Friday, 10 March 2017

Local and national: how the public wants the NHS to be both

Local and national: how the public wants the NHS to be both The research conducted for this report shows that while people may have heard the term ‘devolution’, there is little public understanding of what it entails. It finds that while people believe that local control will improve healthcare and welcome public participation in NHS decisions, they are also deeply committed to the principle that healthcare entitlements and standards should not vary from place to place. It includes analysis of the research findings, and reports on the first experiments in NHS devolution, along with calls from authors for greater public accountability and involvement. Fabian Society

Emergency care and resuscitation plans

Emergency care and resuscitation plans A discussion of the ReSPECT model of  planning around do not resuscitate orders. BMJ

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NHS trusts record 15,000 excess deaths

NHS trusts record 15,000 excess deaths "Significantly high" death rates have been recorded at 19 of England's 133 NHS trusts, a BBC investigation has established.

There were 15,396 more deaths than expected at the trusts in the period between 2011 and 2016.

Blackpool Teaching Hospitals Foundation Trust had the highest number of excess deaths - 1,878 over the five years.

The analysis reveals a strong link between high mortality rates in England and lower than average doctor numbers. BBC News

Hunt demands NHS hits target for A&E care

Hunt demands NHS hits target for A&E care Jeremy Hunt has told NHS hospitals they must get back to meeting the target for seeing patients swiftly in A&E.

In a speech on Thursday, the health secretary said it was "critical for patient safety".

The target of seeing 95% of patients in four hours has been missed in England since July 2015. There was a record low of 85.1% in January.

Mr Hunt demanded progress this year and said the target should be hit next year after new funding in the Budget. BBC News

Budget ‘does nothing to plug hole in NHS funding’

Budget ‘does nothing to plug hole in NHS funding’ The chancellor’s spring budget has been slammed by doctors, and other stakeholders, for failing to address the “gaping hole in NHS finances”.

While the announcement of £2 billion for social care has been largely welcomed, many feel the budget does not go far enough to boost health finances.

Dr Mark Porter, British Medical Association council chair, said: “This budget does nothing to address the gaping hole in NHS finances. There is a £30 billion gap to fill and we should be increasing the UK’s health spending by at least £10.3 billion to match that of other leading European economies. The NHS and social care are at breaking point and have been failed by party politics for too long. We need politicians from all sides to come together to agree a long-term solution to the challenges facing health and social care.” OnMedica

NHS chiefs order hospitals to begin urgent overhaul of A&E care

NHS chiefs order hospitals to begin urgent overhaul of A&E care Plans requiring GPs to assess every patient when they arrive at A&E come as NHS England discloses worst ever performance in January

NHS chiefs have ordered hospitals to push through an urgent overhaul of A&E care, with GPs assessing every patient when they turn up to help the health service avoid another winter crisis.

The move comes as the NHS in England disclosed that it recorded its worst performance to date in January, missing vital treatment targets covering A&E, cancer and planned hospital care. Continue reading... The Guardian

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I went to a death cafe to learn how to talk to dying patients

I went to a death cafe to learn how to talk to dying patients Medical students do not learn how to talk about death. Junior doctors are forced to learn on the job – and that isn’t fair on patients or families

It is taboo in British culture to talk about death. We say someone has “passed away”, “kicked the bucket” or “left us” – anything to avoid even using the word. This has consequences. While 70% of people wish to die at home, half of us will actually die in hospital. Our reluctance to talk about death and make our wishes known is part of the reason for this.

So I didn’t expect to enjoy visiting a death cafe. As soon as I arrived, I knew I had made the right decision, however. The room hummed with a low level of chatter, and I felt prepared to practise talking about death and dying. Continue reading... The Guardian

Treat sepsis patients within an hour, watchdog tells NHS staff

Treat sepsis patients within an hour, watchdog tells NHS staff NHS staff must begin treating patients suspected of having potentially lethal sepsis within one hour, the watchdog has said in a bid to crack down on avoidable deaths.

The National Institute of Health and Care Excellence today says that anyone showing symptoms, such as increased temperature, heart rate and rashes, must be swiftly examined by a senior doctor and started on life-saving drugs. The Daily Telegraph

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Patients promised speedier access to GPs as long waits named and shamed

Patients promised speedier access to GPs as long waits named and shamed Patients will be promised speedier access to GPs with family doctors named and shamed for long waiting times, under new NHS plans.

The new targets come alongside a major overhaul of emergency care, with promises to increase the proportion of 111 calls assessed by medics, amid concern that too many decisions are being made by ill-trained handlers.

The plans come as official figures show record waits in Accident & Emergency departments, and warnings that the number of patients stuck on trolleys is “going through the roof”.

Simon Stevens, head of the NHS, has ordered hospitals to empty up to 3,000 beds as soon as possible, in order to relieve pressure on services. The Daily Telegraph

British doctor 'shocked' after fraudster worked in Australian hospitals using his ID

British doctor 'shocked' after fraudster worked in Australian hospitals using his ID A respected British rheumatologist has expressed “shock” after discovering that his identity was stolen by a fraudster who worked in hospitals in Australia for eleven years despite being unqualified.

In a case that is being investigated by the NHS and Australian health authorities, a fraudster allegedly stole documents in India which belonged to Dr Sarang Chitale, who lives near Manchester and works at Leigh Infirmary in Leigh, near Manchester, and several other clinics in the region.

The fraudster, whose real name is Shyam Acharya, used Dr Chitale’s documents to enter Australia and register with the medical board in the state of New South Wales. The Daily Telegraph

Thursday, 9 March 2017

KGH car park plan set for approval

KGH car park plan set for approval The car park was the subject of a planning application in January.

The move will almost double the number of spaces available in that particular car park, from 227 to 451.

Car parking has been the subject of much public frustration at the hospital, with patients and relatives often caught in queues and nearby residents frustrated by vehicles parking inconsiderately. Northamptonshire Telegraph

Guidance: Domestic abuse: a resource for health professionals

Guidance: Domestic abuse: a resource for health professionals This resource looks at how health professionals can support adults and young people over 16 who are experiencing domestic abuse, and dependent children in their households.

It will help health staff to identify potential victims, initiate sensitive routine enquiry and respond effectively to disclosures of abuse. Department of Health

Report highlights need for early intervention for diabetic foot ulcers

Report highlights need for early intervention for diabetic foot ulcers A report published today finds that early intervention is important in the management of diabetic foot disease, with people who receive expert care most quickly having the best outcomes.

