Monday 30 June 2014

New KGH unit helps 10,000 patients

New KGH unit helps 10,000 patients

The team behind an award-winning care unit at Kettering General Hospital are celebrating a successful first year in which they have seen almost 10,000 patients. Evening Telegraph

Northamptonshire health body to involve the public in future decision-making

Northamptonshire health body to involve the public in future decision-making

A public health body has called on the public to play a more active role in shaping local health services. Chronicle & Echo

DH issues guidance on 'safe havens'

DH issues guidance on 'safe havens'

The Department of Health has issued guidance on the creation of patient data 'safe havens' that will govern access confidential data held by Health and Social Care Information Centre. EHI News

Protecting personal health and care data

Protecting personal health and care data

The government proposes allowing access under strong controls to information from peoples’ personal care records which could be used to identify an individual. These access procedures known as safe havens will need to be accredited by the secretary of state for health. NHS Networks

Six million people went to A&E because they failed to get an appointment with their GP

Six million people went to A&E because they failed to get an appointment with their GP

Millions of people are turning up at accident and emergency departments asking for medical help because they face long delays to get an appointment with their family doctor, a study published today warns. The Guardian

Expert view: how should we fund the NHS of the future?

Expert view: how should we fund the NHS of the future?


A mega funding crisis is beginning to engulf the NHS that will change the service out of all recognition. It could spin the service into a residual poor law-type institution. A £2bn deficit is forecast to rise to an annual £30bn deficit within seven years a cool one-third of the current budget. The Guardian

Continue reading...

GPs who miss cancer could be named

GPs who miss cancer could be named

GPs with a poor record in spotting signs of cancer could be named under government plans to boost NHS transparency. BBC News

Diabetes complications preventable

Diabetes complications preventable

The findings were published in the National Diabetes Inpatient Audit (NaDIA), carried out by the Health and Social Care Information Centre, in collaboration with Diabetes UK. NHS Networks

Lack of anatomy training could lead to shortage of surgeons

Lack of anatomy training could lead to shortage of surgeons

Medical students are leaving university with a "worrying" lack of anatomical knowledge, top surgeons have warned, with many never having dissected a body and some qualifying as doctors without even seeing a cadaver. The Independent

National report sheds new light on the health and care of older people

National report sheds new light on the health and care of older people

The new report, Focus on the Health and Care of Older People, June 2014, aims to provide a wider picture of older people's health and lifestyle and pulls together data on hospital activity, mental health, social care, prescribing, NHS workforce, census data and life expectancy. NHS Networks

'Supercooling' keeps organs fresh

'Supercooling' keeps organs fresh

A new technique known as "supercooling" can preserve organs for days before they are transplanted, US researchers claim. BBC News

Refer more diabetes patients to structured education, GPs told

Refer more diabetes patients to structured education, GPs told

GPs should refer more diabetes patients to structured education so they can better self-manage their condition, experts have advised. GP Online

Hospitals told to stop profiteering from parking

Hospitals told to stop profiteering from parking

Norman Lamb, the health minister, said he was prepared to insert a clause in the standard NHS contract to stop executives repeatedly hitting patients with high parking fees. Daily Telegraph

Patients with learning disabilities still in long-stay hospitals

Patients with learning disabilities still in long-stay hospitals

Some 88% still awaiting transfer date, new data shows. Onmedica

Whistleblowing framework: call for evidence - government response

Whistleblowing framework: call for evidence - government response


Following a consultation on support for whistleblowers, this document outlines the government's response. Employees who blow the whistle on wrongdoing in the workplace will receive more information and support under new measures to strengthen whistleblowing legislation.  Department for Business, Innovation & Skills (BIS)
Government response
BIS news

News story: Antibiotics wins the Longitude Prize

News story: Antibiotics wins the Longitude Prize


One of the problems contributing to antimicrobial resistance (AMR) is the lack of a simple test to tell doctors when an infection is caused by bacteria and should be treated by antibiotics. Incorrect use of antibiotics to treat viral infections gives bacteria the chance to develop resistance (without providing any benefit to the individual) and so later down the line, when you really do need an antibiotic, there might not be one that works. 5,000 people die each year in the UK from antibiotic resistant infections.

Chief Medical Officer Dame Sally Davies worked with the Longitude Committee to develop the antibiotic challenge which will help conserve our antibiotics and fight antimicrobial resistance.

Over the summer, the Longitude Committee will develop the challenge criteria that will set out what people need to do to win the multi-million pound prize. Ideas can then be submitted from the autumn and competitors will have up to 5 years to put their solution forward for assessment by the Committee.

Chief Medical Officer, Dame Sally Davies said:

I am delighted that Antibiotics has been voted to receive the Longitude prize funds. I feel extremely passionate about the work that will be able to take place now, and I thank everyone that has taken the time to vote.

Thanks to the Longitude Prize, we will be able to start the development of a rapid diagnostic test, which will help to conserve the antibiotics we have and thus ensure they remain effective for as long as possible. Antimicrobial Resistance is one of the most important issues facing modern medicine in the world today and development of a rapid diagnostic has the potential to improve patient care on a global scale.

Department of Health

Friday 27 June 2014

Independent report: Liverpool Care Pathway review: response to recommendations

Independent report: Liverpool Care Pathway review: response to recommendations

The Leadership Alliance for the Care of Dying People, made up of 21 national health and care organisations, has published One Chance to Get it Right, the response to the recommendations set out in More Care, Less Pathway, the independent review of the Liverpool Care Pathway.

The response sets out the Alliance’s commitment that care for all people in the last days of their life should be compassionate and tailored to the needs and preferences of the dying person. To achieve this, the Alliance has developed 5 new Priorities for Care, which set out the standards of care that dying people and their families should expect to receive.

The Alliance has also published:
the commitments Alliance members have made to implement the Priorities for Care
a summary of public engagement into the Alliance’s proposed approach

Further materials for health and care staff and organisations involved in implementing the priorities are available from the NHS Improving Quality website.

