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

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

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.

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.

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.

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.

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

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.
Patients could not get physiotherapy services unless they had seen their GP twice, with the appointments at least six weeks apart. Even then, they could only see a physiotherapist a maximum of twice and could not receive any hands-on treatment. Patients were only guaranteed one session of "assessment, diagnosis and exercise prescription". For some people in pain that simply involved being shown how to do exercises or given sheets outlining postures that would best relieve their pain. Under Principia's cost-cutting measures patients were only to see a physiotherapist for a second time "if required".
The document, obtained under the Freedom of Information Act and passed to Society, admits that rationing caused "dissatisfaction and anger" among patients and cost the NHS more because some people whose conditions did not improve had to be treated in hospital and take drugs to manage their pain.
But the appendices to the report – detailing the views of local GPs, physiotherapists and patients – are more explicit. One unnamed GP's feedback stated: "Two sessions just isn't enough for anything. There are occasional patients who can benefit from two sessions, but almost all are coming back to us saying that they haven't had enough appointments. Waiting six weeks before being able to refer is no use for any acute injury, or indeed for those with acute significant back pain – with sciatica, for example. Some do go private after the NHS offered sessions, with the same physiotherapist. This system seems to be a retrograde step for physio. I understand that it was a cost-saving [measure], but our primary concern ought to be treating our patients better than this, surely."
Another doctor was equally blunt: "I was appalled when the physio sessions went down to two. Patients have been displeased with the two-session approach … I realise cost savings have to be made but to offer a half-hearted service is not the answer."
The policy has hit the least well-off the hardest, a third GP said. "A lot of patients are gaining some improvement with their two sessions of physio and feel they would benefit from further, but most of the time they feel unable to pay. Physiotherapists also ring us and ask if there is any way we can fund further sessions, as they feel they will be able to improve patients' symptoms given further sessions."
Some patients even needed hospital care because they did not get enough treatment to start with, the GP added, saying: "I have on a few occasions had to make another referral to secondary care, as a patient has not made the improvement we might have seen in the past with six or eight sessions of physio."
Negative effect
Unsurprisingly, patients' problems appeared to be aggravated by such minimalist care. One physiotherapist told Principia: "We are not providing patients with the appropriate treatment for their condition, which has had a negative effect on outcomes. Our outcomes data show that 41% of patients would respond favourably to more follow-up sessions. Another physio said: "Although some patients will have done well with their self-care programmes alone, there are many who really needed further treatment. Only a small proportion elected to continue privately. Most could not fund it. Utilise our clinical skills rather than tying our hands."
The report should be seen as a cautionary tale of the chaos that can ensue when NHS services are opened up to competition, warns the Chartered Society of Physiotherapy.
"What we see is that patients are being denied appropriate treatment purely on financial grounds. How can a physiotherapist be expected to treat a patient's condition without touching them? There is no published evidence to support that approach," says Phil Gray, the organisation's chief executive.
"This farcical situation is a direct consequence of opening NHS services to this form of open market competition when the health service is facing big financial challenges. This scheme is a disgrace, but we fear it is a taste of what is to come with the introduction of this form of competition across the NHS," he adds.
The coalition government has changed the term of "any willing provider" to "any qualified provider", but not its thrust. Primary care trusts in England have had to select three of eight services – including podiatry, back and neck pain services, talking therapies, and leg ulcer and wound healing – which from September at the latest they will have to allow non-NHS providers to deliver.
Critics see "any qualified provider" as the battering ram of impending privatisation, facilitated by health secretary Andrew Lansley's view that increasing competition as part of his NHS shake-up will drive down costs, extend patient choice and force providers to offer good quality care.
Race to the bottom
Gray, though, believes it will spark a race to the bottom in quality and that patients will be baffled rather than liberated by being able to choose between providers. "Any qualified provider is a deeply flawed way to deliver healthcare and the government simply has to recognise the dangers it poses for patient care," he says.
Simon Burns, NHS minister at the Department of Health, denies the Rushcliffe experience is any sort of portent of what is to come. "The Principia scheme was an entirely local initiative developed several years ago under the last government. It has nothing to do with our plans for modernising the NHS, or the national 'any qualified provider' initiative, which seeks to give patients the choice of who provides their treatment. It was certainly not a pilot for it. This local scheme is being re-used simplistically by those who oppose reform in an attempt to deny patients of choices they want," he says.
"We have always been clear that there is no excuse for imposing arbitrary restrictions that deny patients the treatment they clinically need. That's why our reforms give control to those who know their patients best: doctors and nurses in the NHS. We strengthened the health bill following the listening exercise to make clear that competition must only be used to benefit patients, never as an end in itself, and only where GPs, clinicians and experts deem it appropriate for their local communities.
"Unlike the Principia scheme, choice of any qualified provider will be based on quality standards developed with patient groups and clinicians, and fixed NHS tariffs so that there is no competition on price, only on quality of services," he adds. 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

Hundreds 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

'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

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

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.

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
Measures like these may be considered if someone is thought to be a danger to themselves or to others.
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 2012
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

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