Tag Archives: patient safety

Campaigners to march on Department of Health over calls for safe NHS staffing levels

Patient safety campaigners will march on the Department of Health this week to call for safe staffing levels on NHS wards.

The demonstration follows a decision to end key research at the National Institute for Health and Care Excellence (NICE) into safe staffing ratios that the NHS could use.

Campaigners, led by Julie Bailey, who helped expose the Mid Staffordshire care scandal, will deliver a letter to the Health Secretary Jeremy Hunt on Thursday, calling on him to reverse the decision.

Nursing leaders and patient safety experts have expressed concern that the research, which will be taken on by NHS England, will now be “based on cost” and not evidence of what is safest.

The protest is a blow to Mr Hunt, who has gained a reputation as a staunch advocate of patient safety issues.

Cure the NHS, the campaign group founded by Ms Bailey, said in a statement: “Jeremy Hunt has been at the forefront of promoting patient safety. But this recent announcement appears to be a backward step and goes against all he has promoted.”

Source The Independent

NHS England to develop new indicator for nurse staffing levels

More than a third of hospitals had a fill rate for nursing shifts of more than 100% during May, according to data published for the first time yesterday.

Data on nurse staffing was one of three new indicators published on the new patient safety section of the NHS Choices website, as part of the government’s new Sign up to Safety campaign.

Greater transparency around nurse staffing data was a central to the government’s response to the Francis report last year.

However, while trusts were rated either “good”, “bad” or “OK” for performance against other factors, such as infection control and incident reporting standards, trusts have not been judged for their staffing levels.

This decision was taken in response to concerns about how valid comparisons could be made between organisations on staffing without a national standard.

Instead, staffing data has been reported as a percentage of planned nursing hours that were filled during the month.

Just 7.6% had fill rates of less than 90%, while half of trusts had fill rates of 90-100%.

However, the data is an aggregate of all registered nurse and healthcare assistant hours over the month, so may mask situations where a shortage of registered nurses has meant more healthcare assistants have been used or wards with regular understaffing.  

Fill rates of more than 100% are likely to have been driven by increases in patient acuity which meant more staff were required than originally planned, such as one to one “specialling” of particularly vulnerable patients.

NHS England chief nursing officer Jane Cummings said it was too soon to say from the data which organisations had concerning levels of staffing and the most valuable aspect of the information at the moment was the ward level data trusts were required to publish on their own websites.

Asked about plans to rate trusts on their staffing levels in future, she said a composite indicator would be developed over the next six months, which would also look at factors such as sickness absence rates and use of temporary staffing.

Ms Cummings said the idea would be to start with an indicator for acute trusts and move into other sectors when the National Institute for Health and Care Excellence developed guidance for them.

The development of staffing guidance by NICE was a key recommendation of the Francis report. Draft guidance on staffing adult inpatient wards was published for consultation in May.

The staffing data on NHS Choices comes from more than 20,000 shifts across 6,700 wards.

Only two trusts failed to submit their May data by the deadline: North Bristol Trust because staff and services were moving into a new hospital during the month, and Guy’s and St Thomas’ Foundation Trust because they had been recording the data in a different format.

Source Nursing Times

New cosmetic rules ‘are appalling’

Fresh rules for the cosmetic procedures industry in England are “appalling” and pay “only lip service” to patient safety, warn surgeons.
Ministers said it will become illegal to offer dermal fillers without training.
But surgeons said the decision not to classify them as prescription only has been labelled a “missed opportunity”.
The whole industry has been accused of acting like “cowboys” and selling products “like double glazing”.
The £2.3bn cosmetic procedures industry is dominated by the non-surgical end of the market such as fillers, laser hair removal and Botox.
They account for nine in 10 interventions and are worth 75% of the market.
Dermal fillers, used to plump up lips and get rid of wrinkles, are one major area of contention.

Just filler

Former beauty clinic manager Sarah Payne recalls how a dermal filler treatment went badly wrong
A review of the industry in 2013 by the medical director of the NHS in England, Sir Bruce Keogh, warned fillers could cause lasting harm, but were covered by only the same level of regulation as ballpoint pens and toothbrushes.
He said they were a crisis waiting to happen and should become prescription only.
However, this will not take place – a move criticised by plastic surgeons.
Rajiv Grover, a consultant plastic surgeon and president of the British Association of Aesthetic Plastic Surgeons (BAAPS), told the BBC: “Frankly, we are no less than appalled at the lack of action taken.
“Legislators have clearly been paying only lip service to the sector’s dire warnings that dermal fillers are a crisis waiting to happen.
“The ability to classify fillers as prescription only would have allowed three birds to be killed with one stone.
“It would effectively have controlled the marketing and sale of these fillers, it would have regulated who can perform these injections and it would have provided an automatic ban on advertising.

