Last update 7th. April 2008
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A Patient writes
Next time you inspect a GP Surgery check with the patients how their appointment was made...
An official responds and a trip to the optician produces a surprising observation
Dr Crippen- The NHS Blog DoctorCurrent first page. Consider Dr C. on statins. The blog starts on January 1st 2006
The NHS Resource Centre for Patient and Public Involvement
“The Resource Centre for Patient and Public Involvement will develop and support citizens to improve health”. PPIFO finds no focus on risk reduction. Same ole' same ole'?. You decide. Click for their website.
Society Guardian Jargon buster
Jane Barratt writes to Patricia Hewitt on developing a centre of excellence that treats muscle pain and helps depression- two major Public Health problems. Jane on how she found her cure for Fibromyalgia with Chronic Fatigue Syndrome (CFS)
Jane on the brutality of muddled experts "Clinical Medicine Creates Unnecessary Physical Disability"
Jane engages her Strategic Health authority on her post-natal care and eleven years of unnecessary pain. The key technical questions are ignored by the PCTs who didn't consult any experts. Price and Fox should explain this irresponsibility to their regulating Forums.
Estimates vary but at least 500,000 sufferers seems to be a lower bound Richards and Scott BMJ 2002
The person most likely to kill you is not a burglar, mugger, deranged relative or drunken driver- it's your Doctor. Coleman explains how to protect yourself. "The revered guru of medicine" Nursing Times. "...enlightened, trenchant and sensible..." The Observer
" Betrayal of Trust" (1994). Free download of Coleman's critique of Medicine and the Pharmaceutical Industry.
NEW Dr Matthias Rath on cancer, heart disease, the pharmaceutical industry lobby and vitamin c therapy.
Richard Titmuss was one of the twentieth century's foremost social policy theorists, writes Mike Reddin. A collection of his writings on public health, health promotion and health inequalities has been published with commentaries by experts in each field. £19.99 (The Policy Press 2004). More.
An historically oriented series of interviews by Jonathan Miller, sceptic rather than critic, on Radio 4 with reminiscences of Titmuss by his daughter Prof. Anne Oakley. This is Public Health oriented with interesting discussions of blood transfusion and altruism, of the risks of vaccination, immunological response and organ donation (Hugh de Wardener on "all of physiology": Homeostasis- "La fixité du milieu intérieur..." delightful) and care of the new born and the aged. This was made in 2002 and disappointingly bland on the prevalence of iatrogenesis. An extended interview with Sir Iain Chalmers of The Cochrane Collaboration redresses the balance somewhat in respect of double blind trials.
Thanks to Martin Rathfelder of Central Manchester PPIF and of Socialist Health Association who host an excellent Acronym Glossary
List of NHS trusts & PCTS
National Health Service Reform and Health Care Professions Act 2002. This Act, "the Act", in the above regulations established PPIFs
Draft extract from Annex to Tender Information for FSOs -What an FSO is expected to do
BMJ free fulltext access to the Journal of the British Medical Association. Highly recommended.
Search PubMed -the U.S. National Library of Medicine's free digital archive of biomedical and life sciences journal literature.
This organization and site is under development.
Please contact web support with corrections, criticisms and suggestions.
Join the National Association of LINks Members
Malcolm Alexander and Ruth Marsden write:
Full text and membership enrolement form. Membership costs £5.00 payable by cheque.
Our mission is complete. We remind all that Patient Safety is the first consideration: safety in diagnosis, treatment and rehabilitation.
We watch, hoping for improvements, as Links take over from Patient Involvement Forums.
Newsletter of the National Association of Patients’ Forums
Patient safety is the theme of this website. We hope the Steering Group's Newsletter will reflect this after the manifesto has been developed. We will publish the contact list when it is available.
National Forum Elected
No announcement from CPPIH yet. The first meeting will be in London, CPPIH office, 22nd May, 11.0am – 3.0pm. Relations with external bodies will be discussed and future objectives. As usual we regard any objective other than patient safety to be vacuous window dressing. Whilst there is relative chaos the incompetent and self-serving survive. Look at how many hours doctors spend actually seeing patients.
Multiple confirmatory diagnoses, supported by routine necropsy, should be the overall objective but access to patient records, if they wish it, and hospital accounts should be automatic (with training to support). Don't fight for it. Shame them into it. Keep your dealings open or you'll loose your authority.
What is the rate of iatrogenic disease? Get staff to wash their hands and surgeons to operate on Friday afternoons (thereby reducing or banishing surgical waiting lists) and Patient Forums will have achieved something. Find out what sucessful best practice is in other countries e.g. in Mental Health and for hospital acquired infection. Connecting for Health (NHS IT: Report of Public Accounts Committee) will change the world of medical research and best practice development. Once properly applied it will greatly facilitate rational healthcare and banish the paper shuffle.
You need evidence? Get in touch.
Remember from the Statutory Instruments 2003 No. 2123 8.(2) "Any staff provided ... shall be under the direction of the members". Use it or loose it. Good Luck!
National Audit Office attacks Consultant productivity
Patients have not seen any improvement in the care they get under the new consultant contract, a watchdog says.
Health Committee PPI report
The Health Committee has published its Third Report of Session 2006-07 on Patient and Public Involvement (HC 278-I)
Janet Albu died on Sunday. She was an inspiring founding helper with this website. The funeral is next week. We will all miss her very much. Janet was a celebrated pioneer of Optometry for the poor in Africa, Pakistan and India. She ran Optometry at Moorefields Eye Hospital and was a great supporter of Age Concern.
LINks Bulletin Issue 1 – March 2007
Some news from DoH on Local Involvement Networks. As we have said Doctors find it hard not to have queues despite their large numbers. Is there any chance surgeons will work Friday afternoons? Most seriously preventible error is extraordinarily high and largely unacknowledged if not denied. We are yet to be convinced that rearranging the Forum deck chairs is an adequte response. The Socialiist Health Association (SHA) addresses this question.
Learning from Mistakes
On Behalf of the SHA Martin Rathfelder announces a conference: Learning From Mistakes
Monday 30th April 2007 10am - 4pm at Friends Meeting House, 173 Euston Road London
We will be considering the recent report on Complaints by the Healthcare Commission and in particular whether there are possibilities of increasing the opportunities for learning from mistakes in the new arrangements for public and patient involvement.
Cost (This includes lunch): £90 for NHS, commercial and statutory organizations, £45 for voluntary and charitable organizations, £25 for members of the Association (including members of affiliated organizations such as Amicus and Unison). Unfunded individuals and organizations please contact us. Please use the booking form.
Home access to NHS records plan
Patients are set to be able to look at their medical records on their home computer, it has been announced.
14,500 patients in Bolton will be the first to have computerised NHS records set up. Full story: BBC News. Patients can opt out but personal and overall standards of care can only be driven up by this.
HealthSpace was the officially designated name for personal records. At this time it is not clear if the Detailed Healthcare Record will be available, if desired, along with the patient summary record. HealthSpace Homepage.
Elderly at risk in nursing homes
BBC Panorama reports. "12 years ago the Law Commission proposed legislation which would protect older people from abuse and neglect but so far, governments have refused to implement it."
Social Care needs our attention. In March 2006 Panorama reported on the sick and elderly selling their homes to pay for NHS care. See "A growing scandal".
Health Committee PPI Inquiry: Evidence
There is also evidence here on NHS Deficits, Workforce Planning and expenditure on Health and Personal Services.
All Party Parliamentary Group on PPI: ring fence for independence
On 30th January invited PPI representatives met MPs, Meredith Vivian of DoH and Sharon Grant Chair, CPPIH in Central Hall Westminster. Patrick Hall MP of the Bill committee took the chair supported by Rt Hon Kevin Barron MP, of the Health select committee, and Dr Richard Taylor MP who is on both committees. Amidst criticisms of lack of detail in the Bill Dr Richard Taylor MP promised more attention to the independence of LINks from local authority control and ring fencing of funding. From the floor Eli Pang of the PF National Association steering group reported the Electoral Reform Society will be scrutinising nominations on Friday prior to elections to form a National Forum. A clear message that a National LINk body could regulate local bodies did not emerge. The term LINKs was rightly criticised for its lack of specificity and "Health Watch" or "Care Watch" was proposed by a Surrey Forum member.
There was real focus by the end of the meeting and the conflict of interest posed by Local Authority control: party politicisation and patronage via grants to voluntary groups who would be LINks members, were cited. Now Social Care was to come under scrutiny there is even more motive to legislate for independence. Support contracts should be with LINks directly. Sufficient funding for anti-discriminatory access and means of overcoming Commercial Confidence in out-sourced contracts was urged. An increase in lay-inspectors was required. Well-embedded Forum members spoke and we saw that success was possible. Meredith Vivian said a model support contract was being produced. CPPIH escaped criticism for withholding budget control from Forums. We always welcome contributions.
Nick Green writes to Dr Richard Taylor MP.
Martin Rathfeder and Ruth Marsden report on the meeting with remarks on the National Forum.
Patient Forum changes "will fail"
So says the BBC commenting on the BMA report. "The British Medical Association said the structure of Local Involvement Networks (Links) was flawed and open to unacceptable variations...it warned the suggested £100,000 and £150,000 funding for each group will not be enough to pay for staff salaries, premises and running expenses."
The BMA statement is supportive of the idea of inspection and warns "there is a danger of LINks being patronised, out-thought and manipulated by managers". There is constructive criticism of strengths and weaknesses.
First witnesses called to HC PPI Inquiry
The first evidence session is Thursday 1 February at the Wilson Room, Portcullis House. Open to the public. Ring 020 7219 4272 to check for any last minute changes.
At 10.00 am
At approx 11.00 am
Further evidence sessions will take place on Thursday 8, Thursday 22 February, and on Thursday 1 March. Further details to be announced.
The uncorrected transcript of each evidence session is placed on the Health Committee website as soon as possible after the meeting.
The Committee has the power to send for persons, papers and records.
Current Membership of the Health Committee:
Rt Hon Kevin Barron MP (Chairman) [L] Rother Valley
Local Government and Public Involvement Bill second reading
Tucked away in The Times' January 20th "News in Brief" our correspondent Veronica Brinton spotted this:
NHS patient groups to be abolished
Parliament will on Monday abolish the only formal mechanisms by which patients can influence the policy of the NHS (Nigel Hawkes writes).
The second reading of the Local Government and Public Involvement Bill will abolish the Commission for Patient and Public Involvement, and the 400 patient and public forums, set up three years ago to replace community health councils. Yesterday, in a speech to the Policy Network Conference, Tony Blair extolled the importance of 'patient power', without referring to the imminent abolition of the bodies that his Government set up to provide input into NHS policy. Sharon Grant, chair of the commission, said that the abolition of the groups would remove 'important rights and functions, won during fierce in-fighting inside and outside Parliament'.
She said that there was 'little detail' about the Government's plan instead to establish local involvement networks (LINks) at local authority level.
Worried? We should be.
Catalogue of abuse in NHS care homes
The Healthcare commission is launching an audit of learning disability services across England and will inspect 200 of them. Fiona Ritchie, who heads the commission's work on learning disability, said: "People have lived like this for too long." The Guardian reports.
"Ministers are poised to step in before the commission uncovers any more scandals, by ordering that the NHS surrender its lead role, and will pass more than £2bn in funding to local councils".
The Commission's findings in Sutton and Merton.
Health Minister can compel if LINk access denied
Research for the Bill can be found here. Page 96 states:
If any reader thinks "may" should not become "must" please let us know. With the news that Hospital acquired infection is still uncontrolled and hand washing, hygiene etc still not applied with any rigour there is more than ever the need for lay unannounced inspection to remind healthcare workers how people from the real world expect them to behave. Police Custody Suites are expected to admit visits by lay volunteers "immediately" (ICVA Training Manual 2004 p37 para 36).
After last week's revelations by Sir Gerry Robinson about a top hospital there can be no doubt that the mental wizards of the NHS couldn't organize a party in a brewery. Please, please NHS prove us wrong!
See sections 155 and 156 of Part II of the Bill itself. The powers are kept at the disposal of the Secretary of State. "The Secretary of State may by regulations...".
Neil Woodnick writes:"Whilst the reasons given in the report for the failure of the Forums are correct, the new proposals fall far short of the powers that were given to PPI Forums in 2003. As far as I am concerned unless the proposal for LINks are considerably enhanced PPI in HealthCare is now dead and buried. Apparently one of the reasons why the FSO’s were appointed the first time round was to act as a ‘channel’ to bring the voluntary sector on board for the Forums. What makes the DoH think they are going to come to the party this time ?"
Hospital starved our grandmother to death, family tells inquest
Last year 170,000 patients had nutrition withdrawn and died. Patient Forums should consider scrutinising these procedures. For many patients this might be the best way to die but for some it is not.
A tragic case is reported in The Telegraph. After a hip operation the patient suffered a stroke. Her hearing aid and false teeth were removed and she didn't respond to Doctors questions. Her family reported she requested them to bring her food.
Redesigning the broken processes in the Health Service
Toyota's quality focussed lean manufacturing approach is applied to the Wirral Arrow Park Hospital A&E Department. Peter Day for BBC Radio 4 "In Business" programme from 4th January talks about applying engineering process redesign techniques to improve the patient experience and remove unnecessary delay.
Audio stream. 30 mins.
The queue is not an asset! Ex-ophthalmic surgeon, Kate Sylvester, back from aerospace industry explicitly states rationing by keeping routine patients waiting was how she was brought up to work.
Now there is light at the end of that ghastly tunnel: working smarter, not harder, by organising patient flow better. As we all suspected the queue, which does not grow, is not produced by demand. It is an NHS cultural phenomenon.
Dr John Bibby talks about the implications for PCTs and GPs 24 minutes in.
John Seddon's Vanguard consultancy website. "Doing less of the wrong thing is not doing the right thing". Best Value is misapplied in the Public Service and is not removing waste.
From Wikipedia "One of the most concise and well-regarded statements of how to achieve quality is Deming's 14 points".
"Can Gerry Robinson Fix the NHS?" Starting January 8th BBC2 Monday, Tuesday, Wednesday 9-10pm. At Rotherham General Hospital ("high performasnce" three star rating for the last four years) he discovers an NHS where staff don't know who is in control, where consultants wield enormous power and where, despite waiting lists, there are operating theatres lying empty.
Programme One: Ground breaking. Gentle persistence exposed the trivial non-problems that can be easily dissolved to produce the zero length queue. There are no financial rewards for succesful outcomes as there would be in a commercial context. Now the money follows the patient expect improvement.
Programme Two: A simple solution in ophthalmology is found, eventually, to what appears to the participants to be intractable. We observe the sensitivity of Timetabling and scheduling to minor constraints is well known to some specialist computer scientists. No single best solution may exist. But where a timetable exists trial and error thinking by participants will suffice to produce a new schedule. It was not clear that staff had a clear grasp of the constraints that apply. Success in orthopaedics, success in Childrens clinic. Was Friday working achieved?- not clear yet. Computer simulation of the hospital would help people come to meetings, if they really are necessary, better prepared.
Programme Three: The Chief Executive walks the floor! It works. Count how many nurses are treating patients, walking, doing paperwork or talking to other staff. It's all it takes to see how time is spent. More bottlenecks removed. Easy peasey- but as somebody said "Like herding cats". Friday afternoon working? This would produce 10% more work and Worth £4-5 million per year. PCT sees it as too costly! The minister P. Hewitt says it's up to them. Gerry says there are strings attached preventing this. Staff in the NHS have low expectations. Too much management bullshit says Sir Gerry Robinson and, as we say, bullshit baffles brains. Very small improvements in performance will produce zero length queues- but the peverse incentives for consultants have to go. Payment per procedure not payment per session has to come and we add bonuses for good outcomes. Now how do we optimise error reduction in diagnosis? Certainly we will need more independent opinions and more General Physicians...
Open University website on the programme which includes an interview with Gerry Robinson.
Health Committee PPI Inquiry: Some submissions
Mike Cox makes detailed recommendations. On the creation of LINks, recommendation 3.2, he says "CPPIH should be immediately removed from the re-organization process and this should be conducted by a federation of service users and carers." Mike wants better treatment of disabled service users. His criticisms were claimed to be defamatory and CPPIH lawyers closed down his PPEyes website. He includes his dossier of CPPIH Incompetence.
Mandy Lawrence is critical of the running and organization of Mental Health PPI. Secretive Trust members have been present at meetings "who use bureaucracy and red tape to block questions and concerns". Mandy's blog addresses these questions further.
Neil Woodnick submits Forums were "ill conceived from the start" with "significant departure from the policy originally discussed in the House.". The minister, David Lammy, advised the Health Committee that support for Forums was to be outsourced: these "FSOs failed completely to promote Forum awareness".
Paul Tovey "Patient & Public Involvement In Mental Health The Ethos And Realities And Evolving LINks". While focussing on long term mental health Paul asks for LINks that can commission research.
PPIFO submission "Patient Safety and the Autonomy of LINks". Thanks for the improvements.
London Ambulance Patients' Forum says "No Minister!". Press Release.
Intel, Healthcare and the Royal Society
Craig Barrett, Chairman of Intel, talks about his company and future developments. He leads off with fascinating remarks about healthcare and the indifference to IT solutions in a profession that is paid by patient contact rather than quality of care outcome. PDF overview. Video interview by Charlie Rose.
The Royal Society looks at IT in healthcare. "Low cost technology is key to improve healthcare". In his evidence Security Engineering expert Professor Ross Anderson of Cambridge Computer Laboratory states "The NHS should use standard commercial off-the-shelf equipment, plus free/open-source software where appropriate."
Local Government and Public Involvement in Health Bill
Despite the Health Committee inquiry it looks like legislation is in preparation but there is no draft or date for 1st reading yet. See Government Bills in progress. If you have any comments on the proposals you can contact the Local Government Bill team.
No question we are getting an opportunity to have our say. Thanks to Tony Fletcher. After 1st reading progress and amendments can be seen here.
Health Committee agrees PPI Inquiry terms of reference
Organizations and individuals wishing to submit a short memorandum are invited to do so no later than Wednesday 10 January 2007.
The Committee point out memoranda need not address all of the issues and ask for concise numbered paragraphs preferably submitted electronically to firstname.lastname@example.org. Full guidelines for submitting evidence to the Committee.
The Committee asks:
What is the purpose of public and patient involvement?
What form of public and patient involvement is desirable, practical and offers good value for money?
Why are existing systems for patient and public involvement being reformed after only 3 years?
How should LINks be designed, including:
How should LINks relate to and avoid overlap with:
In what circumstances should wider public consultation (including under Section 11 of the Health and Social Care Act 2001) be carried out and what form should this take?
NICE challenged on dementia drug ruling
The drugs Aricept (donepezil), Reminyl (galantamine), Exelon (rivastigmine) and Ebixa (memantine) are involved. The Guardian reports.
Lately there have been increasing challenges to NICE by patients. The costs and measures of effectiveness would be a great help to those of us who may soon be involved in allocating PCT funds.
NICE uses pharmaceutical company funded research. Without independent statistical research on outcomes from patient records we will not have reliable data. This is why the success of the "Connecting for Health" NHS IT project is so important.
Sceptics find many drugs of no value with only over-used and abused antibiotics having real applicability. Treatment of a misdiagnosed patient has to be ruled out and death certificates, the gold standard of correct diagnosis, are only correct an astonishing half of the time.
If science is physics or stamp collecting (as Rutherford said), we need a lot more systematic stamp colecting from NHS. Dr Vernon Coleman discusses the pharmaceutical industry in his free online book "Betrayal of Trust". Published in 1994 but nothing much has changed since then.
"My Government will continue its reform of the National Health Service, offering more information, power and choice to patients, with equal access for all and free at the point of delivery."
Where is Labour's Health Policy Taking us?
This will be an opportunity to discuss the future direction of the Labour Party's health policy to be held at Toynbee Hall, 28 Commercial Street, London E1 6LS - (nearest tube Aldgate East) 10am - 3pm Saturday 2nd December 2006 With Prof Nick Bosanquet, and Dr Jacky Davis - who will have very different views about where we should be going.
Martin Rathfelder, Director, Socialist Health Association, writes: The Labour Party National Policy Forum consultation document on health has been released, and this will be part of our discussions. The document centres around two questions:
1. How do we do more to empower patients?
2. How do we help people lead healthier lives?
Are these the most important questions we should be asking? Some of the other issues we might want to raise include the policy of permanent revolution in the NHS, the introduction of more commercial and voluntary sector care providers, payment by results, patient and public involvement, local accountability, whether mental health is really a priority ... We may also want to think about the current EU consultation about healthcare across European borders.
You do not have to be a member of the Labour Party to attend, but you must be prepared to make constructive comments.
Submissions are to be sent in by March 2007 to the Labour Party. Anyone can send their comments, but we hope that a clear well argued submission from us will carry some weight. Cost (This includes lunch specially imported from Brick Lane): £25 for non members, £10 for members of the Association (including members of affiliated organizations such as Amicus and Unison). If you really cannot afford this please say so and we can waive the charge. Please use our booking form.
