Tag Archives: NHS

Safe nurse staffing bill moves closer to becoming law in Wales

A safe nurse staffing bill in Wales has moved one step closer to becoming legislation, after ministers took a vote on its financial implications.
Welsh assembly members passed the motion on the financial resolution for the Safe Nurse Staffing Levels (Wales) Bill last night.
It will now move onto the next part of the legislative process, which will see ministers consider amendments to the bill.
A further two stages will still need to be passed before the bill can become law.
Leader of the Welsh Liberal Democrats Kirsty Williams, who put forward the bill at the end of 2013, said last night’s decision was a signal ministers would agree for the law to be introduced.
“Nurses in Wales have to care for more patients per head than any other part of the UK. We simply can’t allow this situation to continue”
Kirsty Williams
She said the bill was a “golden opportunity” to combat negative media headlines about the Welsh NHS.
“The premise of this bill is simple – making sure there are more nurses on our hospital wards means each nurse will have more time to care for each patients.
“This will lead to better care outcomes for those patients, and a more manageable workload which might stem the flow of nurses leaving the profession,” she said.
“Nurses in Wales have to care for more patients per head than any other part of the UK. We simply can’t allow this situation to continue,” added Ms Williams.
A recent poll by the Royal College of Nursing in Wales of the general public found 90% said it was important to bring in the law.
If passed, it would see Wales become the first country in the UK with a legal duty on safe nurse staffing levels.
Source The Nursing Times

Patients with life-threatening conditions can wait twice as long for ambulance because they called 111

The NHS is investigating an ambulance trust in the south of England after it took an unauthorised decision to delay help for patients who may have suffered strokes and other potentially lethal conditions.

Under NHS rules, calls designated as “life-threatening” – even if they come through the 111 service – are supposed to receive an ambulance response within eight minutes.

South East Coast Ambulance allowed itself an extra 10 minutes to deal with some calls, meaning that life-saving cases had to wait up to 18 minutes.

Tonight patients’ groups said the “experiment” was “extraordinarily alarming” and meant patients were being “effectively punished” for calling 111, rather than 999. Health officials said South East Coast Ambulance Service Foundation trust had acted “unilaterally and inappropriately” by introducing the unauthorised scheme.

The trust, which covers Sussex, Kent, Surrey and North East Hampshire, last night refused to say how many patients had been affected by the policy, which affected calls between last December and February of this year.

“We have asked the trust to review the action it took to make sure there was no harm to patients”
Paul Streat, regional director at Monitor

It also refused to comment on whether any patients had died or come to harm as a result. Regulators are now examining how many people came to harm.

Joyce Robin, of Patient Concern, said: “It is incredibly shocking. These are the kinds of decisions which would clearly increase the risk of death and suffering, and not the sort of experiment which should have been allowed.”

Last night the trust refused to say who had introduced the policy, now under investigation by NHS regulators and senior health officials, or to disclose whether any managers had been disciplined.

The decision affected all calls categorised as “Red 2,” which covers conditions such as strokes which can be life-threatening, but less immediately time critical than “Red 1” calls, such as cardiac arrests. The NHS 111 helpline was created in order to ensure that all patients, including non-emergency cases, get the right help when they need it.

If a case is designated as life-threatening by call handlers, an ambulance should then arrive within a target time of eight minutes.

Monitor, the watchdog for foundation trusts, said it would work with the trust to review the impact the practices may have had on patients.

The revelations follow earlier concerns about practices employed by the 111 helplines, with a Daily Telegraph investigation earlier this year revealing pressures on call-handlers not to dispatch ambulances:

Paul Streat, regional director at Monitor, said; “We have asked the trust to review the action it took to make sure there was no harm to patients, and look again at the way decisions are taken to prevent something like this happening again.”

The watchdog said it had concerns about the way the trust is run, suspicions it was breaching its licence to provide NHS care, and might clear out some of the board of the trust if sufficient improvements were not made.

