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NHS rationing ‘is denying patients care’ as cash crisis deepens

Patients are being denied mental health care, new hips and knees, and drugs to boost their recovery from illnesses including cancer as the NHS increasingly rations treatments to try to overcome its growing cash crisis.

A survey of doctors reveals that three-quarters said they had seen care rationed in their area over the last year – including treatments such as speech therapy, operations to remove varicose veins, Botox to help children with cerebral palsy move better and even potentially life-saving stem cell transplant surgery.

Disabled children were having to use ill-fitting wheelchairs, teenage girls were banned from accessing medication to tackle male-style hair growth and women had been unable to access surgery to have breast enlargements or reductions as a result of growing restrictions across England, the research concluded.

Medical organisations said the findings showed patients were paying the price because an underfunded NHS was having to force them to wait for care or deny it altogether.

Dr Mark Porter, leader of the British Medical Association, said: “The NHS is being forced to choose between which patients to treat, with some facing delays in treatment and others being denied some treatments entirely. This survey lays bare the extreme pressure across the system and the distress caused to patients as a result.”

Almost four in five (78%) of the 749 doctors in England who took part in the survey – conducted for the Guardian by Binley’s OnMedica, a healthcare data and intelligence provider – said patients who were denied treatment suffered increased anxiety as a result.

One patient killed himself after experiencing a delay in receiving help with mental health problems.

Another doctor told how “several teenage girls with hirsutism [male-style hair growth on the face, chest or back] have experienced severe psychological distress and bullying [after being denied drugs to treat it]. Some have self-harmed and been admitted to hospital as a result”.

A 22-year-old woman with relapsed acute myeloid leukaemia died after being denied a second allogeneic stem cell transplant.

Her doctor said her late relapse and good response to salvage chemotherapy meant there was a 50% chance that a further transplant would have cured the disease.

However, the local GP-led clinical commissioning group refused to fund the procedure, which would have used healthy stem cells to try to help her bone marrow, and she received palliative care instead.

The findings prompted the health minister David Prior to warn that NHS bodies might be acting illegally by rationing.

“Treatment decisions should only be made by doctors based on a patient’s individual clinical needs,” he said. “Local health bodies have a legal responsibility to provide services meeting the needs of their local population, and we expect NHS England to act if there is any evidence of inappropriate rationing of care.”

Almost two-thirds (64%) of doctors said patients would be forced to go private.

A quarter (26%) said the rationing of procedures, such as hernia repairs, made it more likely that the person would end up being admitted to hospital as an emergency if their health worsened.

Prof Neena Modi, president of the Royal College of Paediatrics and Child Health, said she was concerned that some of society’s most vulnerable children, including those with disabilities and mental health problems, were being affected by NHS rationing.

“The financial pressures on the NHS are subjecting vulnerable children to a postcode lottery,” she said.

Most (86%) of the 536 hospital doctors and 213 GPs who took part said rationing was occurring “for financial reasons” and 39% said it was “to help manage demand”.

Only 28% said it was because the evidence for the clinical evidence for certain treatments had changed and so they were no longer recommended.

The survey also found that:

  • Significant minorities of medics had seen restrictions on the removal of benign lumps and bumps (36%), breast reduction or enlargement (31%), varicose vein treatment (31%) and cosmetic surgery (28%).
  • Almost one in four (23%) had encountered drugs being rationed because they were too expensive. Cancer treatments were cited by 13% of doctors and “costly drugs” by 10%.
  • The same number (23%) had seen fertility treatment cut back.
  • Eighteen per cent had come across mental health care being withheld.
  • And 10% had seen hip and knee replacements cut back, despite the ageing population leading to growing numbers of older people needing such surgery.

One doctor in southern England told Binley’s how disabled children forced to wait for more than a year to receive injections of Botox, which is used to treat muscle conditions such as spasticity in children and adults, suffered increased pain or disability as a result.

The same doctor said that, due to rationing of wheelchairs, “children waiting for wheelchairs have pain and deformity from ill-fitting chairs, which are contributing to hip dislocation and worsening scoliosis”.