A conference on "The New Deal on Patient and Public Involvement" is scheduled for 9th January 2007 in Westminster. Dr Richard Taylor MP (independent), a member of the Health Committee, has agreed to speak in the morning. More when we have it.
New York proposes ban on trans fats
Trans fats are artificially hydrogented fats invented in the early 1900s. In 1988 the suggestion was made that these fats were implicated in the large rise in heart disease causing an estimated 50,000 deaths annually in US. The Centre for Science in the Public Interest brought a class action lawsuit against Kentucky Fried Chicken which it has now dropped since KFC announced it would cease using trans fat by May next year. Public hearings in New York are underway to consider a city-wide ban. The Guardian reports
Doubts about flu vaccine
Tom Jefferson, co-ordinator of the vaccines field of the highly-respected Cochrane Collaboration, called for an "urgent" re-evaluation of vaccination campaigns. The Guardian reports.
Where is the pressure for higher quality medical research going to come from- if not from patients? With perpetual doubts about the quality of manufacturer and manufacturer sponsored research by medical professionals the single most effective tool will be the properly updated patient record which can be searched for statistical data on treatment outcomes. This depends on the success of the "Connecting for Health" (CfH) IT plan. The future of Patient Forums and a closer relationship with the Healthcare Commission with a tight focus on risk reduction for patients seems the only important way forward. If staff can't wash their hands what faith can we have that the right statistics, if collected at all, can then produce the required action without formal governance by patients?
On flu many find large doses of Vitamin C powder (5 grams or more per day) to be extremely effective yet in many medical professionals' minds Vitamin C is seen merely as a placebo. It's so good the pharmaceutical lobby tried to persuade the EU to ban its sale last year. It's less profitable for manufacturers. See e.g. Doctor Yourself. We need a study on perverse incentives in the Health Business.
Not washing hands kills more than drunk driving
Speaking at the International Society for Quality in Healthcare conference, Sir John Oldham, Head of the Improvement Foundation, said clinicians who fail to wash their hands should be treated with "equal disdain" to drink drivers.
"Simple things like clean wards and effective hand washing between patients cuts the incidence of hospital acquired infections enormously. How hard is that?"
"Given the existence of MRSA, not having clean wards and not washing your hands is the clinical equivalent of drink driving. It maims and kills." "And we should treat it with equal disdain. This isn't the fault of the government; it is the responsibility of individuals."He added effective hand washing has been proven to cut the occurrence of hospital acquired infections, which cost the NHS £1 billion every year. London Today
Why did Krista Ocloo die?
The medical profession is coming clean about the inaccuracies of medical decision making. At the Prime Minister's press conference this week Chief Medical Officer Sir Liam Donaldson told the world 50% of clinical decisions taken in accident and emergency departments were "inappropriate". Lord Rutherford once said "All science is either physics or stamp collecting". Unfortunately the medical professions doesn't systematically collect its "stamps". In a week where Breast Screening might do more harm than good and NICE has refused funding in England for use of anti-bone cancer drug Velcade we turn to the case of the death of Josephine Ocloo's daughter.
Age two Krista had successful corrective surgery for a congenital heart defect. At 17 after chest pains exploratory catheterization found nothing wrong. A year later she died in bed at home. Josephine would like to know what went wrong. You would think the profession would like to know too. Apparently not. Josephine has spent ten years going through channels. We would like you to sign her petition.
Peter Walsh, Chief Executive, Action against Medical Accidents (AvMA) says "Krista’s case is a poignant example of so much that is wrong with the systems for investigating and responding to medical errors and the barriers to accessing justice. Her mother’s determination to ensure that lessons are learnt for the benefit of others also typifies the feelings of thousands of families who have lost loved ones as a result of avoidable errors".
Healthcare Commission annual healthcheck results
Overall, 4% of NHS trusts got the highest rating of ‘excellent’ for quality of services, 36% were rated ‘good’, 51% were rated ‘fair’ and 9% were rated ‘weak’. There are 570 Trusts. National results and search for Trust by type and name. Quality of services and use of resources results. Harrogate and District NHS Foundation Trust and The Royal Marsden NHS Foundation Trust rated excellent in both categories.
Concern about NPfIT "Connecting for Health" mounting
Computer Weekly reports. The productivity of a small expert group of programmers, as shown by Dr Amir Hannan, for example, is apparently not understood by participants in the development of this vital NHS IT project.
Vast over expenditure has encouraged a feeding frenzy amongst commercial suppliers who can perpetuate redundant complexity and make money whilst conflict in implementing evolving standards, e.g. in Decision Support and Workflow, is unresolved.
With the right approach all the problems can be dissolved but strong clear and open technical leadership is essential to get to version 1.0.
Resistance can be expected from a medical culture that must accept that for the first time it will become truly accountable.
Commercial confidentiality should not be allowed to support circumvention of full technical audit.
Mental Healthcare unsafe
The casual savegery of an alienated staff indifferent to their duty of care and to patient safety was brilliantly captured in Channel 4's Dispatches: " Britain's Mental Health Scandal". Undercover cameras showed mixed sex wards with the violent combined with the self-harmers and the sexually anxious. Staff expectations were low and no criminal behaviour was reported to police. This was bedlam rather than a caring therapeutic environment. National guidelines were breached by an unconcerned staff. Then came the preposterous "What me worry?" statements from the Trusts involved.
PPIFO thinks Staff should be put back in uniform and proper safety critical discipline enforced. We find patient criticism of staff incompetence can result in denial and prolonged detention with intensified medication. We understand mental health care in France can be incomparably better than in brutish Britain.SANE and MIND websites on whose work much of the programme was based.
Involuntary Tranquiliser Addiction meeting at House of Commons Dining Room A, 4-6pm 7th November. By invitation with Jim Dobbin MP contact Michael Behan 0208 743 3456. Main Speaker Professor C. Heather Ashton.
Shipman's former patients go online
In today's too often slapdash hit and miss NHS we are all potential victims. This GP didn't wait for NHS IT Connecting for Health to get their act together, he did it himself. Dr Amir Hannan, who took on Harold Shipman's patients, has spent three years developing a secure website which lets patients access their highly-confidential records to allay their fears and give them more information about treatment. This Manchester practice is the first in the world to allow patients to see their medical records at home. Story from Manchester Evening News.
Wrong site sugery errors increase
Washington Post reports: Surgery on the wrong body part- or the wrong patient- is widely regarded as the one of the most flagrant errors in medicine. In recent years some physician and patient advocacy groups have tried to eliminate such errors by having doctors or patients- or both- mark the correct site or verify the procedure beforehand. This may be 20 times more common than previously thought. Reporting should be mandatory say the authors Seden and Barach in September's Archives of Surgery. They estimate between 1,300 and 2,700 cases per year in US. BBC News reports in UK 23 claims in 2003-4, 35 the following year and 40 in 2005-6. The American figures suggest the UK figures are underestimates.
Rights of Inspection and visits: Do councils want LINks?
Robert Jones of Isle of Wight PCT PF writes to Leslie Forsythe of CPPIH (who don't support training for visits). He says "I am sure that inspections are vital, and I do not doubt the capacity of the lay visitor to carry them out, with good quality and appropriate training.
"I think the CPPIH, in the time left to it, should be supporting statutory powers of inspection and should not allow any lack of confidence in forum members – which you will deny, but that’s what it looks like to me – to undermine further the already extremely sketchy framework that seeks to describe the LINks and what they will be able to do." Full text.
Robert tells us "councillors coming back from a Local Government Association conference are of the view that LINks may never happen: the local authorities want nothing to do with the proposal that they should set up the LINks with undisclosed amounts of money to make it possible, not least because:
I tell it as it was reported to me." He adds this may not reflect all the views of delegates.
As long as a National Forum governing council is elected by Forums with expert support from their own staff, the Healthcare Commission and, say, the Warwick Centre, then future Forum autonomy will be assured.Forums know what is needed even if CPPIH and DoH appear not to.
Mental Health Services scrutinised by Healthcare Commission
"People suffering mental health problems are being failed by poor access to out-of-hours services and counsellors, according to a report" from The Guardian.
The first National Review of adult mental health services highlights the gaps.
Referral Mangement investigated by Channel 4 news
Channel 4 News has discovered that more than 100 NHS trusts are in the process of setting up new referral management centres to sift through GPs' letters before they reach consultants, and there are already concerns about patient care.
Accenture: NHS failure is "track record for success"
Accenture has pulled out of the Connecting for Health NHS IT programme. Channel Register reports. In future its contracts will be run by Computer Sciences Corporation.
Age at death comes into focus
How old are your patients when they die? It's hard to find a better measure of performance. Age, wealth and environment all play a part and there are wide differences in life expectancy around the country. From the This is Lancashire we learn "areas were told that male life expectancy must rise to 78.6 years by 2010 but in Burnley that figure remains at 74.1, in Pendle it is at 75.3 and in Rossendale it is 74.6.
"For women the target is 82.5 years but in Burnley the current age is 78.2, in Pendle is 80.0 and in Rossendale women are still only living to an average of 79.5 years."
Currently in UK life expectancy has increased by one year every five years. From Office of National Statistics in 2004 65 year old men could expect to live to 82 and women to 85.
PF chair of Burnley, Pendle and Rossendale PCT, Derek Holmes, said the figures are "very concerning".
He said: "These things do move slowly but we need to make sure that investment is made in the right places to improve the situation." Health minister Caroline Flint told the House that in Burnley and Pendle progress targets are not being met - and the gap is still widening.
Patient Record Conference
Patient Forums are invited to the 3rd Annual Conference of the Care Record Development Board (CRDB) to be held at the London Business Design Centre in Islington on November 28th. Download Booking form and flyer. Online registration. CRDB website.
One in seven GP surgeries fail minimum standards
The Guardian reports. "A total of 522 premises were unfit among London's 31 primary care trusts; in some areas, including Bromley, Lewisham and Havering, almost all premises were unfit." The mysteries of the GP contract continue to baffle. GPs have always been employed as private sub-contractors yet the BMA is calling for more money from Department of Health. Amongst reports of GPs having patients ring back later to make it look as though they are seeing patients within 48 hours (which makes them make more money) we see yet another dismal failure emerging despite record increases in funding.
Premature death and reduced life expectancy was found in the report "Equal Treatment: Closing the Gap" by the Diability Rights Commission looking at problems of access for patients with learning disabilities and mental health problems. The Disability Equality Duty (DED) of the 2005 Disability Discrimination Act requires public authorites to eliminate unlawful discrimination.
LINKS – Soft Snow on the landscape?
Mark Oley Vice Chair of Eastern Birmingham PCT PF shares his concerns about the new regime. He raises concern about conflict of interest and inspection powers. CPPIH did not like his letter which he submitted to Forum Focus. We point out professionalisation of the inspection process is well within the reach of Patient Forum members, if they are not too ill, and provided proper professional training is given. A list of 1. Simple questions to ask patients who are willing and 2. Queries to staff checking that patients are being treated properly. Simple checks to see correct routine is being followed. Really quite remarkable that CPPIH was unable to do this- still they've got another year. £90 million gone and £30 million to go (their estimated budget).
Health after Blair
Best practice to change for Brain injury
Persistent vegetative state (PVS), said to describe death, has been shown to respond to conversation and the treatment of trauma and injury has come under closer scrutiny. Functional magnetic resonance imaging (fMRI) has shown brain activity present. The research by Cambridge neuroscientists was led by Dr Ian Owen. Report from The Guardian
Research by Prof Ian Roberts at the London School of Hygiene and Tropical Medicine shows major trauma from traffic accidents and battlefield injury were a leading cause of death and disability, yet most trauma treatments were unproved and some had been shown to increase the risk of death. The Independent reports. Corticosteroids may have killed thousands with brain injury.
Michael English says PPIFs may be emasculated
Michael English was an MP from 1964 to 1983 and knows his way around Whitehall. He doubts Downing Street has authorised these alterations to policy and fears the White Paper is being circumvented. In moving LINks (and PPIFs perhaps) to local authority funding he sees a conflict of interest because of local authority funding of Social Care services whose efficiency contributes substantially to hospital admissions rate. Michael is chair of Lambeth PCT Forum and the recently formed London Region PF Executive. Full statement and Press Release. Michael has agreed to an interview in September so mail us with your questions please.
We recommend maintaining the independence of Patient Forums by election of a fully funded and supported National Forum. Dissolution of Patient Forums' focus with local special interest groups may not serve to make NHS working practices safer for patients. Ministers would do well to remember the maxim ascribed to Hippocrates "First do no harm". Whatever happens Patient Forum inspection powers must be beefed up particularly with Safety training.
Have you been in conflict with CPPIH?
We have had a number of reports from Forum members, ex-members and members who have resigned in protest about CPPIH use of dispute procedures to try to discredit critics. If you have experienced this or know of others who have please tell us. You may remain anonymous if you wish. Click here to email or write to us at PPIFO, Room 40, 5-7 Belsize Grove, London NW3 4UT.
Patient Safety moves up the agenda
Encouraging noises are coming from Department of Health. They are organising focussed groups on Patient Safety. We welcome this initiative which we understand has come from Sir Liam Donaldson, the Chief Medical Officer. Contrast this with those secretive souls who negotiated the PFI contracts for new hospitals set to drain profitable billions from the NHS for years to come. Dispatches reporter Liam Halligan didn't find out who they were. The Daily Telegraph comments. Anyone out there care to tell us?
Listening to patient voices
Congratulations to members of the South Manchester Primary Care PF who have published their report "Hear Our Voices". They have collected patient comments from GP services, Dental services, Hospital services, Walk-in Centres, Podiatry, Sexual Health, Phlebotomy (Blood), Mental Health and Drug services, Pharmacies services and Medication, Maternity services, Men’s Health services, Health Awareness, Promotion, Physical Exercise, Information and Media Coverage of Health, Patient Advice and Liaison Service, NHS Direct, Being a Carer and Social Services.
Extra billions for NHS largely wasted
See press release from the Civitas think tank. Download "THE NHS and the NHS PLAN: IS THE EXTRA MONEY WORKING? A Review of the Evidence in 2006".
"Total public spending on the NHS in England has increased from £44.9bn in the first year of the NHS Plan (2000-01) to £76.4bn five years later (2005-06)." But change is too slow and circumvention remains. We have reported on the deliberate barriers to seeing your GP -see our new feature A Patient Writes. Now we find "patients were kept waiting inside ambulances outside A&E until staff were confident they could be treated within the four-hour government target once admitted".
Rather than be honest with patients about their limited expertise doctors prefer to bully patients into obedience by keeping then waiting unnecessarily. This has the added bonus of maintaining demand for the private sector where, miraculously, there is less waiting. The appalling practice of demonising vulnerable patient critics, the refusal to enforce proper hygiene standards, keep records, provide treatment and diagnosis risk statements and the lying about mistakes and accidents continues to be routine while patients suffer and die without good reason.
From The Guardian: Key targets met, but little improvement in services while DoH insists taxpayers are getting value for money. DoH isn't trying hard enough. Under the new arrangements for Patient Forums' statutory inspection powers must be strengthened with training in patient safety.
CPPIH written evidence to Commons Health Committee on NHS deficits
Sharon Grant reports Forum concerns with NHS deficits. She writes "Choice can only work well, both for communities and individuals if clear and unambiguous financial information is available about available policy and treatment options. The NHS will need to raise its game significantly in this area."
An anonymous GP contributes concern about the competence of PCT staff.
40,000 errors 36 deaths due to medication errors
Healthcare Commission reports. Sadly we cannot endorse these figures. They may be more than one order of magnitude short of the actual figures. Leaflets describing the action and side effects of drugs are required to be given to patients by European Law. This correspondent has never been given such a leaflet. Last year National Patient Safety agency reported 840 deaths due to accidents. Dr Foster suggested the real figure was closer to 40,0000. By not giving Heparin for bed rest patients after surgery some 60,000 deaths have been estimated- three times the official NHS estimated of deaths from deep vein thrombosis.
When Forums inspect acute wards simply ask patients if their drugs have been correctly given. This will drive up compliance standards.
Why do 80 trusts have no data access?
From E-Health Insider: Dozens of NHS trusts across the North West and West Midlands remained without access to their main patient management software after a Sunday morning failure at a data centre run by Computer Sciences Corporation hosting NHS systems.
NHS Connecting for Health issued the following statement: "Regrettably, NHS Connecting for Health (NHS CFH) can confirm that there has been serious interruption to computer services provided by CSC Alliance in the NHS in the North West and West Midlands of England since 10am on Sunday 30 July 2006. This incident was caused by Storage Area Network equipment failure and has affected several other organizations which also use the CSC Maidstone Data Centre."
This statement has no credibility and only a proper description of the fault suffices. A switch failure could have full service restored within seconds not days. All other conceivable faults can be fixed in a comparable time. The incompetent seek yet more leverage over the gullible. Too much was paid for NHS IT. Local copies of data should be sufficient to keep services running without any interruption. What do the engineers on the job say? This is the time to challenge any commercial confidence and non-disclosure agreements. Patient Forums could inspect since NHS work is undertaken.
Stoke Mandeville to be prosecuted?
The Independent reflects on the recent report (published following an investigation into two serious outbreaks of Clostridium difficile at Stoke Mandeville Hospital). Anna Walker, the chief executive of the Healthcare Commission, said: "There is a question whether there are prosecuting powers which should be looked at in relation to this case."
Staff don't wash their hands in the NHS despite intense Patient Forum and media pressure.
There are many reasons patients die unnecessarily in hospitals. Hospital acquired infection is one major cause. Adverse drug reactions, medical error, bedsores and malnutrition are likely greater in their effect. Patient Forums might like to consider writing to their Chief Executive to establish the most common mistakes their staff make. Inspection procedures can then be adopted to ensure that bedsores are promptly treated, known patients responses to drugs are properly considered, medical errors are reported and learned from and malnutrition is only found where patients agree to wihdrawal of therapy, not as a cover-up.
Stoke Mandeville is an established centre of international excellence for paraplegics and spinal injuries. Their arrogant indifference to repeated outbreaks of clostridium difficile infection shows that even the excellent need to be sharply reminded of the fundamental. A few well chosen high profile prosecutions will change medical culture in the way that Patients expect and make denial unsustainable.
C. Difficile is the commonest cause of diarrhoea in hospitals and causes more than 2,000 deaths a year, twice as many as MRSA.
National homes swindle: A growing scandal
In March 2006, Panorama investigated how sick and elderly people are compelled unlawfully to sell their homes to pay for NHS care. The film prompted the biggest viewer response Panorama has ever had with 1,700 emails and 3,000 phone calls. Watch Panorama on Sunday 23 July at 2230 BST on BBC One or live on this website.
Chief Medical Officer calls on NHS to eradicate waste
Sit Liam Donaldson says both under-use and over-use of treatments are rife and proposes tighter checks and controls, including tariffs for improper prescribing. BBC News.
Allergies are increasing in Britain
Food allergy may be suffered by as many as 18 million in their lives in UK. Increasing levels of hygiene and exotic food are though possible sources. Hospital admissions have tripled in the last ten years. We ask what about the cocktail effect of persisting organic pollutants? These are still not routinely monitored at autopsy.Political Gateway reports.
Albu: Patients vulnerable to blackmail
In a survey of 125 NHS employees, 80 per cent admitted loading personal files on to their own laptops or memory sticks, with a quarter of them admitting the devices had later been stolen - with the culprit able to see confidential information on patients.
Janet Albu of the Patient and Public Involvement Forum said: "This horrifying. It leaves patients vulnerable to blackmail and must be stamped out." Sunday Mirror Exclusive
Responsible NHS employees' IT activity is logged. The extraordinary number of subsequent thefts of memory sticks suggest criminality is not restricted to Revenue tax credit fraud and Immigration officials. Memory sticks can be encrypted or "security wrapped" to make them useless to information thieves.
Forums to go. New powers for patients with Local Involvement Networks?
"Ministers said patient power will be further boosted by the setting up of patient bodies called Local Involvement Networks (LINKs) to take on the responsibilities of patient forums." reports BBC
Press Release from Patricia Hewitt."These changes will build upon the existing 'patient forums' by establishing new Local Involvement Networks (LINks) designed to have more clout to influence services both in hospitals and in community settings.". A DoH document for information and comment A stronger local voice: A framework for creating a stronger local voice in the development of health and social care services. "Money will be given to the local authorities" and a model contract outlining the basic principles will assist local authorities in tendering for a host organization to run the LINk". "Whilst we are not seeking any legislative change in this area, the proposed merger of current health and social care regulation and inspection bodies does provide an opportunity to integrate and build on the current strengths." We assume this mean LINks retain statutory powers of inspection.
The report of Harry Cayton's Expert Group. "Indeed CPPIH argues that 'deploying the public as amateur inspectors of health services can at most be a cosmetic and unsatisfactory activity, involving few people and achieving change on a very small scale'." We point out to Harry Cayton that 'amateur inspectors' currently ensure Police detainees are properly treated under the Police and Criminal Evidence Act (PACE) see the Independent Custody Vistitors website - if focussed training were given this could work well in NHS.