The trust said it introduced the process in order to “re-triage” some calls coming from 111 to 999, to determine whether an ambulance was needed, potentially upgrading some calls.

It refused to say whether calls which were subjected to a 10 minute delay, on top of the normal eight minute response time, were treated as successfully hitting NHS targets.

Paul Sutton, trust chief executive said: “The process was undertaken to ensure that the right response was provided to patients and that we were able to respond promptly to the most seriously ill patients.”

“However we recognise that it was not well implemented and we did not use our own corporate governance processes correctly. These are serious findings.”

Peter Walsh, chief executive of the patient safety charity Action against Medical Accidents said: “This is a very worrying example of what happens when NHS organisations are allowed too much slack and depart from standardised and evidence based procedures. There has to be a full investigation and complete transparency about how this was allowed to happen, and what the consequences have been for patients”.

Source The Telegraph

Woman left in ‘unrelenting pain’ for 15 years after NHS failed to carry out simple scan

A woman was left in “unrelenting pain” for 15 years because of NHS failings while parents were accused of child abuse for trying a herbal remedy for eczema, in cases highlighted by the NHS Ombudsman.

The body – the highest authority for complaints against the health service – has released details of some of the worst cases referred to it, detailing a catalogue of blunders.

The Ombudsman, said too often those who complained about their treatment suffered a “devastating impact” because the NHS failed to provide an honest explanation of what had gone wrong.

The report is a snapshot of 192 case summaries of the 1,075 investigations concluded by the Parliamentary and Health Service Ombudsman (PHSO) in February or March this year, with most cases involving the NHS.

They detail cases in which a father died from blood poisoning, after doctors failed to treat it, a family was forced to pay £102,000 for care which should have been funded by the NHS and a woman who almost lost the use of her ankle thanks to poor NHS advice.

In one case, a woman who complained of “severe and unrelenting” facial pain in 1997 was repeatedly refused an MRI scan. When a scan was finally carried out by Isle of Wight NHS Trust in 2012, it identified the source of the pain, which was resolved by surgery.

The Ombudsman said the MRI should have been offered 12 years sooner, and secured an apology and payment of £750 compensation.

In another case, Sheffield Children’s NHS Foundation Trust was forced to pay £500 in compensation to a couple a doctor told them that if they used a herbal cream on their son’s eczema instead of prescribed drugs, they would regard it as a “child protection issue”.

The ombudsman said there was “insufficient evidence” to justify treating the family’s preferences as a safeguarding matter.

The report tells how a female patient almost lost the use of her ankle, thanks to poor advice from the NHS about her fracture.

Milton Keynes Hospital NHS Foundation Trust told the woman to rest the joint for two months but the woman was sufficiently worried to seek a second opinion, privately.

The PHSO said the patient would have lost the use of her ankle permanently if she had followed the NHS advice, and the trust has reimbursed her the £323.50 paid for the private appointment.

Newcastle Upon Tyne Hospitals NHS Foundation Trust sent a man suffering a painful lump on his buttock home with antibiotics but within three weeks was back with pain in his foot.

Doctors found the initial infection had spread and he died from blood poisoning two days later.

The trust claimed the admissions were unrelated but PHSO said the lack of appropriate treatment on the first visit compromised the man’s chance of survival, and ordered that £2,000 compensation be paid to his daughter.

At South Lincolnshire Clinical Commissioning Group (CCG), health officials were forced to pay a family £102,000 after trying to make them pay towards care home costs which the NHS should have funded.

Avon and Wiltshire Mental Health Partnership NHS Trust was criticised over the death of a man who committed suicide shortly after being discharged from hospital, following an overdose.

The PHSO said the trust did not do enough to establish whether he was at risk of further self-harm.

Ombudsman Julie Mellor said: “In many of the complaints we see, the organisation complained about has done the right thing to put things right. But too many people aren’t getting the answers to what went wrong from the organisation they complained about.

“Complaints alert people to where problems are and should be welcomed by all levels of the organisation from the frontline to the board, so that much-needed improvements are made.”