Blood test for breast cancer comes step closer

Blood test for breast cancer comes step closer

A simple blood test which could help predict a woman’s chance of developing breast cancer is in development, after new research uncovered a genetic “early marker” of risk, scientists have said. Independent

Work experience student makes cystic fibrosis breakthrough

Work experience student makes cystic fibrosis breakthrough

A medical student on work experience has made a breakthrough in cystic fibrosis research that will improve treatment and could extend sufferers’ life expectancy. Independent

Health and wellbeing metrics and demographics

Health and wellbeing metrics and demographics

We’ve added new information, case studies and useful links to the health and wellbeing section of our website on using metrics and demographics. 
NHS Employers

Hunt calls for shared records and data

Hunt calls for shared records and data

The NHS will not reach its full potential without sharing of electronic patient records across health and social care, Jeremy Hunt has said. EHI News

Shine like a star: inspirational improvement innovations

Shine like a star: inspirational improvement innovations

Across the country teams are often developing and implementing ideas to improve safety, efficiency and person-centred care, but it's less common for teams to have the space and time to build the initial evidence needed to get wider interest and adoption. The Shine programme aims to help teams to do just that, says Jo Bibby.
Health Foundation

The impact of the older generation on England's healthcare system

The impact of the older generation on England's healthcare system


The government has produced a report looking at the impact people aged over 65 have on the NHS. We look at the figures

The proportion of England aged over 65 has increased dramatically over the past 50 years and looks set to grow even more in the coming decades

In 1951, 11% of people were aged 65 and less than 1% were over 85. In 2011, those proportions had increased to 16% and 2% respectively. Government projections suggest that by 2051, one in four will be over 65 while 7% of the population will be 85 and over. Guardian

Continue reading...

Call to halve target for added sugar

Call to halve target for added sugar

People need to more than halve their intake of added sugar to tackle the obesity crisis, according to scientific advice for the government in England. BBC News 

Juice could no longer count towards 'five a day'

Juice could no longer count towards 'five a day'

Health officials are considering changes so fruit juice no longer counts towards 'five a day' amid concerns that it is fuelling Britain's obesity epidemic. Daily Telegraph

Plain cigarette packaging regulations to be announced by ministers

Plain cigarette packaging regulations to be announced by ministers


Department of Health confirms it is bringing forward moves on plain packets, delighting doctors and health charities

Plain packaging for cigarettes will come a step closer when ministers announce regulations to enact the historic move on Thursday. Guardian

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Vitamin D deficiency linked to high blood pressure

Vitamin D deficiency linked to high blood pressure

"Vitamin D supplements could help high blood pressure," The Independent reports. The paper reports on new research into genetic variations associated with low vitamin D levels and their relationship with blood pressure.

Researchers pooled 35 studies of nearly 100,000 people with a European background. They found that the lower the vitamin D levels, the higher blood pressure was.

But they did not look at whether vitamin D supplements or exposure to sunlight would lower blood pressure. And, similarly, they also did not look at whether a lowering of blood pressure improves health outcomes.

These findings are also limited by the fact the study only included people with a European background. It is therefore unclear whether a similar association would be found in other ethnicities.

Thursday 26 June 2014

Challenge to walk 20 million steps in a weekend as county is revealed to be ‘fifth fattest’ in UK

Challenge to walk 20 million steps in a weekend as county is revealed to be ‘fifth fattest’ in UK

A campaign to get people walking in Northamptonshire has been launched after it was revealed the county was the fifth fattest in the country. Chronicle & Echo

Sustaining and assuring the quality of student nurse mentorship: what are the challenges?

Sustaining and assuring the quality of student nurse mentorship: what are the challenges?


This briefing focuses on sustaining and assuring the quality of mentorship within a difficult economic climate and at a time of debate about its future direction. National Nursing Research Unit (NNRU)
Briefing
NNRU - publications

Interactive map reveals stark differences in mortality rates across UK

Interactive map reveals stark differences in mortality rates across UK

People living in Blackpool, Manchester and Middlesbrough are twice as likely to die as other parts of the country, according to the Office for National Statistics. Daily Mail

NICE approves canagliflozin as new type 2 diabetes treatment option

NICE approves canagliflozin as new type 2 diabetes treatment option

NICE has approved the use of canagliflozin in combination with other anti-diabetic drugs to treat people with type 2 diabetes, widening available treatment options for GPs. GP online

NICK BOYLE: How the NHS wastes billions over everything from drugs to surgical gloves... by a top consultant surgeon

NICK BOYLE: How the NHS wastes billions over everything from drugs to surgical gloves... by a top consultant surgeon

The organisation is filled with dedicated people, but they have to work in a bureaucratic, sluggish system, writes consultant surgeon NICK BOYLE. Daily Mail

NHS must earn trust on data - Manning

NHS must earn trust on data - Manning

The NHS needs to earn back the trust of patients in the way that it handles data, the chair of the Health and Social Care Information Centre has said. EHI News

BMA votes for care.data opt-in

BMA votes for care.data opt-in

The British Medical Association has voted in favour of making care.data an opt-in system rather than an opt-out one. EHI News

Lamb supports tech for integrated care

Lamb supports tech for integrated care

Technological innovation is "critical and central" to integrating care and addressing the financial pressures facing the NHS, care secretary Norman Lamb has said. EHI News

Developing pharmacy’s contribution to public health

Developing pharmacy’s contribution to public health

This report gives details of how Public Health England is providing leadership for the development, implementation and evaluation of public health practice for pharmacy, taking national and local priorities into account.  Public Health England 

Cannabis use 'genetically linked' to schizophrenia

Cannabis use 'genetically linked' to schizophrenia

“Study finds people predisposed to the condition [schizophrenia’] and drug users share common genes,” the Mail Online reports. A new study suggests that ‘schizophrenia’ genes are associated with cannabis use.

It has long been known that there is an association between cannabis use and schizophrenia – but the “direction of travel” has been hotly debated.

Does cannabis use trigger the onset of schizophrenia in vulnerable individuals? Or are people with a genetic predisposition to develop schizophrenia more likely to use cannabis than the population at large (possibly as a coping mechanism)?

This latest study suggests that the latter may be the case; at least in some people. The study involved 2,082 healthy adults whose genetic make-up was examined for risk factors for schizophrenia.

Five top tips on how to make person centred care really work

Five top tips on how to make person centred care really work


Better communication, access to information and involving patients in their care aren't just 'soft stuff' they have real benefits
Are personal health budgets the solution to integrated care?

There is little mystery about what matters to patients and their families. Research highlights a small number of things that people regard as vital. These include good information and communication from professionals, involvement in decisions yet respect for preferences, emotional support and empathy, and continuity and co-ordination of care. Some or all of these matter to everyone who comes into contact with health and care services, and they are of especial importance to the growing number of people affected by long-term conditions and disabilities.

