NHS is failing gay and bisexual men, major survey reveals

NHS is failing gay and bisexual men, major survey reveals:

Campaigners fear lack of trust may discourage men from accessing crucial health advice and testing
Gay and bisexual men are neglected and sometimes discriminated against by a health service that tends to focus solely on their sexual health, despite the fact they are more likely to self-harm, attempt suicide and experience depression, according to a major study.
Almost 6,900 gay and bisexual men across the UK who had used NHS healthcare services in the last year were surveyed by gay rights charity Stonewall. The survey reveals that a third have had a negative experience related to their sexuality. Confidence in confidentiality systems and lack of opportunities for discussion were so poor that the same proportion had not even come out to their GP or other staff. The men said they were more likely to be open about their sexual orientation with their manager and work colleagues than with healthcare professionals.
Stonewall's chief executive, Ben Summerskill, says the findings of the report – the largest such study in the world – are "deeply troubling" because the lack of trust may discourage Britain's 1.8 million gay and bisexual men from accessing crucial advice and testing services.
Nearly a third of respondents had never had an HIV test, despite early diagnosis now being a public health priority, and 54% had never discussed HIV with a healthcare professional, the survey reveals.
In the last year, 3% of gay men and 5% of bisexual men had tried to kill themselves compared with 0.4% of all men. Over the same period, 7% of gay and bisexual men had deliberately harmed themselves, compared with just 3% of all men.
Mental health issues were even more acute among younger gay and bisexual men: of those aged 16 to 24, 6% had tried to take their own life in the last year and 15% had harmed themselves. Domestic abuse was another serious problem: half of those surveyed had experienced at least one incident from a family member or partner since the age of 16, compared with 17% of all men.
The report lays bare discrimination in the health service. "I overheard the reception staff say to a nurse: 'The poof is here for his appointment,'" David, 23, told Stonewall. Jack, 37, described how his doctor wrote "homosexual" in capital letters on a letter he had to take to hospital after breaking his wrist. Every time a different doctor pulled up his details on the computer, the same tag would appear.
Nathan, 20, said his GP refused to speak with him, ushering him out of the office and telling him to contact the local sexual health clinic instead.
Several respondents talked of health professionals assuming that because they were gay, they must be HIV positive, while others described professionals referring to them having wives or girlfriends, even after they had made it clear they were gay. Some had distressing experiences of their same-sex partner rights being ignored. "My partner is terminally ill with cancer," said Eddie, 52. "Even though he asked for his treatment to be talked over with me and to call me before his family, they have often not done so."
Of the third of respondents who had not been tested for HIV, 70% said it was because they did not think they had put themselves at risk, while a third said it was because they had never had any symptoms of HIV infection.
"These figures raise grave concerns about the effectiveness with which hundreds of millions of pounds of public money have been spent on HIV awareness and prevention in recent years," the report says.
Summerskill adds: "Patients accessing healthcare should be confident that they'll be treated compassionately, confidentially and with complete openness. But this research reveals that for many gay and bisexual men in Britain this is simply not the case."
The report also finds that respondents were more likely to smoke, drink and take illegal drugs. "It ill-serves our gay and bisexual communities when these uncomfortable truths are ignored," says Summerskill.
The report makes a number of recommendations that could help health services improve, from the Royal Colleges updating professional development programmes for their members to include topics such as same-sex partner rights, to frontline staff being trained about the importance of not assuming someone's sexual orientation. Workers should also encourage disclosure by asking open questions and having clear confidentiality policies. Just one in 11 of respondents said they had been given the opportunity to come out.
Policies explicitly protecting gay and bisexual people from discrimination should be displayed at surgeries and hospitals, and improving access to sexual health services for gay and bisexual men should be made a public health priority, the report concludes.
A Department of Health spokeswoman says lesbian, gay and bisexual people are prioritised in its mental health strategy because it recognises "they are at a higher risk of mental health problems, violence and self-harm". She adds that the latest GP Patient Survey shows that 84% of gay, lesbian and bisexual respondents described their overall experience of their GP surgery as "good". The Guardian

Will the nurse training overhaul rebalance the curriculum v caring conundrum?

Will the nurse training overhaul rebalance the curriculum v caring conundrum?:

After a barrage of reports involving the neglect of hospital patients, the training and education of nurses is going under the microscope
Nursing may not quite be in crisis, but it is certainly going through a rough patch. So the launch today of a commission of inquiry into nurse education and training is enormously significant both for its timing and for who is behind it.
The commission is to be led by educationist Lord [Phil] Willis, a Liberal Democrat, and it has been initiated by the Royal College of Nursing. Hitherto an unswerving advocate of the model of training that the profession has been moving to over the past 20 years, culminating in it becoming degree-entry only from next year, the RCN is seizing the initiative before it is grabbed by others.
As its chief executive and general secretary Peter Carter acknowledges, "nursing has recently come under increased scrutiny from various sources, some of which have questioned the compassion and dedication of the profession". In setting up the commission, the college has decided to act "rather than refuse to accept that there may be issues in some areas".
This is an important and sensible admission. The charge sheet is now too long to deny that some nurses lack a certain something in the way they approach the job. Stories of ward staff chatting at nursing stations while their patients struggle to reach food and drink are legion, while the horrors of the mid-Staffordshire scandal – involving hundreds of unnecessary deaths of neglected patients – will be revisited later in the year by publication of the report of the public inquiry.
And the evidence keeps coming. In a new report on Leeds general infirmary, inspectors of the Care Quality Commission describe how they felt obliged to step in to seek help for patients during a recent two-day visit. "Had we not intervened, we believe some needs would not have been met," they say, formally registering "major concerns" about care standards and staffing levels.
Plainly there were questions of adequacy of staff numbers at Leeds. But the outlook for NHS funding means that hospitals and community health services will be waiting a long time for reinforcements. Besides which, many critics of modern nursing think the profession's leaders are too ready to hide behind defences of team size and skill mix.
The draft report of the Commission on Improving Dignity in Care, published in February, argued forcefully that there is a compassion deficit in the attitude of many nurses and other health workers towards older patients. It called for recruitment to be based as much on assessment of a candidate's caring qualities as on their academic record. Others, however, think that basic caring skills are no longer being taught properly during nurse training, and this is where the spotlight will be on the RCN's new commission.
The argument goes that in replacing hospital-based training with a university-based system, with nursing students doing placements in care settings, the reforms of the early 1990s sowed the seeds of today's failings. Abolition of state enrolled or assistant nurses, and their replacement by cheaper healthcare assistants, served to compound the problem.
Will Willis, whose mother was a district nurse, venture into this territory? He says he has no preconceptions and is being given a free hand to explore the commission's remit of identifying the "defining features" of nurse education to produce a workforce fit for the future. That will, he makes clear, include looking at the curriculum and at whether there is "the right balance" between classroom and workplace.
It seems unlikely, though, that the commission will question the principle of degree-based training. Across the rest of Europe and beyond, Willis points out, there is "a strong move towards a graduate nursing profession". The Guardian