CPPIH was never focussed. Patient Safety underlies every patient concern.
Instead CPPIH produced a vague unfocussed and incompetent muddle of patronising blether only maintained by breaching budgetary statutory instruments which supported Forum members directing their staff. In many cases these staff were barely competent and only accepted direction from CPPIH. The new arrangements do not seem to address these concerns. The rudeness and incompetent arrogance of staff in one London borough led to two out of five forums breaking up or not forming at all and a call for a Public Inquiry. CPPIH is still withholding details of its internal inquiry into unrelated events in this same London Borough. Many reported similar experiences amidst many resignations.
Only the highest standards will be acceptable from LINks. No more lying and circumvention only visible prompt changes to working practices: all accidents to be reported, no unnecessary queues, more multiple diagnoses, more information about treatment options and risks, strict hygiene and no more labelling critics and accident victims as mad cranks. Comments and contributions please!
CPPIH Area Meeting at York: Minister to speak around July 19th?
On July 3rd 95 Forum members met in York. Standy by for a ministerial announcement in the week beginning 19th July. Amongst CPPIH staff present were Sally Young, Steve Lowden, Leslie Forsyth, David Orchard and Richard Brocklehurst. Ruth Marsden was of Tees PPIF and has sent us her notes of on the meeting. The following points came from members
There was a question and answer session and a talk by Steve Lowden. Full text of Ruth's notes. CPPIH non-compliance with Statutory instruments in the matters of members' direction of support staff, allocating budgets and supplying contact information for other forums can be seen to have produced many of these problems.
NHS redress bill and Forum Statutory powers
Janet Albu writes to Glenda Jackson MP asking her to support amendments to the NHS Redress Bill which are being proposed by Sandra Gidely MP. Investigation of Patient Safety incidents should be properly independent and Forum statutory powers to inspect NHS should be maintained.
Here at PPIFO we would like to see a properly produced training scheme for Forum members focussing on Patient Safety in the manner of the Independent Custody Visting Association. Patient Forums are particulary suitable as monitors of Patient Safety and its investigation.
When an incident occurs or a concern raised responsible staff can be notified and explain to Forums what corrective measures are being taken. This happens now at monthly meetings with borough police and voluntary ICVA inspectors around the country. This seems an ideal model for Forums to apply.
Call for Patients to own their records
Professor Mike Pringle, a healthcare informatics expert and a leading clinician advising the NHS IT programme, says "I support the view that the information in the record is owned by the patient, but others borrow it for legitimate purposes of patient care."
Dr Richard Fitton, a GP who routinely allows patients to see their electronic records, says the government should state outright that patients own their data. "If you pay me through taxes to produce a record I think that philosophically these records belong to you. If you want me to publish them on the web, or give you a complete copy, that's fine." Fitton dismisses as rubbish the idea that patients should be spared clinical details. "If you're dying of cancer, you want to see everything." Full story from The Guardian.
Patients who want to access their records on the web (see Healthspace) will have secure password protection and, we expect if a patient wants them, visibility controls.
BMA votes to reverse policy on euthanasia
The British Medical Association has voted to reinstate its policy of outright opposition to euthanasia and doctor-assisted suicide, just a year after adopting a neutral stance on the issue. The Independent reports.
Last year 170,000 patients had treatment withdrawn according to the first report on Euthanasia in the UK. How many mistakes were covered up?
What killed my Dad?
BBC1 10.45pm Tuesday 27th 2006. This is a story behind the inaccuracy of death certificates. Admitted for a hip operation, his primary cause of death was listed as pneumonia but he had acquired hospital infections. The profession cannot learn from its mistakes until it knows the true causes of death. The covering up has to stop.
I'd like to see my doctor
You ring up on Wednesday afternoon. "She can see you next Wednesday morning. Could you ring again on Monday morning between 8.30 am and 9.00 am and you can see her within 48 hours". Chaos continues to reign here in London. PCT PFs please note. On average the rate of arrival in a queue equals the rate of serving. You only have to clear the backlog once. Perhaps this discourages time wasting patients but it leads to more "did not attends". The delay certainly makes patients with authentic illness more compliant as they get more ill. It has to stop. Is medical culture "fit for purpose"? You decide.
45% of Children in Care have mental health problems
Diet and physical exercise are both crucial elements to mental health – a link with poverty which correlates with the lower levels of concern about such matters among those from disadvantaged backgrounds. The BMA Report " Child and adolescent mental health – a guide for healthcare professionals" was prepared by Prof Sir Charles George and Prof Vivian Nathanson. From The Guardian "Children who have been in care, witnessed domestic violence or who are from poor or asylum-seeker backgrounds are at higher risk of developing mental health problems, said the study from the British Medical Association (BMA)."
Choosing healthy embryos
Parents with a high risk of having a child with a serious genetic disorder, such as cystic fibrosis, will be able to select healthy embryos through IVF as a result of new technology from Guy's and St Thomas' Hospital, UK.
The new test, called PGH (pre-implantation genetic haplotyping), takes a single cell from an IVF embryo. It can tell whether there is something wrong with the embryo. This procedure is useful, even for fully fertile couples who are concerned about their likelihood of having babies with genetic defects. Reports from Medical News Today. Report from The Independent.
Private Sector moves in to manage GPs
"Private companies are poised for a significant takeover of family doctor services, with a third of all National Health Service primary care trusts (PCTs) expected to award lucrative contracts by the end of the year" reports The Telegraph.
A judicial review of North Eastern Derbyshire PCT’s decision to appoint United Health Europe Limited to provide GP services in two villages was refused. Richard Smith, MD, formerly the editor of the British Medical Journal and chief executive of the BMJ Publishing Group, is the chief executive officer for the company. In a past BMJ review Richard Smith has supported the radicle views of Ivan Illich on iatrogenesis.
NHS Confederation responds. CPPIH Chair Sharon Grant comments. As self employed contractors GPs are free to organise themselves in whatever way they wish. PPIFO will support any measure that leads to a better service for patients. Here, in London as elsewhere in the country, there is much room for improvement of GP services.
NAO reports on Connecting for Health delays
From The Indepenedent: The NAO said electronic patient records would be fully delivered from late 2007 after pilots in 2006. That is two years later than planned. Choose and Book, the online booking system has also been delayed, along with other key services that the upgrade enables. Yet the report claims the entire implementation of systems will be complete by 2010, in line with initial expectations.
IT and telecommunication costs have fallen dramatically in recent years. This is not reflected in the project cost. When cultures "unfit for purpose" battle it out you pay. PCs cost £500, software per PC could be brought in at around £500 per machine. One PC + software for every NHS employee would cost £1.3 billion. We will be charged £12.4 billion. This is the largest IT project ever and the Industry is watching. In this case the benefits to patients will be substantial if an easily used, elegant working system results. But beware, too many cooks spoil the broth.
Wikipedia on NPfIT:Connecting for Health
Call for no consent Euthanasia
Len Doyal, emeritus professor of medical ethics at Queen Mary, University of London, in an article for the Royal Society of Medicine Journal Clinical Ethics, calls for doctors to be able to end the lives of some terminally ill patients "swiftly, humanely and without guilt" - even if they have not given consent.
"We have a situation where these decisions are being made all the time and yet we have no coherent system of regulation for them. We really don't know what is going on out there, as they do in Holland where all this is legal or in Oregon where they have physician-assisted suicide", he says. The Guardian reports.
Last year 170,000 patients, around a third of all UK deaths, had treatment withdrawn.
A complete and accurate treatment record is imperative if this is to be applied. Currently there are no guarantees that Patient records are correct. Failure to record a medical intervention must be made a criminal offence. Euthanasia used as a cover-up of medical error must lead to criminal prosecution for murder.
NHS productivity rate 'falling'
NHS productivity is stagnant or falling by most measures, although experts say methods of measuring need refining. This story earlier this year from BBC News
Has the report been buried? Time to exhume particulary with the horrors of a "not fit for purpose" Home Office and a Revenue handing out £2 billion a year to the wrong people. If the Public Service doesn't learn to manage itself fast the Tories will take over and sell it to business- but at least it might put an end to the denial and circumvention that wastes maybe 55% of tax payers' money (HM Treasury Millennium Study on UK Productivity SOL 11/00 19585). We are not dumb punters, we are stakeholders in a life and death business. Learn to manage or we'll have to teach you ourselves.
GPs to be graded for quality
By April next year Doctors' surgeries will be inspected for quality ratings. From The Times: The ratings will be reviewed — with the possibility of upgrade or demotion — every three years after a two-day assessment by a panel including a doctor, nurse, surgery manager and patient representative
Britain’s 10,500 GPs will be encouraged to display their rating on a plaque outside their surgery and also on letterheads. Practices that repeatedly fail to achieve the basic level can expect to be replaced.
Patient Forum excellence
Department of Health announced a Patient and Public Involvement Resource Centre to develop and support NHS staff and organisations to involve people in local health services to start June 1st 2006. Press release. "The overall aim should be to understand how best to shape and influence the governance and management of health services" said Dr Jonathan Tritter, Executive Director of the Centre. Let's hope he means it and supports training of Forum members to ensure Patients get the proper treatment they have agreed to.
Gloucestershire PF shows us the way
At the sharp end Don Espie of Gloucestershire Hospitals PPI Forum reports on what a successful Forum can do. They push all the right buttons by participating in hospital committees, taking a risk assessment approach and establishing tools and protocols for Hygiene assesment, amongst many other things. A model for us all. Read and emulate!
Are Forum members signing their accounts?
This is the time of year when CPPIH requires you to sign your accounts (e.g. para 34 page 17 "Handbook for PPI Forum members" Dec 2004). But yet again Forums have not allocated budgets for their activities and the support organisations they direct. So they cannot sign their accounts as the true and fair representation of income and expenditure that the law requires. The Handbook says accounts will show sources of income other than from CPPIH. Is any of this legal? Doesn't this violate Forum autonomy and make Forums into CPPIH pawns?
CEO Steve Lowden writes to Forum members about the PPI review. Does he explain this violation of the Forum Statutory Instruments? Patients are concerned entirely with their safety in the NHS. Has CPPIH trained Forum members to ensure safety and proper treatment? No. Have they spent £90 million? Yes. Will CPPIH staff ever work again in Health? You decide.
Primary Care Trusts to be halved
The number of ambulance trusts will be cut from from 29 to 12 from July. 303 Primary Care Trusts will be merged into 152. Some £250m may be saved. The new arrangements come into force in October and will bring over 70% of PCTs in line with council social services boundaries. Reports from BBC News and The Telegraph.
Full details from Department of Health.
If the possibility, mooted in 2004, of merging all Trust Forums with Primary Care Forums were realised then the number of Forums will be reduced from 572 to around 164.
New consultant contract has no benefit for patients
The King's Fund study "Assessing the New NHS Consultant Contract - A something for something deal?" asks why performance is not better monitored and finds little change in working practices.
"False diagnosis: How ministers mishandled the contracts for NHS consultants" Times leader.
Patient Perspectives on Change: Safety and Justice
From the action against medical accidents (AvMA) Conference of May 9th we reproduce their agenda for safety and justice.
Patient Safety and Empowerment: An Agenda for Change
We recommend the work of the AvMA to Patient Forums
Nurses fume, Hewitt fiddles, Patients die but we don't know why
To manage you need authority particularly in Life and Death matters. Authority flows from reproducible scientific results which answer the question of how well a procedure works. PPIFO's consulting cybernetician wrote to Dr Crippen:
Without getting tediously detailed Sir Brian Jarman (Dr Foster) estimated 25% of lethal accidents arose through misdiagnosis. Sington and Cotterell show 50% of death certificates are wrong; Dr Foster estimates 40,000 lethal accidents per year (from Hospital Episode Statistics). Staff report 840.
Prof John Senders (Canada's leading expert on hospital safety) estimates iatrogenic disease at between 5 and 50% of all patients presenting.
A lot of this depends on definitions but an upper bound from applying Matthias Rath's figures to UK suggests 2 out of 3 people die in hospital because of unintended injury. But this is uncertain. Just this year we had 170,000 dying patients having treatment withdrawn in the first study of euthanasia in UK. Around 250,000 patients die in hospital each year. Advance directives are fine if they are ethically applied - but there's not much prospect of that in the current culture of bullying, circumvention, cover-up and unreported accidents.
Formal methods to minimise error exist but are dormant in the NHS. More specialist General Physicians are really what is needed for diagnosis and lots of blind confirmatory opinion depending on the likely uncertainty. Once the patient knows what's wrong the treatment specialists can put in their bids.
A favourite story here is the guy who wanders into his GP thinking he's got some horrible disease that, say, 1 in 1000 people suffer. He asks for a test with a 95% probability of getting true positive results. The Doctor tells him the test is positive. The chances this chap has the disease, assuming no other predisposing factors, are still 50 to 1 against because out of a 1000 people tested, 50 false positives result and only 1 true positive will be found. This is why multiple tests and opinions are always needed. Hence the plea for more science in Medicine. Post mortems should be routine including analysis for persistent organic pollutants.
As patient inspectors Forums are still at the stage of checking hygiene, nutrition standards and that staff actually turn up and work to maintain zero length queues. There is a long way to go but it needn't take long. Protocols for reliable diagnosis and remedy in the face of high uncertainty are routine in high tech industry. NHS staff know there are lots of trivial but safety critical problems remaining unaddressed.
Staff have no respect for their managers because resources are wasted and not matched to safety critical need. Only the authority of statistically robust knowledge can guide us. We need more science and less bluster to do the right thing.
Pledge to end NHS elderly abuse
From BBC News "In five years time no older person or their carers will be treated with anything other than dignity" Liam Byrne Care Services Minister. Another role for Patient/Carer Forums?
Forums highly critical of support - Blair presses for reform
From The Times: "The truth is we have now reached crunch point, where the process of transition from the old system to a new way of working in the NHS is taking place," said Mr Blair.
"There will be difficult transitions but the interesting thing is that the remedies are available."
But also from The Times "NHS patient groups axed two years after creation".
"At a meeting this week of 200 patient forum leaders, Harry Cayton, the National Director for Patients and the Public, made it clear that the forums were unlikely to continue in their present form. Mr Cayton is the co-chairman of a panel that is due to report to ministers next month on the future of patient involvement in the NHS. His remarks suggest that patient forums are unlikely to be part of that future.
"Members of forums have been highly critical of the way they were set up and supported. The forum administration was farmed out by the CPPIH to “forum support organisations”, many of which were hopelessly inefficient or had little knowledge of the NHS."
We have had reports that Harry Cayton has been interviewed on Radio 4 saying Forums would continue with different support arrangements. Properly organised routine inspections by Forums of the NHS will encourage hand washing, cleaning and the reporting of accidents.
The model created after the Scarman Report to reduce deaths and injuries in Police Custody should be applied to Patient Forum inspections. After weekly unannounced inspections a report is made to the Police and the local volunteers Custody Visiting panel. Progress with remedies for issues raised by volunteer inspectors are discussed at monthly meetings with the senior responsible Police officers. This is simple and effective if adequate training is set up. For this to work a standard set of questions for staff and patients who want a visit must be developed and allowed to evolve. e.g. For the patient: are your dietry requirements met, seen a doctor, had medication- has the ward been cleaned, have staff washed their hands, would you like us to check your treatment record, tell someone you are in hospital, see your GP, are any advance directives being applied? etc. For staff: have doctors, nurses, cleaners attended to-day? Then inspect for cleanliness, proper visitor behaviour eg no sitting on beds etc. This is just a flavour of the kind of thing needed. Independent Custody Visiting Association website.
Wanless calls for free basic care for elderly
BBC reports.The government has been urged to scrap means testing and provide a minimum level of social care for elderly people. BBC Q&A on Social Care. Download the King's Fund Wanless report in full.
The Healthcare Commission considers the failure of Public Services to consider older people. The report "Living well in later life" by the Healthcare Commission, the Audit Commission and the Commission for Social Care Inspection reviews progress within the National Service Framework. Download.
20,000 NHS Hospital job cuts forecast
According to today's Times. If it is the knaves who go because they block better working practices to protect their private interest then we welcome it. These days better working practices means work smart to work less. Unfortunately knights sometimes get fired in these circumstances ostensibly because they will find it easier to get another job but actually to protect improper activities. For senior staff there is less work and more money in chaos rather than order. We advise Forums to urgently review human resource policies and ensure that the knights are kept and staff are actually working their contracted hours. Much of the waste is produced by inadequate administration and unnecessary negotiation for what should be routine. BBC reports.
Patients view their GP records at home over web
Two patients from a Derbyshire practice have viewed their GP records over the internet from home as part of a trial the practice hopes to extend to 1000 patients over the next 18 months.
Dr Richard Fitton Hadfield Medical Centre in Derbyshire told EHI Primary Care: "We are absolutely delighted with it and the patients who have done it think it’s fantastic. They get an excellent view of their whole GP record with extra information so that, for example, if your record includes the word angina a screen comes up explaining all about what angina means."
Dr Fitton added: “Just like with internet banking a lot of people want to do it and a lot of people don’t but you have to offer it to those who are interested.”
Crisis at Good Hope obscures health policy failings
An independent report commissioned by the Eastern Birmingham PF into the financial crisis at Good Hope Hospital has found that financial position and the proposals are both built on a significant underestimation of the crisis and that the proposed action steps will actually damage the health economy and patient care in the North-East of Birmingham. Additionally, the research finds that Government policy – choice, payment by results, marketisation – will create further tensions in any ability the hospital has to stabilize itself. Press release.
Nigel Crisp goes: stricter working practices the only solution
In 2004 Crisp congratulated his staff who "performed magnificently" but we warned a culture of dubious authority without responsibility continues unchallenged. In 2005 Crisp warned the situation threatens to "erode public confidence in the management of the NHS as a whole." In September we have "It is not acceptable for any NHS organisation to spend more resources than it has been allocated or received in income." Crisp did not attend Claire Rayner's Patient Association conference "100 days to clean the NHS". We warned "Forums will not tolerate this continued indiscipline by his employees".
Sir Nigel Crisp's biography contains little to suggest a man able to challenge and reform working practices. The inability of management to deal with real issues, the endless circumventions and dirty little secrets, has to stop.
For the next incumbents, Sir Ian Carruthers and Hugh Taylor, the first job is to banish unreported injuries and lethal accidents. No reporting: no job. That simple. Second to banish conflicts of interest through stricter regulation of the safety critical workplace. There are plenty of staff. Fire the knaves, the knights will cheer and the rest will follow. Lack of improvement in working practice is the real problem. Indifference to this kills patients and staff moral as the mystery of queues, unobserved hygiene standards and disappearing budgets shows.
Comment from Nigel Hawkes in The Times. "An explanation is needed for the lamentable failure and huge cost of primary care trusts. If Oscars were awarded for the casual waste of public money, the Department of Health would never be short of nominations."
It's the doctors' fault the NHS is in financial trouble, says Hewitt quoted in the Telegraph. Citing the work of surgeon John Petri (our hero) she said "The other surgeons in that hospital were not particularly keen to adopt the same practice. There is clinical resistance to the changes we are talking about."
Go for excellence and stop rearranging the deck chairs. Richard Granger has joined the Departmental Board of the DoH. Now do what it takes to get CfH (NHS IT) fully working. It can deliver the change to working practices we need.
Panorama: NHS care swindle
The NHS is ignoring the law. "The social worker said we’d have to sell the house to pay for mum’s care". Law breaking is apparently routine in the NHS. Panorama reports. 40,000 homes per year are sold because social care rather than health care is needed. The Coughlan case established a precedent finding all care must be free if health is threatened. But the NHS defies this finding. Why haven’t PFs made further legal challenges on behalf of patients? In future they must. The sad fact is, as we have repeatedly shown, there’s plenty of money in the NHS but it is wasted by a sanction free management indifferent to its responsibility. The quality and value for money of health and social care cannot escape scrutiny any longer.
PPI Review Expert Panel
This is the full reply to Mike Cox's inquiry from Helen McKenna, Senior Policy Manager, DoH. 11 permanent Members- none from Patient Forums and two from CPPIH. CPPIH systematic flouting of Statutory Instruments appears to be of no interest to the panel. The reporting by NHS staff of less than 1 in 40 lethal accidents, their failures of hygiene, the queues (despite 2.1 in-patients for each doctor) and the failure of Trusts to keep accounts properly have no focus in the questions they ask. The panel asks for brief responses to four questions only.
We suggest competent technical support, clearly defined cost and performance information on services with better focussed training, more recruitment and a properly budgeted media plan is all that is required to make Forums effective. When inspections uncover non-compliance Trust authorities are informed and if the necessary improvements are not made the failure is reported to the press and Stategic or local scrutiny body. Annual Forum reports would reflect outcomes: failures and improvements in quality. That is what the Statutory Instruments intended. That is what patients want. If anybody has any better ideas let's hear them please!