It also reports that the basic framework for effective prevention and management of diabetic foot disease in England and Wales is often missing.

It is estimated that between five and seven cent of people with diabetes will have a diabetic foot ulcer at some point in their lives, at an estimated cost of £935 million to the NHS.9

The National Diabetes Foot Care Audit (NDFA) 2014-2016, published by NHS Digital and Diabetes UK, collected data on 11,000 individuals with acute diabetic foot ulcers.

Cancer treatments 'not being trialled in children'

Cancer treatments 'not being trialled in children' Children with cancer could be missing out on potentially life-saving drugs because EU regulations allow drug companies to opt out of running trials in children, cancer experts say.

Since 2012, 62% of approved EU cancer drugs were not tested on under-18s.

But cancer scientists say the rules should be changed so that adult cancer drugs have to be tested on children. BBC News

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NHS to be hit harder than expected by compensation shake-up, Budget reveals

NHS to be hit harder than expected by compensation shake-up, Budget reveals The NHS will be hit harder than expected by a controversial shake-up of personal injury compensation – forcing the Chancellor to borrow an extra £1.2bn a year.

And higher motor insurance premiums because of the shake-up “will be fully passed on to consumers”, the Treasury’s watchdog has acknowledged. The Independent

Budget 2017: Philip Hammond accused of back-door NHS privatisation by funding 'shady' reform plans

Budget 2017: Philip Hammond accused of back-door NHS privatisation by funding 'shady' reform plans Philip Hammond has promised the NHS will receive £425m in government investment over the next three years – but the way these funds are allocated could in fact lead to further NHS privatisation, campaigners have warned.

Sarah Carpenter, national officer for health at trade union Unite, said she feared the Government was trying to privatise the NHS through the back door by funding “shady” reforms in the guise of giving extra money to the health service.

“What they’re trying to do is potentially be able to say they’re giving money to the health service, but actually giving money to a part of it no one’s heard of,” Ms Carpenter told The Independent.

Over half of NHS staff work unpaid overtime every week, survey finds

Over half of NHS staff work unpaid overtime every week, survey finds Annual survey reveals morale is high but workloads, sick rates and overtime highlight challenges

This past year has sent shockwaves through an already challenging working environment in the NHS. From the withdrawal of nursing bursaries and junior doctors’ strikes to the uncertain impact of Brexit on 58,000 EU nationals currently working in the health service, workforce pressures continued to build for an already overstretched service.

So what do the findings of the latest NHS staff survey, released on Tuesday, tell us about how staff are coping? Covering 316 participating NHS organisations, the survey is the biggest in the world, capturing the experiences of more than 423,000 healthcare professionals across the country. Continue reading... The Guardian

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Hammond's budget bows to demands for social care cash injection

Hammond's budget bows to demands for social care cash injection Chancellor responds to crisis in care for older people with £2bn extra, but charities are concerned it will not be enough

Philip Hammond responded to the growing crisis in social care in England by pledging to put £2bn extra into it over the next three years and also produced an unexpected £425m to help the NHS cope better with winter and transform how it works.

Additional money for social care was necessary both to improve the help older people receive as the number of over-75s grows quickly in the coming years and also to ease the huge pressures the NHS is under, the chancellor said in his statement. Continue reading... The Guardian

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New app that REPLACES doctors to launch nationally

New app that REPLACES doctors to launch nationally Developed by Babylon Health, it is now hoping to roll the concept of chat-bots for NHS 111 helplines out nationwide. It tells patients which specific service to visit, as close to their home as possible. The Daily Mail

£100m for GPs in A&E to weed out those not seriously ill announced in Budget

£100m for GPs in A&E to weed out those not seriously ill announced in Budget GPs will be placed in A&E departments to turn away people who are not sufficiently ill as part of a £100 million effort to crack down on hospital overcrowding.

The measure, announced by Philip Hammond in the budget, follows a relentless increase in A&E admissions which at one stage this winter saw one in two hospitals issue emergency alerts indicating they were unable to cope. The Daily Telegraph

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Wednesday, 8 March 2017

Warning over highly-contagious superbug sweeping the nation

Warning over highly-contagious superbug sweeping the nation A new variant of a gene that causes resistance to our strongest antibiotics has been discovered in a healthy person, prompting fears it could be spreading.

The team of investigators discovered a new variant of the well-known gene that causes resistance to polymyxin - currently the toughest antibiotic in our arsenal against bacteria.

The new multidrug-resistant bacteria, which carries the gene variant, was found on a patient with salmonella and could easily be passed on in bacteria.

More troubling, the gene was found in a healthy individual during a routine medical, suggesting that other healthy carriers may be spreading the resistance unknowingly. Northamptonshire Telegraph

An NHS winter that never seems to end? 

An NHS winter that never seems to end?  No one would ever claim that winter in the NHS is easy. Our most recent Quarterly Monitoring Report (QMR) duly paints a picture of accident and emergency (A&E) departments that are struggling to cope as the health needs of patients become both more complex and more acute. The recent publication of the latest set of daily performance reports for the traditionally busy winter months of 2016/17 now allows us to take a closer look at how the NHS held up this winter. The King's Fund

NHS staff survey 2016

NHS staff survey 2016 This year's NHS staff survey has found that overall staff engagement has reached a peak, indicating that staff felt that they have opportunities to show initiative and contribute to improvements at work. The proportion of staff reporting witnessing errors and adverse incidents is the lowest it has been since 2012. This year's survey data is available in an interactive dashboard format which enable users to benchmark their data against other organisations more easily. Picker Institute
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Only a third of MPs believe that A&E departments are adequately resourced

Only a third of MPs believe that A&E departments are adequately resourced A poll by the Royal College of Emergency Medicine reveals just 33% of MPs believe emergency departments have the resources they need to keep patients safe.

The poll of 92 MPs of all parties and regions of the UK also found strong support for a transformation fund for emergency departments with four times as many saying they would support such an initiative as oppose it.
Over 60% of MPs said they would support Emergency Departments (EDs) receiving more money to help with the retention and recruitment of staff.

Despite government claims that the NHS was getting more than the minimum £8bn by 2020 it had asked for, the poll found that only half of Conservative MPs believe that Emergency Departments are currently being adequately resourced.

Collection: Local Alcohol Profiles for England (LAPE)

Collection: Local Alcohol Profiles for England (LAPE) Alcohol use has health and social consequences borne by individuals, their families, and the wider community.