Anna Bradley, chairman of Healthwatch England, said: “The Ombudsman’s findings are worrying but sadly not surprising. Our research shows that three in five people who complain about health and social care services feel their complaints are not properly addressed.”

Source The Telegraph

NHS and care sector: Safety a ‘big concern’ in England

Safety across the NHS and care sectors in England is a “significant concern”, with particular problems in hospitals, inspectors are warning.

The Care Quality Commission review found three-quarters of hospitals visited under its new inspection regime so far had safety problems.

Over 40% of care and nursing homes and home care services and one in three GP services also had problems with

Lack of staff was identified as a major issue in hospitals and care services.

The way medicines were managed and how mistakes were investigated and learnt from were also highlighted.

‘Kept on trolleys’

Among the individual cases flagged up were:

  • A&E patients being kept on trolleys overnight in a portable unit without proper assessment
  • Staff at a GP surgery not undergoing basic life-support training in the past 18 months
  • Medication mistakes at a care home – including delays giving drugs and signs of overdoses

The findings – contained in the CQC’s annual report – are effectively a mid-term update of the new tougher Ofsted-style inspection regime.

They cover the first 14 months of the inspection programme, which was launched in April 2014 and is expected to be largely completed by April 2016.

So far more than 5,000 organisations have been inspected – nearly half of hospitals, 17% of care services and 11% of GP surgeries and out-of-hours providers.

However, those deemed most at risk have been predominantly targeted first, so the level of failure is not necessarily representative of the overall sector.

During the inspections, CQC experts look at a range of different issues, including:

  • The quality of management
  • Whether staff are caring
  • Safety

Each organisation – from GP surgery to hospital – gets a rating for each, resulting in an overall rating of inadequate, requires improvement, good or outstanding.

The results of these are widely published throughout the year, whereas this report looks at some of the common problems identified during the whole process.

Of all the issues looked at, the CQC said most concerns had been raised about safety.

Some 13% of hospitals were judged unsafe, 10% of social care services and 6% of GP services.

Once those judged to be not safe enough are included, it brings the numbers with safety problems to 74% for hospitals, 43% for social care services and 31% for GPs.

The report said improving leadership was the key to tackling the problems.

David Behan, CQC chief executive, told Radio 4’s Today programme: “What we know from our report and from other research is that the leadership of an organisation sets the culture of that organisation.

“If the leadership says the important things around here are quality and safety, then that’s what people attend to.”


Royal College of Nursing general secretary Janet Davies believes financial problems are a major factor – last week it was revealed trusts had already racked up a deficit of nearly £1bn in the first three months of this financial year, greater than the overspend for the whole of 2014-15.

She added: “Whether nursing care is delivered, in hospitals, care homes or the community, it depends on having the right number of staff with the right skills and support. There must be more investment in training nurses, keeping nurses and listening to nurses.”

Mr Behan said money was “important”, but added that hospitals with similar amounts of money achieved different results.

Katherine Rake, chief executive of Healthwatch England, the patient watchdog, said it was vital to learn from mistakes, describing the problems highlighted as “unacceptable”.

“We would now like to see all services operate with the right culture of openness and transparency when things go wrong,” she said.

But Rob Webster, of the NHS Confederation, which represents trusts, warned the financial pressures and negative publicity was creating a “toxic environment”, which in turn had caused a “revolving door of NHS leadership”.

“[This] is bad for the health service, and bad for patients,” he said.

Source BBC News

NHS ‘backtracking’ on ward nurse numbers introduced after Mid Staffs

The NHS has been accused of backtracking on improvements in patient safety made after the Mid Staffs scandal by reducing the number of nurses on wards because of its growing financial crisis.

NHS bosses have told hospitals they no longer have to ensure that one nurse is caring for no more than eight patients at a time, in order to help tackle a £2bn black hole that has left 80% of hospitals facing deficits of up to £100m each.