You can contact the Review Panel via CPPIH with your views until 25th March. Details in the letter.
Children grow fatter as experts dither
From The Times. Full report from National Audit Office. It has already taken 31 experts 18 months simply to agree how obesity should be measured, the National Audit Office, the Healthcare Commission and the Audit Commission found.
That delay means it is likely to be 2007 before children are routinely weighed and measured, meanwhile obesity in the under 11s increases.
Malnutrition a major NHS problem
So says Dr Mike Stroud of the Institute of Human Nutrition at Southampton University in a report from Reuters.
The National Institute for Health and Clinical Excellence (still called NICE) has issued new guidelines. Doctors and nurses were told to take extra care identifying patients who may be malnourished in a bid to eradicate the problem which costs the NHS millions every year. Malnutrition within the general population is estimated at less than 5 percent, among hospital in-patients and those in care homes 40 percent many be suffering from poor nutrition. The figures jump for those over 65 with as many as 60 percent of elderly hospital patients possibly malnourished.
In hospital one in 10 catches infection
Florence Nightingale must be turning in her grave. Doctors and nurses should be rubbing their hands with soap more often. Pharmaceutical companies will be rubbing their hands with glee as the demand for more expensive antibiotics continues. The BMA Board of Science reports. Coverage from The Mail and The Scotsman. No more ties for doctors or, surprisingly, white coats. MRSA deaths up 22% from Reuters.
Stronger voice for patients
From a Department of Health Press Release: "A further step towards creating a more comprehensive system for people to get involved in the NHS was announced today by Health Minister Rosie Winterton.
"To conclude a review of Patient and Public Involvement (PPI), the Department will establish an expert panel to consider the evidence collected so far on how the arrangements for ensuring a strong local voice in health and social care can be strengthened."
Harry Cayton, Director for Patients and the Public said:
"The White Paper sets out the aims we have for greater engagement of individuals and communities in the NHS. I look forward to working with members of the expert group, reviewing the evidence and proposals we have so far and hearing from expert witnesses."
For non-media enquiries contact 020 7210 4850.
"Patient forums could be on way out"
This is the first sentence from the current issue of the Health Service Journal (9/2/06 Subscription only) by Ian Lloyd in the News and Opinion section. A more "organic" approach is favoured. According to National primary care director Dr David Colin-Thom primary care trusts could account for themselves through a series of 'triggers' activated through mechanisms such as patient surveys, local authority overview and scrutiny committees and petitions via councillors.
This is a clear attempt by NHS professionals to escape the direct scrutiny that the Statutory Instruments guarantee Patient Forums. CPPIH is going because it supported this circumvention: they flouted the Statutory Instruments when they provided no budgets, interfered with Forum activities by control of inadequate research grants and abused their complaints procedures to suppress criticism. The Forum support research staff provided in many parts of the country were often incompetent. We have had reports of staff unaware of patient risk, unable to take minutes, sometimes controlling agendas. Again this violates the Statutory Instruments. In many cases Patient Forums were reduced to public relations pawns rather than the "critical friends" reducing waste and the widespread mistreatment of patients that Parliament intended.
Forums must make it perfectly clear to MPs that the Statutory Instruments are fine and Forums will not go. Regular unannounced inspections to check patients are getting the treatment that they deserve is what was intended and is what should be done. It was necessary for detainees in police cells. It is necessary for patients, as the statistics on this website have repeatedly shown: It is estimated less than 1 in 40 lethal accidents are reported by staff; hospitals are still dirty yet there is one cleaner for every five patients and still there are queues when there are only 2.1 in-patients for every doctor. Routine multiple blind diagnoses is still a life and cost saving dream.
Given CPPIH policy of mixed ability recruiting proper training should have been given. Why was this never done? CPPIH wasted its opportunity and budget. A forensic audit is required.
We invite comment from CPPIH and Dr Colin-Thom.
On behalf of all Forums we urge the newly elected, but still unannounced, all London Forum to put this at the top of their agenda.
Commission for Social Care Inspection finds medication standards flouted
Full Report. Patient Forum responsibilities here are subject to local variations.
A some stage a patient oriented review of the applicability of drugs will have to be undertaken. Possible claims for Ginko Biloba to Alzheimer's disease, St John's Wort to depression come to mind, Niacin for schizophrenia, vitamin C and L-Lysine to stimulate the immune system of cancer and heart disease patients and the Atkins (ketogenic) diet for epilepsy and the attention deficit disorders.
Sadly a profession which has been loudly told to clean up and wash it's hands and can't do it-MRSA rate still not reducing has too many conflicts of interest, particulary in pharmaceutical development, to be relied on to do the Right Thing. It would be a mistake for Patient Forums to advocate therapies that have been adopted through scientific fraud or don't work. Meticulous record keeping, via NHS IT Connecting for Health, of the outcomes of a given therapy will check proper dosing and put an end to this nightmare.
Our health, our care, our say
The "Our health, our care, our say" White Paper sets out a vision to provide people with good quality social care and NHS services in the communities where they live. Guardian reports. Mike Cox comments in a letter to Meredith Vivian, ex-Head of Patient Public Involvement now Head of Responsiveness and Accountability for Department of Health.
In his reply Mr Vivian says: "Thank you for your note. Section 11 places a duty on trusts, PCTs and SHAs rather than government departments. Apart from this legislative detail I take the point that I think you are making ... that we must ensure that our processes for involving and consulting patients and the public in the development of PPI proposals are robust. We shall endeavour to achieve this expectation."
Mike advises that Meredith Vivian has said he is still Head of PPI. Our questions to him about quantitative resources for Forums remain unanswered. Another example of DoH maladministration: CPPIH violates the Statutory Instruments governing Patient Forums while it denies Forums their budgets and avoids best value checks by Forum Members.
Cancer treatment inequality kills 17,500 yearly
"Many cancer networks, particularly in more deprived areas, are failing to address these problems. It is hard to believe that nearly a third of the networks visited by the National Audit Office had no comprehensive plans for providing cancer services in their locality. But that was what they were set up to do." So says Edward Leigh MP of the Public Accounts committee. Independent reports.
Millions for NHS pay, but little for beds and operations
The Times: "Hospitals shut wards as cash crisis bites". "The Prime Minister is to order a shake-up of ministers and top civil servants, such is the concern in Downing Street about perceived NHS disarray. It follows six years of unprecedented rises in NHS funding." 4,000 jobs are at risk says the Health Service Journal.
It is not obvious that this could be an opportunity for Patients. There are too many people doing too little in the NHS. There are 7 NHS staff for every patient in a bed (about 170,000 beds in total with around 80,000 hospital doctors). What do they do all day? Patients come to see doctors. Time to fire the knaves as Prof. Julian Le Grand, Tony Blair's Health advisor calls them. He says "employ competitive mechanisms but that do not allow unfettered self-interest to dominate altruistic motivations."
Socialist Health Association announces two events in London "Choice, Markets, Competition in the NHS - What does this mean for health inequality?" Tuesday 28th February and "Focussing on advice and advocacy for disadvantaged patients in a more market based system" Monday 6th March 2006. More details.
Euthanasia: a first authoritative study
Doctors in the UK were responsible for the deaths, through euthanasia, of nearly 3,000 people last year, it was revealed yesterday in the first authoritative study of the decisions they take when faced with terminally-ill patients. More than 170,000 patients, almost a third of all deaths, had treatment withdrawn or withheld which would have hastened their demise. More from the Guardian.
Mental Health and nutrition
The nutritional component to mental health has been known of for many years. From 1906-1940 some 3 million Americans suffered from pelagra and its associated dementia, dermititis, diarrhoea and death. This was found due to a deficiency of Vitamin B3, now known as Niacin. Subsequently Abram Hoffer developed Niacin therapy for schizophenia.
Cancer radiotherapy and benefits
Not enough radiotherpaists are being trained to meet demand. A familiar sounding story prompting a simple sounding question. Why not train more? As ever with NHS services it's not clear that efficient use of existing resources is being made. If there is a queue, patients are more compliant when their turn comes. Compliant patients are easier for doctors to manage and queues suggest a popular service with everyone working hard. The reality is usually a little different. If there is a queue PFs should ask if equipment is used at weekends and if weekday activity is properly managed. In surgery this is generally not the case as Mr John Petri demonstrated recently. (Surely PPIFO's man-of-the year.)
Simple steps like doing maintenance and calibration out-of-hours can stop queues proliferating. Most important is clearing the queue with overtime then keeping it clear with extra activity as needed. Rigid nine-to-five has to go. This is a patient service most effective if given promptly. It is not a service for keeping staff employed.
One has to ask what is the efficacy of Radiotherapy? Until we have a bank of reliable statistics for similar patients we will not really know.
Lastly Macmillan cancer relief reports the Public Accounts Committee attacks the "'scandalous' lack of access to benefits advice for terminally ill cancer patients". This is just the kind of thing PFs can do well: ensure GP or Consultant staff assist with the 24 page Disabled Living Allowance application.
London Regional Election results
Why hasn't CPPIH published the results? Can they do anything properly? In CPPIH's world nobody seems to make mistakes certainly not in the NHS or in their benighted organisation. Judge for yourselves in this CPPIH Summary PPI Annual Report for 2004-5. Some forums may be busy and some have been looking at hygiene but are they systematically reducing risk for Patients? The day will come when a risk aware National Forum will develop random inspection procedures that will stop NHS staff mistreating patients. It's taken a while to realise that CPPIH simply doesn't know how to do this. This means PPIFO has a job to do. In coming months we will seek not merely to report but to make recommendations on how to do this with a minimum of fuss.
Patient Choice and Mental Health
Patricia Hewitt announced choice of up to four hospitals is now available for all acute consultant referrals. But where can patients find out what the choices are? In many cases the GP will have to guide the patient but there are websites with some information. Dr Foster will tell you what consultant services are available with waiting times and distance from your post code. Details of the hospital mortality and expertise in emergencies, children, hearts, hips, eyes, diagnostic testing and cancer can also be checked in the Dr Foster "Hospital Guide 2005". A named consultant quality index as is being pioneered at St George's is not available, yet. The minister said "During 2006 we will be extending choice further, and by 2008 patients will be able to choose from any hospital or provider which meets NHS standards at NHS costs".
NHS IT Connecting for Health Choose and Book problems continue.
Mental Health patients are currently excluded from this but the recent Sainsbury Centre report "A vision for mental health in 2015" seeks to redress this balance.
Mike Cox writes: This is a seminally important report which contains a wealth of positive material valuable to user and carer groups campaigning for improved services, attitudes and conditions in mental health.
However the target is for 2015. Setting such a definite target creates justification for MH NHS trusts and local authorities to prevaricate about adequate services NOW.
Nutrition in care Homes under fire
Social Care inspectors found one in five elderly homes last year failed to meet government minimum standards for meals. BBC Reports.
Vitamin D and cancer?
To stimulate the immune system take large 6-100 gram doses of Vitamin C intravenously if cancer is the diagnosis. Linus Pauling helped establish this but his findings are disputed in often flawed studies eg Rory Collins et al where only 250mg of Vitamin C was given daily to treat congestive heart disease. Now Prof. Cedric Garland of UCSD found in a paper for next month's American Journal of Public Health, that vitamin D could reduce the chances of developing breast, ovarian and colon cancer, and others. BBC reports.
Clostridium difficile kills 934
The first set of data from a mandatory reporting scheme last year showed there had been over 44,000 cases of the infection in English hospitals. The chief medical officer, Professor Sir Liam Donaldson, and chief nursing officer Christine Beasley have warned hospitals to review policies and procedures for handling cases following checks by the Healthcare Commission, the NHS inspectorate and the Health Protection Agency, who said it was "deeply worrying" that hospitals were not following guidance. The Guardian reports
Two-thirds of hospitals too dirty
The spot-checks were carried out in 37 NHS acute hospitals, 33 NHS mental health and community hospitals, 11 independent acute hospitals and 17 independent mental health hospitals.
Kennedy urged proper protection for whistleblowers
Professor Ian Kennedy, chairman of the Healthcare Commission, has said there must be proper protection for whistleblowers at a 1997 meeting of the Committee on Publication Ethics. He said they were often ignored, victimised or labelled as pathological.
This was recalled by Jo Revill reporting in The Observer on the case of Dr Aubrey Blumsohn, a bone specialist and senior lecturer at Sheffield University. Dr Blumsohn was involved in testing Procter and Gamble's Actonel osteoporosis drug. He asked his name to be removed from the published paper and was suspended by Shefield University in September.
"Part of Blumsohn's case centres on the way in which articles are 'ghostwritten' by professional medical writers who work for the drugs companies, then published under the name of the independent academic to give them more credibility. Ghostwriting and a lack of access to data for independent researchers are just two issues that worry academics. For years, scientists have argued that Britain needs a statutory body to investigate such problems, as well as to detect the most serious cases of scientific fraud."
NHS lottery blamed for 5000 deaths
Dr Foster's Hospital Guide 2005 (download in .pdf) This is key reading for Patient Forums, CPPIH staff and Forum Support sub-contractors. The report shows a nearly twofold difference between death rates in the best and poorest hospitals. £4.5 billion could be saved, enough to build ten large hospitals, by discharging patients on time. There is a fourfold variation in heart bypass mortality and 20% lack stroke units. Waits for MRI scans can be up to two years and few hospitals are organised to fight MRSA: a third do not screen patients and only 3% have isolation wards for infected patients. These kind of factors lead to the conclusion that 5,000 deaths could be prevented. See press report in The Times.
Burton Hospitals Trust comes bottom but says it has since reduced its mortality to below average. PPIFO points out this shows mistakes can be corrected quickly so the real time alerting that the Connecting for Health IT system can provide must be hastened. Routine unannounced Patient Forum member inspections can be a real help here.
Royal Free in Hampstead has the best mortality (27% below average) with Barts, the Hammersmith Hospitals, St Mary's Paddington and UCLH almost as good.
On page 24 we read "This year England spent £69bn on the NHS – that’s about the same as the gross domestic product of Ireland. It’s double what was spent on it in 1997 and will increase further to £90bn by 2008. This is about the same amount the French spend on healthcare and, according to the World Health Organisation, France has the best health service in the world. At that point we will want to know whether our hospitals are as good as French hospitals. And if not, people will want to know why.
"Last year, over a quarter of NHS trusts ended the year in deficit. The press warned of cuts to frontline staff and threats to patient care. How can this be possible given the additional expenditure on healthcare? As Sir Nigel Crisp, the chief executive of the NHS, warns, the situation threatens to 'erode public confidence in the management of the NHS as a whole.'"
Surgeon told to make patients wait as PCT makes cuts
BBC reports Mr Alastair Paterson of Royal Cornwall Hospital's breast care centre in Truro, who has been a surgeon for 17 years, said he ran a diary system which meant seeing and speaking to the patient and making a date for their operation. He has never had a waiting list.
He said "I will not be bullied into changing my practice, and I have let them know that." Slowing down was a false economy he insisted.
Hewitt: "inefficiency and poor financial management" not acceptable
Emergency turn-around teams are to be sent. Telegraph reports. Hit squads to tackle £620m NHS debt Politics.co.uk reports. Conservative health spokesman Andrew Lansley said "In circumstances where the public are paying more in their tax than ever before to the national health service, that, frankly, is an outrage."
Now will somebody wake up and give Forums their budgets? CPPIH has said it has made contracts that do not need Forums to allocate budgets. Such contracts are "not valid" or "ultra viries" according to experts.
CPPIH does not have the power to ban Patient Forum work
So says Iqbal Bhana Regional Manager for the Commission for Patient and Public Involvement in Health in his letter to the Huddersfeld Daily Examiner. However he advised that an NHS Staff survey might not be in line with PF responsibilities. "We have been hearing how a lot of staff are disaffected" said Sean Wade Chair of Calderdale and Huddersfield PF. "We thought it would benefit the patients. If the staff are not happy, it affects patient care. Now we have been told we can't go ahead with the survey. We are an independent, statutory body and for this to happen is a sham. The survey is being scuppered by the Trust and the Commission. They have said no without even seeing it."
What if Sean and his members want to take legal advice? CPPIH has withheld their budget. This is in clear breach of Statutory Instruments e.g Membership and Procedure 2003 2123 10(1), 10(4)(c) and (d). This policy continues to subvert Forum autonomy throughout the country and whilst government allows this to continue CPPIH has lost any authority it might have had.
Medical education fails to prepare new doctors
So says Jed Mercurio, writer of the BBC series "Bodies". He is a qualified doctor and reviews the BMA reaction to nurses who prescribe in the Guardian. A short fascinating piece that illuminates the continuing blindness of NHS management to formal risk averse procedures which are standard in hi-tech industry. Long hours and on-the-job training do not make patients safe.
The President of the Royal College of Surgeons disagrees and asks the Prime Minister to secure an opt-out from the European Working Directive for surgeons-in-training. Qualified surgeons don't like change it seems. Next time he writes to the Prime Minister the President might like to show how he can banish waiting lists and make up the 30% loss of training time he claims by following Mr John Petri's "Dual Operating" example of improved time management. Mr. Petri of Norfolk and Suffolk's James Paget Trust won the Amicus Medical Futures Award for the Best Innovation to Improve Healthcare Efficiency.
Using Private Sector worsens NHS Trust debt
Good Hope Hospital sends patients to Little Aston Hospital. East Birmingham PF vice chair Mark Oley said “During the past two years the financial crisis at Good Hope has grown at a disproportionate rate. It’s own Annual Report shows that in 2004 the crisis had resulted in a deficit of £3.57 million. By 2005 this had grown to £8 million. The full impact is now £20 million. This was made more acute by greater use of the private sector in carrying out operations."
The Forum will submit its evidence, much gathered under FoI, to their Overview and Scrutiny Committee. Full Press Release.
BMA warns of lack of quality and performance data in private sector.
GP surgeries must be open evenings and weekends
From the Independent GP surgeries should extend their opening hours into the evening and weekends if that is what local people want, the Health Secretary said today.
Patricia Hewitt said that some practices were already operating opening hours from 8am to 8pm to allow better access for working people.
Ms Hewitt said that the public were often pleased with the service they got from GPs once they actually saw them, but were not impressed by the problems they faced getting appointments at times to suit them. The Guardian reports. Extended use of nurses and the voluntary sector has been seen as the means of achieving this.
Assisted dying for the terminally ill
Joan Ruddock (Labour MP for Lewisham Deptford) has said she will introduce the Assisted Dying for the Terminally Ill Bill into the House of Commons if it passes through its stages within the House of Lords. Ms Ruddock chairs the All Party Compassion in Dying group of MPs.
Lord Joffe's revised Bill has been published and is today receiving its first reading in the House of Lords. More from politics.co.uk
The bill now advocates assisted dying, whereby doctors can prescribe a lethal dose of medication for a patient to take themselves. It would require two doctors to state that the patient has less than six months to live, and two separate declarations by the patient, including one witnessed by a solicitor.
A Safer Place for Patients: Learning to improve patient safety
"Progress made by the NHS in reducing unintentional harm to patients in hospital": A report by National Audit Office. "An analysis of 256 (96 per cent) NHS acute, ambulance and mental health trusts’ responses to our main survey showed that in 2003-04 trusts recorded some 885,832 incidents and near misses. Our follow up survey found that for 2004-05 there were around 974,000 reported incidents and near misses. Few trusts included hospital acquired infections which may increase this by around 300,000 incidents (around 30 per cent of which may have been preventable)."
"Other published estimates of death as a result of patient safety incidents range from 840 to 34,000 but in reality the NHS simply does not know." BBC reports. Daily Mail reports " Blunders kill 34,000".
Experts are caught in a definitional dance as the DVT figures, below, show.
Dr Matthias Rath's figures, recommended to us by Prof John Senders (Professor of Safety Science, Department of Anesthaesia & Critical Care at University of Miami; Professor Emeritus of Industrial Engineering at the University of Toronto; Adjunct Professor of Law at Osgoode Hall School of Law of York University, Toronto), for US if applied to UK suggest 3 - 4 out of 5 patients die because of errors. He estimates between 5% and 50% of patients are suffering from iatrogenic disease. The inaccuracy of death certificates confirms this (Sington and Cottrell).
Short Essay by John (founding member of the Board of Directors of the Institute for Safe Medication Practices, Canada, and continually involved in the analysis of medical misadventures) on "Human Error in Medicine".
Preventable Deep Vein Thrombosis kills 60,000 per year in NHS?
Regular readers will be familiar with the 840 deaths due to lethal medical accident reported last year by staff to National Patient Safety Agency (NPSA).This estimate fell short of the Dr Foster team's estimate of 40,000 deaths per year in NHS due to medical error. Recent comments from Dr Alexander Cohen of King's College Hospital and in the Journal of the Royal Society of Medicine call even these high figures into question. Doctors are not applying Heparin anti-clotting treatments for bed rest patients recovering from surgical operations. This may lead to more than 60,000 deaths per year in NHS. DoH claim 20,000 deaths per year from Deep Vein Thrombosis but cause of death is often wrongly recorded as heart attack. From The Sun. From Lifestyle Extra. From The Times.