NHS reforms will put children's lives at risk: NHS managers

NHS reforms will put children's lives at risk: NHS managers: Children's lives will be put at risk by the Coalition's health reforms because confusion among new organisations could lead to another Baby P, NHS managers have warned. The Daily Telegraph

Cancer tests 'not widely available'

Cancer tests 'not widely available':
Cancer patients may be missing out on the most effective treatments because of poor access to new biomarker tests, according to a survey of senior hospital doctors. The Independent

Drugs firm sues doctors for being cost conscious

Drugs firm sues doctors for being cost conscious:
Independent experts have condemned the Swiss pharmaceuticals company Novartis for trying to force the NHS to buy an expensive drug to treat patients suffering from a degenerative eye disease, rather than using a cheaper, unlicensed alternative. The Independent

Information Data Requests – Guidance for NHS Foundation Trusts and Sponsors

Information Data Requests – Guidance for NHS Foundation Trusts and Sponsors: This document explains the changed requirements relating to information data requests to NHS Foundation Trusts. Monitor

Five deaths a month at Northampton General Hospital ‘avoidable’ report suggests

Five deaths a month at Northampton General Hospital ‘avoidable’ report suggests:
FIVE deaths a month could allegedly have been prevented at Northampton General Hospital if better care had been given, new analysis has suggested. Northampton Chronicle and Echo

Patient increase hits Northampton General Hospital’s A&E targets

Patient increase hits Northampton General Hospital’s A&E targets:
HUGE numbers of patients meant Northampton General Hospital failed to deal with the required number of patients within four hours in the last year. Northampton Chronicle and Echo

Can the NHS improve quality while saving money?

Can the NHS improve quality while saving money?:
Health Minister Simon Burns explains how better care and listening to patients about their experience of care can result in the NHS having to spend less money.
In his latest blog, the minister highlights the work being done by South East Essex Community Healthcare to improve care for children whose asthma is difficult to manage.
He says:

‘People have voiced concerns that the NHS’s efficiency drive will in some areas reduce the quality of care. I understand those concerns.
‘The NHS’s funding is of course, protected. But because demand is increasing, it is in the middle of a major mission to find up to £20 billion of efficiency savings that it will then put back into frontline care. Back into frontline care, note – not back into Treasury coffers.
‘It is doing this not by cutting good services, but by discovering better models of caring for people. For example, making sure the fifteen million people with long term conditions – on whom nearly three quarters of the NHS’s budget is spent – spend less time in A&E, and get more of the support they need to stay in good health.’

See Simon Burns’ blog Department of Health

Nurse faked dying man's records

Nurse faked dying man's records: A Bupa nurse employed at a care home in Northamptonshire is struck off after faking the records of a dead man to cover her neglect. BBC News

NHS faces challenge over eye drug

NHS faces challenge over eye drug: The pharmaceutical company Novartis is challenging the use of a cheaper alternative to its drug Lucentis for a common cause of loss of vision. BBC News

Nurses and pharmacists now able to prescribe controlled drugs

Nurses and pharmacists now able to prescribe controlled drugs: Nurse and pharmacist independent prescribers across the UK can now prescribe controlled drugs following a change to drug legislation. GP Online

CCGs given 'complete freedom' on support

CCGs given 'complete freedom' on support: Health secretary Andrew Lansley has said that clinical commissioning groups will have complete freedom to choose the organisation they want to use for commissioning support. E-Health Insider

Management of long-term sickness absence

Management of long-term sickness absence: This guidance is for all who manage long-term (or recurring short or long-term) sickness absence and incapacity, including employers and people working in the NHS. NHS Employers

Fees paid under parts 2 & 3 of Annex G of the GMS Statement of Financial Entitlement: adjustments to compensate PCTs in 2012-13

Fees paid under parts 2 & 3 of Annex G of the GMS Statement of Financial Entitlement: adjustments to compensate PCTs in 2012-13:
Following negotiations between the GPs’ Committee of the British Medical Association and NHS Employers, ministers have signed off a new method for calculating dispensing fees. Richard Armstrong, Head of Primary Medical Care Commissioning Development Directorate, has written to PCT Directors of Finance, with details of the agreement and actions for PCTs.

• Dear colleague letter
• Payments to be made by PCTs to each GP practice
• Department of Health - news

The Government's strategic objectives for the NHS Commissioning Board Authority

The Government's strategic objectives for the NHS Commissioning Board Authority:
Health Secretary Andrew Lansley has set out the Government’s strategic objectives for the NHS Commissioning Board Authority and the basis against which the Authority will be held to account.

• Letter
• Department of Health - news

CQC criticised after care home assault

CQC criticised after care home assault:The Care Quality Commission is under fire after secret filming revealed an 80-year-old woman being slapped by a carer at a home in London.The filming was done in secret by Jane Worroll, whose mother was at the care home in Ash Court in London, after she noticed bruises on her relative's arms and legs.It showed carer Jonathan Aquino slapping Maria Worroll, who has Alzheimer's and arthritis, six times. After...  Healthcare Today

Arthritis 'postcode lottery of care'

Arthritis 'postcode lottery of care': Some health authorities are spending less than a pound a day helping people with arthritis and other joint problems, while others spend three times that, according to a review that has found a postcode lottery of care. The Daily Telegraph

Ensuring Access to After-Hours Care

Ensuring Access to After-Hours Care: In recent years, several countries, including the Netherlands, Denmark, and Germany, have sought to expand access to after-hours care—often by transitioning from the traditional approach, in which practices designate someone to be "on-call," to group-based or regional approaches. As the U.S. seeks to strengthen primary care, particularly through the development of patient-centered medical homes, it has a great deal to learn from these international models. The Commonwealth Fund

Schedule 6 of the terms of authorisation

Schedule 6 of the terms of authorisation: Schedule 6 of an NHS foundation trust’s terms of authorisation lists the information they have a legal or statutory obligation to supply. Monitor

Quality Governance Framework

Quality Governance Framework: The Quality Governance Framework assesses the combination of structures and processes in place, both at and below board level, which enable a trust board to assure the quality of care it provides. The framework now forms part of the assessment process, Compliance Framework and risk-assessment of transactions. Monitor

Ambulance crew sick days reduced

Ambulance crew sick days reduced:
AMBULANCE crews are receiving extra care and support in a bid to cut the service’s absence rate. Evening Telegraph

Judge calls for urgent action to prevent care home thefts by staff

Judge calls for urgent action to prevent care home thefts by staff:
A JUDGE has called for urgent action to be taken to stop vulnerable people in Northamptonshire being swindled out of thousands of pounds of cash by greedy care home workers. Northampton Chronicle & Echo

Undercover filming shows Alzheimer's sufferer being repeatedly beaten

Undercover filming shows Alzheimer's sufferer being repeatedly beaten:
Footage of an Alzheimer's sufferer being repeatedly beaten by a member of staff at a care home will be screened tonight. The Independent

The big ideas

The big ideas:
In the latest issue of Public Service Review: Health and Social Care, NHS and Commissioning Board Authority Chief Executive Sir David Nicholson, calls for a system to get the best out of the world-class talent to be found in the National Health Service.
Read the article.