Reducing harmful drinking is one of seven priority areas that Public Health England is focusing efforts on securing improvement.

The Department of Health commissioned PHE to produce an evidence review of the public health burden of alcohol, published in December 2016.

The local alcohol profiles have been designed to provide information for local government, health organisations, commissioners and other agencies to monitor:
the impact of alcohol on local communities
services and initiatives that have been put in place to prevent and reduce the harmful impact of alcohol

The data is updated once per quarter.

View the Local Alcohol Profiles for England. Public Health England

Hospital winter pressures: how did NHS trusts perform in 2016/17?

Hospital winter pressures: how did NHS trusts perform in 2016/17? This briefing examines the performance of the NHS over the three peak winter months covering December 2016 to February 2017. The analysis finds that the number of temporary beds opened to cope with demand on A&E units in the busiest part of this winter was equivalent to eight additional hospitals. The briefing calls for a formal review of how the NHS manages winter pressures, with a focus on the ring-fencing of winter funding and the impact of cancelling non-urgent operations. NHS Providers

Dying from inequality: socioeconomic disadvantage and suicidal behaviour

Dying from inequality: socioeconomic disadvantage and suicidal behaviour This report links higher risk of suicide with inequality calls for greater awareness of the risks of suicide and for direct support to those with unstable employment, insecure housing, low income or in areas of socioeconomic deprivation. Samaritans 

Latest experimental statistics about female genital mutilation published

Latest experimental statistics about female genital mutilation published New official figures published provide experimental statistics on female genital mutilation (FGM) in England, from October 2016 to December 2016. NHS Digital

Ebola vaccine tested on humans in UK trials

Ebola vaccine tested on humans in UK trials Researchers in UK are currently part of a worldwide effort to develop a vaccine for Ebola, so that it’s ready should another outbreak occur. BBC News

NHS to revamp 111 helpline after sustained criticism of service

NHS to revamp 111 helpline after sustained criticism of service More callers will get chance to health professionals under changes to be phased in across England from next month

The NHS is to revamp its heavily criticised 111 telephone helpline to ensure that many more people get to discuss their illness with a nurse, doctor or other health professional rather than a call handler.

GPs and mental health health nurses will also start to play key roles after the overhaul, which is intended to improve public confidence in 111 so that fewer patients visit A&E or a GP’s surgery. Continue reading... The Guardian

Smoking numbers hit new low as Britons turn to vaping to help quit cigarettes

Smoking numbers hit new low as Britons turn to vaping to help quit cigarettes New data reveals a significant decline in number of smokers over last five years, while the daily number of cigarettes consumed has also fallen

The number of smokers in Britain has reached its lowest point since records began in 1974, according to new data, while more than a million people say they are using e-cigarettes to help them quit smoking.

The latest data from the Office for National Statistics shows that 17.2% of adults in the UK smoked in 2015, down from 20.1% in 2010. Continue reading... The Guardian

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Google can detect tumours with a 92% accuracy rate

Google can detect tumours with a 92% accuracy rate DeepMind is on the verge of becoming a much-needed medical breakthrough. Owned by Alphabet, Google's parent company, it claims it can detect 92.4 per cent of tumours it scans for. The Daily Mail

NHS chief 'pushed out' after exposing a sex ring involving consultants and doctors, hospital staff say

NHS chief 'pushed out' after exposing a sex ring involving consultants and doctors, hospital staff say The NHS's longest serving chief executive has been “pushed out” of his job after he suspended senior consultants who used hospital premises to have sex, according to hospital insiders.

Sir Leonard Fenwick, Newcastle and Tyne Hospital Trust's chief executive, was put on "extended leave" from the hospital under mysterious circumstances earlier this year, a decision which angered a number of staff and governors. The Daily Telegraph

Patients are not priority, warn half of staff at scandal ambulance service 

Patients are not priority, warn half of staff at scandal ambulance service Almost half of staff at a scandal-hit ambulance trust do not think their patients are put first, with almost one quarter too frightened to raise safety concerns with managers, research shows.

The NHS staff survey shows that South East Coast Ambulance trust is the worst in the country across a host of rankings.

The trust has been at the centre of a string of scandals, with at least two call handlers saying they were driven to attempt suicide as a result of an “endemic culture of bullying”.

Several claimed they were left under such pressure they could not concentrate on emergency calls, impairing their responses to the public. The Daily Telegraph

Numbers missing two-month cancer treatment target window doubles amid warnings A&E crisis is sucking away resources

Numbers missing two-month cancer treatment target window doubles amid warnings A&E crisis is sucking away resources The number of NHS cancer patients waiting longer than the crucial two-month target window has nearly doubled in the last five years, a new report reveals.

Macmillan Cancer support have warned that patients are dying because overrun A&E departments are draining the hospital resources needed to give them the prompt treatment they need.

One in six people diagnosed with the disease began treatment after the aimed-for 62 days in 2016, according to the charity, making it the third consecutive year in which the health service failed to keep pace with rising demand. The Daily Telegraph

Tuesday, 7 March 2017

Hospital staff in Northampton await decision on cancelled salary rise

Hospital staff in Northampton await decision on cancelled salary rise Staff at a St Andrews Hospital are awaiting a decision on whether their postponed pay rises will be reinstated. Northampton Chronicle and Echo

Pupils 'suffering in silence' with mental health issues, University of Northampton expert warns

Pupils 'suffering in silence' with mental health issues, University of Northampton expert warns Schools must put the mental health of their pupils at the top of their agenda, a lecturer at the University of Northampton said in a new report for the Government. Northampton Chronicle and Echo

Adult social care: a pre-budget report

Adult social care: a pre-budget report This report calls on the Chancellor to bring forward £1.5bn funding from the improved Better Care Fund to make up for the shortfall in adult social care funding. The report also calls on the government to commit to closing the funding gap for the rest of parliament through to 2020 and highlights the urgent need for a cross-party review on the provision and funding of social care in the long-term. House of Commons Communities and Local Government Committee

Government urged to tackle 999 ambulance abuse callers

Government urged to tackle 999 ambulance abuse callers Calls have been made for harsher penalties to protect ambulance control room workers from abusive callers.

Figures obtained by the BBC under Freedom of Information laws revealed hundreds of verbal attacks in the past three years including threats to kill, racist and sexual slurs.

The union Unison has urged the government to bring in tougher punishments to deter abusive callers.