NHS Waiting Lists can be eliminated
So John Petri, a consultant orthopaedic NHS surgeon, claims. From Times Online "by introducing a French-style “production line” under which he carries out overlapping operations in different theatres.
"Mr. Petri introduced the system after finding himself frustrated at spending time “drinking tea” while patients were being made ready for operations at his Norfolk hospital."
Trial figures show that over 50 operating sessions, Petri performed 270 major and minor operations using the dual theatre system. Two colleagues using the traditional single theatre approach together performed only 225 operations.
Petri can now operate on patients within two weeks of their first consultation. “I don’t drink tea between operations any more. My waiting list is zero,” he said.
From BBC News24 "He believes his system could increase the use of surgeons' time by almost 90%." He operates in 5 hour sessions rather than the usual 3½ hours and says he has more private patients too. "Surgeon's non stop ops", reports The Sun. Results, not excuses indeed.
Results, not excuses
Alan Patching, Aussie guru, tells NHS IT leaders internal politics and a 'silo mentality' are to blame for organisations' poor project delivery, and called for a new focus on delivering "results, not excuses" in order to reverse the trend. "When people see something that's bigger than themselves, better results are guaranteed. You won't get these results if cynicism persists on a daily basis." Sound advice for everyone in the NHS. E-Health Insider reports.
Bavaria launches patient-controlled health records
Patients will own their online record and be able to decide which clinicians can access their data, change or delete it. If a patient does not want to assign these access rights themselves they can ask their GP, pharmacist or other representative to assign authorisations to access the record. NHS CfH will start next year giving patients who want it secure on-line access to their records and similar visibility controls are promised.
Fraud in the NHS
A private sector manager coming into the NHS would take the number of workers' hours contracted and the number of patients succesfully treated and conclude there are an awful lot of workers- yet there are still queues and all this labour is not deployed to minimize error. Staff report less than 1 in 40 lethal accidents according to recent estimates. Why are these accidents, from which so much can be learned, not reported? There are fundamental culture problems in the NHS which Forums must address. The NHS Counter Fraud Office has a leaflet. October 2005 is "Fraud Awareness Month" so be aware. If something strikes you as not quite right, look into it.
Sadly this is not just unentitled patients claiming free prescriptions or altering them. We are talking about staff claiming payments for work not done, managers claiming payments for phantom employees and stock and external suppliers being paid but not supplying. If performance is not up to scratch it may just be that staff are cheating.
Better pay deal for cleaners, porters and caterers but...
BBC reports. Of couse we are delighted that low pay workers are getting an increase but concerns about working practices, supervision and training remain unaddressed and apparently not part of the package. These jobs are seen as low status in the Service. But nutrition is a potentially major part of the therapeutic regime when drugs compromise the immune response. Cleaning is laughably primitive when compared with the food industry and much redesign is overdue. Porters save lives too- if they keep the supply chain running smoothly. Time for job enrichment. Meanwhile at the top end we get reports we cannot publish and amongst these are the supplier consultancies with senior managers, doctors in part-time market research on drugs and lax, if not non-existent, quality control of outsourced contracts. No doubt some of our DoH readers ponder this but what are they going to do about it? From no interest in the job to conflict of interest is a short step for too many in the NHS.
British delays keep new drugs from cancer patients
From the Sunday Times Stockholm's authorative Karolinska Institute reports our National Institute for Health and Clinical Excellence (NICE) is unable to cope with the task of approving drugs. Caution is not bad practice where benefits are often marginal, however the lack of availability of drugs is the primary reason why cancer survival rates in Britain are relatively poor despite the government's £2 billion cancer care plan.
Only 67% of patients survive one year after diagnosis in Britain compared with 81% in France and 73% in Bosnia-Herzegovina. Survival rates five years after cancer is detected are at 48% in Britain compared with 61% in France and 54% cent in Bosnia. Full story
NHS hospital patients 40 times more likely to catch MRSA than in Europe
The Daily Mail reports on a recent Lancet Infectious Diseases paper by Barry Cookson director of the Healthcare Protection Agency. Last year he found in the BMJ that isolation of infected patients works. This appears to contradict work at Royal Free and UCLH.
From the Mail handwashing is still the single most effective measure. Others include sterilisation of equipment, frequent ward cleaning, isolation of infected patients, bed washing and keeping affected staff away from work. This is Patient Forum business.
What can one infer about an NHS management so incompetent it cannot get the simple Nightingale basics right? They lose the moral high ground they need to manage patients ethically. The swamp needs draining. Justice for patients and staff is what we want.
Worst Mental Health Trust in the country
Brenda Williams pledged to campaign outside the St Pancras Coroner's Court for an investigation into the Camden and Islington MH Trust treatment of Margaret Walsh, Damien Hirst's godmother, who committed suicide on May 9th. The Crisis Team was too slow to act. Ms Williams ex-husband Barry Tebb said "Camden has the highest suicide rate in the country...I think it is the worst mental health trust in the country."
This follows claims that the Inquiry into the Anthony Hardy case was a whitewash and advice given to Bill Oddie, the Naturalist and Goodie, by a doctor "I was told that if you are not mad when you go in, you soon will be."
The Patient Forum inspected the Highgate Mental Health Centre and Royal Free wards in November last year. Their overall recommendations were that both Units could do more to provide patient information, that the Highgate Unit would be improved by flowers among the shrubs in the garden and that Facilities for making hot drinks and preparing food should be available on Alice Ward, Royal Free Hospital
Last year's allegations of assault, theft and drug taking in the Royal Free remain uninvestigated by the Forum.
NHS chief criticises trusts for running up £250m deficit
"It is not acceptable for any NHS organisation to spend more resources than it has been allocated or received in income.", said Sir Nigel Crisp, NHS Chief Executive.From the Guardian Sept 17th: Sir Nigel identified several ways to economise. They included reducing the use of temporary staff, making more use of the NHS's own supply agency and sharing back-office functions such as finance, human resources and IT.
Doctors' leaders are concerned that trusts are trying to balance their accounts by closing wards or reducing staff cover. The British Medical Association is preparing to publish an inventory of cuts.
Forum members should consider monitoring waste in administration and human resources as a means of maintaining service levels to patients at a time when 156 Trusts in England have overspent despite record investment. If CPPIH is to be around for another year it should instruct FSOs on mistakes in hospital book keeping.
From the Guardian reporting on what it calls a £1.6 billion deficit, 7th September: "Although the health service received a 7% increase in budgets this year, the money came with strings attached, requiring economies which are causing confusion among managers and doctors due to the complexity of NHS finance." When it comes the National Forum should scrutinise this unnecessary wasteful confusion. Management by objectives is still not routine in the Public Service, and DoH in particular. Very few are fired for incompetence even though patients face it all the time. The key objective is to increase the age at death of those patients who wish it with minimal and correct intervention. A grateful public will be happy to pay staff bonuses on that basis. Time for the mental wizards who lead the profession to don their thinking caps again.
Umbilical cord synthetic toxins
Alkylphenols, artificial musks, bisphenol A, brominated flame retardants, organochlorine pesticides, perfluorinated compounds, phthalates, tricolosan were all highlighted by the Daily Mail from a study by Greenpeace and World Wildlife Fund (WWF).
Dry cleaning, red meat, dairy products, packaged food, ready meals, use of non-stick pans and pesticide exposure were reduced by Mrs Elizabeth Salter Green of WWF. She found, from before and after three years blood tests, that chemical levels decreased sharply, but were still detected in her breast milk. She said "I feel extemely angry with the Government and industry for letting this go on."
Isn't it time NHS started taking a more pro-active precautionary approach to Public Health? Persistent Organic Pollutants (POPS) are everywhere in homes and the water supply. Should not POPS be routinely monitored at autopsy, in drinking water and food?
NHS Trust Management failure persists
No excuses now as the Blair government has increased funding but financial deficits grow and NICE best practice is ignored. London Health Emergency found deficits in 16 of the 28 Health Authorities. John Lister said 29 hospital and mental health trusts are facing deficits or savings targets of at least £10 million in the current financial year, and another 22 trusts are facing a £5 million plus shortfall. Added to this, more than a dozen Primary Care Trusts face huge deficits, some in excess of £10 million. The Daily Mail reports
National Audit Office found that a third of Trusts were unable to introduce National Institute for Health and Clinical Excellence (NICE) recommended drug treatments and technology support in 2002-2003. BBC reports. The postcode lottery goes on. " Patients given second-rate treatment in funding chaos" from the Telegraph. "Most Hospitals deny patients best treatment to save money" from the Times. The Guardian reviews allocation of 2002-2003 budget.
The National Forum, when it comes, must have the expert support necessary to scrutinise Trust control of expenditure on patient services.
Healthcare, Patient risk and IT
Prof Denis Protti discusses the prospect and the successes at the Veterans Hospital Administraion. Two Powerpoint slide presentations in .pdf format on Lessons learned in Denmark, New Zealand and USA on Patient Safety and Quality and Healthcare: dare we predict where we are going in 21st Century?
A Third or more of GP patients can't book in advance
Diana Church tackled Tony Blair about this during the election campaign. Department of Health is in some disarray. Two weeks ago they were "completely denying there was a problem", she said: "That is just not the experience of people on the ground". The Independent reports. BBC report and are asking for comments. Heathcare Commission report. 41% patients say they should have been seen sooner. There are concerns about adequate information about medicines and referral letters.
National Forum draft schedule and role
Another year of CPPIH? Apparently August 2007 is their new close down date. But what will they actually do till then? Will Forums ever direct their discretionary budgets for patient liaison and research? Or is it to be another year of circumvention? Another year without Forum member contact lists. Another year of vacuous negotiation over trivial office procedures- so bad it led to the call for an Independent Public Inquiry in London. Can anybody be this incompetent and have nothing to hide? We'll see.
Leslie Forsythe of CPPIH explains a member reference group has been meeting and consultation outcomes will be collated in December. A draft constitution will be out by February and National "plebiscite" in March and elections in May/April 2006. The KMS has it at National and Regional Forums.
We will be watching to ensure developments are in strict compliance with Statutory Instruments which guarantee Forum integrity and autonomy.
We must not allow Forums to be anything less than independent when NHS staff don't know how many mistakes kill or injure and can't even clean properly or wash their hands. Their mistakes have been denied for so long they have become part of the culture. The Bristol Inquiry, the Shipman Inquiry and Freedom of Information puts an end to all that.
The National Forum should retain independent legal advisers and fulfill the regulatory function (proper spending of budgets, production of annual reports, resolution of member disputes, a public register of members) currently attempted but not delivered by CPPIH. A small but active, expert administrative secretariat will be required. This would make Forums genuinely independent. The main job will surely be to prepare an annual report which identifies the changes needed in NHS working practice and employment contracts. The detail will come from the annual reports of local Forums and the patients they represent. The National Forum should promote events to help members develop the skills to inspect and monitor for patients and make the relevant constructive recommendations.
This model could be widely applied to all aspects of the Public Service which wastes 52% of its income by not following best practice (The HM Treasury Millennium Study- 17% from poor investment and 35% from poor productivity- £680 million per day.) It is important we, as a society, get this right for best choice and accountability with less cost. Free care for children and the old, more and better biological research, fair pensions are all achievable with better consumer regulation.
All party group on Patient Public Involvement in Health
The committee consists of Patrick Hall MP (Chair), Labour; Peter Bottomley MP (Vice Chair), Conservative; Baroness Masham of Ilton (Vice Chair), Crossbencher; Dr Richard Taylor (Secretary), Independent, contact 0207 219 4598. Liberal Democrat members are Mike Hancock MP and Martin Horwood MP. Conservative members are David Amess MP, Cheryl Gillan MP, Stephen Hammond MP, John Baron MP and Earl Howe. Labour members are Patrick Hall MP, Dr Rudi Vis MP, Lord Harris of Haringay, Derek Wayatt PM, Harry Cohen MP, Kelvin Hopkins MP, Neil Gerrard MP, Joan Humble MP, Jonathan Shaw MP, Andrew Love MP.
CPPIH provides administrative assistance by keeping minutes and drawing up agendas with their Parliamentry and Public Affairs Manager Laura Bruni. Parliamentary Register details.
Lethal hospital infections rocket
BBC reports. Soap and water hand washing and bleach for ward washing are preferred. If doctors and nurses won't wash their hands they must be sacked. Once this happens compliance will improve. Cleaning contract quality regulation must be improved. The specialist nature of hospital cleaning must be recognised. Seton During is looking at this, as a citizen, without the support of his Forum. Contact him if you are investigating contract cleaning. Whilst NHS cannot promptly and properly deal with this their credibility plunges. A National Forum hygiene working group is obviously needed to encourage stricter regulation and a group action for patient victims.
St George's publishes death rates by speciality and for bypass surgeons
From The Times: Michael Summers, chairman of the Patients' Association. "We thoroughly approve of the move and very much hope that others will follow," he said. "We hope the Government will become involved so that patients can compare hospital against hospital."
The British Medical Association said: "We believe it is important that patients have the information they need about doctors treating them. But we are concerned that simply publishing crude figures will be misleading as they are dependent on many factors, importantly an individual's current health status."
Cardiac surgery results. At last! It's a beginning. Congratulations to St George's and the bypass team.
St George's mortality rates by speciality. Remarkably across the UK life expectancy is improving by 1 year every 5 years. This is apparent across the whole hospital which shows a roughly 20% improvement in survival over the five year period. Those who have speciality treatments show less of an improving trend. All of surgery would have shown improvement but for a rise in mortality in first quarter of this year. Was there a rise in post-operative infection?
Healthcare Commission urges quality controls in A&E
In the largest departments, on average, one patient arrives every 5 minutes. As in the acute and primary care sector it is not clear how delays are produced other than by staff inactivity ("Employing more staff does not, on its own, necessarily lead to improved performance" p.27).
Medical services should be organised for the convenience of patients not staff. Staff must abandon the pretence of being busy to produce compliant patients. No doubt assaults on staff would decrease if this were done. A zero-length queue is an indicator of skill not over-staffing.
In yet another expensive blunder some 2000 Junior Doctors, a third of the new entry, are unemployed BMA claims. Well we know by now they don't do management in the NHS. DoH claims it's really only 112.
Time for Forum members to brush up their mangement skills. We will try to guide you through that minefield in coming months to produce a patient centred NHS. Unfortunately for the Junior Doctors we will soon be entering a period of "less is more" as prompt, informed service becomes the norm through the synergy of properly applied IT. An opportunity, perhaps, to promote some SHOs and for some of the less competent to take early retirement. This seemed to to help the VHA escape its ghastly past.
Sunday Times investigates adverse drug reactions (ADRs)
Their study ends with a quote from Dr Benjamin Rush, who signed the 1776 American Declaration of Independence "Unless we put medical freedom into the Constitution the time will come when medicine will organise into an undercover dictatorship".
The Sunday Times reminds us of the yellow card scheme to report directly rather than through your prescriber. Worstpills lists drugs to avoid. Social Audit is looking at anti-depressants and the Adverse Psychiatric Drug Reactions Information Link is looking at psychiatric drugs.
Healthcare Commission 2005 NHS performance
The ratings are on acute, specialist, ambulance, mental health and primary care trusts (PCTs) in England, assessing performance in the year ending 31 March 2005. Guardian comments. New Gerald Gilbert writes.
Legal victory could open MRSA claim floodgates
The Daily Mail reports Kitty Cope received "substantial damages" after contracting an MRSA infection while undergoing hip replacement surgery in 2001. Lawyers say this is the first reported case of its kind. She will use the money for a stair lift and walk-in bath.
Hospital chiefs face sack over MRSA reports the Telegraph.
Accident statistics unbelievable
Last year the Times told us "blundering kills 40,000" patients per year, from a Dr Foster report in BMJ vol 329 August 2004 "How often are adverse events reported in English hospital statistics?". This month the Times tells us deaths due to accidents are down to 840 patients, from "Building a memory: preventing harm, reducing risks and improving patient safety" by the National Patient Safety Agency (NPSA). But reporting is not mandatory with only eighteen Trusts providing useable data. Guardian reports.
Patients agreeing to be treated expect doctors to do their best. They expect failure to report an accident to be a sackable offence.
Will Forums have to make police style anti-terrorist raids to inspect hospital mortuaries for the profession take this seriously? Comparing the death certificate with the results of randomly chosen post mortems could give a truer picture of the situation than we currently have. Analysis of pollutant toxic burden should be routine after death.
The NPSA definition of an adverse incident here is very narrow. In June the Public Accounts committee warned about the NHS "fog of ignorance" and estimated the deaths from hospital acquired infections to be 5,000 per year. The MRSA Support Group suggests deaths may be nearer 20,000 per year. Rath puts death from mistakes as the single highest cause of death in US hospitals. Scaling Rath's figures for UK suggests 150,000-200,000 deaths involve medical mistakes: medical nemesis indeed. Safety is not a matter for fudging like this.
Panorama: Undercover Nurse
Heartbreaking. Play the program. All the hospital Chief Executives who don't walk the floor, visiting any of their wards at any time have a lot to answer for. This programme featured a ward with no named nurses, no care plans, fluid balance charts not kept and incontinence untended. How can we trust Doctors who tolerate this? Forums must use their inspection powers to stop this.
The Brighton and Sussex University Hospitals Trust is £8 million in debt. Where does the money go? Not to the patients apparently. They don't do management in the NHS.
This is just the kind of thing we were set up to monitor. Thank you Panorama for helping Forums.
Now is the time to get joint working arrangements in place so FSOs aren't duplicating efforts. A generic set of accounts estimating expenditure on staff hours per bed might be helpful to estimate your Trust's performance against the NHS average. When patients are in decline a pain-free and dignified death seems to be what these funds should produce. I knew a patient who died smiling even though he had just lost the power to speak, but then his carers were gentle and concerned.
Healthcare Commission wants Trusts to review maternity services
In Europe only Poland and Slovakia have worse infant mortality rates. Deaths in pregnancy and childbirth are up 50% from 1999 with 30 mothers dying to 45 in 2003. Overall this is a small problem but the Sunday Times quotes Sir Ian Kennedy, the commission's chairman, "there is too much poor practice that needs to be rooted out". No estimate of injured mothers or babies was quoted. Only 46% of deliveries are regarded as normal. The Observer reports.
No criminal liability for dirty hospital managers
Ministers have backed off from a threat to prosecute hospital managers who fail to ensure that staff follow a legally binding code designed to stop the spread of superbugs. Guardian reports.
Patricia Hewitt, the health secretary, told Jonathan Dimbleby soon after her appointment in May: "We can't have a situation where we've got tougher hygiene laws and standards in food factories than we have for people who are very very ill in hospital."
From the Patient Safety Act (Denmark 2003-in English) "A health care professional reporting an adverse event shall not as a result of such reporting be subjected to disciplinary investigations or measures by the employing authority, supervisory reactions by the National Board of Health or criminal sanctions by the courts". Reporting adverse incidents is a requirement for employees in Denmark. Whistle-blowing is not encouraged in NHS and often leads to suspension, from the Society of Clinical Psychiatrists. Time for a Patient Safety Act with teeth. Readers Digest reports on the "Secret NHS Scandal"
Panorama: Undercover Hospital Cleaner
An acute Trust Forum member says this program should be part of the standard training/induction package for Forum members. Another says put Microbiologists in charge of cleaning. Play the program now in Real Player.
Viewers respond. A Doctor writes, "The shortcomings of contract cleaning were of no surprise. But where were the ward sisters? Were they not aware of what goes on?". A viewer from Scotland writes "I am disgusted ...not only with the unacceptable levels of hygiene but lack of basic knowledge from all levels of staff including, nursing staff." They don't "do" management in the NHS. It looks like a culture of grown-up dangerous naughty children. Any dissenters? The PPIFO Forum is at your disposal. There are a few wanting to change this. They can count on our support. The Annual PPIFO awards for the best and worst? Why not? Nominations welcome. Next week Wednesday 20 July 2005 21:00 BST, BBC One "Undercover nurse".
A third of day surgery cases cancelled
The NHS doesn't "do" management. Why not? Are senior staff so compromised they have no authority?
Filthy staff and premises, queues when none are justified, mistakes unreported are all trivial to prevent but little is effectively done. These are all problems with rapid or "overnight" solutions and no extra money is required. Today the Healthcare Commission reports on Day Surgery.
BBC reports 45% of theatre time is wasted because of late starts and delays.
Health Secretary Patricia Hewitt said trusts should strive to gain the "potential pot of gold" available from simple efficiency savings.
Half of patients had not been assessed for suitability before they arrived for their operation. Reports from Guardian, Times, Telegraph. 74,000 operations are 'lost' every year. We need better measures of benefit from many of these procedures.
What are my chances Doc?
Jan Poloniecki of St Georges Medical School discusses the problem of getting a fair answer in his BMJ paper " Half of all doctors are below average". If the best and the worst performing doctors are widly separated there is a problem. And if the best and worst off patients presenting for treatment are widly separated there is another problem.