Watchdog accused in care home row

Watchdog accused in care home row: The Care Quality Commission is being criticised for failing to take sufficient action after undercover filming showed an 80-year-old woman being slapped by a care worker. BBC News

CCGs adopting 'worst of PCT habits', warns GPC

CCGs adopting 'worst of PCT habits', warns GPC: Clinical commissioning groups (CCGs) are excluding LMCs from the development of their constitutions and risk morphing into 'the worst of PCTs', GP leaders have warned. GP Online

QOF could link to patient benefits and ignore GP workload

QOF could link to patient benefits and ignore GP workload: Primary care could be made more efficient if QOF points were linked to patient benefits rather than GP workload, research by a member of the NICE QOF team suggests. GP Online

Health and social care influenza pandemic preparedness and response

Health and social care influenza pandemic preparedness and response:
This guidance is intended to support local preparedness and response planning in England during the transition period through to 2013. The key changes in the strategy learned from the 2009 pandemic are: develop improved plans for the initial response to a new pandemic; ensure a response that is proportionate to a range of scenarios; allow for differences in the rate and pattern of spread of the disease across the country and internationally; and develop improved plans for managing the end of an influenza pandemic.

• Guidance
• Department of Health - news

Dementia and end of life care: implications for people with sensory loss

Dementia and end of life care: implications for people with sensory loss:
This report summarises the issues discussed during a half-day seminar held in February 2012, organised by the Social Care Institute for Excellence, ARUP and the Thomas Pocklington Trust.

• Report
• Pocklington Trust - publications

Andrew Lansley backs lower pay for NHS staff in poorer areas

Andrew Lansley backs lower pay for NHS staff in poorer areas:

Health secretary risks new political storm by supporting proposals that unions say will worsen the north-south divide
Andrew Lansley, the health secretary, is threatening another controversial revolution in the NHS by proposing that its staff be paid less if they work in poorer parts of the country.
The cabinet minister is backing a plan for regional pay, which would mean that nurses, midwives, hospital porters, cleaners and paramedics would earn less if they work in the north or the Midlands rather than in the south of England. Official documents reveal that the only exemption backed by the Department of Health would be for highly paid managers working in new bodies established to deliver Lansley's controversial NHS reform programme, widely criticised as a privatisation of the health service.
The department, according to a submission to the NHS pay review body, believes special arrangements would be necessary for this new cohort of executives to "attract and retain high-calibre leaders and staff responsible for transforming delivery".
The revelation was seized upon by the government's critics on Saturday night as fresh evidence that the coalition is out of touch with the British public.
Health unions accused the health secretary of seeking to drive down wages in the provinces with the crippling consequence of creating an ever deeper north-south economic divide. They said women would be particularly badly hit by the proposals.
The policy is also likely to reignite disputes within the coalition over Lansley's handling of the NHS, with one senior Liberal Democrat attacking the proposal as "divisive and ideological" and warning that regional pay in the NHS was a "red-line issue" for Lib Dem MPs.
John Pugh MP, the co-chairman of the Lib Dem parliamentary policy committee on health and social care, said: "Not content with cementing the divisions between the north and south, Andrew's proposals harden the divisions between the well-paid and the rest. This demonstrates his continuing, unfortunate talent for alienating the people he needs to rely on most: NHS staff.
"Regional pay proposals and the blinkered ideology that underpins it remains a red line for many Lib Dem MPs and risk provoking an enduring, embittering standoff within the coalition which will profit no one."
Lansley's recommendation was made in response to the call by the chancellor, George Osborne, in his recent budget for the public sector to be "more responsive to local pay rates" to help the private sector grow in economically depressed parts of the UK.
Osborne argued that public sector pay should mimic the private sector and be more reflective of local economic conditions. In written evidence to the independent NHS pay review board, Lansley's department agrees that there is a prima facie case for regional pay in the NHS, described in the document as "market-facing pay".
The document suggests setting a national basic pay rate at a "minimum level necessary" and paying additional supplements in particular geographical zones. It says: "Current rates of pay in the NHS do vary geographically, but significantly less so than the pay of comparable staff in the private sector. The introduction of more sensitive market-facing pay would therefore enable more efficient and effective use of NHS funds." It further argues that "where the NHS pay premium is relatively high there is the potential for private sector enterprise to be crowded out with adverse impact on the prospects for local economic growth."
The document says the department favours a "measured approach, at least initially", and recommends the "introduction of one, or perhaps two, additional zones of geographical pay differentiation." It adds: "These could then be assessed and the evidence base on market-facing pay further developed to permit the consideration of the case for introducing further additional zones in the future."
The pay row is set to escalate when the shadow health secretary, Andy Burnham MP, addresses the Unison health conference in Brighton this week. Burnham said: "National pay is part of what underpins a truly national health service. Labour will defend it, as it is fair to staff, helps control costs and brings stability to the system.
"It is often harder to work on the NHS front line in more deprived parts of the country and yet this government wants to pay those staff less and reinforce the north-south divide. It will infuriate NHS staff to see senior managers arguing for one rule for themselves, and another for staff. They are seeking to insulate themselves from these changes, while driving down pay for thousands of front-line staff across the country."
Christina McAnea, the head of health at Unison, the largest health union, which will present its evidence on regional pay on Monday at its health conference, said: "The Department of Health's evidence on regional pay is built on sand. For a government that says it wants to cut paperwork, introducing regional pay would be a massively expensive, bureaucratic nightmare, designed to cause huge disruption and conflict.
"Regional pay would cause skills shortages in so-called low-cost areas, with nurses, midwives and specialised staff being hard to recruit and retain, hitting the care of patients.
"The government want to introduce a market ethos into the NHS but most private companies abandoned regional pay scales years ago as divisive and unworkable."
The Department of Health said: "Our evidence shows how more market-facing pay could help employers make better use of the NHS pay bill. It makes clear that there is a compelling case for implementing market facing pay for all Agenda for Change staff in England, whether they fulfil a support role, work in administration or work on the front line, such as nurses and other clinical staff. The principle of equal pay applies to all staff across the entire country.
"Any recommendations must be implemented in a way that is simple, effective and safe. National organisations like Health Education England are however in the very early stages of development.
"We have therefore invited the NHS pay review body to consider how, in the absence of detailed evidence about the appropriate job markets, their recommendations on market-facing pay might affect recruitment and retention, including the implications for equal pay in these particular organisations." The Guardian

Patients with rare illnesses 'losing out' in NHS drug allocation lottery

Patients with rare illnesses 'losing out' in NHS drug allocation lottery:

Health experts fear new national framework governing allocation of drugs could hit some more than others
People with rare diseases are failing to receive vital medical treatment because their illnesses are not recognised in guidelines that govern the distribution of NHS-approved drugs.
Health experts who fear that a new framework governing drug allocation that comes into force next year could see some people lose out.
Anglea Tyermans, 38, who has arteriovenous malformations (AVMs), an extremely rare cardiovascular defect that affects less than 1% of the population, fears she will die if she does not receive a course of injections approved by Nice, the clinical body that oversees drug allocation on behalf of the NHS.
Her primary care trust in West Sussex will not pay the £15,000 for her to have the one-off treatment, which her lawyers say will arrest her illness. Experts appointed by West Sussex PCT said "further research" was required.
Rare Disease UK, an alliance of organisations that support people with uncommon illnesess, estimates there are more than 6,000 rare diseases that will affect 1 in 17 people in the UK.
A new commissioning board next year will oversee the allocation of medicines to end the "postcode lottery" that sees some patients deprived of a drug because of where they live.
But Alastair Kent, chair of Rare Disease UK, warned economising could have an impact on how the board determines future allocations of drugs.
Kent said: "The rhetoric is about everybody achieving better healthcare but for the rhetoric to meet the reality is a huge ask." The Guardian