In addition, physiotherapists working with children using ill-fitting wheelchairs believed their role was “almost negated by the lack of postural control for these children”.

Modi said: “Of course this is concerning. No child or young person should receive a different level of care because of where they live. Some of the examples cited here involve some of the most vulnerable children – those with mental health problems and with long-term conditions. It’s crucial that these children get the right treatment, and where appropriate equipment, to manage their condition. If this isn’t the case, not only will their quality of life be compromised, but problems will be stored up for the future.”

Doctors are divided on rationing; 94.4% think it will inevitably increase as a result of the rising demand for care and NHS’s tight finances.

Three-quarters (74%) believe that the NHS is right to be rationing treatments either because that helps the NHS survive financially, or because not all treatments should be funded by the service or because free NHS services can be abused by patients.

However, one doctor said rationing was “a false economy. If people are not treated early, their problems become more costly to treat and they need to be treated for longer, leading to greater overall cost across the NHS in order to save a little in one part.”

Another said restricting care “is detrimental to the patient/doctor relationship if there is a feeling that treatments and tests are withheld on financial grounds only”.

Sarah Eglington, Binley’s healthcare intelligence director, said: “The fact that the majority of doctors surveyed are aware of restrictions on NHS services or treatments in England will shock many. But the harsh reality revealed by our research is that rationing is already occurring and it is likely to become increasingly common owing to rising demand for care and the NHS’s tight finances. Health professionals don’t want decisions purely to be made on cost.”

An NHS England spokeswoman said: “The basis on which people receive NHS care – within the funds parliament makes available – should always reflect their ability to benefit from treatment. The NHS strives to ensure we get maximum value from every penny available on behalf of patients.”

The findings come after a National Audit Office report found that one in four patients now struggles to get through to their GP surgery on the telephone, and dissatisfaction with family doctor services is rising. In 2014-15, 27% of patients said it was not easy to speak to their practice by phone, up from 19% in 2011-12.

Three-quarters of patients get an appointment within the timeframe they wanted but, overall, satisfaction is slowly declining, the NAO found.

The percentage of patients who get to see their preferred GP always, almost always or most of the time, has also fallen, from 66% in 2011-12 to 60% in 2014-15.

A fifth of patients also said opening hours were not convenient, up slightly on 2011-12.

Source The Guardian

NHS patients to be monitored remotely in digital healthcare revolution

NHS patients with long term illnesses could soon be able to monitor their conditions remotely through high-tech clothing and wearable gadgets which will link directly to their medical records, under new proposals announced today.

Within five years patients across the country are likely to be able to go online and speak to their GP via videolink; order prescriptions or see their entire health record as part of widespread digital revolution of healthcare in Britain.

People suffering from chronic conditions like asthma, diabetes, heart disease or high blood pressure could be constantly monitored remotely through wearable skins sensors or smartphone apps with data uploaded directly to health records so that problems can be spotted immediately.

Wearable tech like Jawbone, Fitbit, Misfit, the Pebble and Apple smartwatches are already able to monitor heart rate, sleeping patterns, steps taken, diet, alchol intake and running speed.

But companies are also developing health gadgets which can check blood pressure, monitor insulin levels and even pick up neurological conditions by videoing eye movement or depressive symptoms through language used on Twitter feeds.

Apps which remind patients to take their medication are also likely to be rolled out following a successful pilot on Tyneside.

The Neatamo JUNE bracelet measures sun exposure, and its app tells you how much cream of various factors to rub on in order to stay safe. It is hoped that widespread use could lower the number of people with skin cancer.

By 2018 nearly three million people are expected to have at least three long-term medical conditions like diabetes and dementia, resulting in growing demand and pressure on health and care services. Health experts are hoping the digital revolution will free up resources and allow people to monitor their own health rather than relying on professionals.

It is estimated that going digital will save the NHS up to £5 billion over the next decade.

The Fitbit Charge can already monitor heart rate, calories burned and number of steps taken

“The proposals announced today are a major step forward in using technology, data and information to transform the delivery of England’s health and social care services,” said Andy Williams the Chief Executive of the Health and Social Care Information Centre.

