Survey reveals staff saw potentially harmful mistakes made at Northampton General Hospital:
FOUR in 10 Northampton General Hospital staff saw potentially harmful mistakes in the space of a month, new figures suggest. Northampton Chronicle and Echo
Tuesday, 27 March 2012
Why continuity of care is crucial for patients | Lara Sonola
Why continuity of care is crucial for patients | Lara Sonola: Continuity and co-ordination is essential for safe, effective and high quality care and it matters to everyone. However, for older patients it has fundamental importance. (Blog, 23 Mar 2012) Kings Fund
Partnership working for child health programme
Partnership working for child health programme:
The documents include guidance, health visiting attributes, health visiting factsheets and questions and answers. NHS Networks
The documents include guidance, health visiting attributes, health visiting factsheets and questions and answers. NHS Networks
Third of babies 'to live to 100'
Third of babies 'to live to 100': A third of babies born in 2012 in the UK are expected to live to 100, according to a new report. BBC News
NHS ageism 'harming elderly care'
NHS ageism 'harming elderly care': The elderly are being passed around hospitals in England like parcels, often going without treatment because of ageist attitudes, a report suggests. BBC News
Health Bill now set for royal assent by Easter
Health Bill now set for royal assent by Easter: The Health Bill is set to receive royal assent and become law by Easter after completing its passage through parliament last week. GP Online
Choose and Book use on downward slope
Choose and Book use on downward slope: Usage of Choose and Book has fallen from a high of 57% to 50%, with some areas almost halving their use of the Department of Health's e-booking system. E-Health Insider
Seven-day NHS 'unaffordable' says BMA
Seven-day NHS 'unaffordable' says BMA: Attempts to make hospitals work seven days a week are unaffordable because the move will cost the NHS billions of pounds a year, the British Medical Association has warned. Daily Telegraph
Co-codamol recalled
Co-codamol recalled: The Medicines and Healthcare products Regulatory Agency (MHRA) has warned that some batches of co-codamol could contain incorrect strengths of the painkiller.The MHRA said a problem in manufacturing the pills could have resulted in the mistake, which meant some packets of batch LL1701, which expires in September 2014, contain 30mg instead of 8mg of co-codamol per tablet.While the 8mg tablets can be bought from ... Healthcare Today
Health reforms could damage NHS, warns draft risk register
Health reforms could damage NHS, warns draft risk register:
Document points to danger of emergencies being less well managed and increased use of private sector driving up costs
Emergencies in the NHS could be less well managed under the government's controversial health reforms, according to a draft version of a risk register on the bill (PDF) which has been leaked.
Labour claimed the register served as a "damning indictment" of the health reforms which recently passed into law after a bruising parliamentary battle.
The warnings about the threat posed by the bill were issued in a draft version of the risk register, dated 28 September 2010, which was leaked to the health writer Roy Lilley.
The government has been criticised for refusing to comply with a ruling by the information commissioner to publish the Transition Risk Register, drawn up on 10 November 2010, after an FOI request by the former shadow health secretary, John Healey.
The register sets out the risks posed by the health and social care bill which will devolve 60% of the NHS's £100bn budget to new GP-led consortia. The draft version of the register warned of:
• A longer term danger to the NHS's ability to cope with emergencies. It said: "The NHS role in emergency preparedness/responsiveness is more difficult to manage through a more devolved organisation, and so emergencies are less well managed/ mitigated."
• Greater costs if new GP-led consortiums make greater use of the private sector. "One example of area where system could be more costly is if GP Consortia makes use of private sector organisations/staff which adds costs to the overall system."
• A danger that the new system is set up too quickly, threatening the running of the NHS.
• A loss of financial control. "Financial control is lost due to the restructuring of budgets distributed between or allocated to organisations within the system [to be clarified]," it said.
• Unfavourable media coverage. "Public reputation. There is a risk that the transition will be presented in a negative light via the media. Two of the biggest risks which have already surfaced in the media are i) that the reforms will continue to be characterised through the prism of privatisation and ii) financial cuts."
Health secretary Andrew Lansley's reforms were built on demolishing a layer of management – the primary care trusts which currently purchase care on behalf of patients. But the document highlights the risk that the reforms would sow confusion between rival bodies on the ground during the transition to Lansley's new look NHS. Civil servants also rate highly the danger that the £20bn savings may not materialise as managers lose focus and that the quality of patient care suffers.