Medics filmed 'offering female circumcision'

Medics filmed 'offering female circumcision':
Up to 100,000 women in Britain have been "circumcised", with medics across the country offering to carry out illegal genital mutilations on girls as young as 10, it was reported yesterday. The Independent

Integrated care pilots reveal mixed results | Nick Goodwin

Integrated care pilots reveal mixed results | Nick Goodwin: Have the Department of Health's integrated care pilots driven improvements in the quality and cost effectiveness of patient care? (Blog, 19 Apr 2012) Kings Fund

Early implementers sought to test long term conditions year of care funding model

Early implementers sought to test long term conditions year of care funding model:
Early implementers are being invited to apply to test a potential new way of funding long term conditions care. The LTC year of care funding model will be tested by six early implementer sites and prescribes a set approach for the purpose of national evaluation.
The model is described in Quality, Innovation, Productivity and Prevention long term conditions which is published today along side an application form and supporting guidance for those interested in becoming early implementers.
The deadline for applications is Friday 25 May 2012.
QIPP long term conditions is aimed at health and social care commissioners and providers who are implementing integrated LTC care services to improve outcomes and people’s experience. The funding model has been developed through the QIPP LTC work stream to support health and social care teams in integrating care in a more sustainable way by aligning funding with people’s needs.
The  model, which is is not mandated,  has been developed using evidence and best practice and  will be formally tested by the early implementer sites. The model will evolve over time with this testing phase informing future developments. Department of Health

The week: issue 244

The week: issue 244:
On the agenda this week: the Secretary of State launches a consultation on standardised packaging of tobacco products, foreign doctors to prove they can speak English before practising in England under new government proposals, and the Prime Minister announces a call to action for frontline nurses to share best practice with colleagues across the NHS. Department of Health
 
Download ‘the week’ issue 244 13 – 19 April 2012 (RTF 546KB)

Home births more 'cost effective'

Home births more 'cost effective': Research by a team at the University of Oxford has indicated that planned births at home and in midwifery units are more cost-effective than giving birth in hospital.
Writing in the British Medical Journal, where they compared costs and outcomes for mother and baby of giving birth in different locations, they said this was particularly the case for women who had given birth before.
They focussed on 60,0... Healthcare Today

NHS needs to integrate mental and physical health services for better care and impressive savings

NHS needs to integrate mental and physical health services for better care and impressive savings: A new report from the NHS Confederation Mental Health Network makes the case for combining mental and physical healthcare. NHS Confederation

From vision to action: making patient-centred care a reality

From vision to action: making patient-centred care a reality:
The Richmond Group, an alliance of leading health and social care charities, is calling on the Government to ensure patients are central to the delivery of care in the redesigned NHS in England. This report sets out what the group would like to change to put patients at the heart of the NHS.

• Report
• Asthma UK - news

NHS waiting times rise 6%

NHS waiting times rise 6%: New research from the Patients Association has revealed that waiting times are getting longer for common surgical procedures.
It has warned of increasingly long delays for the most common forms of surgery in NHS hospitals, despite Prime Minister David Cameron’s election pledge to cut waiting times.
Latest figures show that waiting times rose by 6% for eight types of surgery between 2010 and 2011. The ... Healthcare Today

Read the full report here

Spending cuts biggest challenge for health service leaders

Spending cuts biggest challenge for health service leaders:

Our survey found that the impact of cuts is as big a challenge for the NHS as implementing the Health and Social Care Act
The impact of spending cuts is as big a challenge for the NHS as implementing the Health and Social Care Act, say healthcare leaders.
An exclusive Guardian healthcare network survey asked members what they think are the main concerns facing the health sector; 64% said implementing efficiency savings, 62% said the impact of the Health and Social Care Act, and 35% said planned NHS reforms.
Other responses included the increasing demands placed on the health service by demographic changes - citing both the ageing population and an ageing workforce. One member wrote the biggest challenge was "becoming more cost efficient while maintaining and improving quality"; and another cited unco-ordinated thinking and planning.
The issues of spending cuts and the government reforms are recurring themes throughout the survey, with many members blaming them for the aspects they like least about their jobs, and also fearing the effect they will have in the year ahead.
Our survey was launched before the health and social care bill gained royal assent to become the Health and Social Care Act, and asked members whether they personally supported the proposed reforms - 68% said no, 11% said yes, and 21% were unsure.
One member branded the bill "unworkable", another commented "this bill could well be Cameron's 'poll tax'", and a third said: "The NHS remains a political toy and is bounced on a whim from minister to minister."
Members were also asked whether they think there should be more private sector involvement in the health service - 56% said no, 27% said yes and 18% were unsure.
And the questionnaire - completed by more than 500 healthcare network members - also asked whether healthcare leaders think there should be more integration of health, social care and housing services. Some 89% said yes, while 5% said no and 6% were unsure.
The research revealed a very strong sense of public service among healthcare network members, with a large proportion saying the chance to help people, care for patients and improve others' lives was the most enjoyable aspect of their job. Many also cited patient contact, while the variety of their role and the challenges of delivering care were also repeatedly mentioned.
When asked what they liked least about their jobs, many members said they felt uncertain about their future - whether due to government policy, NHS funding or job insecurity. A number mentioned that politics - at a local and a national level - were having a negative impact on their work, and many felt that paperwork, meetings and administration (one member cited "death by email") were the least enjoyable aspects of their work. Other members cited workloads, staff shortages, work place pressure and poor morale.
Most members (73%) think their jobs will become more difficult in the year ahead - and cuts and reorganisations were again mentioned by many.
One member said: "We are fighting to understand the new NHS structures, in 12 months we will still be trying to understand them and delivering in a changing landscape."
Another commented: "There is a huge amount of work to do, and in some instances there is a lack of focus, vision and lack of support. With uncertain financial times, and in the challenging political climate. Things are very tough."
But 25% think their role will stay the same over the next 12 months - and 3% believe it will get easier.
The research is the second in a series of quarterly questionnaires sent to healthcare network members and promoted via Twitter and Facebook. The first questionnaire also found that spending cuts are the biggest challenge facing NHS leaders.
Watch out for further opportunities to contribute to healthcare network research later in the year, and in the meantime please add your comments on the issues discussed in this piece below. Guardian Professional. 