Around 97 per cent of GPs surgeries now offer patients the chance to book appointments online and see a summary of the health records, but the new plans aim to allow people to be able to see their entire record by 2018.

A third of all ambulances now share their records digitally with A&E doctors, providing them with speedy access to critical clinical information.

Last year Health Minister Dr Dan Poulter said Britain was on ‘the brink of a personalised healthcare revolution that could scarcely have been predicted a few years ago.’

NHS England’s National Director for Patients and Information, Tim Kelsey, will look at the feasibility of turning the entire NHS estate into a free Wi-Fi zone.

Wi-Fi would reduce the administrative burden on doctors, nurses and care staff, currently estimated to take up to 70 per cent of a junior doctor’s day, freeing up more time to be spent with patients.

It would also open up the possibility for ‘wearables’ to be used to monitor patients in hospital. For example, over a fifth of patients with diabetes will have experienced a largely avoidable hypoglycemic episode whilst in hospital. This technology can help patients and their doctors identify problems early.

Tim Kelsey, National Director for Patients and Information, said: “The NHS is embracing the offering of digital services to patients, with more than 55 million patients set to benefit from progress.

“As well as giving patients more choice and control, better use of technology can save money.

“Letting people rebook online will help tackle the estimated £160 million that missed appointments cost the NHS each year.”

The new NHS online site there will also house a library of NHS approved digital tools, resources and apps that have a proven track record of effectiveness in helping people to live healthier lives.

NHS England said it would ensure that privacy of patient data would be upheld and that all steps were being taken to prevent hacking.

A spokesman said: “Ensuring patient confidentiality is of upmost importance to everyone working in the NHS and the robust processes already in place to ensure that patient data is protected extends data held electronically. “

Source The Telegraph

Hospital patients to be asked about UK residence status

Patients could be made to show their passports when they use hospital care in England under new rules introduced by the Department of Health.

Those accessing new treatment will be asked questions about their residence status in the UK.

Patients may need to submit passports and immigration documents when this is in doubt, the department said.

Hospitals will also be able to charge short-term visitors from outside Europe 150% of the cost of treatment.

The department said the new rules came into force on 6 April for overseas visitors and migrants who use NHS hospital care in England.

Primary care and A&E care will remain free.

There will also be financial sanctions for trusts which fail to identify and bill patients who should be charged, it said.

The plans are part of a crackdown on so-called “health tourism”.

Andrew Bridgen, the Tory MP for North West Leicestershire in the last Parliament, told the Daily Mail: “This is not the International Health Service, it’s the National Health Service.

“Non-UK nationals seeking medical attention should pay for their treatment.

“The NHS is funded by UK taxpayers for UK citizens and if any of us went to any of these countries we’d certainly be paying if we needed to be treated.”

Most foreign migrants and overseas visitors can currently get free NHS care immediately or soon after arrival in the UK but they are expected to repay the cost of most procedures afterwards.

The charges are based on the standard tariff for a range of procedures, ranging from about £1,860 for cataract surgery to about £8,570 for a hip replacement.

Non-UK citizens who are lawfully entitled to reside in the UK and usually live in the country will be entitled to free NHS care as they are now.

Sourced from the BBC Online

Training cuts could harm patients, doctors warn

Proposals to shorten in-job training for qualified doctors in the UK could seriously compromise patient care and safety, leading doctors have warned.

They say there is a lack of evidence for the plans, which could see the time it takes to reach consultant level cut by two years.

They have called on the government to “pause” the training review.

A Department of Health spokesman said changes would only take place if they were in the best interests of patients.

Currently doctors spend the first two years after graduation rotating between about half a dozen different areas of medicine, such as obstetrics or A&E.

Many then specialise and stay within that area until they reach consultant level. Depending on which area they choose to focus on, that can take between eight to 10 years.

‘Broader knowledge’

The Shape of Training review into specialist doctor training was chaired by Prof Sir David Greenaway of the University of Nottingham.

The report made 19 recommendations in 2013 for changes to medical training.