The Department of Health said that it did not comment on leaks. But it is understood that the leaked document looked familiar to officials. Ministers are likely to argue that the document is an early draft drawn up four months before the publication of the health and social care bill. Since then the bill has undergone two major changes during the government's "listening exercise" last spring and in a series of parliamentary amendments. Ministers will also say that a report to be published on Tuesday shows that the NHS is on course to meet the so called "Nicholson challenge" to save £20bn over the course of this parliament.
But Labour seized on the document. Liz Kendall, the shadow social care minister, said: "This is a damning indictment of the health bill – forced through by the Tories with cover from the Lib Dems. It shows beyond doubt the high risks the bill poses to patients and taxpayers. The government has repeatedly tried to hide these risks, but its own assessment of the bill makes them devastatingly clear. Patients and the public will not forget or forgive David Cameron for his reckless NHS gamble."
Andy Burnham, shadow health secretary, said: "Now we know why David Cameron refused to publish the risk register before the bill was through parliament – it's because civil servants were telling him his reorganisation was likely to cause major damage to the NHS. David Cameron will never be forgiven for knowingly taking these risks with the country's best-loved institution."
Clare Gerada, chair of the Royal College of General Practitioners and a critic of the reforms, tweeted that the risk register was "very scary reading & should have been disclosed long ago".
Healey said: "This is exactly the type of information that the public and parliament lacked while the bill was being debated. This shows how unprepared the NHS and civil service were for this huge NHS reorganisation."
A Department of Health spokesperson said: "We have always been open about risk and have published all relevant information in the impact assessments alongside the bill. As the latest performance figures show we are dealing with those risks, performance is improving – waiting times are down and mixed sex wards are at an all time low - and we are on course to make the efficiency savings that the NHS needs to safeguard it for the future." The Guardian
Emergencies in the NHS could be less well managed under the government's controversial health reforms, according to a draft version of a risk register on the bill (PDF) which has been leaked.
Labour claimed the register served as a "damning indictment" of the health reforms which recently passed into law after a bruising parliamentary battle.
The warnings about the threat posed by the bill were issued in a draft version of the risk register, dated 28 September 2010, which was leaked to the health writer Roy Lilley.
The government has been criticised for refusing to comply with a ruling by the information commissioner to publish the Transition Risk Register, drawn up on 10 November 2010, after an FOI request by the former shadow health secretary, John Healey.
The register sets out the risks posed by the health and social care bill which will devolve 60% of the NHS's £100bn budget to new GP-led consortia. The draft version of the register warned of:
• A longer term danger to the NHS's ability to cope with emergencies. It said: "The NHS role in emergency preparedness/responsiveness is more difficult to manage through a more devolved organisation, and so emergencies are less well managed/ mitigated."
• Greater costs if new GP-led consortiums make greater use of the private sector. "One example of area where system could be more costly is if GP Consortia makes use of private sector organisations/staff which adds costs to the overall system."
• A danger that the new system is set up too quickly, threatening the running of the NHS.
• A loss of financial control. "Financial control is lost due to the restructuring of budgets distributed between or allocated to organisations within the system [to be clarified]," it said.
• Unfavourable media coverage. "Public reputation. There is a risk that the transition will be presented in a negative light via the media. Two of the biggest risks which have already surfaced in the media are i) that the reforms will continue to be characterised through the prism of privatisation and ii) financial cuts."
Health secretary Andrew Lansley's reforms were built on demolishing a layer of management – the primary care trusts which currently purchase care on behalf of patients. But the document highlights the risk that the reforms would sow confusion between rival bodies on the ground during the transition to Lansley's new look NHS. Civil servants also rate highly the danger that the £20bn savings may not materialise as managers lose focus and that the quality of patient care suffers.
The Department of Health said that it did not comment on leaks. But it is understood that the leaked document looked familiar to officials. Ministers are likely to argue that the document is an early draft drawn up four months before the publication of the health and social care bill. Since then the bill has undergone two major changes during the government's "listening exercise" last spring and in a series of parliamentary amendments. Ministers will also say that a report to be published on Tuesday shows that the NHS is on course to meet the so called "Nicholson challenge" to save £20bn over the course of this parliament.