Private companies providing GP out of hours services are 'worse than NHS'

Private companies providing GP out of hours services are 'worse than NHS': Private firms providing GP out of hour services fail to assess urgent cases within 20 minutes and leave patients waiting longer than two hours to see a doctor, a study has found. The Daily Telegraph

Death of autistic boy shines light on national problem

Death of autistic boy shines light on national problem:
A coroner warned yesterday that the "gross failure" of mental health services to help an autistic boy, who was bullied and committed suicide, could be a national problem affecting others with similar behavioural needs. The Independent

Seventeen-year ‘healthy years’ gap between north and south of Northamptonshire

Seventeen-year ‘healthy years’ gap between north and south of Northamptonshire:
PEOPLE in south Northamptonshire have up to 17 more years of healthy life than someone living in Corby, health experts have suggested. Northampton Chronicle & Echo

Data definitions

Data definitions: A new Audit Commission briefing addresses key issues with data definitions that are a major cause of dispute within the NHS - it updates key guidance and looks at the underlying causes of these issues. Audit Commission

Breast cancer map 'a key moment'

Breast cancer map 'a key moment': What we currently call breast cancer should be thought of as 10 completely separate diseases, according to a study which has been described as a landmark moment for treatment. BBC News

Hospitals 'overcharging for care'

Hospitals 'overcharging for care': NHS money is being wasted by hospitals wrongly charging the health service for treating short-stay patients, a watchdog says. BBC News

RCGP hails 'momentous' plan to extend GP training to four years

RCGP hails 'momentous' plan to extend GP training to four years: The RCGP has hailed a 'momentous day for general practice' after Medical Education England backed its call to extend GP training to four years. GP Online

Out-of-hours comparison tool launched

Out-of-hours comparison tool launched: Data on the quality of out-of-hours services can be easily compared by commissioners and providers using an online benchmark tool that goes live today. E-Health Insider

Long-term health gains: investing in emotional and psychological wellbeing for patients with long-term conditions and medically unexplained symptoms

Long-term health gains: investing in emotional and psychological wellbeing for patients with long-term conditions and medically unexplained symptoms:
A new Mental Health Network report brings together the evidence across diabetes, chronic obstructive pulmonary disease and coronary heart disease, plus medically unexplained symptoms, to present a business case for investing in psychological services. This briefing summarises the report and describes how primary and secondary health services can improve patient outcomes, while reducing the overall costs of care for the NHS.

• Briefing
• NHS Confederation - publications

NICE reject Avastin for advanced breast cancer

NICE reject Avastin for advanced breast cancer: The National Institute for Health and Clinical Excellence (NICE) has decided a drug for women with breast cancer that has spread should not be available on the NHS.
The decision comes despite evidence that Avastin can stall progression of the disease for three months.
NICE has issued draft guidance on Avastin, also known as bevacizumab, which says that the drug which costs more than £3,500 a month for ... Healthcare Today

NHS and civil servants plan pension strike in May - BBC News

NHS and civil servants plan pension strike in May - BBC News:

BBC News

NHS and civil servants plan pension strike in May BBC News NHS workers and civil servants are to stage a one-day strike in May over their pension dispute. The Unite trade union, which has 100000 members in the NHS, will walk out on 10 May, a day after the Queen's speech is to set out the NHS reforms. Unite and PCS to strike over public sector reformProfessional Pensions Unite sets date for industrial action over pension reformManagement in Practice May 10 chosen for public sector strikeJournal Live ITV News -Finance Markets -The Guardian all 417 news articles »

NHS waiting times rise for operations

NHS waiting times rise for operations:
NHS patients are having to wait longer for some surgery and fewer operations are taking place, according to new data. The Independent

Finance boss is jailed for taking £330,000

Finance boss is jailed for taking £330,000:
A CARE home finance manager who stole more than £330,000 meant for adults with learning disabilities to buy fur coats, jewellery, champagne and a cruise has been jailed for almost three years. Evening Telegraph

Common challenges to improving quality

Common challenges to improving quality: In my experience, improvement leaders often begin new areas of work with a compelling personal vision of the potential for quality to be much improved. I think there’s a cultural bias in health management of action over reflection, and often a strong temptation to give insufficient time to the initial challenges, says Penny Pereira. Health Foundation

First ever mandatory care standards bring hope of improved care for children and young people with diabetes

First ever mandatory care standards bring hope of improved care for children and young people with diabetes:
Set by leading paediatric doctors, nurses and commissioners, working in partnership with NHS Diabetes, the ‘Best Practice Tariff for Paediatric Diabetes’ sets out 13 mandatory care standards¹ for paediatric diabetes service teams to meet. Providers who can prove they meet these levels of care will qualify for greater funding. Local services unable to achieve these standards will be supported to improve but face having their funding withdrawn if unable to reach the required level by April 2013. NHS Networks

Nursing and Care Quality Forum outlines work to improve nursing care

Nursing and Care Quality Forum outlines work to improve nursing care:
The Nursing and Care Quality Forum, which aims to improve the quality of nursing care across all care settings, met Prime Minister David Cameron and Health Secretary Andrew Lansley today to discuss the work the Forum will deliver.
The independent Forum will begin its work by identifying and supporting the spread and adoption of best practice across four areas:

• how to promote and achieve accountable and empowered nurse leadership across the system
• how to make sure that the right culture and the right values that put patients first prevails at all times
• how best to involve, listen to, hear and respond to feedback from patients
• how to make sure that those providing care have the time to do so properly.

Across all four of these themes, the Forum will consider the knowledge, skills and educational needs of staff providing nursing and care to people. It will engage patients, staff, carers and professional experts, and aims to capture the experience and views of as many people as possible.
The Forum, which is chaired by Sally Brearley, is made up of a range of expert voices, including front-line nurses working in hospitals and the community, patient representatives and members of professional bodies and voluntary sector organisations.
The Forum’s Chair, Sally Brearley, said:

‘We want best practice to be common practice. The Forum’s mission is to identify and spread best practice to help all nurses deliver compassionate, dignified, respectful and safe care. We want nurses to feel confident and proud to give top quality care to those who need it.’

Prime Minister David Cameron said:

‘Nurses are some of the most caring, compassionate people in the country and I want to do everything possible to allow them to do a fantastic job.
‘That means learning from the best – and helping everyone to match those great standards. That’s why I’ve asked the Nursing and Care Quality Forum to scour the country, find out what works best and share it across the NHS.
‘We’ve seen how innovative changes to nursing can increase patient trust and confidence in their care. These are the kind of ideas we need to explore if we are to change the way nursing works and restore a sense of pride in the profession.’

If you would like to feed in your views on any of the above four themes to the Forum, you can contact it by email at ncqf@dh.gsi.gov.uk
Read the Nursing and Care Quality Forum mission statement.

See the Forum membership list and biographies.
See press release

Forget 'social care pot of gold'

Forget 'social care pot of gold': There will be no "pot of gold" to answer the prayers of councils struggling to look after the elderly, according to social care chiefs. BBC News

90% of GPs believe financial pressures will increase in next five years

90% of GPs believe financial pressures will increase in next five years: More than 90% of GPs believe financial pressures will increase in the next five years, a survey has revealed. GP Online

Mental health and homelessness: planning and delivering mental health services for homeless people

Mental health and homelessness: planning and delivering mental health services for homeless people: This Briefing sets out the policy context around tackling homelessness and addressing the mental health needs of homeless people. NHS Confederation

'Striking the Balance': practical guidance on the application of Caldicott Guardian Principles to domestic violence and MARACs (multi agency risk assessment conferences)

'Striking the Balance': practical guidance on the application of Caldicott Guardian Principles to domestic violence and MARACs (multi agency risk assessment conferences):
This guidance has been published jointly by the Department and the UK Council of Caldicott Guardians to assist those who need to share information about individuals involved in domestic violence. It sets out the underlying ethical considerations between confidentiality and information sharing and identifies the role of the Caldicott Guardian to ‘strike the balance’ between maintaining the individuals’ confidentiality and privacy and wider considerations such as protection from harm.