Yet we know that our health and social care systems do not deliver them consistently. For example, half of hospital inpatients in England report that they are not as involved as they would like to be in decisions about their care. Only 3% of GP patients have a written care plan that is shared with them. Lack of information and poor communication lie at the heart of many negative experiences of care. Guardian

Continue reading...

Vitamin D supplements could help high blood pressure, scientists say

Vitamin D supplements could help high blood pressure, scientists say

Vitamin D supplements might be a cheap and effective way to treat high blood pressure, scientists have said, after a study uncovered the best evidence yet of a link between vitamin levels and hypertension. Independent

Wednesday 25 June 2014

Investigation into deaths of five residents at Northampton care home to be reopened by police

Investigation into deaths of five residents at Northampton care home to be reopened by police

The investigation into the deaths of five residents of a former Northampton care home is to be reopened by Northamptonshire Police. Chronicle & Echo

Sir Robert Francis review of whistleblowing processes

Sir Robert Francis review of whistleblowing processes

It has been announced that Sir Robert Francis will lead a review of whistleblowing processes in the NHS. NHS Employers

Press release: NHS rated on open and honest reporting culture in world leading transparency drive

Press release: NHS rated on open and honest reporting culture in world leading transparency drive

Unprecedented hospital data release aims to ensure NHS remains a world leader on safety

New safety drive with ambition to save up to 6,000 lives and halve avoidable harm

New data published today will for the first time allow the public the opportunity to compare key safety measures across hundreds of NHS Trusts in England.

It shows that the vast majority of NHS hospitals are rated as “good” or “ok” for their reporting culture. However, around one in five acute trusts, or 20 per cent have been rated as “poor” for open and honest reporting, underlining the need to support NHS staff to report and raise safety concerns.

Sign up to Safety

Sign up to Safety

Today, the Secretary of State for Health launched a new campaign to make the NHS the safest healthcare system in the world, building on the recommendations of the Berwick Advisory Group. The campaign has set out a three-year shared objective to save 6,000 lives and halve avoidable harm as part of our journey towards ensuring patients get harm free care every time, everywhere.

The Sign up to Safety campaign is for everyone in the NHS. It will generate a movement which places the safety of patients as a top priority in everything the NHS does. NHS England, Department of Health, Monitor, NHS Trust Development Authority, NHS Litigation Authority and CQC have all agreed to sign up to safety and have made a commitment to align their organisations’ work with the campaign, which will be led by Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust. NHS Commissioning

For more information visit the Sign up to Safety website.

Spike in whooping cough cases lead to vaccination fears

Spike in whooping cough cases lead to vaccination fears

One in five children who see a doctor with a persistent cough may have the rare and dangerous condition whooping cough, new research indicates. The Independent

Doctors face new language checks

Doctors face new language checks

New powers allowing the medical regulator to check doctors' English language skills come into force, in a move hailed as an "important milestone". BBC News - Health

Tackling health inequalities: the case for investment in the wider public health workforce

Tackling health inequalities: the case for investment in the wider public health workforce


Royal Society for Public Health (RSPH) -
This report calls for greater investment and better understanding of the impact of the wider public health workforce - people who are not professionally qualified public health practitioners, but have the ability or opportunity to positively impact public health in their community. This includes health trainers, health champions, and non-health professionals. It argues that this “wider workforce” could be instrumental in reducing the burden of health inequalities – the financial cost of which was last estimated at close to £60bn.  Kings Fund Blog
Report
Press release

Phones carry bacterial 'fingerprint'

Phones carry bacterial 'fingerprint'

More than 80% of the most common bacteria present on fingers end up on the screens of smartphones, according to a study. BBC News - Health

New 3D breast screening increases cancer detection by 41%

New 3D breast screening increases cancer detection by 41%

Pennsylvania scientists found the scan, also known as digital breast tomosynthesis, also led to a 15 per cent drop in patients being unnecessarily recalled due to false alarms. Mail online

Ibuprofen could prevent premature ageing by combating arthritis, study shows

Ibuprofen could prevent premature ageing by combating arthritis, study shows

Ibuprofen, taken by millions of Britons every day to treat headaches, could be a cheap and simple antidote to the toxic effects of chronic inflammation, scientists say. Daily Telegraph

Royal Colleges join forces to call for more action on mental health, making a commitment to what the two Colleges themselves will do

Royal Colleges join forces to call for more action on mental health, making a commitment to what the two Colleges themselves will do
In a new joint statement published today, the two Colleges set out how they will work together to improve the physical health of patients with mental health problems, including calling for rebalanced of NHS resources to support better care in the community for people with mental health problems.

There is strong evidence that people with serious mental health problems are more likely to suffer from physical health problems, including diabetes, coronary heart disease and respiratory disease.

In addition, people with serious mental health problems die on average 15-20 years earlier than the rest of the population, with over 33,000 dying prematurely every year

The RCGP and RCPsych are united in their determination that patients should benefit from:
More time to discuss, plan and manage their long-term care in consultation with GPs, psychiatrists and other health professionals in the community.
Services which are better coordinated with one another, and around patients’ lives, with health professionals from different disciplines – including GPs and psychiatrists – given the time and resources to develop more effective ways of working together.
Better continuity of care, with patients able to see members of the same team if they wish.
More care delivered closer to home outside hospitals, and expanded outreach services to those who need it.

UK 5 Year Antimicrobial Resistance (AMR) strategy 2013-2018: measuring success

UK 5 Year Antimicrobial Resistance (AMR) strategy 2013-2018: measuring success


This guidance outlines measures agreed by the UK antimicrobial resistance strategy High Level Steering Group, based on advice from expert scientific advisory committees including the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI). It covers 4 areas: trends in resistance; quality of prescribing in primary and secondary healthcare settings; public and professional knowledge and understanding of antimicrobials and their appropriate use; and global security through ensuring global alignment in addressing AMR. It is aimed at clinical professionals, NHS managers, primary and secondary care prescribers,stakeholders and healthcare workers. Department of Health
Guidance
DH - publications

Patient safety alert on risk of harm relating to interpretation and action on PCR results in pregnant women

Patient safety alert on risk of harm relating to interpretation and action on PCR results in pregnant women


A patient safety alert has been issued by NHS England on the risk of harm relating to interpretation and action on Protein Creatinine Ratio (PCR) results in pregnant women. The alert has been issued to all NHS services involved in ordering, processing, issuing and receiving urinary protein measurements in pregnancy. NHS Commissioning 
Read the full patient safety alert

Going with change: allowing new models of health care to be provided for NHS patients

Going with change: allowing new models of health care to be provided for NHS patients

This report uses examples from retail and manufacturing to illustrate how NHS hospitals and GP practices will operate in the next decade. NHS Networks

GPs' surgeries 'at risk of closure'

GPs' surgeries 'at risk of closure'

Thousands of patients could be left without a local GP as surgeries face closure due to a finding crisis, doctors warn. Daily Telegraph

NHS England publishes staffing data

NHS England publishes staffing data


The NHS take another step forward in its commitment to openness and transparency today as nurse, midwife and care staffing data down to ward level is published for the first time.