The letter states: “We would stress that a 1:8 ratio is a guide not a requirement. It should not be unthinkingly adhered to. Achieving the right number and balance of clinical and support staff to deliver quality care based on patient needs in an efficient way that makes the best possible use of available resources is the key issue for provider [hospital] boards.”

The letter from NHS bosses to NHS foundation trust and NHS trust chief executives.

The move, set out in a letter to all hospital chiefs, has sparked fears that patient safety will be sacrificed to help hospitals cut costs. It makes clear that financial considerations are deemed to be as important as the safety and quality of care patients receive when deciding how many nurses should be on duty.

Cash-strapped hospitals may be tempted to cut their nurse staffing levels as a result of the new advice, the Royal College of Nursing (RCN) warned. Staffing takes up 70% of the NHS’s budget and its bill for employing temporary staff to plug gaps in rotas, especially expensive agency nurses, has hit £3.3bn in the last two years.

The letter has been signed by NHS England, the Care Quality Commission, the National Institute for Health and Care Excellence (Nice), and the regulator NHS Improvement. It recommends that hospitals can ask health professionals, such as physiotherapists, to help look after patients, and use technology to monitor their condition, to reduce the need for nurses on duty.

It urges hospitals “to take a rounded view of staffing” that shows they are “making the best use of resources” as well as providing safe care. It lists a set of variables, including how ill patients are, and then adds: “In some cases these factors will mean a higher number of nurses per patient, and in other cases it will mean a lower number or different configuration of staff can be justified.”

It adds: “It is therefore important to look at staffing in a flexible way which is focused on the quality of care, patient safety and efficiency rather than just numbers and ratios of staff.”

The NHS is under heavy pressure from ministers to make £22bn of “efficiency savings” by 2020 to help plug the £30bn gap expected to have developed in its finances.

The new advice is a substantial downgrading of guidelines produced only last year by Nice, which insisted that no nurse should look after more than eight patients to ensure good, safe care. That ratio was widely hailed as a way of avoiding a repeat of the Mid Staffs scandal, in which a lack of nurses was found to be a key cause of the appalling care.

Howard Catton, the RCN’s head of policy, said: “There’s a risk that people in the NHS may interpret this letter as a green light to row back on safe staffing when the NHS’s finances are in the perilous state that they are.”

However, he added that other suggestions in the letter, such as allowing hospital managers to use their professional judgment about how many nurses were needed and not rigidly applying fixed ratios, were “common sense”.

Labour said the NHS circular showed that patient care could be put at risk as a result of the fast-ballooning deficit.

“The idea that hospitals can ignore safe-staffing guidance will alarm patients. Safe staffing levels are essential for patient safety and were a key recommendation of the Francis report,” said Heidi Alexander, the shadow health secretary.

“If ministers attempt to balance the books in the NHS by cutting staff and putting patients at risk, then Labour will oppose them all the way. It is yet further evidence that the financial crisis in the NHS is now a real threat to patient care.”
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Ian Wilson, chair of the British Medical Association’s representative body, said: “Adequate staffing levels are vital to deliver safe, high-quality patient care. Flatline funding at a time of rising demand has left services and the frontline staff who deliver them under enormous pressure. The solution is not to stretch existing staff even further, but to ensure the NHS has the resources needed to deliver safe care.”

But hospital bosses welcomed the move away from the 1:8 ratio. “NHS England boss Simon Stevens deserves credit for persuading Jeremy Hunt to soften his previous hard line on safety at any cost. We need to be pragmatic in the face of spiralling deficits,” one told the Guardian .

“It will give more discretion to senior nursing colleagues, giving them a vote of confidence. A ‘one size fits all’ is not the solution to staffing levels; it is about empowering frontline leaders.”

Canadace Imison, director of healthcare systems at the Nuffield Trust thinktank, said: “This letter shows a welcome attempt by NHS regulators to deliver a consistent message about safe staffing levels. It also rightly recognises that the 1:8 nurse to patient ratio is a crude metric and not to be seen as a benchmark.”