The Home Office said sufficient laws were already in place. BBC News

Parents 'should decide' care of baby

Parents 'should decide' care of baby Connie Yates and Chris Gard are challenging doctors in court to keep their son Charlie on life support. BBC News

General practice could be vertically integrated into new accountable care systems, says Stevens

General practice could be vertically integrated into new accountable care systems, says Stevens Accountable care organisations (ACOs) being developed in parts of the NHS will see stronger integration of primary and secondary care under unified leaderships, Simon Stevens has said. GP Online

NHS mental health trust to be prosecuted amid claims it failed to offer safe care

NHS mental health trust to be prosecuted amid claims it failed to offer safe care Southern Health is first NHS provider after Mid Staffs scandal to be taken to court after patient fell from roof at Melbury Lodge, Winchester

A mental health trust is to be the first NHS provider to be prosecuted under legislation brought in after the Mid Staffs scandal.

Southern Health NHS foundation trust is being taken to court after a patient sustained serious injuries during a fall from a low roof at Melbury Lodge, Royal Hampshire county hospital, Winchester, in December 2015. Continue reading... The Guardian

NHS manager who earned £1m jailed for fabricating qualifications

NHS manager who earned £1m jailed for fabricating qualifications Jon Andrewes, 63, worked for more than a decade in various senior health jobs across south-west England

A former probation officer who earned more than £1m working in very senior NHS management roles after he fabricated qualifications has been jailed for two years.

Jon Andrewes, 63, claimed to have two PhDs and a master’s degree but only had a higher education diploma in social work and a teaching qualification. He also lied over his work history, falsely claiming to have worked in the Home Office. Continue reading... The Guardian

NHS forced to provide 4,500 extra beds a day

NHS forced to provide 4,500 extra beds a day NHS Providers reveals how hospitals avoided a ‘full-blown crisis’ this winter by creating the equivalent of more than eight extra hospitals

Hospitals had to provide 4,500 extra beds a day at the height of the pressures this winter to avoid “a full-blown crisis”, NHS bosses have revealed.

That is the equivalent of creating more than eight extra hospitals to cope with unprecedented demand in recent months when large numbers of patients were stuck on trolleys and in the back of ambulances outside A&E units. Continue reading... The Guardian

Thousands pained by poor artificial limbs from the NHS

Thousands pained by poor artificial limbs from the NHS Ten years ago, Victoria Marks from Cornwall had to amputate one of her legs. Since then the mother of two has been fitted with 'dozens' of prostheses, all costing £5,000. Tired of the constant pain, she gave up. The Daily Mail

NHS trust to start using Uber for non-emergency patients

NHS trust to start using Uber for non-emergency patients Patients will be able to use Uber for journeys including appointments and generally getting out-and-about when they might otherwise be housebound or reliant on family and friends. The Daily Mail

Monday, 6 March 2017

Is a ‘death tax’ for social care about to be announced?

Is a ‘death tax’ for social care about to be announced? In 1972, Richard Nixon visited the People’s Republic of China, reversing years of US policy. His anti-communist credentials enabled him to do something other politicians shied away from for fear of being labelled soft on communism. Are we about to see a ‘Nixon goes to China’ moment for social care? One that will see David Cameron, George Osborne and Andrew Lansley forced to eat a red rose?

Well, just possibly. Reports suggest that Theresa May and Philip Hammond are looking at funding at least some social care costs by making a claim on people’s estates once they have died – a form of inheritance tax, or, as the Conservatives usually dub it, a ‘death tax’. The King's Fund

‘The social care system is on its knees’

‘The social care system is on its knees’ Commenting on the Communities and Local Government Committee’s pre-Budget report on adult social care, Richard Humphries, Senior Policy Fellow at The King’s Fund, said: ‘The Committee’s report adds to the overwhelming evidence that the social care system is on its knees. We estimate that the sector faces a funding gap of around £2 billion next year, so it is essential the Chancellor addresses this in next week’s Budget.

‘Additional funding in the Budget would provide welcome relief for older and disabled people, their families and carers who are being let down by the current system – and for hard-pressed councils and providers struggling to keep the system afloat. But without long-term reform of social care funding, this is like pouring water into a leaking bucket. The King's Fund

Tens of thousands march against 'hospital cuts'

Tens of thousands march against 'hospital cuts' Tens of thousands of people - including NHS workers, campaigners and union representatives - have marched in London to protest against "yet more austerity" in the health service.

Protesters on the #OurNHS march wanted to draw attention to plans which could see hospital services in nearly two-thirds of England cut back.

Union leaders say many NHS services "are on their knees".

The Department of Health says it is investing an extra £4bn in the NHS.

Organisers say that "at least 250,000" people took part in the march, which began in Tavistock Square and ended in Westminster, where speakers including Labour leader Jeremy Corbyn addressed the crowd. BBC News

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WHO: Air pollution linked to 600,000 child deaths

WHO: Air pollution linked to 600,000 child deaths The director general of the World Health Organization has said air pollution is "one of the most pernicious threats" facing global public health today and is on a much bigger scale than HIV or Ebola.

Dr Margaret Chan told the Today programme that poor air quality was having a disproportionate impact on the young. BBC News

Number of mental health patients treated hundreds of miles from home hits new high

Number of mental health patients treated hundreds of miles from home hits new high Mental health services for the most seriously ill patients are in “crisis”, experts have warned, with increasing numbers of people being sent hundreds of miles away from home to receive treatment - despite government promises to end the practice.

An analysis of official statistics shows mental health patients in England were sent for “out-of-area” treatment on 2,037 occasions in the four months to January 2017 alone. More patients were in treatment away from their home area in January than at any point since the data began being collected last year. The Independent

BMA calls for extra £10bn a year for NHS in Hammond's budget

BMA calls for extra £10bn a year for NHS in Hammond's budget Increase would bring health spending in line with 10 leading economies in Europe as proportion of GDP, says doctors union

The British Medical Association has urged the government to increase health spending by £10bn a year to bring funding into line with other leading European economies and shore up the NHS.

The union for doctors said increasing health spending to a proportion of GDP that matched that of the 10 leading economies across Europe could pay for at least 35,000 extra beds a day and several thousand more GPs. Continue reading... The Guardian

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Emergency £1.5bn funding for social care is needed, MPs tell chancellor

Emergency £1.5bn funding for social care is needed, MPs tell chancellor Communities and local government committee calls on Philip Hammond to plug gaps in budgets

The chancellor should commit an extra £1.5bn in immediate funding for social care in next week’s budget, according to a cross-party committee of MPs who say there is an urgent need for a wider review of the way the system is financed.