• Guidance
• Department of Health - publications

Improving care for lung cancer patients: a collaborative approach

Improving care for lung cancer patients: a collaborative approach:
The Improving Lung Cancer Outcomes project aims to improve the quality of care and patient experience for lung cancer patients. The project paired hospitals and multi-disciplinary teams and encouraged them to visit each others’ services and review their processes. This publication outlines examples of best practice and practical examples of quality improvement projects.

• Publication
• RCP - news

NHS 'must do more to respond to rising numbers of homeless'

NHS 'must do more to respond to rising numbers of homeless':

Many homeless people struggle to register with a GP and gain access to health services, NHS Confederation warns
Health services needs to "up their game" to respond to rising levels of homelessness and people sleeping rough as the recession lingers and benefit cuts begin to bite, according to a report by the providers of NHS services.
The NHS Confederation, representing all hospitals and providers who treat the homeless, warn that those on the streets often struggle to register with a GP and that many suffer from mental health problems that doctors refuse to treat unless they are "clean".
About 70% of people who use homelessness services have mental health problems, and many self-medicate with alcohol or drugs.
"For a range of NHS-funded services, we are not treating homeless patients for mental health who are intoxicated. People are not accepted because they use drink or drugs. Clearly they do need to be referred for therapy, so it's not good enough to say, 'Go away and clean yourself up,'," said the confederation's mental health network director, Steve Shrubb.
Shrubb said there was concern in the NHS that homeless numbers were increasing at a time when the health regulator Monitor warned of cuts of 7% a year for three years. He said the government's own estimate that 2,200 people were sleeping rough on any one night in England – a jump of 23% on the previous year – was too low. "We probably have that in London alone," he said.
Shrubb pointed out that a study by the University of York revealed that 23,000 people were already in emergency accommodation, slipping in and out of homelessness. "A lot of our members tell us that this is the tip of the iceberg. There are a lot of particularly young people moving from couch to couch, staying on friends' floors. It only takes a small crisis for them to be on the streets. We need to get an idea of how big this problem is."
Charities backed the report and warned that the government's programme on mental health might be too narrow. Peter Cockersell, the director of health and recovery at St Mungo's, a homeless charity, said the government's focus on improving access to psychological therapies (IAPT), centred around cognitive behavioural therapy, was in some cases obscuring those with the greatest needs.
"We are seeing counselling and therapy services [for the homeless] closed down. IAPT is getting bigger but it is working with a much narrower group of clients," Cockersell said. One of St Mungo's clients, Len, a former alcoholic who spent eight years on the streets, told the Guardian that he had only "got clean because of the therapy provided by the charity. That's all been cut now." The Guardian

One in four women buy wrong medication after misdiagnosing themselves on the internet

One in four women buy wrong medication after misdiagnosing themselves on the internet: Women with embarrassing medical problems are misdiagnosing themselves after consulting 'Dr Google', research suggests. The Daily Telegraph

Exclusive: Crisis in care of elderly as £1bn cuts bite

Exclusive: Crisis in care of elderly as £1bn cuts bite:
Hundreds of thousands of elderly and disabled people face cuts to their support and assistance this year as councils struggle to find new savings of £1bn from social-care budgets, an investigation by The Independent has established.

Government to unveil plan to improve NHS language skills

Government to unveil plan to improve NHS language skills:
Doctors whose English is not up to scratch could be struck off amid fears that patients are being put at risk. The Independent

Independent advocacy for people with mental disorder

Independent advocacy for people with mental disorder

This report sets out the principles of advocacy and provides recommendations and guidance. Independent advocacy is an excellent way to ensure that an individual’s rights are upheld and that the individual receives the care and treatment that they are entitled to. It also has benefits for psychiatrists and can improve the quality of the relationships between people with mental health problems and professionals.
This report replaces CR74: Patient Advocacy, 1999.

Politician’s fears for Corby health services

Politician’s fears for Corby health services:
NHS reorganisation costs are hitting Corby health services, a prospective MP has claimed. Evening Telegraph

Guidance on direct access to diagnostic tests for cancer

Guidance on direct access to diagnostic tests for cancer:
The guidance aims to help GPs in determining which patients would be suitable for direct referral to local services providing the diagnostic tests.
It deals specifically with the circumstances and symptoms that may warrant such referrals and is aimed at health care professionals across primary and secondary care and those who both provide and commission services. NHS Networks

Dementia: a public health priority

Dementia: a public health priority:
This report, produced jointly by WHO and Alzheimer's Disease International, aims to raise awareness of dementia as a public health priority; to articulate a public health approach; and to advocate for action at international and national levels. NHS Networks

‘Striking the Balance’ Guidance on information sharing

‘Striking the Balance’ Guidance on information sharing:
This guidance has been published jointly by the Department and the UK Council of Caldicott Guardians to assist those who need to share information about individuals involved in domestic violence, for example at a MARAC (Multi Agency Risk Assessment Conference) – a local, multi agency victim-focused meeting where information is shared on the highest risk cases of domestic abuse between different agencies.
It sets out the underlying ethical considerations between confidentiality and information sharing and identifies the role of the Caldicott Guardian to ‘strike the balance’ between maintaining the individuals’ confidentiality and privacy and wider considerations such as protection from harm.
Read the report: ‘Striking the Balance’: Practical Guidance on the application of Caldicott Guardian Principles to Domestic Violence and MARACs (Multi Agency Risk Assessment Conferences) Department of Health

NHS warning over night discharges

NHS warning over night discharges: The medical director of the NHS in England tells hospitals to stop discharging patients overnight to free up beds. BBC News

RCGP in talks about UK-wide NHS plan

RCGP in talks about UK-wide NHS plan: RCGP wants all four UK governments to adopt 10 core values for the NHS. GP Online

A crisis in nursing?

A crisis in nursing? Complaints against nurses and midwives rise by 57 per cent NMC

Walking a useful tool to treat depression

Walking a useful tool to treat depression:

Researchers at the University of Stirling have said taking a walk could play a part in beating depression.The results of a study published in the Mental Health and Physical Activity journal revealed that walking had a "large effect" on depression.The research team looked at eight studies involving 341 people to determine the effect of walking on depression.The report's authors said &qu... Healthcare Today

Government response after swine flu may have led to more deaths: Liam Donaldson

Government response after swine flu may have led to more deaths: Liam Donaldson: The Coalition's decision to scrap the flu awareness campaign after coming into power may have contributed to hundreds of preventable deaths, the government's former chief medical officer has said. Daily Telegraph

David Cameron to announce nursing overhaul

David Cameron to announce nursing overhaul: David Cameron will say that 'nothing counts more than a friendly face and a calming word' as he announces an overhaul of nursing. The Daily Telegraph

NHS to launch three new breast-feeding programmes across Northamptonshire - Northampton Chronicle & Echo

Northampton Chronicle & Echo

NHS to launch three new breast-feeding programmes across Northamptonshire Northampton Chronicle & Echo But a raft of other services will be paid for by NHS Northamptonshire over the next 12 months with £60000 of funds. They include project work in an area of low breast feeding or high drop-off rates, where mums begin breast feeding and for some reason ... Northampton Chronicle & Echo

Health and wellbeing boards – System leaders or talking shops?