The information is available in one place on a new safety section on NHS choices alongside a range of other information including safety reporting, infection control, blood clots, pressure ulcers and patient and staff feedback.

Jane Cummings, Chief Nursing Officer for England, has also posted a blog on how providing accessible and meaningful information about our local health services is establishing the NHS as a global leader in openness and transparency and helping to inform the public and drive improvements. NHS Commissioning
Now read Jane Cummings’ blog
Also see: www.nhs.uk/safety

Tuesday 24 June 2014

One in five hospitals rated 'poor' for honesty on safety risks

One in five hospitals rated 'poor' for honesty on safety risks

Jeremy Hunt is to launch a new transparency drive which will rate hospitals more highly for being honest about their errors.  Daily Telegraph

Fears hospital mistakes covered up

Fears hospital mistakes covered up

An analysis of reporting incidents shows 29 out of 141 hospital trusts in England are not registering the expected number of safety incidents. BBC News - Health

Guidance: UK AMR strategy: measuring success

Guidance: UK AMR strategy: measuring success


Antimicrobial resistance is when infections caused by microorganisms survive exposure to a drug that was supposed to kill them or stop their growth, this is a particular problem with antibiotics.

The measures agreed by the UK antimicrobial resistance strategy High Level Steering Group, taking advice from expert scientific advisory committees including the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI), cover 4 areas:
trends in resistance
quality of prescribing in primary and secondary healthcare settings
public and professional knowledge and understanding of antimicrobials and their appropriate use.
global security through ensuring global alignment in addressing AMR

These measures apply equally to human and animal health.

Department of Health

Public Health England looks for high tech ways to improve nation’s health

Public Health England looks for high tech ways to improve nation’s health


The competition has been launched to demonstrate the commitment from PHE to identify and support the latest applications and utilities in order to make a difference to people’s lifestyles.

Successful Health X businesses will be offered promotional support through PHE’s Change4Life campaign, a presence on NHS Choices and help with product development. NHS Networks

Helping the NHS to change: Monitor’s annual plan for 2014/15

Helping the NHS to change: Monitor’s annual plan for 2014/15


The way Monitor regulates NHS foundation trusts will be reviewed with the aim of ensuring those organisations which provide healthcare are given room to innovate and take calculated risks, in order to provide better quality services for patients and better value for money.

The move is just one of several actions announced by Monitor in its annual plan, aimed at encouraging the NHS to develop services that better meet the needs of patients whilst doing more with the money it is given. NHS Networks

Mental health services 'a car crash'

Mental health services 'a car crash'

Mental health services in England are "a car crash" and not prioritised by the health secretary, says the Royal College of Psychiatrists' outgoing president. BBC News - Health

Are personal health budgets the solution to integrated care?

Are personal health budgets the solution to integrated care?


The health and social care system is facing increasing pressures that traditional solutions can't address
Health and care integration could prove too costly for the NHS

Integration used to mean common assessments, merged teams and management restructures. Times have changed, and it's no longer just about changing job titles and Tupe Transfer of Undertakings (Protection of Employment). Over the last few years the health and social care system has begun to embrace the idea of "person-centred, co-ordinated care" that shifts the focus from organisations back to the experience of the person needing support.

Some of this has become necessary because people receiving care are no longer willing to accept that certain models of institutionalised provision are right for them just because they have a particular diagnosis. Choice and control, while being policy terms that have been repeated so often that there's a risk of losing the meaning, do resonate with us all personally in the decisions in life that are most important: where we live, who's in our life, and how we spend our time. The Guardian
Continue reading...

Reducing unintentional injuries among children and young people

Reducing unintentional injuries among children and young people


These resources for local authorities cover the prevention of accidents to children and young people in the home and on the road. The reports show that whilst the number of children and young people killed or seriously injured continues to fall in England there are still significant numbers of deaths and emergency admissions from preventable causes. It also highlights actions that local partners can take to reduce accidents including improving safety for children travelling to and from school and using existing services like health visitors and children’s centres. 
Public Health England (PHE) 
Reports and data
Press release

Doctors reject seven-day routine services at BMA annual meeting

Doctors reject seven-day routine services at BMA annual meeting

Doctors have rejected the provision of seven-day routine NHS services after debates at the BMA annual representatives' meeting (ARM). GP Online

Stress 'causes damage to the heart,' study finds

Stress 'causes damage to the heart,' study finds

"Stress is already known to be bad for the heart, but now scientists have discovered why it is so harmful," The Times reports.

A new US study now offers a plausible model of how chronic psychological stress could lead to heart damage. It involved both mice and junior doctors.

Researchers checked the blood of a small group of doctors after a week at work in intensive care. After a week of this stressful work, their white blood cell count had increased.

Similarly, when mice were exposed to chronic stress (tilting their cage for an extended period of time), they also showed increased levels of white blood cells.

This finding is of interest and possible concern. Previous research suggested inflammatory white blood cells might be involved in the process of causing the rupture of fatty atherosclerotic plaques in the arteries of people with heart disease, which causes a heart attack.

However, this research is very far from providing conclusive proof that stress leads to the development of heart disease, or directly causes heart attacks.