The wide-ranging review involved many leading medical organisations, including the General Medical Council (GMC), and other bodies overseeing medical education.

One proposal was to shorten consultant training to between six and eight years. Another was to allow doctors to be fully registered to practise when they left medical school, rather than waiting a year as they do now.

Sir David’s report suggests an argument for changing the structure of training is that there are more patients with a complex mixture of conditions.

This means doctors need to have a greater breadth of knowledge, rather than specialising early in their careers, it says.

But leading doctors are worried these changes could mean they will be allowed to practise fully autonomously before they have gained all the skills they need.

The proposal would “result in people finishing training and being labelled as a consultant much earlier on, when in fact they are not reaching the same standard that patients have come to expect”, Dr Tom Dolphin of the British Medical Association (BMA) junior doctors’ committee told the BBC.

The BMA has called for a “pause” in policy development while safety concerns are addressed and said any changes should be piloted in small studies before being rolled out more widely.

The Royal College of Physicians has also raised concerns, saying shortening doctors’ training would “compromise both quality of patient care and patient safety”.

A Department of Health spokesman said no decision had been taken to shorten consultant training or change doctors’ registration, adding that any changes would only take place if they were in the “best interests of patients and following appropriate consultation”.

Tribunal ruling

Meanwhile documents seen by the BBC have also raised questions about the transparency and political independence of the review.

An 18-month battle to reveal minutes of undocumented meetings between senior civil servants, politicians and the report’s chairman concluded in court last month.

The GMC, which sponsored the review and provided administrative support, was forced to publish the details of numerous meetings with ministers and officials.

Notes from one meeting between Prof Greenaway and a Department of Health representative said they were eager the report would provide “an opportunity for ministers to be radical”.

Minutes from another meeting, which involved other senior civil servants from the department, noted that: “Ministers [are] setting strategic direction and feeling happy”.

Neither of these meetings, which took place during the review’s call for evidence in 2013, was referred to in the final report.

The GMC said the notes were an informal record of the conversations, and the issues were raised to help “inform our thinking”.

But the tribunal ruled against the GMC, saying: “We are satisfied that it is strongly in the public interest that these proposals are made on the basis of sound criteria and any political influence or otherwise needs to be transparent.

“There should be transparency relating to the process that led to the conclusions.”
‘Potentially harmful’

Ben Dean, a junior doctor who made Freedom of Information requests to reveal the content of the review, said the idea of shortening the training time for hospital consultants could be dangerous for patients.

“Generally trainees just want to become properly trained consultants, so they can actually practise with a degree of autonomy and not feel uncomfortable and out of their depth.

“Without doing anything to improve training quality, cutting training time is potentially harmful, particularly if you devalue what it means to be a consultant.

“The consultants do train the trainees so if your consultants are less skilled then there may be a knock-on effect.”

A Department of Health spokesman said: “There was nothing other than routine engagement with Sir David Greenaway’s independent report from anyone at the Department of Health.”

Niall Dickson, the GMC’s chief executive, said: “The independent review was established by the four governments of the UK to look at the changing needs of patients and the type of doctors that will be needed to provide high quality care in the future.

“There are recommendations made in the review that could require changes to postgraduate training and everyone accepts that more work needs to be done to understand the benefits and impact of such changes.”

He added: “It is highly unlikely that there will be agreement about all of the issues but it is clear that work will be undertaken to look at the key issues.”

Source BBC News

Some patients ‘wake up’ during surgery

More than 300 people a year in the UK and Ireland report they have been conscious during surgery – despite being given general anaesthesia.

In the largest study of its kind, scientists suggests this happens in one in every 19,000 operations.

They found episodes were more likely when women were given general anaesthesia for Caesarean sections or patients were given certain drugs.

Experts say though rare, much more needs to be done to prevent such cases.

‘Unable to move’

Led by the Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland, researchers studied three million operations over a period of one year.

More than 300 people reported they had experienced some level of awareness during surgery.

Most episodes were short-lived and occurred before surgery started or after operations were completed. But some 41% of cases resulted in long-term psychological harm.