But it also leaves NHS trusts no wiser about whether they should under-staff or overspend in order to provide high-quality care, Imison added.

Source The Guardian

NHS facing £2bn deficit and ‘worst financial crisis in a generation’

Hospitals have overspent by nearly £1bn in three months due in part to soaring bill for agency and other temporary staff, according to regulators.
The NHS overspent by £930m in three months this year and is on course for an annual deficit of at least £2bn, in what regulators described as its worst financial crisis in a generation.
Hospitals are spending more than their budgets as they struggle to cope with what one NHS leader called a “triple whammy” of growing demand for care, £2bn of unexpected staff costs and the service’s finances being the tightest for years.
The NHS is missing many waiting time targets, medical services regulators revealed on Friday. The increasing difficulty of recruiting and retaining enough personnel to staff every ward has led to a soaring bill for agency and other temporary employees.
Separate reports published on Friday from the two bodies that oversee foundation trust (FTs) and non-foundation trust hospitals in England reveal a massive recent deterioration in the NHS’s finances.
The 151 FTs regulated by Monitor recorded a collective deficit of £445m between the start of April and the end of June this year, and expect to end 2015-16 as a whole £1bn in the red. 
The 90 NHS trusts supervised by the NHS Trust Development Authority (TDA) fared even worse, accumulating a combined deficit of £485m – £73m worse than expected – with 80% of its hospitals overspending in those three months. They spent more than £380m on agency and contract staff in response to understaffing. 
Monitor’s report says: “The current level of deficit is not affordable.”
It details how many foundation trusts are failing to meet NHS waiting times for A&E care, cancer treatment, non-urgent operations in hospital and vital diagnostic tests.
Monitor said hospitals had to “continue to improve how they operate, including making radical changes to how care is delivered, if they are to counter the intense pressures they’re under from an increased demand for care and a worst-in-a-generation financial position”.
Dr David Bennett, Monitor’s outgoing chief executive, said: “The NHS simply can no longer afford operationally and financially to deliver the substantial efficiency gains required to ensure patients get the services they need.”
The Observer revealed last Sunday that Monitor and the TDA had been “leaned on” by Whitehall officials to delay publication of Friday’s reports until this week’s Conservative party conference was over.
Jeremy Hunt, the health secretary, has ordered hospitals to reduce their spending on both temporary staff and management consultants in an attempt to cut costs. But privately NHS bosses say persistent understaffing and the need to provide good quality care because of the toughened NHS inspection regime raise doubts that the bill for agency staff can be cut.
Last week Monitor appointed Jim Mackey, the chief executive of Northumbria Healthcare NHS foundation trust, to be the chief executive of a new body called NHS Improvement – formed by a merger between it and the TDA – that will try to crack down on overspending.
Chris Hopson, the chief executive of NHS Providers, which represents trusts, said: “These results are not a surprise. Providers have been flagging their rapidly deteriorating financial position for more than two years now.
“NHS trusts and foundation trusts are doing everything they possibly can to avoid financial deficits, but they are experiencing a triple whammy: rapidly rising patient demand, an extra £2bn unfunded staff cost they have been required to add, and the deepest and longest funding squeeze in NHS history, despite the NHS ringfence.”
The likelihood of a £2bn year-end deficit will put pressure on George Osborne, the chancellor, to give the NHS emergency funding in his spending review next month.
Source The Guardian

Chronic pain patients who face a year-long wait to see a doctor: NHS struggling to cope with increasing demand as services are cut

Patients living with chronic pain are being forced to wait up to a year for appointments with NHS specialists, according to a Mail on Sunday investigation.

Those referred to hospital clinics are usually in agony from back, neck, hip or nerve problems. Pain can be so debilitating that some even attempt suicide.

But trusts are struggling to cope with increasing demand, and services being cut or transferred into the community in some areas.

A Freedom of Information request to NHS trusts in England revealed that the longest single wait for an appointment was 60 weeks, by a patient at Devon Partnerships NHS Trust. The average wait for all patients at the Trust was 27 weeks.

