted to the National Reporting and Learning System (NRLS) by 31 May 2012 was 612,414. This is an increase of 2.3 per cent compared to the previous reporting period (1 April 2011 to 30 September 2011.)

Cancer patient work plans altered

Cancer patient work plans altered: Fewer cancer patients will have to look for work while receiving treatment, under revised proposals from the Department for Work and Pensions. BBC News

RCGP sets out 10-year plan to improve general practice

RCGP sets out 10-year plan to improve general practice: General practice has a key role to play in transforming the NHS over the next decade but will struggle to cope without investment in more GPs, longer training and support for existing staff, a landmark RCGP consultation warns. GP Online

Procurement of healthcare (clinical) services: briefings for CCGs

Procurement of healthcare (clinical) services: briefings for CCGs:

Working
with CCGs and others, the NHS Commissioning Board Authority has
developed a series of procurement briefings for CCGs that summarise the
key elements of legislation and guidance currently governing NHS
procurement of healthcare services.

• Introduction: why do CCGs need to understand procurement?
• How does procurement fit with the different stages of commissioning? 
• What are the procurement options?
• Which rules apply to a procurement process?
• How should a procurement process be conducted?
• Summary of the decision-making process.
• NHS Commissioning Board - news

Ban on MPs with mental health issues to be axed

Ban on MPs with mental health issues to be axed:
Moves are under way which would allow people with serious mental health issues to become MPs, company directors and serve on juries.
At present, people with such conditions are banned from serving in Parliament or holding some other key posts.
But now, the government has given its support to a private member’s bill by Tory MP Gavin Barwell, who’s Mental Health (Discrimination) Bill earlier received ... Healthcare Today

Public 'putting off visiting GPs'

Public 'putting off visiting GPs': Health experts are encouraging people not to put off seeing their GPs after research showed that almost a quarter of Britons would not see a doctor for a complaint because of the hassle of getting an appointment.The Independent

Third of mental health patients want more physical health support

Third of mental health patients want more physical health support - Communitycare.co.uk:

The Guardian

Third of mental health patients want more physical health support Communitycare.co.uk The Care Quality Commission's (CQC) 2012 survey of people using community mental health services found that 36% of patients 'who needed support' for their physical needs had not received any, up 5% from the previous year. The number of patients who ... More help urged for mental health patientsNursing Times New health ministers' portfolios unveiledHealth Service Journal all 40 news articles »

Complaints about doctors' professional conduct reach record levels

Complaints about doctors' professional conduct reach record levels: General Medical Council report shows one in 64 doctors now face possibility of being investigated by the regulator.
Complaints about the professional conduct of doctors rose by 23% last year to reach record levels, according to figures published today.

More hospices needed 'to care for people dying gradually'

More hospices needed 'to care for people dying gradually': More hospices and care homes are needed to cope with increasing numbers of people dying "gradual" deaths, say doctors. The Daily Telegraph

Doctors from crisis-hit eurozone countries heading to UK for work

Doctors from crisis-hit eurozone countries heading to UK for work: The financial crisis in the eurozone has led to a dramatic increase in the number of doctors from countries such as Greece and Spain leaving to work in the UK, new figures have revealed. The Independent

Patients see doctors via webcam

Patients see doctors via webcam: An NHS Foundation trust in Northamptonshire is using video consultation for doctors appointments. BBC Northamptonshire

Three-hour wait in agony for ambulance

Three-hour wait in agony for ambulance:
A teenage boy had to suffer in agony waiting for an ambulance to arrive after he shattered his knee while playing football. Evening Telegraph

Public asked for views on ambulance service changes

Public asked for views on ambulance service changes:
A public consultation on changes to East Midlands Ambulance Service is being launched on Monday (September 17). Evening Telegraph

More than a third of East Midlands men’s bellies so big they cannot see their genitals

More than a third of East Midlands men’s bellies so big they cannot see their genitals:
A survey suggests that 37 per cent of East Midlands men are unable to see their own genitals because they are so obese. Northampton Chronicle and Echo

Ads to show 'reality' of nursing

Ads to show 'reality' of nursing: A campaign by the Royal College of Nursing aims to show the reality of nursing, and to explore the reasons behind failures in care. BBC News