Patients described a variety of experiences – from panic and pain to choking – though not all episodes caused concern.

The most alarming were feelings of paralysis and being unable to communicate, the researchers say.

One patient, who wishes to remain anonymous, described her experiences of routine orthodontic surgery at the age of 12.

She said: “I could hear voices around me and I realised with horror that I had woken up in the middle of the operation but couldn’t move a muscle.

“While they fiddled, I frantically tried to decide whether I was about to die.”

‘Rare but concerning’

She told researchers that for 15 years after her operation she had had nightmares of monsters leaping out to paralyse her.

And it was only after she made the connection between this and her operation that the nightmares stopped.

Each person’s experience was analysed to identify factors that could make these situations more likely.

About 90% occurred when muscle-relaxant drugs – used to help paralyse muscles during surgery – were administered in combination with other drugs that normally dampen consciousness.

Researchers believe in some of these cases patients received an inappropriate balance of medication, leaving them paralysed but still aware.

And there were several reports of awareness from women who had Caesarean sections while under general anaesthesia.

Though this type of anaesthesia is most often used in emergency situations, researchers say women should be informed of the risks.

Drug errors

They calculate up to one in 670 people who have Caesarean sections with general anaesthesia could experience some levels of awareness.

But experts argue this is partly due to the balance needed when achieving unconsciousness for the woman while still keeping the baby awake.

Other common factors include lung and heart operations and surgery on patients who are obese.

And some 17 cases were due to drug errors.

Researchers are calling for a checklist to be used at the start of operations and a nationwide approach to managing patients who have these experiences.

Prof Tim Cook, at the Royal United Hospital in Bath, who led the research, said: “For the vast majority it should be reassuring that patients report awareness so infrequently.

“However for a small number of patients this can be a highly distressing experience.

“I hope this report will ensure anaesthetists pay even greater attention to preventing episodes of awareness.” 

Source BBC News

Patients still being sent home at night: Hospitals break NHS pledge to protect frail and elderly

Hospitals have been told to end the ‘unacceptable’ practice of sending thousands of frail patients home late at night or in the early hours.

An analysis of figures from around half of England’s NHS trusts showed that more than 150,000 patients, including 18,500 over the age of 75, were recorded as being discharged from hospital between 11pm and 6am in the past year.

One stroke victim was sent home in freezing temperatures in the early hours without a coat and was later discovered by police wandering around a cricket pitch.

Hospitals have been told to end the ¿unacceptable¿ practice of sending thousands of frail patients home late at night or in the early hours

Senior doctors questioned the figures – saying they may include patients being transferred or those sent home earlier in the day but only recorded as being discharged at night when nurses complete the paperwork.

Nonetheless, NHS England says the practice is unacceptable and that patients should be discharged only if they want to go home and it is safe for them to do so.

Campaigners say hospitals are under pressure to discharge patients at night so they can free up beds for more urgent cases coming from A&E units.

Dr Mike Smith, chairman of the Patients Association, said: ‘They have people in A&E lying in corridors, they have got to be admitted and they have no beds.

‘It’s for the convenience of staff and the person they are admitted but at the gross detriment to the person they are chucking out.’

NHS medical director professor sir bruce keogh told hospitals to end the practice two years ago

Concerns have also been raised that dementia patients are being sent back to care homes at times when the staff on duty are unable to notify the homes of possible changes in care. Nadra Ahmed, chairman of the National Care Association, said: ‘They are going back without any relevant information about what the diagnosis might have been because people are off duty.’

NHS medical director Professor Sir Bruce Keogh told hospitals to end the practice two years ago but the latest figures – obtained by Sky News – suggest that in half of trusts the problem has actually got worse.

Among the 72 trusts that supplied figures – out of 160 – there had been no improvement over the past two years in the number of patients discharged between 11pm and 6am – 152,479 in 2013/14. At 41 of the trusts the number had increased.

In one case, Michael Atkinson, 64, who had suffered a stroke, was discharged from the A&E unit at Royal Bolton Hospital at 3.30am.