In total, 47 of the 80 trusts that responded to The Mail on Sunday’s request indicated that at least one patient had waited more than six months for an appointment.

Patients also waited more than a year for an initial consultation in Walsall, Harrogate, Shrewsbury and at the 5 Boroughs Partnership NHS Foundation Trust, a mental health trust in the North West.

The average waiting time for all patients was more than three months at trusts in West Hertfordshire, Harrogate, Bristol, West Sussex and Medway. However, most said that urgent cases could be seen within a week if necessary.

In some cases, such as in Walsall, the wait was partly due to patients themselves cancelling appointments or failing to turn up.

Dr Chris Jenner, a consultant at the London Pain Clinic and Charing Cross Hospital, said no one should be on the list for more than six months. He added: ‘Pain is just one aspect of what they are going through. The suffering that goes along with it has a psychological effect and can cause depression.’

Katie Adams, 28, who suffers stomach pain caused by endometriosis and agonising leg pain linked to a bladder operation, waited several weeks for an initial check-up at Queen Elizabeth the Queen Mother Hospital in Margate, Kent, in April 2014 – but then two further appointments were cancelled.

Ms Adams, from Herne Bay, Kent, said: ‘I tried to kill myself because it got too much, and I had to quit my job. I dread waking up as I don’t know if I’ll be able to feel my legs.

‘When I called the Trust to complain, I was told that “doctors are entitled to take holidays”.’

The East Kent Hospitals University NHS Foundation Trust said that it was unable to comment.

Source Mail Online

Shocking NHS postcode lottery for elderly care

Elderly people in some parts of the country are nine times more likely than in others to be admitted to hospital as emergency cases – for lack of the right care in their local communities.

Charities said the new official figures are a “troubling” insight into a growing crisis in care of the elderly, with hundreds of thousands of pensioners being admitted to hospitals via casualty in cases which could have been avoided with the right help earlier.

The statistics also reveal a three-fold difference in the chance of cancer sufferers being diagnosed early enough to have a good chance of successful treatment, depending where they live.

The figures, published by Public Health England, are among more than 100 measures assessed today in an “NHS atlas” exposing enormous variations in NHS care.

They also show major disparities in dementia care, the chance of receiving stroke treatment quickly, or receiving treatment at all for a host of common health complaints such as cataracts.

Over 75s living in Canterbury were the most likely to be admitted to hospital as an emergency for a stay of less than 24 hours, with 11,000 cases per 100,000 population.

Officials track this measure because most such stays could be avoided, if the right care was available closer to home. Those living in North East Lincolnshire were nine times less likely to experience have an NHS stay under such circumstances.

Among pensioners with dementia, emergency admissions were most likely in Bradford and least likely in Herefordshire.

Caroline Abrahams, Charity Director at Age UK said: “The growing numbers of older people being admitted to hospital are very troubling and highlight just how much pressure the NHS is under.

“The shortness of stays and the numbers of patients with dementia being admitted suggest that many of these admissions would have been avoidable if the right care and support had been made available in the community.”

The statistics, which compare 211 NHS Clinical Commissioning Groups reveal major differences in the chance of being diagnosed with cancer early, and in survival from the disease.

In Slough in Berkshire, just 18 per cent of those with the disease are diagnosed when it is at stage 1 or 2 – when it is most likely to respond to treatment.

In West Suffolk, the figure is 60 per cent. Tom Cottam, policy manager at Macmillan Cancer Support said the major differences were costing lives.

“This simply isn’t good enough – where you live shouldn’t have a bearing on how early your cancer is caught,” he said.

“It’s crucial people are diagnosed as early as possible as it gives them a better chance of surviving cancer and having fewer long-term complications.”

The East of England has by far the best record for diagnosing cancer in the early stages of its development. Of the top 10 CCGs with the highest percentages of cancer diagnoses made at stage one or two, nine were situated in the East of England.