The communities and local government committee, which has been taking evidence on the subject for a wider report into adult social care to be published next month, said Philip Hammond should take £1.5bn from the better care fund to plug gaps in the coming financial year. The fund is a £5.3bn pot of money from government intended to help local authorities keep people out of hospital, covering both healthcare and social care. Continue reading... The Guardian

For the vulnerable, there’s no place like home

For the vulnerable, there’s no place like home Proposed funding cuts to supported housing in the community show a damaging lack of joined-up thinking on health and social care

Imagine this. You’ve suffered a debilitating mental illness, you’re admitted to hospital and, after weeks or months of treatment, you’re finally deemed stable enough to go home. Only, you can’t – the home you need in the community is not available.

As a psychiatrist, this is a situation I and many others around the country encounter almost daily. Even when patients are ready to leave hospital, a notable number don’t have the specialist supported housing they need to take that step.

Money can be spent more efficiently when people are in the right setting for their level of need Continue reading... The Guardian

Private firms are accused of 'unethical' health tests

Private firms are accused of 'unethical' health tests Gullible patients are being encouraged to take needless and expensive private medical tests, the government has warned. The tests can cost up to £2000 and include full MRI scans. The Daily Mail

More than 600 health quango chiefs on six figure salaries amid cash crisis

More than 600 health quango chiefs on six figure salaries amid cash crisis More than 600 NHS quango chiefs are now on six-figure salaries, with a doubling in the number earning more than the Prime Minister in just three years, new figures show.

Many of the highest earners have made repeated demands on the Government to increase NHS funding as it battles against its worst financial deficit in history.

But figures uncovered by the Telegraph, show that the nine main health quangos are now employing 628 officials on salaries of at least £100,000. The Daily Telegraph

Hospital smoking ban forces patients onto dangerous roads, says trust

Hospital smoking ban forces patients onto dangerous roads, says trust An NHS hospital is refusing to ban smoking on its premises because it believes doing so would put patients in danger of speeding vehicles.

The bosses of Royal Bournemouth and Christchurch Hospitals in Dorset are defending their use of designated smoking areas despite pressure from Government health officials.

The trust said it had previously tried a ban of smoking on its grounds, but that this had only forced smokers dangerously close to the adjacent main road where cars and lorries frequently travel at 50 mph. The Daily Telegraph

People with a learning disability are treated as second-class citizens – it has to stop now

People with a learning disability are treated as second-class citizens – it has to stop now Institutions where people with a learning disability are kept out of sight and out of mind belong in a different century. Yet they still exist and are where thousands of people with a learning disability spend year after year, often detained under the Mental Health Act, often hundreds of miles from their families, at increased risk of abuse and neglect

Wednesday's Dispatches programme echoed the horror of BBC Panorama’s 2011 investigation into the abuse at Winterbourne View, showing the ongoing failure of the government and NHS to deliver long promised changes to the way people with a learning disability are supported. The Daily Telegraph

Friday, 3 March 2017

Revealing Northamptonshire's staffing predicitions would impact on employees' 'mental health' claim bosses

Revealing Northamptonshire's staffing predicitions would impact on employees' 'mental health' claim bosses Despite the county’s five-year NHS savings plans costing £720,000 to produce, health bosses have refused the Chron’s attempts to see predicted staff numbers because it would “impact on the mental health” of employees. Northampton Chronicle and Echo

Northampton nurse struck off for trying to use morphine-like drug for period pain

Northampton nurse struck off for trying to use morphine-like drug for period pain A nurse who worked at Northampton General hospital has been struck off after trying to dispense drugs for her own use.

Northampton mental health hospital speaks out after Channel Four documentary

Northampton mental health hospital speaks out after Channel Four documentary Bosses at a Northampton mental health hospital have hit back at a Channel Four documentary in which a former minister said he believed a patient had been treated like a “prisoner”.

The episode of Dispatches last night saw producers interview two ex-patients at St Andrew’s Hospital, following its “requires improvement” Care Quality Commission rating of September 2016. Northampton Chronicle and Echo

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Sicker patients the main reason for A&E winter pressures

Sicker patients the main reason for A&E winter pressures Sicker patients with more complex conditions are the main reason for worsening performance in A&E departments, according to The King’s Fund’s latest quarterly monitoring report.

Eighty per cent of NHS finance directors who responded to our latest survey identified higher numbers of patients with severe illnesses and complex health needs as a key reason for the pressures on A&E units, while 70 per cent cited delays in discharging patients from hospital. This contrasts with 27 per cent who pointed to poor access to GPs and 20 per cent who identified shortages of clinical staff as key factors.

The survey also highlights the huge effort made by the NHS to prepare for increased pressure on services during the winter. More than 70 per cent of the trusts surveyed increased their staff, while 80 per cent of clinical commissioning groups (CCGs) paid for extra resources in primary care. Other common measures included postponing planned treatment, paying private companies to take on NHS work, and paying higher rates to recruit more agency staff. The King's Fund

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The state of care in NHS acute hospitals

The state of care in NHS acute hospitals The state of care in NHS acute hospitals 2014 to 2016 presents findings from our programme of NHS acute comprehensive inspections.

The report captures what we have learned from three years’ worth of inspections. It gives a baseline on quality that is unique in the world – and also shows that it is possible, even in challenging times, to deliver the transformational change that is needed if the NHS is to continue delivering high-quality care into the future.

Most hospitals are delivering good quality care and looking after patients well. Our reports highlighted many examples of how hospitals are improving and continuing to improve the quality of care they offer, even though there are constraints. We encourage trusts to follow this good practice to improve their own services.

But we also found that some trusts have blind spots about the quality of care they are delivering in a particular core service, even in some trusts rated good overall.

All hospitals told us that patient safety was their top priority, but too often they did not have an effective safety culture or reliable systems to ensure this. Many of the inefficiencies we saw can be avoided, such as hospital acquired infections, or are caused by poorly coordinated care. Care Quality Commission

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Research and analysis: Universal health visiting service: mandation review

Research and analysis: Universal health visiting service: mandation review The Department of Health commissioned this review following the transfer of commissioning of public health services for children aged 0 to 5 years to local authorities in October 2015.