Good doctors can get bad patients and this can reduce their success rate. Best for doctors to treat patients who aren't very ill. Another reason to insist on shorter queues but make sure that diagnosis is correct. The rate of patients agreeing to the wrong or unnecessary treatment is unknown. A second opinion is your traditional right- use it! This is most effective if a new history and tests are conducted by specialists unknown to each other. Proper systematic provision for this must feature in the future Forum agenda. This will likely save money for NHS in the end by reducing iatrogenic disease. Three opinions taken in this way, if all the same, would reduce a 25% decision error rate to approaching 1%.
All of this is doable but only if correct data are routinely recorded can routine best practice in diagnosis and treatment be updated promptly in real-time. Another reason to embrace Connecting for Health. We have just heard a Forum is setting up a Misdiagnosis Group. At last we begin to address the central problems. If you think this unduly cynical browse Richard Smith's (ex BMJ Editor) presentation on Surgery and think carefully before agreeing to surgery.
BMA debates euthanasia
Doctors are divided on whether the law should be relaxed to allow terminally ill patients the right to die from BBC. The right safeguards will be essential: including a complete audit trail of patient condition, all treatment interventions and an advance directive made by the fully competent patient. None of these safeguards can be guaranteed at the present time. Connecting for Health (the new NHS IT) will enable this. Complete patient records checked by the patient could bring a new era of excellence to the NHS.
From the Scotsman delegates believe "the question of the criminal law in relation to assisted dying is primarily a matter for society and for Parliament".
The motion "The BMA should not oppose legislation which alters the criminal law but should press for robust safeguards both for patients and for doctors who not wish to be involved in such procedures." was passed. No changes to current abortion law were recommended.
Top 50 Trusts in the Patient Complaints League
Paul Burns reports on his inquiry to the Healthcare Commission (HC) under the Freedom of Information Act. Top three are Barnet and Chase Farm Hospitals with 49 complaints, Salford Royal Hospitals with 44 and Barking, Havering and Red bridge Hospitals with 36 since the HC took over independent review of complaints in July 2004.
Justice for Patient Forum volunteers
Paul Burns chair of Central and North West London MHT PF campaigns to strengthen protection of Forum members under investigation by CPPIH. He looks at the law and procedures citing recent events in Camden and the call for an independent inquiry. These Camden cases are still unresolved. The members have given their permission for publication of anonymised details.
CPPIH's improper regulation of Forums and their support is bringing Forums into disrepute. PPIFO wants it clearly understood that in future complaints must be investigated by Forums themselves, with proper legal advice, before passing on, if necessary, to their new parent body. The failings of support staff and promulgation of frivolous and vexatious complaints unsupported by fact must never be allowed to impeded the work of members.
If you have had an unfair or unreasonably managed complaint in your Forum please let PPIFO know or get in touch with the authors.
Laundered overalls for Doctors called for at BMA Conference
Dr Butterworth said the hospital where he had trained banned wearing white coats as they were a cause of infection. "I propose that as doctors, nurses and healthcare professionals we should lead the way by using items of clothing that have been properly laundered by hospitals." The Scotsman reports.
£50 billion: Where does all the money go?
Dr Phil Hammond in his MD column in Private Eye reports of 80 Chief Executives in NHS only 9% strongly agreed that improvements matched expectations. A DoH survey found staff are "sick to death of change being rammed down our throats".
Forums must make sure they are not part of the problem. By acting as a focus for reducing risk Forums can re-establish respect for a job well done. But is the job being well done? Cleaning contracts, hand washing, mistakes not learned from but still covered up...Doctors may have the power of life and death over patients but requiring staff to be clean is apparently beyond them.
"Fog of Ignorance" hampering MRSA fight says the Public Accounts Committee. Daily Mail reports. NHS complacent says Independent."The NHS does not know how many patients have died of hospital-acquired infections. The widely quoted figure of 5,000 deaths is based on US research from the 1980s. Evidence from a review of MRSA deaths shows a 15-fold increase since 1992".
There will be no excuses once the new computer system "Connecting for Health" (NPfIT) is up and running- but why still no rush to adopt? "It is genuinely shocking that clinicians can seriously suggest patient care is safer or better by withholding clinical information" from E-Health Insider newsletter 22 June 2005.
Wait for brain scan or go private
How busy are your local scanners? Do they work after 5 o'clock or at weekends? King's College Hospital suggested a private scan reports BBC or wait 18 months. Zero length queues don't suit the private medical sector. A little prompt weekend working and overtime is usually all it takes to keep queues short. Time for Forums to scrutinize queues and consider conflict of interest.
Police say 25% of all offences in Local Hospital
Undercover police will help improve security at Hampstead's Royal Free Hospital which recorded 161 crimes in the last five months including car theft, assaults and 67 thefts. Matt Eley of the Ham & High reports. Last year a £300,000 scanner was stolen from an operating theatre.
Most crime is "opportunist" says Nick Ross at the Barlow Memorial Lecture. Time to design crime out of hospitals. Forums should be on the alert for assault, theft and fraud.
Surprisingly fraud is not a trivial problem. From BMJ 2003 £300 million fraud was prevented in 1999-2003. From this a thousand bed hospital might expect detectable fraud worth roughly £3-400 thousand per year. Some will be fraud free, of course, some will not.
Improper quality control of out-sourced services eg agency staff, catering, cleaning and maintenance can often indicate fraud in contract management. Fraudulent time sheets, corruption in the supply of pharmaceuticals, dentistry and optical services are highlighted by NHS counter fraud services.
Scrutiny of staff approving payments for poor quality work is the usual approach. Email Seton During who is looking at Cleaning Contracts. Staff responsible for queues might also deserve attention by Forums.
NHS Staff 'Do Not Want to Be Treated in Their Hospitals'
The Scotsman reports. A spokesman for the Healthcare Commission, which published its staff survey in March, said: "Staff may have a good reason for not wanting to be treated in their hospital. They may be concerned about confidentiality."
12% of staff work six or more hours of unpaid overtime in an average week.
27% of staff have been harassed, bullied or abused at work in the past twelve months by patients or their relatives; this rises to 37% if bullying and harassment from colleagues is included.
44% of staff reported having seen at least one error that could have hurt either staff or patients in the previous month, compared to 47% last year.
In 2004 there were 117,036 doctors and 397,515 nurses in NHS. Across the NHS there are about two patients in a bed for every hospital doctor and more than two nurses for every in-patient. These estimates are based on DH "Number of Staff in NHS". There are 34,085 GPs seeing their women patients five times per year and men three times per year in 2003/4 from Office of National Ststistics.
PPIFO asks might better matching of these considerable resources to authentic patient need produce less stress in staff and patients? Are all these GP visits really necessary? Why are there still queues for hospital treatment? What proportion of these patients are treated correctly? Reformed patient centred employment contracts are indicated.
Mental Health in the mainstream
Nearly a third of GP consultations involve mental health. Author Jennifer Rankin calls for better access to specialists e.g. via GP surgeries and libraries. The Institute for Public Policy Research has published Rethink's research. Download the Executive summary. BBC reports. From Department of Health Hospital Activity Statistics some 32 thousand beds were available in 2003/4 for mental health patients and 137 thousand in the acute and geriatric sector.
National PPI Forum Convention 2005
The first Convention was held last week June 7-8 at the ICC, Birmingham. Paul Burns reports "One Disenchanted View". Paul was a member of the Convention "Reference Group" and is Chair of the Patient $amp; Public Involvement Forum for the Central & North West London Mental Health NHS Trust. He is going to resign. CPPIH cannot afford to lose members of his ability.
In her convention address Commission Chair Sharon Grant uged the need to "fly the flag for truly independent public involvement in health". Bravo! We hope her staff are listening. If CPPIH fails to set up an effective autonomous National Forum then PPIFO is here to help.
One in 15 Doctors could be abusing alcohol or drugs
The British Medical Association has called for action over alcohol and drug abuse among medics after a BBC survey showed the problem was widespread. BMA Ethics Committee chairman Michael Wilks said the profession was in denial and needed help to tackle the problem. BBC Reports
Mike Cox tells us CPPIH say 1333 members resigned in the twelve months from December 2003. Paul Burns writes to the Guardian " Contracted out". Time for Dr. Steve Lowden, CPPIH CEO, to consult his Statutory Instruments and solve his problem. PPIFO points out to Dr Lowden Forum members keep accounts and direct FSO staff. CPPIH has failed to correct FSO incompetences and wasteful circumventions. Member control must be re-established.
Hospitals could be held criminally liable if patients catch superbugs such as MRSA, Health Secretary Patricia Hewitt has warned. BBC reports on Patricia Hewitt, the new Health Secretary, interviewed on ITV's Dimbleby Programme. Hewitt addresses NHS HR staff on video welcoming the NHS Annual Report. The high standard of cleaning in the Food Industry and a new Hygiene Bill are featured. There are no comments on Patient Safety and Iatrogeny.
The Guardian reports "Health forums 'ailing'". The failure in London of the CIDA Forum Support Organisation (FSO) to have all its contracts renewed was because CPPIH did not effectively enforce its commercial contract with them. Worse CPPIH promulgated nuisance and vexatious complaints, some still outstanding, against members seeking to enforce FSO contract compliance. One member was advised by CPPIH that members do not direct staff contrary to statutory instrument. This produced chaos in London when the inexperience of CPPIH and FSO employees and, one must assume, for some the short-term profit motive, led to constant circumvention of even the most basic of requests. For more than 18 months CPPIH London was unable to state the number of contracted hours by FSOs -as is the Department of Health. We still await a reply from Meredith Vivian. Glenda Jackson MP has written to the Health Minister with the questions.
The mystery surrounding what Doctors actually do all day deepened with a report from the Intensive Care Society which found one in four patients did not see a consultant intensivist within 12 hours. Full story from the BBC.
Mike Reddin sends an article from Washington Monthly. "Just visit any Veterans Administration hospital. You'll find filthy conditions, shortages of everything, and treatment bordering on barbarism." Sound familiar? Now it outperforms Johns Hopkins, the Mayo Clinic and Massachusetts General.
According a RAND corp study Americans receive appropriate care from their doctors only about half of the time. The results are deadly. On top of the 98,000 killed by medical errors, another 126,000 die from their doctor's failure to observe evidence-based protocols for just four common conditions: hypertension, heart attacks, pneumonia, and colorectal cancer (cf. Rath ). VA got its IT right, reduced bureaucracy, fired incompetent Doctors, didn't pay too much but rewarded quality. Phillip Longman tells a story of rational "vanilla" style management.
Maurice Hoffman, Deputy Chair, Central and North West London Mental Health NHS Trust PF writes "SHAs have a duty to monitor the performance of PPI. Forums may wish to inform SHAs when there are difficulties with their Trusts that cannot be resolved." More.
1300 attendees are forecast to attend by BBC news over the next two days. Led by Claire Rayner of the Patients Association and supported by Leslie Ash, who is suing over her recent MRSA infection, a campaign to clean up Hospitals in 100 days is expected. Time to amend staff and cleaning contracts to ensure best practice compliance. UK Patients are 40 times more likely to acquire an MRSA infection than in Holland where best practice is demonstrated.
Hilary Barnard, our founding contributor, Dawn Binnmore and Amy Poole resigned last week saying CPPIH was not applying statute to its commercial sub-contractor support provider, Community Investors Development Agency (CIDA). Representing all Camden's Forums Hilary, Arthur Brill (Royal Free) and Janet Albu (University College) withdrew from a meeting to discuss contractual non-compliance after Timothy Modu, CIDA company secretary, required "without prejudice" terms. This usually means discussions cannot be used in evidence in court proceedings if the attempts at settlement fail and the dispute comes to court.
Kunle Thomas spokesman for CPPIH said "This was a reasonable statement to make and did not imply or suggest legal action."
Forum volunteers have no pecuniary interest and our bound by contract to act as agents for CPPIH. This was "Unprecedented", said Hilary Barnard. An account with more quotes from Hampstead and Highgate Express.
At the PCT Forum a unanimous call was made for an Independent Inquiry
Arther Brill commented "It is a tragedy for London forums that Hilary is leaving - given the time and effort he put in to establishing a London-wide forum and a Camden-wide forum". Janet Albu, a member of UCLH Patient Forum, who has an OBE for services to healthcare, said: "This could damage the whole idea of people volunteering."
Timothy Modu said: "Being accepted for public office doesn't mean that forum members are unaccountable to anyone except themselves. They cannot use their powers just as they please."
The Ham & High reports Camden PCT members claim they get less than one day's work per week for £34,000 paid annually to CIDA.
The text of resolution of 16th March "Camden Patients Forum calls for an Independent Inquiry conducted by people who are independent of the CPPIH, Camden Forum Members, the Department of Health and CIDA into the compliance with the contract by CIDA in its role as an FSO providing services to the Camden Fora and its expenditure of public money, and into the role of CPPIH regarding supervision of FSOs, in particular supervision of FSOs in the London area, and into CPPIH's support or otherwise of volunteers."
Barry Peskin is a ex-Community Health Council member. He comments to the Ham & High on his impressions of CPPIH inexperience and CIDA's attempts to control rather than advise and support. This lead to his resignation from Camden PCT PF.
Steve Lowden, CEO CPPIH, has announced CIDA's contract will not be renewed for some Forums in Camden
Questions about how the money was spent remain unanswered. PPIFO writes to Meredith Vivian, Head of PPI for Department of Health.
Statement from Paul Burns of Chair of CNWL Mental Health PPI Forum & Member of Brent PCT PPI Forum distributed at a Meeting of London Forums on 14th April requesting support for the Camden Three.
Paul Tovey deputy chair of Birmingham & Solihull MHT PF has resigned. He tells us "Spin and illusions are the order of the day both with the Government and with mental health agencies." Lack of proper support to the critics... He writes.
Patient Forums are to merge with their Primary Care Trust Patient Forums. More members are to be recruited. Full DH Press Release. Detailed responses including rough timeline and quotes from the recent Forum survey. Full index of documents. Thanks to Bill Marks of London Ambulance TPF.
Alex Nunes and Peter Packer PF Chairs in Barnet comment
A workshop for London and Southern Regions is scheduled in London for 18th April 2005. Contact Tammy Humphrey tel. 0207 7884912. There is little idea in the NHS of the true error rate in treatment because of circumvention, under reporting and ambiguity in diagnosis. This is the key issue for Forums.
Management of risk requires reporting of all errors, however trivial, in procedure, diagnosis and treatment. Routine strictly enforced error reporting must become part of improving practice. You must expect a large increase in errors reported in coming months and years before improvements will be seen.
Topics to be covered in the workshop:
Brian Jarman of Dr Foster produced a standardised mortality ratio (SMR) for Hospitals to correct for expected mortality. You can check the SMR of in-patients at Dr Foster for hospitals in your Trust. In the year April 2002- March 2003 the best in Trust in England was University College Hospital, London with an SMR of 65. Worst was Royal Bournemouth and Christchurch Hospitals with an SMR of 129.
Some questions for Trusts from Forum members are suggestsed:
This will require tenacity but recall Jarman's results at Walsall. Refer any sceptics to them. Ensure that Trust daily current death rates are closely monitored and discussed. These are the first steps to Quality Management.
The Margaret Dixon case in Warrington brings into question NHS ability to deal with normal demand. We must remember clinicians want compliant patients and delay produces compliance. But the cancellations of operations in Suffolk recently highlight the need for proper cover for emergencies including staff illness. We point out if medicine is improving people should need less contact with clinicians. Are four to five visits to the GP and an increase in the number of operations performed each year a good sign or a bad sign?
Patient Safety: The Agency
|Adverse Drug Reactions||106,000||$12 billion||Lazarou, Suh|
|Medical error||98,000||$2 billion||IOM|
|Bedsores||115,000||$55 billion||Xakellis, Barczak|
|Infection||88,000||$5 billion||Weinstein, MMWR|
|Outpatients||199,000||$77 billion||Starfield, Weingart|
|Unnecessary Procedures||37,136||$122 billion||HCUP|
To estimate UK divide by 5.
We asked the National Patient Safety Agency about their intentions. We will advise when they respond. Independent experts suggest a rate of between 10%-50% of all diseases suffered are produced by Doctors. Quite a range. This is surely the major problem for Forums' putative "Centre of Excellence".
Black Health agency is based in Manchester and is responsible for support to some 22 Forums in the region. They thought their response (.pdf) should go beyond the scope of the questions asked.
"Some wards are disgusting, with urine bottles lying around and no one bothering to take them away. Floors are not cleaned underneath beds and often walls are splashed with blood. Some lavatories are completely foul." The challenge will begin after the Clean Hospitals Summit April 14-15th at London Hilton Metropole. The summit will be attended by England's chief nursing officer Christine Beasley, NHS chief executive Sir Nigel Crisp and health minister Lord Warner. Time for Forums to organise their support. The fantasy that Doctors are not responsible for the nurses they instruct has to go.
Kathy Sheldon Chair, Richmond & Twickenham PPIF tells us SW London Forum members were at a training session on 24th January at which it was said:
Prof John Senders is a world leading expert in Medical Safety, a Professor of Engineering and a Lecturer in Law. He writes about his experience in Canada one of the world's best health services. Claire Rayner then comments and 20 tips to help prevent medical errors are offered. We are still unsure of the overall rate of iatrogenic (medically produced) disease. Some estimates are five times greater than the lowest bound of around 10% of all patients.
Those of us suffering from, for example, diabetes, epilepsy, schizophrenia or the side-effects of a medication know our cognitive powers can be severely limited if we are having a "bad day". The worst case might be a Forum voting on a motion with equal numbers pro and con when an unwell member has a casting vote. Clearly an informal procedure is best but Standing Orders ought to be developed to challenge a member's Mental Capacity. A vote can be taken on the competence of that member subject to some form of appeal after the meeting e.g. to a specially formed sub-committee.
This may seem finicky but some of us have already been in situations where progress has been compromised by temporarily incompetent members. Our authority rests in having real patients as members but also in our ability to make accurate descriptions in our annual reports, to each other and in our official queries etc. There are those, despite ministerial assurances, who would rather see Forums go the way of the CPPIH. We must be ready to defend ourselves with robust procedures to correct our mistakes when necessary. Mental Capacity is ethically important and a Bill is under consideration.
Musculo/skeletal disorders account for 40% of all lost working days, 40% of all disabilities, 40% of early retirement. Back pain is the second leading cause of all sick leave. Sports medicine treatments can be extremely effective but are rarely prescribed on the NHS. Pain killers, surgery and even psychiatry are often the only response. Jane Barratt reports.
BBC reports. You can try out the system which is based on the Yellow Card scheme and due for release in 2006. View data collected on a drug by the Medicines and Healthcare products Regulatory Authority (MHRA) Patient FAQs.
An enquiry into plans to close Residential Homes for older people is to be held starting 24th January. Many are dementia sufferers. Mark Oley Chair E Birmingham PCT PF says "The Inquiry is a first for Birmingham. Nothing like it has ever happened before." Press Release
LAS Trust PF highlights failure to provide staff, computing, offices, training, resource control, recruit members and pay expenses in particular. This experience is shared by many Forums. Read the full report.
This is claimed in the Lancet by a large team from Camden's Royal Free and University College Hospitals but contradicts successful Dutch practice. In this study one in six intensive care patients acquire an MRSA infection. (Dr Foster reports comparative standardised mortality, staff patient/ratios etc. for hospitals and Trusts.)
What does Biant et al say about this? In July we reported them in BMJ eradicating MRSA with simple, cost effective, Nightingale-like, but strictly enforced "ring fencing" protocols. No need for hi tech "Bunny Suit" measures- yet.
More research is necessary the Lancet team concludes. BBC reports.
Observer reports " Scandal of staff cuts on filthy wards". Cleaning staff have been cut while fewer than half our 1,184 hospitals have good cleanliness levels.
Martin Rathfelder Director of Development of the Socialist Health Association reports on their December Conference.
There was an extensive discussion of familiar problems and unresolved questions. PPI members please contact Martin Rathfelder with your support for their declaration calling for a National Conference of Forums. They will present this to CPPIH before their next Board Meeting on 20th January.
Lachlan Clark, Simon Bann, Lee Edwards, and Ara Darzi explain how recording physiological data and videoing procedures in operating theatres could revolutionise analysis of mistakes and working and training in healthcare. From StudentBMJ.
In the current Private Eye 7th January MD, Dr Phil Hammond, reports on the Pickering Proposals. Clearly there is another role here for an autonomous National Patient Forum.
Dr Howard Martin will stand trial in March. Mercy killer, murderer or bureaucratic error? Our sympathy goes to all involved. Strictly enforced record keeping of all that is done to a patient is all we ask.
Two cartoons from Private Eye.
Medical student Kate Mandeville reflects on the dilemmas of queue jumping and the biased perception of professional quality on being treated as "one of us".
