Monday, 5 March 2012
The money, provided by the National Institute for Health Research, will be spent on research nurses and technicians at 19 of the facilities around the country. A huge number of new treatments for conditions including cancer, diabetes, stroke, dementia and obesity will be developed by researchers at the facilities. NHS Networks
The CQC has published a further 20 reports from a targeted programme of 150 unannounced inspections of hospitals and care homes that care for people with learning disabilities.
Gill Hitchcock reports on how Royal Liverpool and Broadgreen University hospitals NHS trust tackled healthcare associated infections
When Diane Wake began a new role at Royal Liverpool and Broadgreen University hospitals NHS trust in 2007 she faced a major challenge. The 800-bed trust was a "national outlier" in terms of its healthcare associated infection rates and, as the trust's new executive director of nursing and operations and director of infection prevention and control, Wake was tasked with tackling this.
"We had large amounts of MRSA, an excessive rate of clostridium difficile, which I felt was totally and utterly unacceptable," she says. "You don't expect a patient who comes into the hospital to leave with something they didn't have when they arrived. For me that really set us off on a journey of what do we need to do differently in this organisation."
The journey to improvement has taken the trust through some radical changes and Wake on an eye-opening trip to Johns Hopkins hospital in Baltimore to learn about its success in tackling healthcare associated infection.
"They had published several articles in the New England Journal of Medicine, about reducing MRSA, and particularly to zero on their critical care units," Wake says.
"And that made me think, how have they done that? Patients, particularly in critical care environments, can be more susceptible to things like MRSA. And that seemed like a massive achievement."
One of the key innovations she witnessed during her five days in Baltimore was the use of hydrogen peroxide vapour for decontamination.
"When they discharged a patient who had an infection, they would clean the room and then use the hydrogen peroxide vapour to decontaminate it," Wake says. "That was something that we were not doing here in the UK and it really interested me."
Johns Hopkins was using the vapour in what Wake describes as a "reactive" way to treat equipment after an infection, but she decided to use the technique "proactively". The trust adopted a system supplied by Johnson and Johnson Medical to apply hydrogen peroxide vapour "across the board in the organisation, whenever we have discharged a patient".
Wake emphasises, however, that the vapour is not a substitute for cleaning and that the trust's cleaners have been "incredibly resourceful" in increasing the amount of cleaning of wards and departments.
She also saw that Johns Hopkins used non-ported cannulas to administer fluids into patient's veins, while Liverpool and Broadgreen was using ported cannulas. There was always a suspicion that ported cannulas could be a reservoir for pathogens, Wake explains.
"So we changed that. And we looked at how we decontaminated patients skin prior to introducing cannulas and then we embarked on a trust-wide training and education programme."
Liverpool and Broadgreen also introduced mattresses auditing. When Wake took up her post there was no regular mattress auditing, making it very difficult to control their lifespan. "Mattresses in a hospital have an eight-year life, all mattresses have a cover which is cleaned once the patient discharged," she explains.
"We did not recognise in 2007 that covers only had a life of three years, so after that timeframe, if a patient is incontinent in bed, there is a risk that if you don't change the cover after three years you can get some seep through to the mattress itself."
Following the initial audit, 80% of mattresses were condemned and replaced, and the trust now dates all its mattresses and covers and carries out weekly checks.
Changes to antibiotic prescribing and management were also introduced because, as Wake explains, there is much research to show that excessive antibiotic prescribing can result in increased clostridium difficile.
"It is about managing antibiotic prescribing well across the organisation," she says. "Certainly our pharmacy team have worked very closely with medical microbiologists, infection control teams and clinicians to make sure that we are really rigorous in ensuring that we are not prescribing inappropriately."
The infection control team was strengthened with the appointment of nurses who specialised in the field. Training for junior doctors has changed to help them with antibiotic prescribing.
"We also implemented something called a 'medicine man' which is basically the figure which we give to junior doctors to put in their pockets and it indicates, according to our antibiotic prescribing policy, if a patient had, for example, an upper respiratory tract infection or chest infection, what the right antibiotic is in the first instance."