But Labour seized on the document. Liz Kendall, the shadow social care minister, said: "This is a damning indictment of the health bill – forced through by the Tories with cover from the Lib Dems. It shows beyond doubt the high risks the bill poses to patients and taxpayers. The government has repeatedly tried to hide these risks, but its own assessment of the bill makes them devastatingly clear. Patients and the public will not forget or forgive David Cameron for his reckless NHS gamble."
Andy Burnham, shadow health secretary, said: "Now we know why David Cameron refused to publish the risk register before the bill was through parliament – it's because civil servants were telling him his reorganisation was likely to cause major damage to the NHS. David Cameron will never be forgiven for knowingly taking these risks with the country's best-loved institution."
Clare Gerada, chair of the Royal College of General Practitioners and a critic of the reforms, tweeted that the risk register was "very scary reading & should have been disclosed long ago".
Healey said: "This is exactly the type of information that the public and parliament lacked while the bill was being debated. This shows how unprepared the NHS and civil service were for this huge NHS reorganisation."
A Department of Health spokesperson said: "We have always been open about risk and have published all relevant information in the impact assessments alongside the bill. As the latest performance figures show we are dealing with those risks, performance is improving – waiting times are down and mixed sex wards are at an all time low - and we are on course to make the efficiency savings that the NHS needs to safeguard it for the future." The Guardian
Dementia patients locked in rooms to make them 'easier to manage'
Dementia patients locked in rooms to make them 'easier to manage': Staff in care homes and hospitals are routinely ignoring patients' human rights over restraint techniques, official report warns.
The Daily Telegraph
The Daily Telegraph
Monday, 26 March 2012
Evaluation of integrated care pilots
Evaluation of integrated care pilots:
The evaluation which commenced in 2009 looked at 16 sites across England who undertook different ways of integrating care, for example, between general practices, community nurses, hospitals and social services.
The report also provides information on evalution methods, data collection and analysis. NHS Networks
The evaluation which commenced in 2009 looked at 16 sites across England who undertook different ways of integrating care, for example, between general practices, community nurses, hospitals and social services.
The report also provides information on evalution methods, data collection and analysis. NHS Networks
Diabetes issues 'at record high'
Diabetes issues 'at record high': Rates of stroke and kidney failure in people with diabetes have reached record levels in England, according to new analysis by Diabetes UK. BBC News
VIDEO: Dementia to be 'national priority'
VIDEO: Dementia to be 'national priority': Care Services Minister Paul Burstow says working towards an earlier diagnosis for dementia must be a priority, as funding for research is to be more than doubled to £66m by 2015. BBC News
Reducing migrant nurses ''will harm care''
Reducing migrant nurses ''will harm care'': The move could have a ''significant impact'' on the quality of healthcare, the government has admitted Public Service
Industrial action update
Industrial action update from Dean Royles: Our director, Dean Royles, has written to HR directors in the NHS with an update on the decisions being made by the various trade unions, in response to the NHS Pension Scheme reforms. NHS Employers
Identifying and managing tuberculosis (TB) among hard-to-reach groups
Identifying and managing tuberculosis (TB) among hard-to-reach groups:
This guidance sets out how commissioners and providers of TB services and other statutory and voluntary organisations that work with hard-to-reach groups can achieve better outcomes through targeted action to find patients early, and by providing intensive clinical and social support to help them complete TB treatment.
This guidance sets out how commissioners and providers of TB services and other statutory and voluntary organisations that work with hard-to-reach groups can achieve better outcomes through targeted action to find patients early, and by providing intensive clinical and social support to help them complete TB treatment.
Alcohol strategy
Alcohol strategy:
This strategy sets out Government proposals to crack down on binge drinking culture, cut down on alcohol fuelled violence and disorder and slash the number of people drinking to damaging levels. It includes commitments to introduce a minimum unit price for alcohol; consult on a ban on the sale of multi-buy alcohol discounting; introduce stronger powers for local areas to control the density of licensed premises; and pilot innovative sobriety schemes to challenge alcohol-related offending.