The review considered the:

  • impact of this transfer
  • support for existing and continued regulation
  • evidence of service transformation
  • risks to sustainability from a range of perspectives using data from different sources
The Cabinet Office’s Infrastructure and Projects Authority provided oversight and an external assessment of the method, findings and conclusions.

The review found widespread support for the regulation of these services to continue and for future arrangements to be considered alongside other regulated public health services. Public Health England

Five year forward view for mental health: one year on

Five year forward view for mental health: one year on This report marks the anniversary of the publication of the Five year forward view for mental health. It highlights the progress made in the first year of the programme, and takes a look at the achievements that need to be built upon to deliver next year and beyond. NHS England

Local support for people with a learning disability

Local support for people with a learning disability Good progress has been made by the Department of Health and NHS England in setting up a programme to close hospital beds for people with a learning disability, but the programme is not yet on track to achieve value for money, the National Audit Office has found.

Delivering an outcomes-based NHS: creating the right conditions

Delivering an outcomes-based NHS: creating the right conditions This briefing summarises a seminar given by Dr Nicholas Hicks, the co-founder and chief executive of Capitated Outcomes-Based Incentivised Care (COBIC). The briefing describes COBIC's outcomes-centred approach that has been adopted by NHS services across England and how it brings together commissioners, providers, other professions, patients and carers. It discusses a case study where COBIC worked with Bedfordshire CCG to improve musculoskeletal care and outcomes, and to decrease costs. Office of Health Economics

NHS 'overcharged' by drug makers' non-compete deal, says CMA

NHS 'overcharged' by drug makers' non-compete deal, says CMA Two pharmaceutical firms have been accused of pushing up the price of a "lifesaving" NHS drug by striking a deal not to compete with each other.

The Competition and Markets Authority (CMA) said in provisional findings that Actavis and Concordia fixed the market for hydrocortisone tablets.

Hydrocortisone treats life-threatening conditions such as Addison's disease.

A pack of the tablets almost doubled in price for the NHS to £88 while the deal was in place, the CMA said. BBC News

Health watchdog warns over online pharmacy services

Health watchdog warns over online pharmacy services People should be wary of buying medications on the internet after an investigation found "widespread failings" at some online providers, the Care Quality Commission (CQC) has said.

The watchdog inspected 11 internet prescription services in England, finding some "potentially presenting a significant risk to patients".

The regulator said while some providers were well-run, others "cut corners".

The CQC says it will visit providers and close any putting patients at risk. BBC News

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Exclusive: NHS England report reveals hundreds of GP practices facing five-figure funding cuts

Exclusive: NHS England report reveals hundreds of GP practices facing five-figure funding cuts Nearly 800 GP practices faced average losses worth more than £50,000 per year under the national PMS contract review, with around 200 at risk of being unable to manage losses safely for patients, an NHS England assessment obtained by GPonline reveals.

Physical restraint in mental health units is traumatising women all over again

Physical restraint in mental health units is traumatising women all over again When a woman or girl is admitted to a mental health unit, her expectation should be of a caring, supportive environment where she can get the treatment she needs to get better. Unfortunately, we now know from Agenda’s latest research on restraint that many are instead in an environment where physical force has become shockingly routine.

Agenda is an alliance of more than 70 organisations campaigning on behalf of women and girls at risk. We decided to ask for data about the use of restraint because previous research we carried out on mental health trusts’ strategies and policies – as part of our Women in Mind campaign – showed that most were failing to take into account women’s specific needs. Continue reading... The Guardian

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The NHS's biggest challenge is convincing the public it has a plan

The NHS's biggest challenge is convincing the public it has a plan People blame immigration and cuts for the NHS crisis. The health service needs to communicate what is really going on

The British public has begun to talk of an NHS in crisis. This is a perception based on headlines decrying the state of the service; reports from healthcare staff (the NHS is the UK’s biggest employer; most people have at least one person in their social circle who works in it); and occasionally participants’ own bad experiences (although most still receive a great service – a tension that can give rise to “I was lucky” syndrome). Meanwhile, according to Ipsos Mori’s January issues index, 49% of respondents said that the NHS is one of the biggest issues (pdf) facing Britain today, a nine-point jump since December 2016 and its highest level since April 2003.

Public opinion abhors a vacuum. In the absence of a clear, concerted and disciplined message, people fill the gaps with their own assumptions, experiences and prejudices. Months of dire headlines have told them the NHS is in trouble, but the public are seeing and hearing little to tell them why, how, or what can be done about it. So they draw their own conclusions. Continue reading... The Guardian

NHS England chief brings in new rules on ward bed closures

NHS England chief brings in new rules on ward bed closures Hospitals to prove quality of patient care in community before losing beds, under criteria to be introduced by Simon Stevens

Simon Stevens, the chief executive of NHS England, has acted to make it much more difficult for hospitals to slash their supply of beds, after the dramatic loss of the facilities in recent years was widely blamed for exacerbating the winter crisis. Continue reading... The Guardian

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Drugs firm lower the costs of 14 key cancer drugs

Drugs firm lower the costs of 14 key cancer drugs Drugs giants including Bayer, Novartis and Pfizer have lowered the costs of 14 key cancer medicines after the NHS threatened to stop paying for them following a review of costs. The Daily Mail

NHS should 'do God' new guidance suggests, with doctors urged to ask the dying about their religious views

NHS should 'do God' new guidance suggests, with doctors urged to ask the dying about their religious views Doctors must not be afraid to do God, new NHS advice suggests, as medics are urged to ask the dying about their spiritual and religious preferences.

The guidance from the National Institute for Health and Care Excellence (Nice) says hospital staff need to do more to ensure that the individual preferences of patients are addressed, as well as their medical needs.

Doctors and nurses will be encouraged to ask patients about their “spiritual, cultural, religious and social preferences,” opening up conversations on matters such as life after death. The Daily Telegraph

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Thursday, 2 March 2017

NHS finances facing 'nasty hangover' after bid to avert winter crisis

NHS finances facing 'nasty hangover' after bid to avert winter crisis Outsourcing work to private sector has dealt big blow to NHS trusts’ efforts to balance books, King’s Fund says.
The NHS’s already precarious finances are facing a “nasty hangover” after hospitals cancelled tens of thousands of operations recently in a bid to avert a full-blown winter crisis, experts have said.
Handing large numbers of operations over to private providers and hiring extra staff to cope with extra demand during December and January has also dealt a big blow to NHS trusts’ efforts to balance their books, the King’s Fund said. Continue reading... The Guardian

Shifting the balance of care: Great expectations

Shifting the balance of care: Great expectations This research draws on an extensive literature review to assess the realism of the narrative that moving care out of hospital will save money. It explores five key areas: elective care, urgent and emergency care, admission avoidance and easier discharge, at risk populations, and self-care. Nuffield Trust

Young people 'fear stigma' if they ask for mental-health help

Young people 'fear stigma' if they ask for mental-health help Over three-quarters of young people say there is a stigma to mental illness and a quarter would not ask for help if they were suffering, a survey suggests.