Unfair cataract rationing needs DH intervention, experts warn

Unfair cataract rationing needs DH intervention, experts warn: The government must take action against PCTs for unfairly restricting cataract surgery for cost reasons following further evidence of rationing, according to the Royal College of Ophthalmologists. GP Online

MPs plan "short" inquiry into NICE

MPs plan "short" inquiry into NICE: PharmaTimes reports that the House of Commons Health Committee has announced that it is to hold a "short" inquiry into the work of the National Institute for Health and Clinical Excellence (NICE). The inquiry will be held before the term of office for the current chair - Professor Sir Michael Rawlins - ends in March 2013. A pre-appointment hearing will be held by the Health Committee for the government's preferred candidate for the new chair towards the end of this year. Prior to this hearing, the short inquiry is intended to examine the way the Institute has discharged its current functions and will look forward to the changes in its role that will come into effect from April 1 next year.
 
The Health Committee is now calling for written submissions on the work of NICE and the deadline for submitting written evidence to the Committee is noon on Monday October 29 2012. PharmaTimes

Down's syndrome patient challenges resuscitation order - BBC News

Down's syndrome patient challenges resuscitation order - BBC News:

Telegraph.co.uk

Down's syndrome patient challenges resuscitation order BBC News A man with Down's syndrome is suing an NHS trust over a hospital's decision to issue a do-not-resuscitate order giving his disability as one of the reasons. The instruction not to attempt resuscitation in the event of a cardiac or respiratory arrest ... Down's Syndrome man takes legal action over 'do not resuscitate' orderThe Independent Family of Down's patient sue hospital over DNR orderThe Guardian Action on do not resuscitate orderLittlehampton Gazette Huffington Post UK all 124 news articles »

Health firms told to get set for £20bn NHS bonanza

Health firms told to get set for £20bn NHS bonanza: Report says there is 'significant opportunity for private sector in primary and secondary care'
Private health firms can expect to win business worth around £20bn from the NHS in the next few years by taking over GP surgeries and setting up new community health clinics, according to a report written for profit-making companies keen to expand their role in the health service.

'We screwed up' - health minister on NHS reforms

'We screwed up' - health minister on NHS reforms: Anna Soubry, a new health minister, has said the Coalition made mistakes over changes to health service. The Daily Telegraph

'Antipathy' to reform hits satisfaction with NHS

'Antipathy' to reform hits satisfaction with NHS: "Antipathy" to the Government's controversial health reforms has dragged down people's satisfaction with the NHS, according to an influential think-tank. The Daily Telegraph

Britain unprepared for 'tsunami' of dementia patients

Britain unprepared for 'tsunami' of dementia patients:
Britain's dementia crisis is so huge that care homes and the health system will soon be unable to cater for the "tsunami" of people expected to be living with the condition, health experts warn. Unless a radical overhaul is taken, they say that hundreds of thousands of patients will face a future defined only by neglect. The Independent

Moving NGH service ‘least bad’ option

Moving NGH service ‘least bad’ option:
Axing some specialist services at Northampton General and Luton and Dunstable hospitals would be the option with the least effect on travel times for patients, a study shows. Chronicle & Echo

Chance to question NHS Northamptonshire's board at AGM - Northampton Chronicle & Echo

Chance to question NHS Northamptonshire's board at AGM - Northampton Chronicle & Echo:

An NHS Northamptonshire spokeswoman said: “The AGM is a chance to look back on some of the successes and highlights of the past year and to discuss with the public future plans for the NHS in Northamptonshire in light of the current NHS reforms.” ...

Tell us plans for Kettering hospital’s future

Tell us plans for Kettering hospital’s future:
Calls have been made for health officials to fully reveal their plans for the future of our hospitals before putting their proposals to the public. Evening Telegraph

Personalisation and personal budgets can support recovery and transform mental health services, according to new report

Personalisation and personal budgets can support recovery and transform mental health services, according to new report: This new briefing paper from the NHS Confederation and the Centre for Mental Health looks at the impact that personalisation and recovery are having on mental health services in England. The first part of this paper describes personalisation, personal budgets and personal health budgets. The second sets out their shared philosophy and discusses what the [read the full story...] Mental Elf

Headline climb in hospital admissions for stress

Headline climb in hospital admissions for stress: Admissions for stress highest in working age adults, while admissions for anxiety highest in the elderly. Onmedica