This strategy sets out Government proposals to crack down on binge drinking culture, cut down on alcohol fuelled violence and disorder and slash the number of people drinking to damaging levels. It includes commitments to introduce a minimum unit price for alcohol; consult on a ban on the sale of multi-buy alcohol discounting; introduce stronger powers for local areas to control the density of licensed premises; and pilot innovative sobriety schemes to challenge alcohol-related offending.
How GPs are set to make a killing out of NHS reform
How GPs are set to make a killing out of NHS reform:
He is arguably the medical profession's highest-profile cheerleader for the most radical reorganisation of the NHS the UK has seen. And, as one of Britain's most senior GPs, he holds our trust. But Dr Shane Gordon is also one of a number of GPs backing Andrew Lansley's reforms who stand to profit personally. And that, critics claim, is the embodiment of a fundamental flaw in the new Bill which could dangerously erode public trust in the NHS – the potentially volatile mix of money and medicine. The Independent
He is arguably the medical profession's highest-profile cheerleader for the most radical reorganisation of the NHS the UK has seen. And, as one of Britain's most senior GPs, he holds our trust. But Dr Shane Gordon is also one of a number of GPs backing Andrew Lansley's reforms who stand to profit personally. And that, critics claim, is the embodiment of a fundamental flaw in the new Bill which could dangerously erode public trust in the NHS – the potentially volatile mix of money and medicine. The Independent
What the NHS can learn from accountable care organisations
What the NHS can learn from accountable care organisations:
The new health models being used in the US are similar to those coming to Britain: the aim is to cut costs while improving the service, says Mark Zezza
Among all the health reform activities in the United States, the arrival of accountable care organisations is considered one of the more promising for bending the health care cost curve while improving patient outcomes.
Accountable care organisations are providers that are held accountable for the cost and quality of care for a defined population of patients. The successful ones are expected to manage costs by aligning incentives for hospitals, physicians and other providers to encourage better co-ordination and to promote continuous quality improvement efforts. Those that are able to keep costs below specified amounts can share in the savings, contingent upon meeting performance standards.
The organisational model is still relatively new and untested. In fact, the results for the Medicare physician group practice demonstration, one of the largest such efforts to date, has been mixed at best: only half of the 10 participants have achieved cost-reduction targets by the end of the fifth year.
However, providers and payers remain committed to the concept. Over the next year, the number is expected to grow substantially, as a new Medicare programme designed specifically for accountable care organisations is set to begin in April. Interestingly, the model bears a strong resemblance to the basis of proposed reforms being introduced in the NHS in the United Kingdom – ie, the clinical commissioning groups. These will also be provider-led and be responsible for managing the health of a defined population of patients under a budget.
At the recent Nuffield Trust Summit, I had the chance to meet several NHS delegates and other UK stakeholders. Three key issues were raised, which I have outlined in more detail below.
Flexibility in design
A key feature of the accountable care organisations framework is its inherent flexibility. For example, participating provider organisations can range from integrated delivery systems to loosely affiliated physician groups that may be linked together through a regional health information exchange.
In addition, payment models can range from one-sided approaches that reward providers for reducing costs, but do not hold them at risk of any excess costs, to two-sided approaches, in which providers can achieve even larger rewards, but are held accountable for excess costs.
Since the US programme is voluntary, this flexibility can help encourage broad participation. However, too low a barrier for entry could lead to the enrolment of providers not ready to co-ordinate and manage care effectively, potentially resulting in wasted investments.
Hospital participation
One suggested cost-reduction strategy is to avoid high-cost hospital services. However, those services represent revenue to hospitals, which calls into question the value proposition for a hospital to participate in the new model.
On the other hand, hospitals can be considered logical leaders for the new model organisations. For example, they already have a management structure and are likely to have a data sharing infrastructure in place, as well as the capital available for the upfront investments needed.
In addition, hospitals may be motivated to protect their market share, realising that change may be inevitable as current payment rates are unsustainable and physician groups and competing hospitals may already be getting a head start in reform efforts.
Engaging patients
The new organisational model does not require any insurance benefit design changes. For example, patients assigned to an ACO under the Medicare program would still have access to other Medicare providers. While this helps ensure that patients retain choice, it also makes it harder for ACOs to manage the care of their patients. Ideally, they will retain their patients by providing high-quality care associated with positive patient experiences.