Almost half of 2,215 16- to 25-year-olds polled by YouGov for the Prince's Trust said they had themselves experienced a mental health problem.

And a third of these felt admitting to problems could harm their job chances.

Fear of stigma was a "major obstacle" to finding help, said Prof Louise Arseneault, of Kings College London.

A third of the young people sampled also said they would worry about appearing weak if they sought help, and most said they would not want to confide in anyone at all. BBC News

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Women warned about private Down's syndrome tests

Women warned about private Down's syndrome tests Pregnant women are being urged to ask questions of private providers offering a new test for Down's syndrome.

The Nuffield Council on Bioethics while many clinics provide a good service, some give too little advice and support.

It says some fail to make it clear that non-invasive prenatal testing (NIPT) can offer only an estimate of Down's risk and is not diagnostic.

One private clinic said counselling was a vital part of the test. BBC News

Osteoporosis drugs may make bones weaker

Osteoporosis drugs may make bones weaker Drugs used to treat weak bones in elderly patients suffering from osteoporosis may actually make them weaker, research suggests.

Scientists at Imperial College London examined the bone structure of hip-fracture patients who had been treated with bisphosphonates.

They found evidence the drugs were linked to microscopic cracks, making bones more fragile and prone to break.

Osteoporosis affects three million people in the UK. BBC News

Hepatitis C charity took drug industry funding

Hepatitis C charity took drug industry funding The Hepatitis C Trust tried to force the NHS to buy more of an expensive drug treatment last year. BBC News

Two out of three people back ‘soft’ opt-out organ donation

Two out of three people back ‘soft’ opt-out organ donation Two thirds of people support a ‘soft’ opt-out organ donation system, such as the one already adopted in Wales, reveal the findings of a new poll carried out by the BMA.

The survey, which questioned 2,011 members of the public in England, Scotland, and Northern Ireland, found that while two out of three people (66%) want to donate their organs at death only just over a third (39%) are signed up to the organ donation register. OnMedica

Oxford University college accused of 'lending credibility to quackery' by hosting homeopathy conference

Oxford University college accused of 'lending credibility to quackery' by hosting homeopathy conference An Oxford University college has been accused of inadvertently “lending credibility to quackery” by agreeing to host a conference on the “alternative therapy” of homeopathy.

The Good Thinking Society, a charity which claims to promote rational thinking and battle “pseudoscience”, has said Lady Margaret Hall, Oxford, will be “adding gloss to a pseudoscientific event” by hosting the annual general meeting of the Society of Homeopaths on 18 March. The Independent

Why are there so few male nurses?

Why are there so few male nurses? Last year just 11.4% of registered nurses in the UK were male. Continued stereotyping is partly to blame

Efforts to promote gender equality in workplaces of all kinds may be widespread, but the number of men in nursing remains stubbornly low. Last year just 11.4% of registered nurses in the UK were male, according to figures from the Nursing & Midwifery Council – only a marginal increase from five years earlier, when they made up 11% of the workforce.

And the proportion of nursing students in the UK who are men hasn’t shifted either, according to the Higher Education Statistics Agency: in 2016 it stood at 11.6%, compared with 11.5% a decade earlier. Continue reading... The Guardian


'Nursing makes all the difference in healthcare': how the job has changed

'Nursing makes all the difference in healthcare': how the job has changed The profession’s agenda has extended but staffing levels, pay, Brexit and compassion fatigue are significant issues

It’s 30 years since Trevor Clay challenged his fellow nurses to rise up and make their voices heard. The profession had been “remarkably insular”, he wrote, and to its lasting cost had taken little heed of the social, political and economic forces that shaped its practice.

Clay, the charismatic leader of the Royal College of Nursing (RCN) during its period of explosive growth in the 1980s, argued that nursing’s great strength – its overriding focus on the needs of the patient – was at the same time its great weakness. “Too many nurses take that suppression of their individual feelings on a daily basis into political life,” he said. “Nursing is perhaps the most unassertive profession in the UK.”

Nurses are certainly not the handmaidens of any other profession Continue reading... The Guardian

75 per cent of Brits fail to eat five-a-day

75 per cent of Brits fail to eat five-a-day The majority of Brits fail to eat their recommended five-a-day - and many struggle to identify what constitutes fruit and vegetables, new study from California reveals. The Daily Mail

Britain's e-cigarette boom is over, data suggests 

Britain's e-cigarette boom is over, data suggests The number of smokers using e-cigarettes to kick the habit is declining amid fears that they are may be just as unhealthy as tobacco, data shows.

Consumer analyst Mintel has found that for the first time since their launch fewer people are using e-cigarettes to quit smoking, with usage among quitters dropping from 69pc to 62pc last year. The Daily Telegraph

Wednesday, 1 March 2017

Northampton care centre 'pin down mentally sick children'

Northampton care centre 'pin down mentally sick children' An investigation into St Andrew’s Health Centre in Northampton found the shocking results.

Children and teenagers are being pinned down and sedated in one of Britain’s largest mental health centres, a shocking investigation has exposed.

One girl of 15 with autism was prescribed powerful anti-psychotics and shut away in a cell-like room for almost two years.

And in a six-month period last year staff restrained youngsters face-down on at least 600 occasions. The Daily Mail

Report highlights alarming level of readmission for COPD patients

Report highlights alarming level of readmission for COPD patientsA new report from the Royal College of Physicians shows that 43% of patients admitted for hospital treatment of chronic obstructive pulmonary disease (COPD) were readmitted at least once in the 3 months following discharge, representing a considerable increase from 33% in 2008.

COPD is responsible for 5% of annual deaths globally, is the fifth biggest killer in the UK and is the only major cause of death that is on the increase.