Health and wellbeing boards – System leaders or talking shops?:
Health and wellbeing boards: System leaders or talking shops?  presents the findings from that survey and includes case studies based on the experience of two early implementers.
The paper assesses the ways in which local authorities have begun to develop new arrangements with their partners – the size, composition and ways of working emerging from the shadow boards. NHS Networks

Consultation launched on standardised tobacco packaging

Consultation launched on standardised tobacco packaging:
A UK-wide consultation seeking views on whether tobacco products should be sold in standardised packaging has been launched.
The government is exploring whether action on tobacco packaging has the potential to bring public health benefits over and above those from our current initiatives.
Standardised packaging could consist of, for example:

• no branding
• a uniform colour
• standard font and text for any writing on the pack

Views are also sought on whether there might be other implications if standardised packaging requirements were introduced, including any potential effect on the illicit tobacco market.
The consultation asks for views on whether:

• tobacco packaging should remain unchanged
• plain packaging should be adopted
• a different option should be considered

Health Secretary Andrew Lansley said:

“Smoking remains one of the most significant challenges to public health. Each year it accounts for over 100,000 deaths in the UK and one in two long-term smokers will die prematurely from a smoking disease. 
“That is why the health ministers across the UK have a responsibility to look closely at initiatives that might encourage smokers to quit and stop young people taking up smoking in the first place.”

You have until 10 July to have your say on the tobacco packaging consultation.
Any decisions to take further policy action on tobacco packaging will be taken only after full consideration is given to consultation responses, evidence and other relevant information.

Systematic review of evidence

The Public Health Research Consortium, a network of researchers funded by the Department of Health’s Policy Research Programme, has published a systematic review of the evidence on plain tobacco packaging.
The review was commissioned by the Department of Health and supported through the Public Health Research Consortium.
The report represents the work and views of the authors, and not necessarily those of the Department of Health.

• Have your say on the tobacco packaging consultation
• Read the full tobacco packaging consultation
• Read the tobacco packaging consultation press release

Department of Health

VIDEO: 'Parkinson's is with you for life'

VIDEO: 'Parkinson's is with you for life': Researchers are to conduct the world's biggest study into the causes of Parkinson's disease, a brain condition that affects almost 130,000 people in the UK. BBC News

Coalition to cut NHS redundancy costs

Coalition to cut NHS redundancy costs: Redundancy payments could add many millions of pounds to the overall costs of the reforms. Health & Social Care News

Elsevier launches Clinical Key

Elsevier launches Clinical Key: Scientific content publishers, Elsevier, this week launched Clinical Key, a "clinical insight engine" that aggregates information from textbooks and journals. EHI News

Doctors turn on No 10 over failure to curb obesity surge

Doctors turn on No 10 over failure to curb obesity surge: Major food and drinks firms fuel crisis with irresponsible marketing, claim doctors, who call for ban on fast-food sponsorship deals. The body that represents every doctor in the country has launched an unprecedented attack on the coalition government's failed strategy to tackle an obesity epidemic in the UK.The Academy of Medical Royal Colleges demands "bold and tough" measures to put an end to the role of "irresponsible marketing" by major food and drinks firms in fuelling the crisis. It calls on ...
Guardian

NHS Bill for England: What changes will the public see?

NHS Bill for England: What changes will the public see?: about the changes patients will see and when they would start to take place. Kings Fund health News

Who will take responsibility for rolling out 'telecare'?

Who will take responsibility for rolling out 'telecare'?:

Despite the government's enthusiasm for telecare, many GPs will be too busy trying to commission to learn how to do it
Last week, I expressed my disappointment with the King's Fund's International Telehealth and Telecare Conference. I am so upset that I am returning to the subject again.
For starters, I was amazed that there were only three GPs present. I found this strange, as telecare is likely to change the way GPs treat patients for ever. Or do GPs consider telehealth as just another irritating technology, like electronic patient records and email, which will go away if you ignore them long enough?
One speaker involved in the project said that GPs were divided between those who were interested, those who were not sure and those who didn't want to know. One GP claimed that telecare increased patient anxiety and workload for GPs.
On the other hand, community matrons and nurses already involved in telecare monitoring were generally very positive. They found that telecare made it easier to manage their own time. They even claimed that telecare would reduce the GPs' workload! This figures in my experience; nurses tend to welcome new ways of treating patients, but doctors hang back, particularly if what is proposed will radically change their way of life.
One of the GPs who did turn up asked the minister, Paul Burstow, a very intelligent question: "We GPs are up to our eyes in learning how to commission. How are going to find time to get our heads round telehealth?"
The minister had been emphasizing that 3millionlives was not a top-down initiative, like Tony Blair's nasty centralised National Programme for IT. It is going to be rolled out by lovely localised commissioning consortia. Paul Burstow had no answer for that GP, who was going to be too busy for telecare.
All he had to offer were "how to do it" guides and awareness campaigns. The trouble is that too many clinicians do not seem to want to know. It will take more than awareness campaigns to persuade them, and then educate them, which could be a long and arduous process, with all the other demands on their time.
Burstow's sidekick in the Department of Health called for the NHS, social services and industry to work together. He asked for leaders to come forward, including financial leaders, to share the vision and drive 3millionlives forward. He is right. But I have heard these calls before, and they haven't been answered.
I can't see where the charismatic champions will come from. Instead, I have a nasty feeling that 3millionlives will come to be regarded by clinicians as just another part of the hated Lansley reforms, and will be rejected by the profession.
There was, however, one bit of good news to come out of the conference. Apparently, Cornwall was not waiting for the peer-reviewed report. It had decided to start extending telecare to 30,000 patients. They had seen the evidence with their own eyes, and have people fired up to give more patients the benefits of telecare. So, why hang about?
Guardian Healthcare Network

Plans to close ambulance stations

Plans to close ambulance stations: The number of ambulance stations in the East Midlands could be slashed if new plans are approved. BBC Northampton

Care home nurse death cover-up

Care home nurse death cover-up:
A senior care home nurse who failed to check on a dying resident, then faked records to show she had served him cake and juice, may be struck off. Evening Telegraph