Statistics released by the trust shows the MRSA infection rates were reduced by 88% between 2008-09 to 2011-12, representing a fall from 34 cases to four. Similarly, clostridium difficile infection declined by 84%, with a drop from 353 cases in 2008-09 to 58 in 2011-12.
Wake maintains that this improvement has resulted from a change of culture. "We really tightened up everything that we did," says Wake. "It is about everybody in the organisation being signed up to the agenda, reducing healthcare associated infection." Guardian Professional.
Prime minister says there is no going back on reforms, as chorus of opposition grows louder
David Cameron has said he does not care about "taking a hit" on the government's radical shake-up of the NHS in England, vowing there was no going back on the reforms.
Addressing the Conservative spring forum, the prime minister said the controversial overhaul was "unavoidable and urgent".
But he sought to reassure party activists over the crucial doorstep election issue, claiming the NHS was "in the party's DNA and that's not going to change".
Cameron's comments come as the chorus of opposition to the coalition's NHS reforms grew louder this week, with the Royal College of Radiologists joining a growing list of medical bodies denouncing the health and social care bill.
On Friday, the college called on ministers to withdraw their plans for a radical shake-up of the NHS in England after a survey of its members.
The British Medical Association (BMA) said on Thursday that the reforms would be "irreversibly damaging to the NHS" and irreparably damage the relationship between family doctors and patients.
But Cameron, rallying Tory activists at the private event in central London on Saturday, said "fortune favours brave governments".
He claimed it was right to take "tough decisions" in a range of areas for the good of the country, including agreeing to go ahead with plans for a high-speed rail link between London and the North that will carve up key Tory heartlands.
That prompted one party member to cry out "No". "Oh, yes it is," the prime minister replied. The Guardian
Lord Carter chairs the NHS Co-operation and Competition Panel (CCP) and is UK head of US-owned healthcare firm McKesson
The Department of Health said it had "every confidence" in the head of the body that polices competition in the NHS after concerns were raised that he also runs one of the UK's biggest healthcare companies.
Scrutiny of the role played by Lord Carter as chairman of the NHS Co-operation and Competition Panel (CCP) comes at a particularly sensitive time for the government as it faces growing opposition to its healthcare reforms, which would usher in a big expansion of private competition.
It is also embarrassing for Labour, which elevated Lord Carter of Coles to the House of Lords under prime minister Tony Blair, and is now leading the political opposition to the health and social care bill, and in particular what it regards as creeping privatisation.
There is no suggestion that Carter has done anything wrong. His role as UK chairman of US-owned healthcare giant McKesson and other companies was well known when he was appointed to chair the CCP, and all jobs are clearly recorded on his parliamentary profile.
On its website, US-owned McKesson says it has contracts with more than 90% of NHS organisations, as well as with other private health companies. However, it is likely to cause further concern about companies that are seen to benefit from a widespread programme of private involvement in public services. There have been calls for more investigation into how much private consultants advising government on the controversial health reforms stand to make from the changes.
Under proposals in the health and social care bill going through parliament, the CCP is due to be merged with another regulatory body, Monitor, which will oversee what is expected to be a huge expansion of private sector companies in the NHS.
Reacting to Carter's dual roles, Dr Clare Gerada, chairman of the Royal College of General Practitioners, said: "He cannot have any credibility when he is also heading a company with such huge interests in the very contracts his organisation is meant to police. GPs are being minutely scrutinised for possible conflicts of interest. But if we are going to have to have transparency, it has to apply throughout the system."
The Department of Health defended the peer's dual roles, in a statement that said: "We do not believe there is any evidence of a conflict of interest. Since the CCP was established, they have done an excellent job in helping to ensure good procurement practice and fair competition, and we continue to have every confidence in Lord Carter."
In a separate statement, McKesson said: "Lord Carter steps down from any investigation where there is potential conflict of interest. Lord Carter was appointed for his experience in this area. It is also worth noting that the CCP only has an advisory role in making recommendations to either the DoH or Monitor. The CCP has a track record of making objective assessments."
The company also stressed that the scope for conflict of interest was "limited" because CCP was in charge of patient services and had no remit over the IT contracts in which McKesson specialises.
McKesson has operated in the UK since 1990, employs 450 staff in the UK, and boasts that its NHS HR and payroll IT system is the world's largest. The Guardian