Doncaster rolls out iPad dementia tests

Doncaster rolls out iPad dementia tests

An iPad-based test for early dementia diagnosis is being rolled out across 24 GP practices in Doncaster, following a pilot. EHI News

Monday 23 June 2014

News: Cransley Hospice Fundraiser Appointed MBE

News: Cransley Hospice Fundraiser Appointed MBE

Diana Patrick, fundraising manager at Cransley Hospice in Kettering has been appointed an MBE in the Queen's Birthday Honours for services to healthcare. Diana first became Fundraising Manager in... NHFT News

Mother-of-two died from cancer after hospital doctors told her to cure a lump on her breast with primrose oil ointment

Mother-of-two died from cancer after hospital doctors told her to cure a lump on her breast with primrose oil ointment

Samina Chaudhry, 33, went back several times to Northampton General Hospital to say the primrose oil treatment was not working. Daily Mail

Northampton General Hospital staff vote for a strike on pay cuts

Northampton General Hospital staff vote for a strike on pay cuts

Forty-eight pathologists working for Northampton General Hospital have voted in favour of strike action over plans that would see each potentially earn £6,000 a year less, a union has said. Northampton Chronicle & Echo

Inquiry into the future of patient care

Inquiry into the future of patient care


An independent inquiry has been set up by RCGP to look at how the NHS can best provide care for patients at a time of constrained resources, to meet the needs of the rapidly increasing number of patients with multiple long term conditions. The inquiry is calling for written evidence from interested organisations and individuals, to help inform the proceedings, to be submitted by 16th July 2014. Kingsfund Blog
Further information and details

Poll: NHS decisions should be left to doctors, say majority of Britons

Poll: NHS decisions should be left to doctors, say majority of Britons

Ipsos Mori survey of 2,000 across UK finds that 65% believe NHS should manage itself without involvement of politicians

The majority of British people believe the NHS has become a political football used cynically to win votes and should be trusted to professionals who understand how best to provide healthcare, according to an opinion poll carried out for the British Medical Association.

The Ipsos Mori survey, released on the first day of the BMA's annual representatives meeting, also found that a third of people were in favour of parliament setting targets for the NHS, compared with 42% who were opposed. The union said the findings supported its insistence that decisions on patient care should be free from political interference and left to doctors. Guardian

Continue reading...

Lib Dems to demand emergency £2bn bailout for the NHS - reports

Lib Dems to demand emergency £2bn bailout for the NHS - reports


Senior party figures reported to be demanding boost as leading doctor attacks squeeze on funding

An emergency bailout of £2bn is needed to plug a black hole in NHS funding, Liberal Democrat sources claim, as a leading doctor called the Government's plans for extended seven-day care as "just bonkers".

Senior Lib Dem figures are planning to approach party leader Nick Clegg to demand the extra funding for the health service ahead of the Government's autumn statement, the Times reported. Guardian

Continue reading...

How stress damages the heart

How stress damages the heart

For the first time scientists have found a direct biological link between stress and inflammation of blood vessels which can lead to heart attacks. Daily Telegraph

Patients 'put at risk' by plans to allow medical students to treat patients

Patients 'put at risk' by plans to allow medical students to treat patients

Patients will be put at risk by plans to allow medical students to treat people as soon as they leave university instead of doing a year's work under supervision, medical leaders have warned. Daily Telegraph

Accident and Emergency showing further signs of strain after record attendances this month

Accident and Emergency showing further signs of strain after record attendances this month

More people are attending hospital accident and emergency departments than at any time since records began, new NHS figures have revealed. Independent

The 'super jab' that is a breath of fresh air for allergy sufferers

The 'super jab' that is a breath of fresh air for allergy sufferers

A once-a-week jab for severe asthma and eczema is being hailed as ‘life-changing’ – eradicating attacks in patients who do not respond to inhalers. Daily Mail

Anti-bacterial bag-for-life could prevent rise in food poisoning when 5p plastic bag charge comes into force

Anti-bacterial bag-for-life could prevent rise in food poisoning when 5p plastic bag charge comes into force

A bag-for-life that slows the growth of bacteria which cause food poisoning could be in the supermarkets within months. Independent

Plans to relax licensing laws lambasted by doctors and alcohol groups

Plans to relax licensing laws lambasted by doctors and alcohol groups

BMA among those to warn changes under bill due to be heard in the Lords are wrong given the damage alcohol already causes

Ministers are under fire because of plans to let the Women's Institute, bed and breakfasts and charities start selling alcohol, which doctors and local councils warn could worsen Britain's drink problem.

The British Medical Association said relaxing the licensing laws was wrong, given the huge damage alcohol already causes and its heavy burden on the NHS.  Guardian

Continue reading...

Friday 20 June 2014

Medical staff vote to go on strike

Medical staff vote to go on strike

Hospital scientists vote to strike over proposed contract changes to their hours and payment rates. BBC News

Cash-crisis NHS trust has £41,774 average pay

Cash-crisis NHS trust has £41,774 average pay

An NHS trust ultimately responsible for putting 43 Northamptonshire nurses’ jobs at risk has an average salary of almost £42,000 a year. Chronicle and Echo

NHS death stats can be years out of date and 'pose public health risk'

NHS death stats can be years out of date and 'pose public health risk'

Official statistics on deaths in England and Wales are as much as two and half years out of date, a coalition of doctors, scientists and charities has warned.  Independent

Revolution in mental health information is launched

Revolution in mental health information is launched

The launch of the new Mental Health Dementia and Neurology Intelligence Networks (MHDNIN) represents a “revolution in information”.

That is the view of Dr Geraldine Strathdee, NHS England’s National Clinical Director for Mental Health, who said: “I am absolutely delighted to be part of this launch which marks the culmination of many months of partnership working between the thirteen national agencies that provide mental health information.

“This is just the very start of the mental health information revolution. NHS England strategic clinical networks and academic health science centres are now supporting the testing of the commissioning care pathway profiles in their localities and we will make changes in line with their feedback.

“More than 300 commissioners, clinical and academic experts, service users and quality improvement champions have generously contributed their time to produce this programme, and we are very grateful to them and their employers.”

In collaboration with Public Health England, the launch of the networks consist of four pilots.