Patients Association issues statement on late night discharges

Patients Association issues statement on late night discharges:
Overnight discharges from NHS hospitals
Katherine Murphy Chief Executive at the Patients Association comments,
“Discharging patients often elderly and vulnerable late at night is totally inconsiderate and unacceptable and displays no compassion or thought for the individual patient.
Hospitals may think it is convenient for them to ask people to leave in the middle of the night but is it convenient and safe for a patient who may well have been in hospital for a considerable amount of time, to go home without any warning to an empty cold house – how patient centred is this?  This is totally unacceptable practice in what is supposed to be a caring environment.  We regularly receive calls to our Helpline from patients and relatives shocked at this callous, cruel and thoughtless behaviour.
NHS Managers need to recognise that discharging vulnerable patients at night is a poor reflection on their management skills and those Trusts that are guilty of doing this must be penalised.
The Patients Association today calls for intervention from the Department of Health, the Care Quality Commission and the Secretary of State for Health.  No patient, unless they are in agreement and it is clinically safe to do so should be discharged after 6pm it is inappropriate”. Patients Association

Changes to the professional use of controlled drugs by pharmacists and nurses

Changes to the professional use of controlled drugs by pharmacists and nurses:
The Royal Pharmaceutical Society is delighted to be able to confirm that legislation which introduces a number of changes to the professional use of controlled drugs by pharmacists and nurses was laid before parliament on the 30 March 2012 and will be coming into force on 23 April 2012. NHS Networks

Guidance on direct access to diagnostic tests for cancer published

Guidance on direct access to diagnostic tests for cancer published:
Guidance on direct referral by GPs to specific diagnostic tests for the assessment of particular symptoms where cancer may be suspected but the urgent GP referral (two week wait) process is not applicable, has been published.
The guidance aims to help GPs in determining which patients would be suitable for direct referral to local services providing the diagnostic tests.
It deals specifically with the circumstances and symptoms that may warrant such referrals and is aimed at health care professionals across primary and secondary care and those who both provide and commission services.
The guidance, which was commissioned by the Cancer Diagnostics Advisory Board, forms part of the broader programme to support the implementation of direct access to diagnostics.
Read the guidance
Cancer survival rates in England are lower than the best outcomes in Europe and the Government has set a level of ambition to save an additional 5,000 lives each year by in England by 2014/15 – equivalent to the European average.
In the majority of cases the GP is the first medical professional to see a patient with symptoms suspicious of cancer and GPs need easy access to the right diagnostic tests to help them diagnose or exclude cancer earlier.
Improving earlier diagnosis is key to improving cancer survival and the actions to achieve this are set out in Improving Outcomes: A Strategy for Cancer, published in January 2011.
Department of Health

Reforms in the 1990s were supposed to make nursing care better. Instead, there's a widely shared sense that this was how today's compassion deficit began. How did we come to this?

Reforms in the 1990s were supposed to make nursing care better. Instead, there's a widely shared sense that this was how today's compassion deficit began. How did we come to this?:
Yesterday, Christina Patterson described how extensive first-hand experience of Britain's hospitals persuaded her that all was not well with British nursing – and how subsequent research suggested that her disquiet was widely shared. Here, she tries to identify the origins of the crisis.The Independent

Late-night hospital discharges to be probed

Late-night hospital discharges to be probed:

Hospitals are ‘throwing patients out of hospitals’ late at night to free up beds, according to an investigation by The Times.
The newspaper estimates that each year more than 400,000 patients are discharged from hospital between 11pm and 6am: many of whom could be elderly or vulnerable patients with inadequate care and support.
The Times sent Freedom of Information requests to 170 NHS hospital trusts and analysed data from 100 that responded. These recorded 239,233 late-night discharges in the past year, which would equate to over 400,000 across the country. This represents around 3.5% of NHS hospital discharges each year.
The Times report included case studies of several patients who had been discharged inappropriately. However, the data reported tells us only the raw number of patients discharged during the seven-hour window. It does not explain why they were discharged, what the patients experienced or how many of the discharges were inappropriate.
Sir Bruce Keogh, Medical Director of the NHS told The Times that he will now investigate the issue of late-night discharges. Sir Bruce said “Patients should only be discharged when it’s clinically appropriate, safe and convenient for them and their families. It is simply not fair to be sending people home late at night. We will look at this.”

Why might patients be discharged at night?

Although the story has been front-page news, it does not explain why so many patients are being discharged at night or how many of these discharges are inappropriate.
Individual patients’ stories support the case that some are being discharged wrongly at night to free up beds but not all night-time discharges will be inappropriate. A small proportion of patients will always leave hospital at night for a variety of legitimate reasons, as some news sources have highlighted:

• Alcohol-related admissions: binge drinking is thought to cause over a million NHS hospitalisations each year, and drunk patients attending A&E may sometimes be transferred to wards so their health can be monitored. They may be discharged or choose to leave at night once they are more sober.
• Births: women who give birth to healthy babies often have no need to remain in hospital, and may choose to return home soon after their delivery rather than staying in hospital for the rest of the night.
• Cleared emergencies: patients brought in at night for suspected emergencies can sometimes be briefly booked into wards for checks and tests. Once it is considered safe for patients to return home they may be discharged the same night.
• Record-keeping practices: the way discharges are recorded in hospitals may not be totally accurate. For example, discharges recorded on paper might be keyed into computer systems at quieter periods such as night-time, suggesting a late-night discharge. Also, errors might occur when entering discharge times.
• Deaths: some hospital record systems count a patient as discharged if they die while in hospital. Therefore the figures are likely to include a number of patient deaths recorded during the seven-hour period from 11pm to 6am.

Overall, while there is evidence that inappropriate late-night admission does occur in the NHS, it is hard to judge the scale of the problem without more revealing data. Sir Bruce Keogh, Medical Director of the NHS has said he will investigate the matter.

How can I give feedback on my hospital stay?

You can use the NHS Choices site to give feedback. As well as rating your hospital, you can also read and leave feedback on your GP practice, dental practice or optician. You can add positive and negative ratings and comment on what you have experienced. To post your views, simply find your facility in our NHS services directory and click the button marked “Rate and comment” to begin.

How can I make a complaint?

If you are not happy with the care or treatment you or a relative have received, or you have been refused treatment for a condition, you have the right to:

• make a complaint
• have your complaint properly investigated
• be given a full and prompt reply

The NHS has its own complaints procedure, which is the first step you can take for any complaint. You can find detailed information about the NHS complaint procedure on NHS Choices.
If you aren’t satisfied with the way the NHS deals with your complaint, you can take it to the independent Parliamentary and Health Service Ombudsman.
Under the NHS Constitution you can also make a claim for judicial review if you think you have been directly affected by an unlawful act or decision of an NHS body, and receive compensation if you have been harmed.

You can also raise your concerns by contacting regulatory bodies such as the Care Quality Commission. Read more about this in other options for complaints.

Links To The Headlines

Scandal of NHS patients 'thrown out in the dark'. The Times, April 12 2012 [Paid content, avaiable via subscription from The Times online]
Overnight discharges from NHS hospitals to be examined. BBC News, April 12 2012
NHS patients 'discharged overnight'. The Daily Telegraph, April 12 2012
NHS patients 'discharged overnight'. The Independent, April 12 2012
NHS chief to investigate overnight discharges. The Guardian, April 12 2012
8000 NHS patients discharged in middle of night 'every week'. Metro, April 12 2012

Health News from NHS Choices