Illegal injections

Ministers have announced that Health Education England will review training for dermal fillers and Botox injections and legislation will be introduced to make it illegal to offer such procedures without training.
Anyone offering fillers will have to so under a named doctor or nurse, whose reputation will be on the line.
The government said it was working at an EU level to as part of a review of medical devices to change the rules on fillers.
Health minister Dan Poulter used the report’s foreword to say: “At its worst, this is an industry that is exploiting people’s insecurities, driven only by profits and with no regard to the physical and mental wellbeing of patients.”
“So it is hard to believe that, while these procedures can change the way you look temporarily and sometimes permanently, to date there has been virtually no regulation of the industry and no controls over who can perform these treatments or where they are carried out, despite the fact that they can so easily go wrong.”
However, surgeons are still concerned that anybody will still be able to offer fillers and there will be no central register of who is qualified.
Mr Grover said the message was “roll up and feel free to have a stab”.

Whole Industry

Cosmetic surgery and interventions became an issue during one of the biggest health scares to face the industry – surrounding substandard breast implants made by the French company Poly Implant Prothese (PIP) – when a lack of records kept by surgeons meant women did not know if they were affected.
At the time there was also criticism of “win a boob job” competitions, mother-daughter offers and time restricted deals on surgery.

Ministers say other measures being announced will improve the whole industry including:

A registry of breast implants to prevent a repeat of PIP
A review into a system of redress if things go wrong with treatment
More rigorous consent process to let patients have time to fully consider their decision to have surgery.
A clamp down on irresponsible advertising with the help of the Advertising Standards Authority.
The Royal College of Surgeons should set standards for the training and practice of cosmetic surgery
Ministers in Scotland, Wales and Northern Ireland will decide separately if they want to introduce any of the measures.
In a statement, Sir Bruce Keogh said: “This is the beginning of a journey, not the end, but I am confident these changes will create a much safer and skilled cosmetic industry which should reassure both consumers and practitioners.”
Source BBC News

New team to ‘improve patient safety’ at Noble’s hospital

A “patient safety improvement” team has been created at Noble’s hospital, the Department of Health has announced.
The government said the critical care outreach team, made up of qualified practitioners, has been established to “enhance care”.
In 2012, ten hospital consultants wrote to management to raise concerns about standards.
An independent review is currently being carried out by the West Midlands Quality Review Service.
It will cost in the region of £200,000 and take about two years to complete.
The first area to be examined is the care of critically ill patients which Health Minister David Anderson said was his department’s priority.

‘Improving patient care’

“Providing timely and effective intervention for those who are acutely unwell is essential in providing high quality care,” he said.
“I am certain that this new team will be able to further enhance the critical care services.”
According to the department of health the team has been established by “reviewing and realigning existing expertise and resources within the hospital”.
Clinical lead for critical care outreach, Pam Makin, said it is a “very exciting initiative” which will “further enhance patient care”.
She said: “The team and I are very much looking forward to developing an effective service with a determination to focus on improving patient care and outcomes.”
According to the Health Department Noble’s already has full and comprehensive critical care facilities in the form of the Intensive Care Unit (ICU) and Coronary Care Unit (CCU) served by dedicated and focussed clinicians.
A spokesperson for the department said: “The new team will ensure that critical care expertise and support is more widely available to clinicians who work outside of ICU and CCU, on wards, where the direct and early intervention of professionals with experience in treating acutely unwell patients can be invaluable”.
The outreach service will operate between 07:15 and 20:45, seven days a week.

Source BBC News

NMC makes progress on case backlog

When the government unveiled its plans for a £72,000 cap on elderly care costs from 2016, ministers were quick to claim they had solved the problem.

The era of huge bills for care, an issue which resulted in tens of thousands of people selling their own homes each year, was over, they said.

But as politicians and campaigners sift through detail it is becoming more and more clear that all is not quite as it seems.

Not everyone will be able to pick the tab up later

One of the measures trumpeted by ministers was the fact that the bill individuals face could be deferred by getting councils to pay for the care and then allowing them to recoup it from an individual’s estate after their death.

This option is already available in some areas, but under the changes every council would have to offer it, they said.

But it has now emerged the option of deferring payments will not be open to wealthier people.

Only those needing residential care who have assets of less than £23,250 (excluding the value of their home) will be able to get their local council to pay the costs.

For example, it means someone with £50,000 in the bank when they enter a care home will have to pay the bills as they come in until that has been reduced to £23,250. Only then will they be able to defer the costs.

Labour peer Lord Lipsey believes this is such a significant loophole that it amounts to a “sabotaging” of the safeguards.

Hotel costs will rack up

The £72,000 cap will not include the amount an individual pays for the “hotel costs” of a care home – that is to say the normal cost of daily living such as food, energy bills and the accommodation.

Under the reforms, these so-called “hotel costs” will be set at £12,000 a year. For a typical care home place that accounts for about a third of the fees.

Therefore, it would mean that an individual could find themselves paying over £100,000 over three years (£72,000 in care fees and £36,000 in hotel costs) before the cap kicks in.

And once it does they will still be liable for the £12,000-a-year hotel costs until their wealth is whittled away.
The biggest losers – those with middle incomes

With any system, there is always winners and losers. In this case it is those in the middle.

The poorest will continue to get social care free as they do now.

But those with assets of over £118,000 (including the value of property) will be liable for care home costs until they reach the £72,000 cap or their assets fall below the £118,000-mark.