Exercise guidelines 'put people off'

Exercise guidelines 'put people off'

How getting off your seat could extend your life. BBC News

PM urges global push on dementia

PM urges global push on dementia

David Cameron has announced more funding for dementia research and urged a global effort to find a cure. BBC News

Modelling, evaluating and implementing cost effective services to reduce the impact of stroke

Modelling, evaluating and implementing cost effective services to reduce the impact of stroke


The objective of this study was to estimate risk of stroke, longer-term needs and outcomes, risk of recurrence, trends and predictors of effective care, to model cost-effective configurations of care, to understand stakeholders’ perspectives of services and to develop proposals to underpin policy.
National Institute for Health Research (NIHR) 
Full report
Scientific summary

Liver cancer and malignant melanoma rates rise sharply in England

Liver cancer and malignant melanoma rates rise sharply in England


Researchers warn that cancers are strongly linked to lifestyle choices, such as smoking, alcohol consumption and obesity

The number of people diagnosed with liver cancer has risen sharply. An Office for National Statistics study shows the incidence of liver cancer in England increased by 70% for males and 60% for females between 2003 and 2012.

It is now the 18th most common cancer in England, the ONS said. The number of women diagnosed with the disease rose from 889 in 2003 to 1,418 in 2012, while the number of men went up from 1,440 to 2,449 in the same period. Continue reading...

Guardian

Penalise lack of EPRs - report

Penalise lack of EPRs - report

NHS trusts that fail to make proper use of electronic health records should be hit with higher insurance premiums and a reduced Care Quality Commission rating, according to a new report. EHI News

DH plans to establish NIB as priority

DH plans to establish NIB as priority

The Department of Health has released its IT priorities for the next year, with the National Information Board and support for the NIB's informatics strategy mentioned as key projects. EHI News

RCGP launches inquiry into future of patient care at time of soaring demand and constrained NHS resources

RCGP launches inquiry into future of patient care at time of soaring demand and constrained NHS resources

The inquiry is to be chaired by Mike Farrar, the former NHS Confederation Chief Executive and former Head of Primary Care at the Department of Health, and will explore how to find cost effective solutions to the medical, social and financial challenges posed by rising levels of multi-morbidity within society.

The inquiry, hosted by the Royal College of General Practitioners (RCGP), will be entitled the Inquiry into Patient-Centred Care in the Twenty-First Century.

Farrar will lead a panel of twelve experts in NHS care, from organisations including the National Association for Patient Participation, Royal College of Physicians, NHS Confederation, LloydsPharmacy, and the RCGP. It will look at the role of general practice within the context of primary, community and social care services.

Thursday 19 June 2014

KGH suffers from cost of bed blockers

KGH suffers from cost of bed blockers Bed blockers at Kettering General Hospital are causing “vast” expense, according to a report to a health body. Northamptonshire Telegraph

Knowledge strategy: harnessing the power of information to improve the public’s health

Knowledge strategy: harnessing the power of information to improve the public’s health This document describes the strategic approach to information and knowledge that the public health system needs to take in order to improve and protect public health and reduce inequalities. The knowledge strategy was developed following an extended and open consultation process and incorporates responses from local government, national organisations and key partners. Public Health England

Dementia progress 'achingly slow'

Dementia progress 'achingly slow' Progress on new research and treatments for dementia has been "achingly slow", the man appointed as global envoy for the disease says. BBC News

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England NHS 'faces funding gap'

England NHS 'faces funding gap' The NHS in England faces a funding gap of up to £2bn for the next financial year, with growing costs set to outstrip income, the BBC understands. BBC News

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Viewpoint: International study backs NHS as GP role under threat

Viewpoint: International study backs NHS as GP role under threat With the NHS under siege from overwhelming pressures and short-term policy gimmicks from politicians from all sides, the latest report from the Commonwealth Fund is a welcome relief, writes BMA deputy chairman Dr Kailash Chand. GP Online

Jeremy Hunt calls for end to cosmetic surgery on NHS

Jeremy Hunt calls for end to cosmetic surgery on NHS Health secretary says public money should not be spent to improve someone's looks

Jeremy Hunt, the health secretary, has expressed his strong opposition to the NHS funding cosmetic surgery at a time when it is under heavy financial pressure.

Hunt said all decisions must be taken on "clinical need", and public money must not be used to pay for surgery just to improve someone's looks. Continue reading... The Guardian

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Nearly half of patients do not understand medical language

Nearly half of patients do not understand medical language The Royal College of GPs found that nearly one half of patients struggle to understand the advice given to them by their doctor or know how to properly take their medication. The Daily Telegraph

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Nurses reject plans to make patients pay £10 for a GP appointment

Nurses reject plans to make patients pay £10 for a GP appointment The UK’s largest nursing union has overwhelmingly voted against plans to introduce £10 charges every time someone goes to see their GP, in what bosses described as an affirmation of the belief the NHS should be free at point of delivery. The Independent

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Hospital wrong to put ‘do not resuscitate’ note in patient’s file

Hospital wrong to put ‘do not resuscitate’ note in patient’s file Doctors have a legal duty to tell patients if a “do not resuscitate” order has been placed in their medical records, the Court of Appeal in England has ruled. The Independent

Tuesday 17 June 2014

Waiting list of 148 people for life-saving organs in Northamptonshire

Waiting list of 148 people for life-saving organs in Northamptonshire There are 148 people in Northamptonshire waiting for a life-saving organ. However, only 11 people in the county received a transplant in the whole of last year. Northampton Chronicle and Echo

Nene Clinical Commissioning Group issue its first annual report

Nene Clinical Commissioning Group issue its first annual report The first annual report for Nene Clinical Commissioning Group (CCG) has now been published. Northampton Herald and Post

Prioritising person-centred care: the evidence

Prioritising person-centred care: the evidence These resources have been designed to make it easy for commissioners and providers to access, understand and make use of the best evidence for various approaches to involving people in their health and healthcare. The booklets draw on information from 779 systematic reviews worldwide. They offer practical ways forward based on accurate evidence so commissioners, health professionals and service-user groups can see what works best and how to invest resources. National Voices

Facing the future: smaller acute providers

Facing the future: smaller acute providers This report finds that small district general hospitals can thrive but the way services are provided to local patients must change to guarantee quality care. The research found that no clear evidence that smaller acute hospitals performed any worse clinically than larger counterparts. However, the analysis showed that there is evidence that smaller providers may be starting to face greater financial challenges, with performance worsening more than the sector as a whole in the last 2 years. Monitor

Hospital wards 'too noisy at night'

Hospital wards 'too noisy at night' Hospitals need to do more to ensure patients get a good night's sleep, nurses say. BBC News

'10,000' NHS patients in data breach

'10,000' NHS patients in data breach As many as 10,000 NHS patients may have been affected by data protection breaches by a private firm, a BBC investigation reveals. BBC News

Avon calling

Avon calling Getting an NHS trust to share data with a local authority is a challenge. Getting 13 health and social care organisations to share data, with the appropriate governance arrangements in place might, to some, seem almost impossible. E-Health Insider

Warning issued over washing raw chicken

Warning issued over washing raw chicken "Don't wash chicken before cooking it, warns Food Standards Agency," The Guardian reports. The Food Standards Agency (FSA) has issued the advice as many people do not realise that washing raw poultry can spread bacteria, leading to an increased risk of food poisoning.