Patients first: improving patients' food and drink experience through a better understanding of their priorities

Patients first: improving patients' food and drink experience through a better understanding of their priorities This report covers a large-scale, independent survey of patients’ preferences and experiences of hospital meals. The aim was to conduct face to face interviews with patients in hospital wards to give useful insight into their requirements and views, providing both robust numbers and a good qualitative understanding. By establishing patients’ preferences and priorities and linking this to their satisfaction with what is currently offered, it will be possible to give guidance to providers of food and meal service to develop and improve their offer. Patients Association

Stand by for a quiet revolution in the NHS

Stand by for a quiet revolution in the NHS There is a quiet revolution happening in the NHS in England. It's under the radar and has been little commented on till now.

Details of the potentially radical changes will emerge at the end of March.

There is, apparently, no need for new legislation.

In effect, the controversial health reforms of 2012 will be bypassed in some parts of England.

Simon Stevens, head of NHS England, will unveil his thinking in late March but he has given some clues to MPs on the Public Accounts Committee.

His aim in some areas is to abolish a fundamental feature of the structure of the NHS in England - what's known as the purchaser/provider split. BBC News

Early warning signs of heart attacks 'being missed'

Early warning signs of heart attacks 'being missed' Early warning signs may have been missed in one in six heart attack deaths in England, a study suggests.

Researchers looked at all heart attack hospital admissions and deaths between 2006 and 2010.

The team, from Imperial College London, found 16% who died of a heart attack within 28 days of an admission had not been diagnosed - despite symptoms like chest pain most likely being present.

The British Heart Foundation has called the research "concerning".

The study authors from the School of Public Health at Imperial College say more research is "urgently needed". BBC News

Drug and mental health admissions highest for a decade

Drug and mental health admissions highest for a decade More patients are being admitted to hospital in England for drug-related mental health issues or poisoning than at any time in the past 10 years.

Official figures reveal 15,074 cases of people in hospital with illicit drug poisoning in 2015-16, 51% more than 2005-06.

Mental health issues had drugs as a cause in 81,904 cases.

Public health experts say falling investment in drug treatment services may explain the rise. BBC News

Doctors describe impact on patients of bed shortages in shocking dossier

Doctors describe impact on patients of bed shortages in shocking dossier Patients are dying because they cannot access specialist care in hospitals struggling to cope and overflowing with patients awaiting discharge, a damning report published by the Royal College of Physicians says.

The report ‘Against the odds; Experiences from the NHS frontline’ collates first-hand experiences from hospital doctors who have been working the NHS frontline over the last couple of months to illustrate the intense pressure the NHS is under.

“Patients are dying as a result of not accessing specialist care, as the hospitals are jam-full,” said one doctor. “We started the day 73 beds down…,” said a second. OnMedica

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Brexit: NHS faces crisis unless Government guarantees right of remain for 145,000 EU workers, TUC says

Brexit: NHS faces crisis unless Government guarantees right of remain for 145,000 EU workers, TUC says NHS and adult social care services are facing a further crisis after Brexit unless the Government guarantees the rights of EU workers to remain in the UK, new analysis has shown.

More than 140,000 NHS and adult social care workers in England are EU migrants, with London, the South East and the East of England the most vulnerable to losing vital staff, the TUC found. The Independent

The Guardian view on Jeremy Hunt: he must practise what he preaches | Editorial

The Guardian view on Jeremy Hunt: he must practise what he preaches | Editorial Monumental failures with patient correspondence put lives at risk. The Department for Health needs to ask what needs to change to ensure it doesn’t happen again

“Just how easy is it to speak about things that have gone wrong?”, asked health secretary Jeremy Hunt in a speech he made last year about improving transparency and ending the blame culture in the NHS. Mr Hunt is himself failing badly on this critical benchmark for greater openness. The Guardian this week has revealed that half a million pieces of medical correspondence, including test results and diagnoses for life-threatening conditions like cancer, sat undelivered in a warehouse between 2011 and 2016. Yet it has taken almost a year for the full extent of this failure to emerge. Continue reading... The Guardian

What impact will Brexit have on nursing?

What impact will Brexit have on nursing? The NHS faces a major shortfall in nurses – and the EU referendum result threatens to derail supply further

The NHS faces a severe nursing shortage. An ageing population has pushed up demand, while an ageing nursing workforce – with one in three nurses set to retire in the next 10 years – is reducing supply. The shortage is particularly acute in mental health, with specialist nurse numbers falling more than 10% in the past five years.

And the Brexit vote may make it even worse. A July 2016 Institute for Employment Studies (IES) report reveals about 4.5% of NHS nurses in 2015 were from EU countries excluding Ireland, a steep rise from the 1% of 2009. In some trusts in London and the east of England, the proportion is as high as 20%. Continue reading... The Guardian

15% of trusts spend less than 14p a day on specialist care

15% of trusts spend less than 14p a day on specialist care Some health trusts are spending just 14p a day per patient providing specialist care for those who are dying, a report has revealed.

It exposes severe lapses in services at evenings and weekends with patients and their families left to cope alone.

A total of 15 per cent of trusts said they do not provide specialist end-of-life care and advice to patients seven days a week.

While 31 per cent do not have dedicated pain control teams – nurses who visit homes and administer medication such as morphine. The Daily Mail

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Every hospital ordered to change its logo by NHS “identity managers” in move which prompts ridicule

Every hospital ordered to change its logo by NHS “identity managers” in move which prompts ridicule Every hospital in the country has been ordered to alter its logo by NHS “identity managers” in a measure which has prompted fury and ridicule.

A ditkat from NHS England means hundreds of organisations will have to rework all their publicity materials, moving the NHS logo so it is above the name of each trust, instead of beside it.

The measure has been introduced by the “NHS identity team” following 1,000 interviews and 28 focus groups with members of the public. It follows a two year review of the health service logo with nine workshops involving 100 communications officials. The Daily Telegraph

Surgeon accused of assaulting patients by carrying out 'unnecessary' breast cancer operations

Surgeon accused of assaulting patients by carrying out 'unnecessary' breast cancer operations An experienced NHS surgeon has been accused of trying to "earn extra money" by deliberately carrying out "completely unnecessary" operations on suspected breast cancer patients.

Ian Paterson repeatedly lied to patients about their conditions and performed dozens of botched mastectomies which caused patients "serious harm" over a 14-year period, a court has heard.

Prosecutors say Mr Paterson "invented" serious risks of cancer in patients and performed life-changing procedures on them for "no medically justified reason". The Daily Telegraph

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