Baroness Mary Warnock the leading medical ethicsist has changed her mind about Euthanasia ( Sunday Times December 12 2004) and backs Advance Directives provision in the Mental Capacity Bill as a means of supporting assisted suicide. With Shipman in mind Forums will no doubt insist on strict transparent accountability with patient pseudonymisation/anonymisation. If properly deployed the new NPfIT IT systems will make this easily achieved. The Guardian notes five year prison sentences in the Mental Capacity Bill to punish abusers of the incapacitated estimated to be some 2 million in UK.
De Havilland reports "The medical profession's culture of looking after its own and not reporting colleagues is putting patient safety at risk, the Shipman Inquiry warned today". Recording age at death and reporting it in real time is the simple quality measure all health professionals should display openly for the patients they treat. Standard practice will show that age at death, on average, is increasing one day every five. Dame Janet Smith's Shipman Enquiry website. Reuters reports. Health Minister responds. Discussion of the statistical problem in Lancet: "Improvement in data quality is essential."
Michael Summer chairman of the Patients Association, said the UK had become the dirtiest country in Europe. "MRSA is killing people at the rate of at least 5,000 if not many more every year." The BBC reports Guidelines for contract cleaners and the 27 worst hospitals are named. The target is to halve MRSA infections by 2008. If, as we are told, properly enforced procedures for hand washing and cleaning are all that is required this is not good enough. The Dutch isolate their MRSA victims. Forums should press for better science and establish zero tolerance procedures. The Guardian reports " Half of hospitals fail to meet good cleanliness standards".
Now is the time to enforce honest, open accident reporting.
BMA welcomes culpability for transmission of infectious diseases.
Forums are advised Group Action (Class Action as it is known in U.S.) is an option.
The Socialist Health Association called for a National Body for Forums at it's conference last week. "We request CPPIH or the Department of Health to fund a national conference to which all PPIFs are invited to send delegates without delay". Full text of the agreed propositions. Martin Rathfelder requests comments.
PPIFO hopes that Requests for Comments (RFCs) will become standard for policy proposals, as pioneered by the Internet Engineering Task Force RFCs lead to best current practice standards. Despite its highly technical nature it is open to any interested individual. RFC 2026 deals with the procedure.
Mechanisms for sharing best practice are emphasised and proper budget control as required by Forum regulations but unsupported so far. In particular the question of the need for an executive committee with staff is raised. The consultation document for London Forums was produced with a consultant commissioned by CPPIH. Contact Andrew Woodgate (01865-436034) of Framework or Hilary Barnard of the Working Group with your feedback before January 17th.
"We all owe them our thanks", "performed magnificently" Nigel Crisp says of his staff and waiting lists are getting shorter but diagnostics are delayed and adverse incidents, better called called mistakes, remain unestimated. In heuristic therapeutics the response to error, at all levels, is the beginning of competence but not in an NHS where a culture of dubious authority without responsibility continues unchallenged by the senior manager. BBC Reports and patients comment.
To day from the real world Marian Walker of Norfolk and Waveney Mental Health Partnership Trust Patient Forum reports concern about poor access to mental health services for children and adolescents. Early Intervention must be routine if, for example, the growth of psychotic knife carrying is to be reversed. In 2000 the Prison Reform Trust found 95% of 16-20 year olds in prison have one or more mental disorders.
And in Cambridge this day a 16 year old girl lies in a coma after multiple injuries from being struck by a car. She has become infected with MRSA. Carolyn Dakers, chair of Addenbrookes PPI reports "There is no centrally-determined policy on dealing with infection control". Addenbrookes has the second highest rate of MRSA in the country. Staff are dirty. Will this ever be a sackable offence?
Dr Richard Fitton of the Care Record Development Board pioneered giving patients in his Hadfield GP practice copies of their records. The Hadfield Project showed how records focus and inform patient consultations. A culture change was produced that empowered patient participation.
NPfIT Electronic Patient records (a.k.a. Care Records) will eventually give all patients web-access to their records with enhanced " sealed envelope" privacy protection. A range of Demonstrator Projects have been run covering integrated social care, cancer, maternity and paediatric services, out-of-hours cover and emergencies, heart disease, stroke and NHS Direct.
The Care Record Service, when it comes for us all, will provide a fully notarised audit trail of all interventions. Proper observation and scientific method becomes routine, driving up standards of care, treatment and lengthening lives.
The cover-up culture that stops us trusting practitioners to offer euthanasia ethically, for example, is banished.
What does the DoH intend to do with the possible £31 billion it wants to spend on NPfIT when hardware and software original costs were £2.3 billion? Surely it should go into shifting staff into the fundamental research so badly needed. Make biology " Big Science", the foundation of the knowledge economy. Finding the proteins that produce pathological outcomes would be a good starting point.
Enthusiasm at the recent Care Records Development Conference was noted about the newly introduced QMAS approach to the Quality and Outcomes framework of the new GP contract. Now financial incentives are offered for better Patient Service. A briefing for lay assessors and sample report from the Archway Surgery, a surgery with its own website.
Computer Weekly reports GPs may boycott CaB on grounds of breach of patient confidentiality. Further some GPs' local medical committees are reported as not wanting to engage with the data spine. This is very odd since the formal control of Patient Confidentiality in the NHS IT plans- NPfIT- is far superior to current "Caldicott" paper practice. Perhaps NPfIT secrecy is the problem. E-Health Insider reports on BMA CaB advice to GPs.
Office of Government Commerce CEO John Oughton was grilled on unnecessary secrecy in IT by the Public Accounts Committee last week. Story from Computer Weekly. Unreasonably high costs in a protected market and a high rate of contract failure indicates improper practices in an industry be it Construction, NHS or IT. "Commercial Confidence" keeps industry outsiders in the dark while competitors are well aware of true costs, risks and opportunities e.g. the inter-company trading and the phantom work that leads to Price Fixing. Despite this transparency is not yet mandatory for Government Contracts. As the Comptroller General of the National Audit Office, Sir John Bourn, knows real time monitoring and alerting for contract non-compliance is long overdue. Failure to do this contributes significantly to the more than 52% waste in Public Expenditue (HMT Productivity in UK HMSO 11/0 19585: 35% from not following best working practice plus 17% from waste in Public Service investment). Proper project control is trivial in this Internet Age. The production of open Knowledge Mines of treatments and physiology are the Great Opportunity for us all.
But the stench of corruption is not as remote as it should be.
NPfIT costs have been estimated by Department of Health at between potential £18 billion and £31 billion. Given that 1.2 million NHS employees all need a pc that would be £15-26,000 per desktop.
An adequate pc with software can be bought at Dixons for £500. So a PC with software for everyone in the NHS can be bought for £600 million with no volume discount.
Perhaps some NHS IT expert out there would like to come clean on this? User training should not be necessary. Servers, printers and network to support in no way accounts for this. The variations in Decision Support rules contemplated hardly account for billions. What is the extra £17.4- 30 billion buying?
No wonder Doctors think there's something wrong. Time for an NPfIT Co-Op to step in before a chaotic orgy of greed and incompetence takes over.
The Register (biting the hand that feeds IT) has its say. Computing takes a look. Accountancy Age highlights the investigation by National Audit Office for Parliament to conclude next summer. This gives suppliers a year to conclude contracts too expensive to cancel- unless a Co-Op steps in?
Arthur Brill of Royal Free PF brought together north central London Forums for a briefing specifically focussed on Methicillin Resistant Staphylococcus Aureus (MRSA). Janet Albu reports.
Topics covered include Health and Social Care, Stigma and Discrimination, Local Implementation, Day Services and Community Participation, Employment, Welfare Benefits, Housing, Education and Training, Ethnicity, Families and Carers, Criminal Justice, Advice and Financial Services. The emphasis is on support requirements.
Janet Upward of Birmingham and Solihull Mental Health Trust reflects on Forum, Commission and Support problems: accounts, rights, independence, community involvement, appointments and restrictions on current Trust patient members.
Dr Alexandra Wyke has kindly sent us a major article from "Health and Social Campaigners' Network News international" August edition on CPPIH and PPIFs. The article is entitled "The end of the world's most ambitious user-led experiment in healthcare restructuring?" (.pdf format). For many of us the end of the CPPIH is an opportunity to develop the guarantees of Forum autonomy Patients want for a safer, quicker and accountable NHS. Martin Rathfelder asks if it's time for a Patients' Parliament.
Hilary Barnard reports: The Working Group met on Monday. As a result, a consultation document is currently in preparation for all London Forum Chairs/leading members on future Regional Forum. Hopefully, this can be circulated next week to allow maximum opportunity for Forum comments. The cut off date for comments is in mid January. The Working Group will then meet to consider responses and develop more detailed proposals. A further all London meeting of Forums is likely in late Feb/early March.
There seems a good deal of agreement on informal contacts and periodic all London meetings around significant themes. There is an area of disagreement on whether to establish a Regional Executive. All the issues will be part of this consultation (unlike the restrictive Opinion Leader Research consultation on post CPPIH arrangements).
Formerly called Electronic Booking, CaB is the key IT application to produce a patient centred NHS without queues. The National Programme for Information Technology (NPfIT) can deliver decision supported best practice to the practitioner with accountability and formal controls of Patient privacy, enhancing the Caldicott rules (e.g. "sealed envelopes" with Patient agreed rules applied to confidential information).
The Output Based Specification (OBS 2- 3vols 1000pp- an independent Chartered Software Engineer commented "a standard setting model of clarity") can be downloaded from E-Health Insider.
The Data Spine will be a searchable data mine including anonymysed patient treatments and outcomes. A NICE-like study will be feasible with a Google-like search taking minutes not years. If strictly implemented NPfIT has the potential to give Patients the NHS they want. This makes the secrecy surrounding the project all the more unjustifiable.
NPfIT supported doctors could offer risk aware Patients properly regulated "agreements-to-treat". Complaints can become trivial to settle with a notarised audit trail of treatment given available with the click of a secure mouse. A data resource orders of magnitude superior to that of any pharmaceutical company can result. NHS management can become accountable, efficient, strict and Just- banishing the inactive, bullying and lethal cover-up tribalism we still see today. Cost cutting can be replaced with fundamental research into physiology and pathology to drive a Knowledge Economy. Career paths can be enriched.
NPfIT System Architecture download. We trust reports of "Show Stoppers" (bugs so bad software can't be released) to be exaggerated. Booking Systems are well understood these days. Experienced Experts are readily available to make all kinds of necessary corrections.
Paul Burns of Brent PCT Forum reports in the X-Forum.
BBC and Medical News Today reports findings (in .doc format) from ARMA - The Arthritis and Musculoskeletal Alliance. Health Development Agency reports Department of Health is committed to arthritis patient needs.
A London Forum member reports. The Working Group will meet on 15th November. Contact is via Camden PCT Forum Chair Hilary Barnard who is the Group member co-ordinating the agenda. A demand for more transparency from CPPIH and FSOs was agreed by the meeting. Inter-forum development is being hindered by CPPIH failing to publish Forum members contact details. Data Protection law is clear. Not for profit organisations keeping a public register are exempt.
Should Patient Forums meet and train at night so workers are properly represented? Ann Godden writes.
Laura McMurtrie moves to Merseyside SHA. Dr Steven Louden (Deputy Chief Exec) takes over. CPPIH Press Notice. Chair of Camden PCTF Hilary Barnard said today "I think that it is important that Steve Lowden should be given the earliest opportunity to show that he will work differently as Chief Executive from his predecessor, particularly in the way that he consults and involves Forums".
Conference to be held in Manchester on 11th November organised by Bearhunt proprietors of PPI Forum magazine (Ten issues per year annual sub £295 -£195). Confidence, Connection and Contribution are the themes. Bearhunt advises attendance by Trust Chief Executives & Chairs, Non Executive Directors, Directors of Nursing, Directors of Public Health, Clinical Directors, PPI Managers, PALS Managers, PPI Forum Support Organisations, Patient & Public Involvement Forum members, Communications Managers, Health Scrutiny Committee Members, Commission for Patient & Public Involvement and Strategic Health Authorities. Prices range from £405.38 to £90.48 (inc VAT) for the day depending on your organisation. Discounts for Forum members and some free places available till closing date 29th Oct.. A review is indicated.
The PCT Joint Working Group of Patient Forums in Manchester asks "How do we monitor NHS services without ICAS information?"
Thanks to Val Bayliss-Brideaux. Dame Janet Smith who is chairing the Shipman Enquiry has been advised.
At a recent two day meeting of the Royal Society the nature of proof and the means of achieving correctness were discussed by world's leading experts. Their strict methods could be applied to patient treatments if we take Roger Taylor, research director of Dr Foster, seriously: "Compared with the transport industry, the number of errors causing very high levels of death is extraordinary." The new NHS IT system NPfIT is coming so no more excuses! We must ensure it is applied correctly.
Desperate children and young alienated adults can be seen as hard to reach patients. According to retiring Metropolitan Commissioner for Police Commissioner Sir John Stevens, feral- wild children cause "vast levels" of crime. Can they be helped by Early Intervention Services before their bullying turns into tragedy? Born to nice, educated, middle class parents psychosis can lead to the psychiatrist. Among the disadvantaged psychosis leads to life imprisonment. Mental Health Trust Forums can help here. Schools, social workers, family doctors, A&E Departments, magistrates and police all have a role to play as do Patient Forums. National Institute for Mental Health in England conference on domestic violence for health professionals. More at the Child and Adult Mental Health website.
A systematic approach to the correctness and consistency of procedures at death is long overdue. This includes advance directives (living wills), post mortems, organ retention, transplants and suspicious deaths. When a patient dies a Public Enquiry to establish best practice has been followed could be routine, but what happens now? Occasionally an inquest may be held where it is found that half all Death Certificates are wrong. The recent Anne Grigg-Booth and Julia Levitt cases (nurses recently charged with killing patients) in the post Shipman era inspires no confidence. In recent (premature) baby/child intensive care cases the courts intended no precedents at a possible cost of £300,000. With no hard statistical and physiological evidence what else can we do? There are ongoing concerns about best practice and approaching a gold standard diagnosis (with post mortem routine- currently less than the inadequate target of 10%) access to organs, euthanasia and clear and prompt protocols for dealing with religious dogma and borderline cases. This is still far from properly ethically organised. It's all still a muddle. This is no way for excellence and skill to thrive. PPIFs could take a lead here.
John Reid said everyone from cleaners to consultants has a role to play in tackling these issues. Promised in 2001 delivered in 2004. Let's make sure this happens. Action plan leaflet. Action plan for cleaner hospitals.
LA Times reports on a Johns Hopkins Study of 10,000 people. BBC Panorama reports on Sugar Lobby including Coca Cola and Tate and Lyle covert funding of UN WHO/FAO Report. Expert agreement to limit carbohydrate consumption to 55%-75% was removed. Modest compared to Dr Atkins who recommends only 5-15% (for regular exercisers) for carbohydrate to reduce risk of heart disease, stroke, diabetes and obesity.
UN Food and Agriculture Organisation (FAO) will "urgently" reconvene the research committee. Doubts persist that low enough levels will be recommended.
Children's Hospital of Philadelphia is undertaking a small study of hyperactivity and "carbohydrate craving" in children. Diet rather than Ritalin may control Attention Deficit Disorder. A low carbohydrate, ketogenic diet is at last achieving increasingly widespread use in controlling idiopathic epilepsy. This was first discovered in the 1920s but superseded by drug therapies which often have undesirable side effects. There are more benefits to the Atkins diet than many realise.
Public Health authorities do not monitor the body's toxic burden. One hundred and seven persistent organic pollutants (pops) e.g. phthalates, which are used in plastics; fire retardants, which are used in plastics, fabrics, furniture and electrical goods and pesticides were measured in a small study (33 volunteers from seven families, three generations) by the World Wildlife Fund (WWF) and the Co-operative Bank. Reports from Guardian and Daily Mirror.
Could this account for the increases in asthma asks Netdoctor, autism, up 273% in ten years in California, Alzheimer's Disease in a LSE cost study of cognitive impairment and cancer from WHO study? Science cannot tell us yet.
Applying the Precautionary Principle monitoring the population is essential says PPIFO, the critical friend's critical friend.
The leading biochemist, Sir Tom Blundell, Chairman of Royal Commission on Environmental Pollution said (June 2003) "Given our understanding of the way chemicals interact with the environment, you could say we are running a gigantic experiment with humans and all other living things as the subject. We think that's unacceptable". So should we.
The efficacy of many medicines are under increasing scrutiny. The Medicines Healthcare products Regulatory Authority (MHRA) yellow card adverse reaction warnings took 12 years to promulgate for Seroxat.
Drug testing errors can produce "pharmageddon": sickness sustained by fear of disease, dependence on inexpert authority, and misplaced faith in drugs which do more harm than good.
Dr Mike Shooter, President of the Royal College of Psychiatrists, said of Seroxat: "It has serious implications for the whole of psychiatry, it has serious implications for the whole of medicine."
"I think a few years down the line we are going to be talking about this with many more sorts of medication."
BBC Panorama scrutinised the risks with Seroxat and the slowly informed response of the MHRA.
Like barbiturates, amphetamines, Librium, Valium and Thalidomide in the fifties and sixties Forum members will expect a decrease in new patient prescriptions for Seroxat and related "Selective Serotonin Reuptake Inhibitors" (SSRIs), Prozac etc., in their Forum's pharmacies. For further reading see Vernon Coleman's 1994 critique of the pharmaceutical industry "Betrayal of Trust" or buy the 2004 book by Medaware and Hardon "Medicines out of Control?" on psychoactive pharmaceuticals. Sample Chapter One on-line.
Forums seek proper autonomy as supported by the legislation but most attendees were employees not members at the "stakeholder" meeting on 27th September. Welcome to our new contributor Dr Charlotte Augst who reports.
Hours after discharge for a broken rib and collapsed lung a spinal abscess developed produced by an MSSA staphylococcus infection. Eight hours of surgery and some months later walking with one crutch is practical. The Daily Mirror has some of the story. This high profile case should be closely followed. Claims that staphylococcus (S. epidermis) is carried by many healthy people on their skin confuses the picture, but MSSA (methicillin susceptible staphylococcus aureus) refers to S. aureus which is the common cause of soft tissue infection and should be easy to treat although 90% are penicillin resistant ( briefing from Princeton University Department of Molecular Biology). MRSA (methicillin resistant staphylococcus aureus) is the tricky one.
See below "5000 die from Hospital acquired infection a year- NHS not sure". Peter Wilson, consultant microbiologist in 4th September BMJ attacks media sensationalism. In the same issue Geoff Watts, BMJ Science Editor, discusses staphylococcal infections.
Wikipedia estimates there are between 500 to 1000 different species of bacteria in our bodies and about ten times more than the number of cells in our body. Much of bacterial ecology is unexplored by science.
Winning Ways from Chief Medical Officer identfies:
Commander Andy Baker of Scotland Yard claims "Some doctors feel some tension between confidentiality towards their client ... and the issue of possibly saving a life". Report on BBC Radio 4.
Guardian letters 13th September discuss procedures used to detain people with potentially dangerous personality disorders.
Ian Wingrove of the London Assembly Green Group reports to Malcolm Alexander of the London Ambulance PF that London's Mayor, answering a question from Darren Johnson, will write to Health Secretary John Reid to ensure continuity of Patient Forum funding during the closure of CPPIH.
The Observer of 19 September reports. Advance Directives or living wills are key to ethical minimisation of suffering. But open scrutiny will be required: seven doctors face charges of serious professional misconduct over alleged failures that allowed Harold Shipman to murder more than 200 people undetected. Monitoring the evolution of healthcare professional culture to routine open reporting of mistakes that can maintain privacy, when patients want it, is the key to driving up standards, so long overdue, and the success of Patient Forums.
Eight Manchester PPIFs have set up a Health Issues Hotline and have been blitzing on Hopital acquired infections with 150 volunteers inspecting 36 Hospitals in North West. From Manchester Evening News "Grime-busters set to fight superbug". Thanks to Val Bayliss-Brideaux Forum co-ordinator (Black Heath Agency) 0161 214 3967. The Hotline is also operating for Yorkshire Forums. Rebecca Camber reports further on the outcome.
BBC reports. Press statement from Department of Health. " National Service Framework for children, young people and maternity services". Bullying, domestic violence and early intervention for psychosis in 16-18 year olds in the core standards. Standards for Maternity Services, Disabled children, Mental Health. All the standards. Guardian reports "NHS plans revolution in care for children".
"There is some evidence of a long-term effect," Dr John Zajicek confirmed to the BA Festival of Science at Exeter University speaking of cannabis-based drugs applied to multiple sclerosis.
Staaij et al find adenoid and tonsil removal is "usually a waste of time and money". BMJ 10th September 2004.
The Patient Forum inspected after authorising Luke David, a Hamstead & Highgate Express journalist, to accompany them under PPIF Regulations. These require information can only be disclosed if a patient cannot be identified. Luke had investigated a patient's claims that assault, theft, alcohol and marijuana consumption went unchallenged. Ex-patients confirmed this.
When asked about this patient's intolerable experiences on the wards in Luke's report in the Ham & High of 13th August 2004 the Trust spokeswoman reflected only on the Trust's two star rating.