GPs can access patient records via tablet devices

GPs can access patient records via tablet devices: The first ever service allowing GPs to access and update their patient records using an iPad or other tablet device has been launched.leading GP software supplier EMIS has just launched the first GP and integrated care system to enable mobile working on all the main tablet devices, from iPads to Android.The EMIS Mobile app allows health professionals to work online and offline, managing patients even when there is no internet connectivity. Functions include accessing their diary and appointment ...Health News

Family of Down's patient sue hospital over DNR order

Family of Down's patient sue hospital over DNR order: Relatives allege doctor at NHS hospital in Kent added 'do not resuscitate' order to man's notes on basis of his disabilityAn NHS hospital is being sued by a family who say doctors placed a "do not resuscitate" order on their relative, denying him potentially life-saving treatment, because he has Down's syndrome.The unnamed family are bringing a legal challenge against a hospital in Kent where a doctor apparently decided staff should make no attempt to resuscitate the patient if he suffered cardiac ... Health News

Preparations for winter planning and reporting set out

Preparations for winter planning and reporting set out:
David Flory, Deputy NHS Chief Executive and Shaun Gallagher, Acting Director General, Social Care, Local Government and Care Partnerships have set out preparations for winter planning and reporting, which this year will run from 6 November to the end of February 2013.
SHA cluster chief executives are asked to ensure preparations are in place and encourage local NHS organisations to review local winter plans and observe the timetable for daily SITREP reporting.
Read letter Preparations for winter planning and reporting 2012/13

Public Health Cold Weather Plan

Later this autumn, as part of the wider suite of measures to protect individuals and communities from the effects of severe winter weather the DH and NHS are planning to publish the second national Cold Weather Plan.
To support the aims of the Cold Weather Plan, the “Warm Homes Healthy People fund” will be made available for winter 2012/2013.  The aim of the fund is to support local authorities and their partners in reducing death and morbidity in England due to cold housing in the coming winter.

Department of Health

NHS accelerating innovation support tool goes live

NHS accelerating innovation support tool goes live: Source: PharmaTimes

The Department of Health has launched an implementation support website to help speed the adoption of six high-impact innovations throughout the NHS, which are identified in the 'Innovation Health and Wealth' report as having the potential to transform both quality and value in the NHS:
 
. increased support for carers of people with dementia
. increased use of technology to allow patients and the public to access healthcare services remotely, should they choose to do so
. the national roll-out of assistive technologies - telehealth and telecare - to three million people by April 2017
. reducing the time it takes from assessment to delivery of wheelchairs for children
. increased use of intra-operative fluid management
. increased opportunities for the NHS to promote the commercial value of its IP and knowledge internationally
 
The new website has been developed by the Department in partnership with the NHS ...

Medicines use in care pathways

Medicines use in care pathways: 'Optimising medicines use in care pathways using pharmacy support' and the 'Medicines in Commissioning Toolkit' are two key interlinked resources that have been revised and updated to support commissioners to help ensure care pathways which involve medicines deliver improved patient outcomes, are safe, use clinical and cost effective treatment options, offer patient choice and the best patient experience. CASH News

Information Governance Toolkit

Information Governance Toolkit: The Department of Health has issued a statement regarding the completion of IG Toolkit assessments. Following a number of queries over the past weeks from NHS organisations regarding the future of the NHS Information Governance Toolkit, the statement stresses there will be no immediate changes to the toolkit and that organisations will be provided with ample notice should any changes be proposed. In the meantime, organisations should complete and publish IGT assessments as usual during 2012/13. CASH News

Final authorisation decision-making process set out

Final authorisation decision-making process set out:
The CCG authorisation governance process is set to be finalised at the NHS Commissioning Board Authority’s meeting in Newcastle on 20 September. A paper seeks the approval of the Board to further proposals on how the moderation, conditions and decision elements of the CCG authorisation process will operate.
A key proposal is to share the recommendations of the Conditions Panel with the CCG prior to decisions being made by the CCG Authorisation Sub-Committee of the NHS CB. The proposal, which has been developed in response to CCG feedback, means CCGs will have two weeks to comment and provide any new evidence that may remove the need for a specific condition.
If approved, it means the final authorisation decision by the CCG Authorisation Sub-Committee of the NHS CB will be four to five weeks later for each wave, and that first decisions on CCG authorisation are due in November 2012, rather than October.
The paper also proposes the membership and terms of reference for:

• The Moderation Panel, chaired by National Director: Commissioning Development Dame Barbara Hakin, will meet once a month from October 2012 to January 2013, and will ensure overall consistency and make recommendations as to whether a CCG should be fully authorised or authorised with conditions.