In South East England, the East Midlands and Yorkshire cancer caught at stage one or two made up less than a quarter of diagnoses in some areas.

Patients in NHS Coastal West Sussex were the least likely to receive cataract surgery, with those in Bradford having almost three times as much treatment.

The study found major variations in stroke care. Patients who suffer a stroke are supposed to be sent to a dedicated unit within four hours, for urgent treatment, improving the chance of survival and lessening the risk of disability. But the research found the proportion receiving care within four hours ranged from 35 per cent to 80 per cent.

Professor Dame Sally Davies, chief medical officer said: “The first step in tackling unfair variation in health services is to identify where the problems are. This Atlas is a key tool in enabling us all to do this.”

Bradford, Waltham Forest in east London and Southwark in south London had the highest number of emergency admissions for over 65s with dementia, while those living in the areas served by NHS Chiltern, NHS North Hampshire and NHS Herefordshire had the lowest, per 100,000 population.

Bruce Keogh, NHS medical director, said: “This Atlas exposes some inconvenient truths about the extent of clinical practice variation in care for some common conditions. “Our challenge now is to consider how we can better understand and tackle the underlying causes.”

Source The Telegraph

‘Weekend effect’ blamed for 11,000 extra deaths in hospital each year

Up to 11,000 more people die each year after being admitted to hospital over the weekend compared with other days of the week, a major study suggests.

The disclosure comes days before a deadline for doctors’ unions to agree changes to consultants’ contracts, in an attempt to increase levels of weekend cover, or see them imposed.

The study of 15 million hospital admissions, published in the BMJ, found a significant “weekend effect” for patients admitted between Friday and Monday.

The figures stand in contrast to estimates by Jeremy Hunt, the Health Secretary, who said in July that the number of extra deaths during weekends was 6,000 a year.

Overall, patients admitted on Saturday or Sunday – when staffing levels and access to backup services are reduced – were twice as likely to die within 30 days of surgery, the study found.

Some of these deaths were because patients admitted at weekends are likely to be sicker, given that less hospital treatment routinely takes place during this period. The study showed that even when this was taken into account, those who were admitted to hospital at the weekend were still significantly more likely to die.

The highest death rates were among those admitted on Sunday, with 15 per cent more deaths, once figures were risk adjusted, and 10 per cent more on Saturday.

Overall, that amounts to an extra 11,000 deaths a year among those admitted between Friday and Monday.

Prof Sir Bruce Keogh, NHS medical director and one of the authors of the landmark study, said it revealed an “inconvenient truth” that could no longer be ignored and required an overhaul in the way services are run.

The research, by University Hospital Birmingham NHS Foundation Trust and University College London, examined the effect of the hospital admission day on death rates across NHS England hospitals for 2013-14.

Prof Keogh said: “The idea that patients are being harmed because of the way we organise our services is quite simply beyond what any of us can regard as acceptable. The moral and social case for action is simply unassailable.”

“Change always brings practical difficulties that must be tackled but we cannot duck the facts,” said Prof Keogh. “It is my job here to point out an inconvenient truth: doctors are trying their best but I have to think about the way that we can redesign services to address this issue.”

Overall, mortality rates from Tuesday to Thursday were 1.6 per cent, creeping up to 1.75 per cent on Friday, 2.64 per cent on Saturday and 3.4 per cent for those admitted on a Sunday, before dropping back to 1.7 per cent by Monday, the figures show.

The research said: “Appropriate support services in hospital are usually reduced from late Friday through the weekend, leading to disruption on Monday morning. This could go some way towards explaining our finding of a ‘weekend effect’ extending into Friday and Monday.”

The Royal College of Surgeons said patients needed better access to senior staff and key tests at weekends.

Its president, Clare Marx, said: “Patients who need treating at the weekend are less likely to be seen by the right mix of junior and senior staff, and experience reduced access to diagnostics. Many doctors and NHS staff already work at night and weekends, and they should be valued and thanked for continuing to provide care during those unsocial hours.