The bacteria in question, campylobacter, is the most common cause of food poisoning in the world and affects about 280,000 people in the UK each year.

New guidance is intended to remind people that washing raw chicken before cooking increases the likelihood of infection through splashing the bacteria on to work surfaces, clothing and cooking equipment. This is known as cross-contamination.

Washing is therefore not recommended – it is also unnecessary as thorough cooking will kill any bacteria.

The NHS must learn from its mistakes

The NHS must learn from its mistakes Sharing knowledge and spreading expertise will improve patient safety

Maurice Murphy died after a nasogastric tube was passed through his nose into his lung instead of into his stomach. Murphy, the principal trumpet of the London Symphony Orchestra for 30 years, was being treated in an NHS hospital in London for a liver complaint. A junior nurse who queried whether the tube was in the right place was told by the doctor in charge: "You don't have the brain to remember that I told you to start the feed. The tube is in the right position."

Murphy, who died in 2011, was a victim of a "never event" errors so called because they should never happen. His case was recalled by Prof Sir Liam Donaldson, former chief medical officer, who told a group of NHS experts this month that never events do still happen at the rate of 300 a year in England. They include (from last year) a woman who had her fallopian tube removed instead of her appendix and 123 cases in which swabs, instruments or other items were left inside patients after surgery. Continue reading... The Guardian

How NHS hospitals spent £5 million on obese patients

How NHS hospitals spent £5 million on obese patients Hospitals are spending thousands widening corridors, buying fridges to store bodies of overweight patients and strengthening operating tables as Britain's obesity crisis continues. The Daily Telegraph

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District nurses could be a thing of the past in 10 years without urgent action, warns Royal College of Nurses

District nurses could be a thing of the past in 10 years without urgent action, warns Royal College of Nurses

There could be no more district nurses in the England within a decade, the Royal College of Nursing (RCN) has said, in an unprecedented warning over the future of the profession. The Independent

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Monday 16 June 2014

Five NHS falls deaths in Northamptonshire in less than a year

Five NHS falls deaths in Northamptonshire in less than a year The NHS trust responsible for Northamptonshire mental health has seen five deaths of patients from falls in 10 months. Northampton Chronicle and Echo

Delivering innovations in the care of older people: an opportunity to brag, steal, learn and deliver?

Delivering innovations in the care of older people: an opportunity to brag, steal, learn and deliver? Older people, especially those who are frail or live with dementia or complex chronic conditions, are becoming the ‘core business’ of health and social care. This trend will only increase: by 2030, one in five people in England will be over 65, and those over 80 are the fastest growing demographic. Living longer is a cause for celebration, but it can present challenges for the health and social care system.

Our recent paper, Making our health and care systems fit for an ageing population, set out a framework and tools to help local service leaders improve the care they provide for older people across nine key components.

Guidance for taking responsibility: accountable clinicians and informed patients

Guidance for taking responsibility: accountable clinicians and informed patients Following recommendations in the Francis Inquiry report that there is a need for a named accountable clinician for a patient's care whilst in hospital, AoMRC was asked by the Secretary of State to see how this could be taken forward. This guidance was developed following discussion and consultation with medical royal colleges, regulatory bodies and professional bodies. Academy of Medical Royal Colleges

Older HIV patients 'need support'

Older HIV patients 'need support' The "silent generation" of around 25,000 older people with HIV need better support to keep them well, nurses say. BBC News

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NHS scan and test delays 'worrying'

NHS scan and test delays 'worrying' Health charities call for urgent action to tackle delays in access to diagnostic tests in England, although NHS England says most patients are investigated promptly. BBC News

Hip replacement cement linked with deaths

Hip replacement cement linked with deaths "Toxic NHS hip implants blamed for more than 40 deaths," The Daily Telegraph reports. Other media sources similarly report how surgical "cement" used in some hip replacements has been linked to the deaths.

This news is based on a study looking at risk of death or severe harm associated with partial hip replacements involving cement for people with a fracture at the top of the thigh bone (fractured neck of femur).

The practice of using cement to attach the replacement "ball" joint to the "socket" is a clinical decision made by surgeons based on their experience and the patient's characteristics.

In 2009, the National Patient Safety Agency (NPSA) alerted health professionals to the risk of bone cement implantation syndrome (BCIS), which can happen when cement is used.

Change service provision to guarantee quality, small district general hospitals urged

Change service provision to guarantee quality, small district general hospitals urged These hospitals can ‘survive and thrive’ but performance has dipped over past two years, says Monitor. OnMedica

GP numbers tumble in England as recruitment crisis bites

GP numbers tumble in England as recruitment crisis bites Take-up of family doctor training is at its lowest level since 2007, sparking fears there may soon be not enough GPs to cope

The government is facing a GP recruitment crisis with new figures showing a fall in the number of family doctors since the coalition came to power amid warnings that the take-up of training places is the worst since 2007.

Official data analysed by the House of Commons Library shows that at a time of ever increasing demand for their services, the number of GPs has dropped by 356 compared with its level in 2009/10. The proportion of family doctors serving every 100,000 people has also dropped, from 70 in 2009/10 to 66.5 now. Continue reading... The Guardian

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NHS bosses’ pay rises four times faster than nurses’

NHS bosses’ pay rises four times faster than nurses’ Pay and rewards for NHS managers have risen at four times the rate of nurses’ salaries in the past two years, a new report has revealed, as frontline staff accused the Government of “double standards” over pay. The Independent

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Exclusive: NHS crisis looms as A&Es miss waiting time targets

Exclusive: NHS crisis looms as A&Es miss waiting time targets
Accident and emergency departments in England have experienced an unprecedented “spring crisis”, missing a key performance target for five weeks in a row and leaving 20,000 patients waiting for four hours or more in the first week of June alone. The Independent

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Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally Despite having the most expensive health care system, the United States ranks last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity, and healthy lives, according to a new Commonwealth Fund report. The UK comes out first overall.