He was later found in a cricket field in sub-zero temperatures in a confused state. The hospital said he left before transport could be arranged but has since undertaken a review to find out why he was discharged at that time.

An NHS England spokesman said: ‘Discharging patients at night without appropriate support is unacceptable, particularly if a patient is vulnerable. Where a patient wishes to leave late at night it should be accommodated only where it is clinically appropriate and with the support of family, friends or carers.

‘The decision to do this should always be based on what is best for the patient.’

Dr Mark Temple, of the Royal College of Physicians, who works at Heartlands hospital in Birmingham, queried the data.

‘We need to know whether this is the time when patients are actually leaving hospital or whether it is when nurses are getting round to recording their discharge on the system.’

He added that it might also include patients being allowed to go home from A&E or medical assessment units having been rushed in during the night with a possible heart attack.

Article was taken from Daily Mail Online

Safe nursing levels recommended

Patients are at risk of harm if a nurse has to care for more than eight people on a ward during the day, draft NHS guidance suggests.
The National Institute for Health and Care Excellence (NICE) said hospitals in England should be wary about that workload being exceeded.
But it stopped short of stipulating one to eight was an absolute minimum, saying flexibility might be required.
The Department of Health said the number of front-line staff had risen.
While individual hospitals are currently allowed to set their own nurse staffing levels, NICE was asked to look at the issue by ministers.
They had promised to explore safe staffing levels following the public inquiry into the Stafford Hospital scandal.
NICE said in its draft guidance that in a situation where the recommended ratio of at least one nurse to eight patients had not been met, the hospital should be able to explain why.

‘Red flag’

There could be cases, for example, where patients’ illnesses and needs were less serious, and, therefore, it would be wrong to set strict thresholds, it said.
But the guidance recommends nurses raise the alarm – or a “red flag” – when care is being compromised, no matter what the ratio.
That could include situations where there are not enough staff to help patients use the toilet, monitor their vital signs or administer medication.
NICE deputy chief executive Prof Gillian Leng said: “There is no floor or ceiling number on the required number of nursing staff that can be applied across the whole of the NHS.”
She said decisions about the number of nursing staff should “allow flexibility on a day-to-day or shift-by-shift basis”.
Speaking to Radio 4’s Today programme, Prof Leng added that while there was “no magic number” for staffing levels, “care needs to be tailored to the patient’s needs”.
BBC health correspondent Nick Triggle said: “It is already accepted that in areas such as critical care ratios are essential.
“But applying this to general wards is another matter – and could have major implications for overall nurse numbers.”
The guidance, which is now being consulted on before the final recommendations are made in the summer, applies to general acute wards.
Specialist areas such as maternity, paediatrics, and accident and emergency will get their own guidance at a later stage.
Many hospitals have already started paying close attention to nurse numbers; for example, a number publicly display actual staffing levels on wards along with what they should be.
NHS England wants this to become routine across the health service, while later this year hospitals will have to submit their staffing levels each month so they can be displayed on the NHS Choices website.

‘Sensible’ guidance

Royal College of Nursing general secretary Peter Carter said: “For any patient to receive substandard care is unacceptable.
“Nurses will be hoping that once the full set of guidelines is completed, the NHS will never again be so vulnerable to short-term financially-driven decisions about patient care.”
He told the Today programme that it was important a ratio of one nurse to eight patients did not become mandatory as there were some settings – such as neonatal wards – where one-to-one care is needed.
To have a situation where “the minimum becomes the maximum” is “in no-one’s interests”, he added.
The guidance does not go far enough, according to former NHS Trust chairman Roy Lilley.
He said: “If you go on holiday and you fly, the steward to passenger ratio is prescribed in law. If you leave your kids at a creche, the carer to kids ratio is prescribed in law.
“If you got to a football ground, the steward to spectator ratio is prescribed in law. But if you leave your granny in a hospital ward, it’s left to one of Gillian Leng’s red flags.”