It means those with assets of between £150,000 and £200,000 face losing between a third and nearly a half of their in care costs.

That compares to 0% for people with below £17,000 and a sixth for those with £500,000. Those even wealthier than that lose even less.

Get ready for rows with your local council

It will be up to local authorities to calculate how much an individual has to pay. They will do this by working out the average they pay for care home places for those who get state help.

This will stop people moving into a luxury care home and racking up £72,000 in costs in super quick time.

Fair enough, you might say.

But the problem – recognised by the Health Select Committee earlier this year – is that councils, with the benefit of buying places in bulk, can often negotiate lower fees than an individual can.

This could lead to disputes over what the true costs are.
Most people will never reach the cap

The original proposals suggested setting the cap at a much lower level. But in the end ministers came up with the figure of £72,000.

This was not plucked out of thin air.

Once a person enters a care home, not many live beyond two years.

In that time just those requiring the most intensive care are ever likely to accrue bills in excess of £72,000.

It means only an estimated one in eight people will benefit from the cap, according to estimates by the government.

And that is why Age UK, which has been campaigning for years for reform of the social care funding system, sees the cap as only a start.

It argues the cap only benefits those with “the greatest needs” who end up in care homes “for a considerable amount of time”.

Source Nursing Times

Competition in NHS is harming efforts to improve patient care, says outgoing chief Sir David Nicholson

Private-sector style competition in the NHS is harming efforts to improve patient care, the health service’s top official has admitted, in a damning verdict on a key pillar of the government’s health reforms.

Sir David Nicholson, the outgoing chief executive of NHS England, said that hospitals were being held back from making changes that made “perfect sense from the point of view of patients” because they did not meet new rules on competition between healthcare providers.

Speaking at an event hosted by the Health Service Journal last week, Sir David spoke candidly about the rules, which have already stood in the way of mergers and service changes that NHS managers and clinicians said were urgently needed.

His comments were made under “Chatham House rules”, but he later gave special permission for them to reported.

“All of [the politicians who drew up the Health and Social Care Act] wanted competition as a tool to improve quality for patients,” he said. “That’s what they intended to happen, and we haven’t got that…”

“I’ve been somewhere [where] a trust has used competition law to protect themselves from having to stop doing cancer surgery, even though they don’t meet any of the guidelines [for the service],” he continued.

“Trusts have said to me they have organised, they have been through a consultation, they were centralising a particular service and have been stopped by competition law. And I’ve heard a federated group of general practices have been stopped from coming together because of the threat of competition law.

“All of these [proposed changes] make perfect sense from the point of view of quality for patients, yet that is what has happened.”

He said that the law may have to change and that the health secretary, Jeremy Hunt, would have to act “quite quickly” to enable “the big changes needed” – an apparent reference to plans to reform NHS services in reaction to major budget restrictions.

“I know the secretary of state would be prepared to take legislation back [to Parliament] if that’s what needs to happen,” he said.

The Department of Health said that proposed NHS mergers had been considered by the Office of Fair Trading (OFT) on only two occasions and that Mr Hunt was “absolutely clear that patient safety must always trump any competition concerns”.

“The Health Secretary has recently met with the OFT to seek assurances that the current system is working well for patients.  As a result, the OFT have committed to set out further guidance on the merger review process shortly,” the spokesperson said.

Sir David’s  criticisms were revealed as the Labour party pledged to make a “a clear break” with its former support for greater competition within the health service.

Speaking at the party’s conference, the shadow health secretary Andy Burnham launched a fierce attack on the Coalition’s record on the NHS, saying that competition lawyers had been allowed to “call the shots”, hospitals had been encouraged to charge patients for more services and private companies had been favoured over NHS providers.

“For too long, market forces have been allowed to advance into the NHS,” he said. “Well no more. We will make a clear break with that… I am not neutral about who provides NHS services, I will never see the NHS as an empty blue and white brand to be used by any qualified provider.”

A Labour source said that Mr Burnham wanted to restore the principle that NHS organisations would be the “preferred provider” of health care – a clear break from the last Labour government’s health policy.

“We let the market in too far,” the source said. “Andy recognised that as health secretary in the dying days of the last government… We’re going back to the idea that the NHS is its own preferred supplier.”

Mr Burnham outlined Labour’s plans to “complete [NHS founder Aneurin] Bevan’s vision” by integrating the health service with the social care sector – a plan which the Government has also made a priority in the face of growing crisis in elderly care provision.

Under a Labour government, elderly people and the disabled would have “one named contact” who would coordinate their care needs, Mr Burnham said.

Home carers would also be able to go with patients into hospital.

End of life care would be free, and terminally ill people would have greater rights to spend their last days at home, he added, in a pledge that was welcomed by Macmillan and Help the Hospices.

The health secretary Jeremy Hunt said that Labour were “playing catch-up on joining up services” and criticised Mr Burnham’s speech for failing to mention the Mid Staffordshire hospital scandal, which unfolded under the last Labour government. 

The Government announced a £3.8bn fund to begin the work of merging health and social care in July.
Source The Independent