• The Conditions Panel, chaired by Deputy Chief Executive and Chief Operating Officer Ian Dalton, will meet fortnightly from November, and will consider what support is required where a CCG has not supplied sufficient evidence to meet a threshold for one or more authorisation criteria. The output of the panel will be a report with the recommended conditions and support for each CCG. Regional directors would be given an opportunity to approve the recommendations made on conditions and support for each CCG being considered from their region prior to consideration by the Conditions Panel. They may choose to take informal soundings locally prior to the Conditions Panel on options where the panel is likely to consider that a CCG needs intensive support.
• The CCG Authorisation Sub-committee will be chaired by an NHS CB non-executive director and will meet twice per wave between October 2012 and February 2013 to make authorisation decisions, and quarterly from March 2013 to consider the removal of conditions. The conclusions of each sub-committee meeting would be published immediately after each meeting, once decision letters have been issued to CCGs.

The Board paper, outlines in full how the moderation and conditions/support processes will work, and how decisions will be made by the NHS CB.
It proposes that a standard review date of March 2013 will be built into all conditions and that CCGs may submit evidence to the relevant regional office which will determine whether the condition can be removed for the majority of conditions. For the more substantial conditions, the sub-committee will need to sanction their removal.
Following the decisions of the Board on 20 September, a factsheet on the process will be prepared and circulated to CCGs.
NeLM News

RCP report: Hospitals on the edge? - The time for action

RCP report: Hospitals on the edge? - The time for action: Source: RCP

This report from the Royal College of Physicians sets out the magnitude of the challenges facing acute care services. It found that hospitals are struggling to cope with the challenge of an ageing population and increasing hospital admissions and concluded that there an urgent need to radically review the organisation of hospital care if the health service is to meet the needs of patients now and in the future.

Doctors' prescriptions 'could severely harm tens of thousands'

Doctors' prescriptions 'could severely harm tens of thousands': Doctors are responsible for prescription errors that could be causing tens of thousands of patients severe harm or death, according to pharmacists.
Telegraph

Report recommends which specialised services should be commissioned nationally

Report recommends which specialised services should be commissioned nationally:
The services listed in the report will be commissioned by the NHS Commissioning Board from April 2013, rather than by Clinical Commissioning Groups. The list will be agreed by Ministers and the Commissioning Board in the autumn. NHS Networks

Safeguarding children and adults in the future NHS

Safeguarding children and adults in the future NHS:
The NHS Commissioning Board Authority has published interim advice on arrangements to secure children’s and adult safeguarding, which provides additional information, in particular, to emerging clinical commissioning groups.  A covering letter reminds PCTs and SHAs of the vital importance of maintaining appropriate arrangements as the health system goes through transition.
The interim advice, with a covering letter from Jane Cummings and Shaun Gallagher (Acting Director General, Social Care, Local Government and Care Partnerships), is in the Resources for CCGs area under the Safeguarding heading.
NHS chief executives will wish to consider the implications of this interim advice.
NHS Commissioning

National audit of intermediate care report 2012

National audit of intermediate care report 2012:
This audit highlights wide variation in service models being used
nationally with differences evident in the extent of multiagency
integration, the scale of services provided, and how intermediate care
sits within the full range of health and community services, in each
local health economy.

• Audit report
• NHS Benchmarking

Kings Fund

Personal health budgets for continuing healthcare: the 10 features of an effective process

Personal health budgets for continuing healthcare: the 10 features of an effective process:
This paper is part of a broader programme of work with PCT clusters
in the north west of England to help support them for roll out of
personal health budgets in 2014. It draws on the learning of pilot sites
in the region and nationally to outline the 10 features of an effective
personal health budget process within NHS continuing healthcare.

• Report 
• In Control - news

Kings Fund

NICE issues draft guidance on the development and updating of local formularies for consultation

NICE issues draft guidance on the development and updating of local formularies for consultation:

NICE is developing good practice guidance on the development and updating of local formularies, for use within the NHS in England and Wales.
 
The Guideline Development Group has reviewed current practice and found that although many organisations have established groups for making formulary decisions, many have identified the need to review their structures as a result of changes to NHS commissioning arrangements. Furthermore they identified a variation in the size and scope of current local formularies, and variation in the processes used by decision-making groups.
 