‘Step forward’

A spokesman for the Foundation Trust Network, which represents hospitals, said the guidance was “sensible” and supported what many trusts were already doing, however.
“Local nursing and clinical teams are best placed to make the judgement on what is best for their patients,” he added.
The guidance also applies to Wales, although it will now be up to ministers there whether it will be applied.
In Scotland, hospitals are already routinely monitoring and publishing staffing levels – although there are no recommended minimums.
Health Secretary Jeremy Hunt said: “NICE’s work on staffing is a major step forward – for the first time in its history, the NHS will have the evidence it needs to make sure that nurses are able to spend enough time with their patients.”
A Department of Health spokesman said the number of admin staff and managers in hospitals had been cut since 2010 but there were 5,100 more nurses working on wards.
“We have increased the NHS budget in real terms and are clear that hospitals must balance their books whilst ensuring compassionate, quality care for all. We know this can and is being done,” he said.

Source BBC News

GPs consider charging for orthotics

South Warwickshire Clinical Commissioning Group (CCG) has drawn criticism for suggesting patients pay for their own crutches, walking sticks and neck braces which are at present free. 

According to a report in The Guardian, Sue Lear, a “service design and innovation” official working on behalf of the CCG, told its patient and public participation group last week that it was keen to reduce its annual £421,000 bill for orthotics. 
Its overall annual budget is £304m and it commissions and funds treatment for the 270,000 people. 
The report says her presentation posed questions about the viability of introducing charges. “Would it be reasonable to ask people to contribute to the cost of orthotics, aids and appliances? If so, which items and how could we agree this? If so, what criteria should be applied, e.g. low-cost items below a specified threshold?” 
Lear also listed 15 different types of aids or devices to which charges, or contributions from patients, might be applied. 
They were: ankle foot orthoses, i.e. foot drop splints; wrist splints; trusses, e.g. for hernias; spinal supports; knee braces; hip braces; lumbar/sacral/abdominal supports; spinal support, e.g. for fractures; cervical support – collars; helmets; toilet aids & equipment; perching stools; walking aids – walking sticks, crutches, frames; bed mobility aids – sticks, beds, grab handles; and bath seats. 
Many such pieces of equipment are never returned by patients once they have finished with them and so cannot be reused, increasing costs at a time when money is tight, Lear is reported to have said. 
However, patient representatives told her that charges would deter some who needed such devices from obtaining them and that any means-testing would prove very complicated to administer. 
Those present at the meeting said the proposal, which Lear described as “tentative”, was given a hostile reception. 
The CCG wanted to gauge reaction to the possibility of introducing what she called “self-funding for orthotics”, which suggests that it may expect at least some patients to pay the full cost of their device. 
The move, uncovered by the anti-cuts group False Economy was rejected by NHS England, trade unions and charities. 
A spokesman for NHS England said: “NHS services are free of charge, except in limited circumstances sanctioned by parliament. An approach like this would appear not to meet these criteria.” 
The CCG refused to answer questions about what it called a “very early-stage” proposal, including who had come up with the idea.
In a statement, it stressed its need to save money. 
“NHS South Warwickshire CCG is committed to the NHS’s key principle of free at the point of use. At our latest patient and public participation group, one of our discussions was about how to improve quality and value for money of our orthotics service,” a spokeswoman said. 
“A number of avenues were discussed, in particular helpful comments about the equipment returns process and whether charging for equipment should be considered. This has not been discussed further.” 
Source www.onmedica.com

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

A&Es get extra £150 million as winter bites

The government is expected to make an extra £150m available for A&E units in England as they gear up for what looks set to be a tough winter, the BBC understands.

Ministers are known to be worried about how hospitals will cope this winter.

The major A&Es are already missing the four-hour waiting time target even though winter is just beginning.

The money comes on top of the £500m bailout fund announced in the summer, which is being spread over two years.

When that pot was announced, ministers said it would allow the NHS to prepare properly.

Only last week NHS England deputy chief executive Dame Barbara Hakin was saying the NHS was “ready for winter”.

The College of Emergency Medicine welcomed the news, saying: “This winter is likely to present real challenges to A&Es.”

More details on where the money will go are expected to be revealed by the government soon.

Source BBC News