Conclusions
As can be gathered from this sampling of issues, the new model is certainly not a sure fix to the problems in the United States health care system. It represents a sharp change from the current health care environment in which most providers are not well-equipped to co-ordinate care and have little financial incentive to do so because of the predominant fee-for-service payment system which rewards inefficiency by paying more for more care, regardless of the impact on patient health.
Thus, it would likely take years and many modifications from lessons learned, to foster the type of change that can permanently bend the cost curve. Given that similar issues are being faced by the NHS, ideally that process can be accelerated by sharing lessons learned across health systems on both sides of the Atlantic.
Dr Mark Zezza is a senior policy analyst at The Commonwealth Fund in the United States. He presented at the Nuffield Trust's Health Policy Summit 2012. Guardian Professional.
Among all the health reform activities in the United States, the arrival of accountable care organisations is considered one of the more promising for bending the health care cost curve while improving patient outcomes.
Accountable care organisations are providers that are held accountable for the cost and quality of care for a defined population of patients. The successful ones are expected to manage costs by aligning incentives for hospitals, physicians and other providers to encourage better co-ordination and to promote continuous quality improvement efforts. Those that are able to keep costs below specified amounts can share in the savings, contingent upon meeting performance standards.
The organisational model is still relatively new and untested. In fact, the results for the Medicare physician group practice demonstration, one of the largest such efforts to date, has been mixed at best: only half of the 10 participants have achieved cost-reduction targets by the end of the fifth year.
However, providers and payers remain committed to the concept. Over the next year, the number is expected to grow substantially, as a new Medicare programme designed specifically for accountable care organisations is set to begin in April. Interestingly, the model bears a strong resemblance to the basis of proposed reforms being introduced in the NHS in the United Kingdom – ie, the clinical commissioning groups. These will also be provider-led and be responsible for managing the health of a defined population of patients under a budget.
At the recent Nuffield Trust Summit, I had the chance to meet several NHS delegates and other UK stakeholders. Three key issues were raised, which I have outlined in more detail below.
Flexibility in design
A key feature of the accountable care organisations framework is its inherent flexibility. For example, participating provider organisations can range from integrated delivery systems to loosely affiliated physician groups that may be linked together through a regional health information exchange.
In addition, payment models can range from one-sided approaches that reward providers for reducing costs, but do not hold them at risk of any excess costs, to two-sided approaches, in which providers can achieve even larger rewards, but are held accountable for excess costs.
Since the US programme is voluntary, this flexibility can help encourage broad participation. However, too low a barrier for entry could lead to the enrolment of providers not ready to co-ordinate and manage care effectively, potentially resulting in wasted investments.
Hospital participation
One suggested cost-reduction strategy is to avoid high-cost hospital services. However, those services represent revenue to hospitals, which calls into question the value proposition for a hospital to participate in the new model.
On the other hand, hospitals can be considered logical leaders for the new model organisations. For example, they already have a management structure and are likely to have a data sharing infrastructure in place, as well as the capital available for the upfront investments needed.
In addition, hospitals may be motivated to protect their market share, realising that change may be inevitable as current payment rates are unsustainable and physician groups and competing hospitals may already be getting a head start in reform efforts.
Engaging patients
The new organisational model does not require any insurance benefit design changes. For example, patients assigned to an ACO under the Medicare program would still have access to other Medicare providers. While this helps ensure that patients retain choice, it also makes it harder for ACOs to manage the care of their patients. Ideally, they will retain their patients by providing high-quality care associated with positive patient experiences.
Conclusions
As can be gathered from this sampling of issues, the new model is certainly not a sure fix to the problems in the United States health care system. It represents a sharp change from the current health care environment in which most providers are not well-equipped to co-ordinate care and have little financial incentive to do so because of the predominant fee-for-service payment system which rewards inefficiency by paying more for more care, regardless of the impact on patient health.
Thus, it would likely take years and many modifications from lessons learned, to foster the type of change that can permanently bend the cost curve. Given that similar issues are being faced by the NHS, ideally that process can be accelerated by sharing lessons learned across health systems on both sides of the Atlantic.
Dr Mark Zezza is a senior policy analyst at The Commonwealth Fund in the United States. He presented at the Nuffield Trust's Health Policy Summit 2012. Guardian Professional.
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