Friday 13 June 2014

Northamptonshire NHS launch campaign to keep pressure off A&E during World Cup

Northamptonshire NHS launch campaign to keep pressure off A&E during World Cup Northamptonshire hospitals have launched a healthcare awaress campaign to ease pressure on A&E departments during the World Cup. Northampton Chronicle and Echo

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Minister praises ‘really impressive’ improvements at Kettering General Hospital

Minister praises ‘really impressive’ improvements at Kettering General Hospital A health minister has praised the turnaround in the performance of the accident and emergency department at Kettering General Hospital. Northamptonshire Telegraph

Independent report: Payment by results: costing in the NHS

Independent report: Payment by results: costing in the NHS The trusts audited were selected based on a previous benchmarking exercise. Of the Trusts audited, 30 were identified as ‘at risk’, 10 as ‘low risk’ and 10 were selected at random. Department of Health

Hospital patients to get named doctor

Hospital patients to get named doctor Hospital patients in England should know which senior doctor is responsible for overseeing their care, according to new guidelines. BBC News

Identify people living in cold homes

Identify people living in cold homes Guidance on how to reduce deaths and illnesses among elderly people in winter has been drawn up by the National Institute for Health and Care Excellence (NICE). BBC News

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Recession 'led to 10,000 suicides'

Recession 'led to 10,000 suicides' The economic crisis in Europe and North America led to more than 10,000 suicides, according to figures from UK researchers. BBC News

NHS reform: the next shift-change

NHS reform: the next shift-change The government's NHS reforms were meant to devolve power away from Whitehall. In practice the health service remains one of the most centralised in the world. Bottom-up change is urgently needed. Public Finance 

Improving quality of life in care homes through community visiting

Improving quality of life in care homes through community visiting What difference could community visiting make to care home residents’ quality of life?

A pilot Community Visitor (CV) scheme in three Essex care homes has shown potential to support community engagement in care homes and improve residents’ quality of life. CVs visited care homes every week for a couple of hours, aiming to befriend older people and enhance communication between care home managers, staff, residents and their families. Joseph Rowntree Foundation

High-factor sunscreen doesn’t cut melanoma risk

High-factor sunscreen doesn’t cut melanoma risk “High-factor sun cream cannot…protect against the deadliest form of skin cancer,” The Guardian reports. Research involving mice with a predisposition to develop melanoma found that sunscreen only delayed, rather than prevented, the onset of melanoma.

Malignant melanoma occurs when cells that produce melanin – pigment that darkens the skin – rapidly divide and grow uncontrollably.

A mutation in a gene crucial for cell growth, BRAF, has been found in several cancers, including around half of melanoma cases. Mice in this study were given this mutation, and all of them developed melanoma when exposed to UV light.

Sunscreen factor 50 delayed the onset and reduced the number of tumours, but did not prevent melanoma.

The study also found that in the mice with the BRAF mutation, UV light damaged another part of the DNA that stops cells dividing too rapidly – tumour suppressor genes called TP53. Sunscreen did not prevent this damage, which means that the cells could grow unchecked.

Mutations in the BRAF gene found in melanomas are not the inherited type, and in humans may be caused by UV exposure and other environmental factors.

It should not be interpreted from this study that sunscreen is useless, but you cannot rely on it solely, especially if you have risk factors for melanoma, such as pale skin and having lots of moles.

NHS England in bid to cut drugs waste

NHS England in bid to cut drugs waste CCGs should work with trusts to better support patients taking medicines. OnMedica

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NHS staff face the risk of going to jail if they mistreat patients

NHS staff face the risk of going to jail if they mistreat patients Deliberate or reckless behaviour towards patients will become punishable by up to five years in prison and £5,000 fines

NHS staff will face the risk of going to jail if they mistreat patients after ministers decided to ignore protests from doctors' organisations and bring in a new criminal offence of "wilful neglect".

Deliberate or reckless behaviour towards patients will become punishable by up to five years in prison and £5,000 fines under the government's amendment to the criminal justice and courts bill. Continue reading... The Guardian

Hospital staff should recognise carers' skills and knowledge

Hospital staff should recognise carers' skills and knowledge Carers have knowledge and expertise not provided by NHS staff, yet they are not consulted in the hospital process

You might think that when the person they care for goes into hospital, carers would receive a period of respite. I don't find it so. My responsibilities continue during my partner's spells of hospitalisation, because while the resources of a major teaching hospital are focused on the problem that led to Victoria's admission (currently, an infected pressure sore), the longer term needs created by her multiple sclerosis don't go away. But they do tend to get disregarded by hospital staff.

A large teaching hospital is a self-contained, if not positively hermetic, system which doesn't really recognise outsiders as having any contribution to make. For example, I have tried repeatedly and unsuccessfully to get the hospital's consultants to include the community tissue viability nurse in discussions of my partner's pressure sore. I want her involved because she is the person who will be my source of information on future management of the wound. She has monitored, and photographed, the sore's progress over the last five years rather than from the point of Victoria's recent admission; she will be the person who takes over management of the wound as soon as she leaves hospital; and she was the first to identify the underlying osteomyelitis that has prevented healing. Yet the hospital team don't feel it's important to include her. Continue reading... The Guardian

Doctors told to apologise to patients when they make mistakes

Doctors told to apologise to patients when they make mistakes Doctors must apologise to patients and admit when they have got it wrong under new guidance being issued today by the General Medical Council. The Daily Telegraph

Figures reveal Britain's dire record on child mortality

Figures reveal Britain's dire record on child mortality

The UK has fallen behind its European neighbours in preventing deaths among children and young adults, dropping from among the best performers in 1970s to one of the worst today. The Independent

Wednesday 11 June 2014

It's time to end top-down reform of the NHS

It's time to end top-down reform of the NHS Politicians’ role in the running of the National Health Service (NHS) needs to be better defined to counter interventionist and centralising tendencies that have hampered effective reform to date, says a new report published today by The King’s Fund.

The report, Reforming the NHS from within: beyond hierarchy, inspection and markets, argues that a new political settlement is needed that clarifies the strategic role of ministers in determining funding, establishing priorities and providing accountability to Parliament, and leaves local NHS leaders with the space to innovate and lead service change. This settlement should reflect lessons learnt from the experience of the present government’s health reforms, which have failed to distance ministers from the operational management of the NHS as originally intended.