The following key components were identified as inherent in the development and updating of local formularies, and are discussed in the draft guidance:
 
. relationships with other decision making bodies
. formulary scope
. terms of reference
. membership
. resourcing
. accountability and reporting arrangements

NME trusts could get central funding

NME trusts could get central funding: Trusts in the North, Midlands and East of England could receive central funding from the Department of Health for a clinical IT system, even if they choose not to take CSC's Lorenzo. EHI News

Hospitals 'can't cope' with rise in elderly patients

Hospitals 'can't cope' with rise in elderly patients: Hospital wards are "on the brink of collapse" due to ever-increasing numbers of elderly patients and weekend staff shortages that are seriously compromising safety, according to a hard-hitting report by the Royal College of Physicians. Telegraph

How to cut spending and raise patient care standards

How to cut spending and raise patient care standards:

NHS Cost Improvement Programmes can play a part in improving quality, as well as cutting costs, argues Bill Upton
Grant Thornton recently carried out a survey of NHS provider finance directors on their Cost Improvement Programmes (CIPs). Results showed that the average CIP target for NHS trusts in 2011/12 was 5.1%, yet by the end of the year the average saved was 4.8%, 91% of the initial target.
For 2012/13, the average CIP target is the same as the previous year, and 4.9% for 2013/14. These results were supported by a recent study by the King's Fund which produced similar findings.
This clearly puts some context around the challenge facing NHS trusts looking to cut costs. The amount that needs to be saved isn't changing substantially year on year, yet the accumulated savings needed over the next few years are large and challenging.
The situation gets worse when targets are missed, with year on year targets having to increase to make up for those when targets haven't been reached. When asked specifically how they plan to achieve their CIP targets for the next couple of years, nearly nine out of 10 finance directors identify service redesign as playing a major role over the long-term.
Financial directors recognise that while headcount and pay reduction are an important part of reducing costs, they can only be taken so far. Fundamentally redesigning patient pathways (the way that patients receive care), offers a way to make costs savings while also actively improving the whole patient experience.
This kind of service redesign can come in many guises, from combining all outpatient appointments (consultation, X-ray, pathology) into one hospital visit; to looking at how aspects of treatment can be delivered in the community.
These pathways will need to centre on the patient's needs and be delivered in the optimum location, avoiding unnecessary duplication, intervention and tests.
However, this type of fundamental change is clearly much harder to put into practice than other cost saving initiatives. It can be difficult to implement at the best of times, and it takes a substantial amount of time to plan – time which many NHS directors simply don't have as they struggle with the limited resources at their disposal.
Less staff means that management is being forced to do more with less, and has to concentrate on running the service without the freedom to step back and take stock. As a result, although finance directors may have identified how patient pathway redesign could be used to cut costs, they have been unable to create worked-up plans for these redesigns.
It is a significant change and requires more cross-organisational coordination than other money-saving measures, meaning it is often easier to focus on incremental smaller gains.
Changing patient pathways is not something that has to be approached in a vacuum, and financial directors should look at how they can get the whole organisation involved. One aspect of our study looked at how clinical staff view CIPs.
Only 22% of financial directors felt their clinical staff saw CIPs as an opportunity to improve quality while reducing costs. The majority (53%), were neutral, believing the goal of the CIPs is to cut costs without having an impact on quality.
In our discussions around the survey, it is clear that those trusts that have a major focus on continually improving standards appear significantly more successful at delivering on-going financial savings. NHS managers should engage with clinical staff to identify the areas where services can be redesigned in a more efficient manner.
However, when seeking this engagement, it is important to stress the role that CIPs can play a part in improving quality, as well as cutting costs. For example, reducing waste or duplicate appointments improves quality but also saves money.
Ultimately, CIP targets mean NHS management is faced with a task that is going to get progressively more difficult. Once the obvious cuts have been made, reaching the savings targets becomes harder.
Implementing fundamental changes to patient pathways will play a major role in future cost savings, but it is only by embracing this now, working with clinical staff, realising the scale of the task and allocating resources appropriately that trust managers can ensure they can continue to reach their cost-cutting targets over the next couple of years.
Bill Upton is partner and head of healthcare at Grant Thornton UK LLP.
Guardian Professional.