“However, the evidence shows this is not currently standard practice, even in high-risk emergency care. This has to change.”

Last week an investigation by The Telegraph found that in some specialties there were six times as many consultants working during the week as at weekends.

Even in accident and emergency departments, there were twice as many senior doctors working during the week as at weekends, despite demand for services being consistent throughout the week, with only a small spike in admissions on Mondays.

A study of heart attack patients presented to cardiologists last week found those who were admitted on Saturday had death rates 20 per cent higher than those who arrived at hospital during the week.

The BMA has been given a deadline of Friday to agree changes to consultants’ contracts – with the removal of the right to opt out of non-emergency weekend work – or see changes imposed.

Dr Mark Porter, chairman of the BMA, has accused the Government of failing to provide detailed plans, and said weekday services would be damaged if doctors were spread too thinly.

“Doctors want the care we provide for sick patients to be of the same high standard, seven days a week,” he said.

“Urgent action on this has been undermined by calls for the entire NHS to be delivered on a seven-day basis without any clear prioritisation.

“The BMA wants better access to seven-day urgent and emergency care to be the priority for investment. This will ensure seriously ill patients receive the best care at all times.”

He said as well as extra doctors, there needed to be investment in more nurses and diagnostic and support staff.

“Given the current funding squeeze on NHS trusts, the only way for many hospitals to increase the number of doctors over the weekend would be to reduce the number providing care during the week.”

Source The Telegraph

Jeremy Hunt warned 18 months ago about foreigners charging NHS for care in their countries

Health secretary Jeremy Hunt was warned over 18 months ago by frontline NHS staff about a loophole which allows foreigners to bill the National Health Service for treatment they receive in their own countries.

A report, specifically commissioned by Mr Hunt into NHS health tourism and published in October 2013, raised concerns that migrants were applying for European Health Insurance Cards in the UK and using them to be treated in their home countries at the British taxpayers’ expense.

Downing Street said the practice – which was highlighted in an investigation by the Daily Mail – was “worrying and completely unacceptable”. It said an existing Department of Health review into the “length and validity” of the cards will now be expanded to look at whether the “system and application process” were being abused by foreigners.

The cards are intended for Britons to charge the NHS for the cost of any urgent medical treatment they might need while overseas within Europe.

The report published by Mr Hunt in October 2013 found “several” frontline NHS staff were raising the concerns that the cards were being applied for under false pretences and used to fund healthcare in their own countries.

The independent 239 page Department of Health study, titled “Qualitative Assessment of Visitor and Migrant use of the NHS in England: Observations from the Front Line”, examined the concerns of NHS Overseas Visitor Officers (OVOs) who are tasked with identifying and charging non-UK residents who are not entitled to free NHS hospital treatment.

The report, which was drawn up by independent consultants, said: “Several OVOs in the sample commented that visitors from EEA countries sometimes present a UK EHIC and they were concerned that this might mean the card had been obtained under false pretences and that the people concerned would then return home and access healthcare which they previously would not be eligible for, with the cost being met by the UK taxpayer.”

Labour said it would be tabling Parliamentary Questions about what Mr Hunt knew of the concerns.

Andrew Gwynne MP, the shadow Health Minister, said: “This explicit warning was in a report commissioned by Jeremy Hunt himself, and he needs to urgently explain why he ignored it.”

Meirion Thomas, a consultant surgeon, said it was a well-known scam. He said NHS numbers should be replaced by National Insurance numbers as the qualification for obtaining one of the cards

A Department of Health source said Mr Hunt’s policy team was working on new policies to curb health tourism, including cracking down on abuse of the cards.

A department spokesman said: “The Government commissioned this report, and was the first to introduce tough measures to clamp down on migrants accessing NHS care.

“The policies we have already announced are being supplemented by ongoing work to get a fair deal for the UK taxpayer, which includes ensuring the EHIC process only supports those entitled to use NHS services.”

Sourcce The Telegrpah