Two weeks later after the Forum inspection Luke reported a spokeswoman for the Trust claimed "a serious breach of patient privacy" and said they would complain to the Forum and the owners of the Ham & High. They claimed Luke David's authorisation ("Functions" Regulation 3 paragraph 1) was improper. Forum regulations are clear that majority decisions at open meetings are only required for annual reports, accounts, expenditure, reviews of services and referrals to other bodies, not decisions to inspect or authorise. In general Forums proceed as they wish ("Membership and Procedure" Regulation 10). The Trust claimed their policy to combat assault, theft, alcohol and drugs was robust.
The Trust is required to respond within 20 working days to the questions arising from the report to the Forum. Trust Chairman Professor David Taylor has been advised that his responses will be published. He is required to explain any action he intends to take or why he will not take any action. If the Patient's Forum is not satisfied the matter is referred to the Strategic Health Authority or the Local Authority Overview and Scrutiny Committee.
Report on a preliminary meeting of Forum representatives which led to the meeting at Camden Town Hall. On September 1st a draft Invitation was agreed to all London's Forum members from Michael English of Lambeth PCTPF and Janet Albu of University College Trust PF. Arthur Brill of Royal Free Hospital Trust PF was in the chair.
"One in ten treated falls victim to errors officials admit" the Times reports. The fact is nobody really knows and many hospitals are still reporting no errors. A Dr Foster Study in the BMJ shows that the number of mistakes to which NHS hospitals openly admit is a small fraction of the total accepted by the Government's patient safety watchdog, according to the Times. Roger Taylor, research director of Dr Foster, said: "Compared with the transport industry, the number of errors causing very high levels of death is extraordinary."
Thanks to all of you who emailed PIFFO about this. It will come as no surprise to members that
Sadly PPIFO suggests a higher figure in the approx 13 million hospital care episodes every year. We know that nearly 10% of patients will acquire an infection and 6% will suffer an adverse drug reaction. The 50% error rate in intravenous injections confirms much progress has to be made in honestly reporting mistakes. The National Patient Safety Agency needs all the support and encouragement Forums can muster as its new anonymous reporting system will, if correctly used, lead to an increase in adverse incidents reported. Then we should see the rate fall... This won't happen overnight. We remind you that 50% of Death Certificates are wrong. Post Mortem examination should be routine for every hospital death. Only that way will diagnostic error and unnecessary treatment come under control.
Results of Healthcare Commission survey of Trust patients.
BBC reports "Patients kept in dark about care".
Mind calls the results "Just the tip of an iceberg". PPIFO advises patients, when the facts are known, to contrast the risks of a treatment with no intervention before giving consent. It is astonishing that the facts are often not known. The profession must be able to defend itself from the Coleman criticism of treatment risk. More and better patient-centred statistics contrasting intervention and non-intervention risks are essential. This would reduce unnecessary GP visits and specialist consultations, however actual hours spent in patient contact by doctors and nurses in hospital and general practice continues to be mysterious. Forums will clearly have to write to their Trusts if no official statistics can be produced. Healthcare Commission please note!
At a meeting of the London Ambulance Service Trust Patient Forum on 2nd. August a motion was passed:
Janet Albu has convened a meeting of the London Action Group for Monday August 9th to be chaired by Malcolm Alexander of the Ambulance Forum at the Charlie Ratchford Centre, Belmont Street NW1 8HF opposite the Roundhouse in Chalk Farm starting at 4.30 pm. PPIFO hopes this measure will eventually produce the proper support Patient Forums need to do their vital job. All Forum members invited.
John Hunt considers a recent Mail-on-Sunday article which argues a secular approach can be Just and the liberal should not be afraid to challenge sectarian prejudice in the practice of medicine.
Full Download. Chief Pharmaceutical Officer's report and the National Patient Safety Agency has created the National Reporting and Learning System (NRLS) an eForm and 32 Regional Managers. Dr Maureen Baker, the NPSA's director of primary care, said: "Mistakes and errors happen in general practice as in every other area of healthcare. The NRLS gives GPs the chance to share patient safety information and so reduce the likelihood of the same problems happening to patients again and again." In the real world tort law (a tort occurs when someone deliberately or through carelessness causes harm or loss to another person or their property) deals with this but denial, circumvention, cover up and their support, bullying, are NHS traditions that PPIFs will need to help reform if this world first is to succeed. Altruism is essential to success and in no way naive.
The Commission for Patient and Public Involvement in Health (CPPIH) will be abolished and stronger, more efficient arrangements will be put in place to provide administrative support and advice to Patients' Forums. Today's full Press release from Department for Health.
From Reconfiguring the Department of Health's arm's length bodies (p.22) stakeholders will be consulted before primary legislation is enacted and in future membership will be the responsibility of the NHS Appointments Commission. From the Q and A "An implementation timetable will be published at the end of October 2004.The review and reconfiguration will be complete by 2008."
Members are reminded that normal contract arrangements still apply throughout the transition period and persistent failure of an FSO to deliver can still result in suspension of their contract. Guardian's David Batty comments
Time for us to say what we want. Some have said Healthcare Commission (they co-ordinate ten bodies who inspect NHS) would be fine. Others say we need far more "Arm's Length" than that. What about a Patient Public Involvement Organisation focussed on preventable error and alerting from patients? We wait for the call. Would some of you like to suggest a budget? There will be meetings on the way forward and we will report on them.
These are the Healthcare Commission performance ratings. Surrey and Sussex Trust is rated zero. Thanks to the Forum chair, our correspondent Emma Wicks, Ken Cunningham says "...the Trust is getting better and we are committed to raising the rating to reflect the real progress we are making." in his Press Release. Members will recall the Redmile-Gordon incidents reported here, see below. Emma's Forum Report will make interesting reading next year.
PPIFO has received a disturbing message from Paul Tovey, Deputy Chair of the Birmingham & Solihull Mental Health Trust PPI Forum, Janet Albu reports.
"Doctors wiped out the deadly MRSA superbug from one of their wards and dramatically cut infection rates during a detailed study using simple hygiene methods."
"During the research they were told to wear clean uniforms, change patients' bed sheets and wash their hands properly between tasks after patients had undergone an admissions screening for MRSA." Paul Sims of evening Standard reports. "Nightingale" measures, from that doyenne of statistics, are all it takes.
Eradication of methicillin resistant Staphylococcus aureus by "ring fencing" of elective orthopaedic beds Biant, Teare, Williams and Tuite BMJ 2004;329:149-151 (17 July). This study was unfunded. Inspecting PPIF members should note the precautions.
PPIFO expects John Reid's new model cleaning contracts to reflect these measures despite recent claims in the Observer (March 28, 2004) of secret clauses in PFI agreements including a 'food and linen' clause affecting University College London Hospital Trust which requires paying more to private sector partners when a threshold number of meals are eaten or bed sheets used. The contract negotiators should explain where the equity lies in such an agreement. Contract scrutiny looks set to become an important feature of PPIF work.
"Improving patient care by reducing the risk of hospital acquired infection: a progress report" download National Audit Office Reports, studies in Orthopaedics and Vascular surgery and comparison of International practices.
"...the NHS still does not have enough information on the extent and cost of hospital acquired infection."
"According to today's report by head of the NAO Sir John Bourn, progress in preventing infections and reducing their number is dependant on changing staff behaviour, but change continues to be constrained by the lack of data, limited progress in implementing a national mandatory surveillance programme that meets the needs of the NHS, and a lack of evidence of the impact of different intervention strategies."
The Department of Health's mandatory MRSA reporting system has revealed an 8 per cent increase in the number of Staphylococcus aureus bloodstream infections from 17,933 in 2001-02 to 19,311 in 2003-04. Of these, about 40 per cent are MRSA, making the UK's rate among the worst in Europe. Infection Rates for Trusts
Thanks to Emma Wicks of the Cystic Fibrosis Trust who sends John Reid's response " Towards cleaner hospitals and lower rates of infection" and his press statement: PPIFs to be asked to assist with cleanliness inspections at least four times per year, cleaning contracts to be improved, speed dialling to housekeepers by new patient bedside phones and, most importantly, providing patients with a means of alerting PPIFs to their needs. BBC Reports.
Kensington and Chelsea gets £30.7 million more than the "formula requires" but Easington County Durham gets £26.5 million less than it should receive. The cancer death rate is 60% higher in Liverpool than in east Dorset. In England less than 50 are waiting nine months for an operation, at the same time in Wales 8,457 patients had been waiting longer than 12 months, of which 1,401 had been waiting longer than 18 months.
But PPIFO notes, as a critical friend, no official statistics on deaths due to medical accident one of the leading causes, if not the leading cause, of death in hospital. Adverse incidents, unnecessary treatments, iatrogenesis and diagnostic error are still the Cinderellas at NHS balls. Men see a GP four times a year and women five times on average. If medicine is improving this is too high to avoid the Illich criticism of unnecessary medicalisation. Proper knowledge of risk could reduce patient demand. A stern look at Obstetrics and unnecessary prescribing, for example, has to be on somebody's agenda. Full text. Press release and statement by Sir Ian Kennedy.
"The precise prevalence and magnitude of medical error is unknown, but it is probably enormous". Weingart, Wilson, Gibberd and Harrison BMJ 2000;320:774-777 (18 March) " Epidemiology of medical error".
Reducing Medical Errors: A Review of Innovative Strategies to Improve Patient Safety. U.S. Congress Subcommittee on Health May 8, 2002. Real Player Archived webcast of the hearing lasting 1hr. 40mins. Download the free Real Player basic required to play this webcast.
Action Against Medical Accidents AvMA is a charity with a team of medically and legally trained caseworkers who can provide free and confidential advice following a medical accident.
Malcolm Alexander writes and now (1st October) Private Eye Comments. John Murphy responds. At a London Ambulance PF a resolution was passed requesting consultation on the future of PPIFs. Marc Jeffery suggests "The Way Forward". He goes on to discuss deficiencies in patient handling by nurses and Strategic Issues for an Interfora body. There is a London Forums Action Group forming.
Retired nurse, Claire Rayner, of the Patients Association, is horrified by the lack of proper hygiene routine in the degree level qualified nurse (Richard and Judy Channel 4 5 July). Why is this problem so hard to master? Is management so weak? National Audit Report from 2000. BBC report 2002. BBC report 2003.
Actress Leslie Ash contracted the MSSA virus while in hospital. Friends had told the News of the World that Ash had lost almost three stone while in hospital. Spokesman, Neil Reading, said that Ash was up and about. "She'll be in hospital several weeks but is up and walking."
From the Royal College of Psychiatrists a survey confirms that bullying of junior doctors is prevalent in the NHS, and shows that psychiatric trainees are not exempt. Those who are bullied are often unsure how to access help, and when they attempt to do so the results are often unsatisfactory. From Psychiatric Bulletin (2004), 28, 225-227
Dr. Marc Jefferey of the joinedupwriting Partnership reflects on the question of Bullying as a Public Health issue.
Health and Safety executive inspector Martin Smith said: "It is essential these cases are brought to the public attention so that similar events are avoided in the future."
A court heard that the tragedy could have been prevented with a £750 temperature valve which would have regulated the water in the hospital bath.PPIFO notes this is far too expensive for such a simple component.
Forum members when inspecting must automatically assume corrupt relationships where commercial contracts are improperly applied. Quality unregulated cleaning contracts should be considered in this light.
Are care assistants not instructed to test the temperature of the water? The patient, Catherine Hourie, aged 39, died five days after suffering severe burns to her lower body which caused the skin to peel away from parts of her legs. Lengthy police investigation did not result in criminal proceedings. She was unable to speak and had been in hospital since the age of nine. The age at death of our disabled is the key to understanding the quality of care in hospitals, homes and community. At present every year our life expectancy increases by more than two months. We should be requiring the same or better improvement for all in care. Full report Guardian 1st July
12 MRI mobile scanners from Alliance Medical, Boots and Oracle are to improve "customer experience". Reduced waiting lists are putting consultants' private sector income under pressure according to Derek Machin, chairman of the BMA's private practice committee. Best practice is all we require! Two stories from Society Guardian today (July 3rd). Thanks to Robin Redmile-Gordon.
Most reactions were either definitely or possibly avoidable. Drugs most commonly implicated in causing these admissions included low dose aspirin, diuretics, warfarin, and non-steroidal anti-inflammatory drugs other than aspirin, the most common reaction being gastrointestinal bleeding. Pirmohamed et al,"Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients" BMJ 2004;329:15-19 (3 July)
" First, Do No Harm". Editorial Comment from Richard Smith editor of British Medical Journal.
"Even a simple system reduced medication errors by 64%" when physicians use computersied drug order entry " Using information technology to reduce rates of medication errors in hospitals" Bates BMJ 2000;320:788-791 (18 March)
"Reid scraps patients' agency six months on" headlines in page 2 of today's Times (July 1st., 2004). Given the warnings many of us have had to send to our support organisations and CPPIH itself this is no surprise.
Patient Forums will always have the support of PPIFO which is made up of members of PPIFs only.
A number of meetings are being held to review lack of constructive activity by Forum Support Organisations and CPPIH. We will report back on their comments on this development. We may need to consider an Inquiry.
We are happy to host a national meeting if it becomes necessary- but part of the art of being us- as opposed to NHS staff- is not having unnecessary meetings!
Those of us invited to sign null accounts, for example, may want to inspect FSO accounts of Forum expenditure closely. Many of us want to commission our own support directly.
We are all committed to keeping alive lay user inspection of the NHS. There are currently ten technical inspecting bodies led by the Commission for Healthcare. We inspect on behalf of the Patient not other Public Authorities.
Our day to day activities will reduce preventable mistakes and our annual reports will track the establishment of properly applied better practice.
To re-establish justice in the NHS work place this must be backed up with the formal written warning to employees not complying with best practice. Jobpilot describe the standard employment contract in UK.
Doctors.net.uk found only 15% of incidents which could have led to death or disability were reported from BBC (27th. June).
"Doctors across the UK have shown a remarkable honesty and frankness about the scale of the problem and a demand that things change for the benefit of their patients" said Doctors.net.uk founder Dr Neil Bacon
Sue Osborn, Joint Chief Executive of the National Patient Safety Agency said "... we have developed an anonymous system that will respect the confidentiality of those who take the time to report to us" .
Michael Wilks, chairman of the British Medical Association's Medico-Legal Committee, said: "The BMA would welcome a system of reporting that allows clinical mistakes to be openly discussed and analysed."
From Medical News Today 27 Jun 2004 "Dr. Bacon said a system used by airline pilots, where any report logged was completely anonymous, would be much more successful. The system would have to be a confidential one, on the web, he added.
PPIFO offers its full support to all involved in reducing error. Medical Error is possibly the leading cause of death in hospitals. Addressing the errors in Death Certificates could lead to the improvements we all want. If medical authorities are serious it is time to reverse the decline in necropsies in hospital.
How long does it really take to train a competent surgeon? 6,000 hours isn't enough apparently. Dr. Phil Hammond discusses this in his current "Doing the Rounds" column in Private Eye (25th June 2004) where he cites Chikwe, De Souza and Pepper explaining in BMJ (21 February 2004) how difficult consultant excellence is to achieve. The mystery of how many hours the consultant actually spends hands-on instructing in mask and gown however is not actually revealed.
Sharon Grant, chair of CPPIH, has been invited to a forthcoming meeting of the London Ambulance Forum members. They will consider a motion to request CPPIH to pay its funding to London CPPIH Branch office. Legislation requires Forums to control their own budgets but following failures in its current Forum Support Organisation to deliver to contract full budget control is urgently needed, reports Malcolm Alexander, chairman of LASPF. Other London Forums are invited to City Hall 6th July 5.30-7.30. The Forum refused to approve their first "null" return statement of accounts. More at the new London Ambulance PF website.
A further cautionary tale from Guardian Tuesday June 22, 2004. Thanks to Mike Reddin. Lack of open independent scrutiny has permitted inexcusable waste if not actual corruption. Nationally, from an HM Treasury Millennium Study 52% of Public Expenditure is wasted, about £630 million per day: 35% from not using best practice compared typically with US, Germany and France and 17% from wasteful investment by Public Service managers. Under used staff could move into Knowledge Mining: a complete description of the Natural World, sustainable process development, free high quality care for children and the elderly, better pensions and a shorter working week. All this follows from improved error control such as is now trivial with the Web.
Robin Redmile-Gordon tells us what happened when his mother had a fall. This is just another routine day in Brutish Britain's NHS. There is no need to tolerate this. We expect written warnings and management instructions requiring stricter compliance with proper working practice. Redmile-Gordon should consider invoicing S&ST Board for his work reducing the risk and cost of their failure to properly manage staff.
ABC News reports on a WHO initiative. We asked where is the fundamental research?
Richard Smith Editor of BMJ 2002; 324:923 reviews Ivan Illich's 1974 critique of Medicine. The review starts
"The closest I ever came to a religious experience was listening to Ivan Illich. A charismatic and passionate man surrounded by the fossils of the academic hierarchy in Edinburgh, he argued that "the major threat to health in the world is modern medicine." This was 1974. He convinced me, not least because I felt that what I saw on the wards of the Royal Infirmary of Edinburgh was more for the benefit of doctors than patients. I dropped out of medical school that day. Three days later I dropped back in again, unsure what else to do. Now I'm the editor of the BMJ, which is ironic. Having deserted medicine, I've become a pillar of the British medical establishment (yes I am, like it or not)."
"When sick I want to be cared for by doctors who every day doubt the value and wisdom of what they do and this book will help make such doctors."
"What was radical in 1974 is in some sense mainstream in 2002. Medicine does seem to have over-reached itself and some reining in will benefit not only patients but also doctors." Clinical, Social and Cultural iatrogenisis are distingushed and 7% of patients suffer injuries when hospitalized, Illich claims. PPIFO asks Trusts to inform Patient Forums when a patient is injured.
Malcolm, Chair of London Ambulance Forum and ex- director of the Association of Community Health Councils calls (Private Eye 11th June) on Sharon Grant to step down in favour of a more critical and active CPPIH Chair.
See Cancer Cases will treble in a generation, warn doctors (Sunday Times June 13th). Can this be true? Fewer smoke- what are the new factors? £1 million per patient for drugs? Why won't costs of treatments fall if they work? Maybe the "50 leading experts" are simply lobbying for more money in their speciality. When will a strict trial of the cheap and easy vitamin C therapy be undertaken? Linus Pauling, the most highly honoured chemist of the 20th Century died aged 93 criticising the flaws in the early studies of his pioneering approach. Prompt intravenous or oral ascorbate (Vitamin C) of around 60 grams per day might be an optimum primary therapy. PCTs could save enormous amounts of money by encouraging large doses for the many illnesses that respond to Vitamin C stimulation of the immune system. Robert Cathcart MD is critical of the medical establishment and lists diseases that might respond. Problem: Pharmaceutical companies can't see a way to make money out of Vitamin C. If the claims made for vitamin C in heart disease, asthma, colds, flu etc are born out a smaller cheaper, less iatrogenic NHS could result. Sad to say some will see that as a threat rather than an opportunity. A PCT level trial would be trivial to conduct. A Lancet study, Khaw et al of 19,496 men and women, ages 45 to 79, in Norfolk, U.K., between 1994 and 1997 showed "death rates were significantly lower among those with higher serum ascorbic acid levels."
Dr Rosy Daniel was one of the 50 experts contributing to the "Cancer 2025" Report. She points out the view that cancer cases would treble was not unanimous. In Sunday Times June 20th 2004 she writes. The Report assumes diet is responsible for 35% of the risk. If it is published on the web we will advise. In June 2002 the BBC reported acrylamide in cooked carbohydrate is implicated in this Swedish study which led to an emergency WHO meeting. Findings.
PPIFO invites the designers and implementers to tell us the story of version 1.0 of the KMS. No doubt a fascinating tale. Can we look to the day when a PPIF will be automatically emailed if a patient is injured? Dr Allenna Leonard, President of the American Society for Cybernetics explains how Knowledge Management can be used for "algedonic" alerting.
Update, thanks to Mike Cox. The KMS was set by using ATG (Art Technology Group, Inc.). Press Release from 11th July 2003.
Proper healthcare promptly given can do much to restore the well-being so essential to a trouble-free settlement in this country. The myth of the overworked healthcare professional has to be properly understood to realise what a small load (for a great good) this places on the NHS. Across NHS 2.5 in-patients per Doctor (less in London see Dr Foster) but there is a tradition of bullying in the NHS and evidence that work is not shared equally. Ruth Appleton of Camden and Islington Mental Health and Social Care Trust Forum writes
Health Minister clears the air as speculations abound on the 'Arm's Length' review: "Patient and Public Involvement (PPI) is an important part of the government's agenda... PPI Forums will survive" Rosie Winterton MP, Health Minister, reported in Shaping Health in London June 2004.
Consult us! Malcolm Alexander, chair of the London Ambulance Public Forum, writes to Rosie Winterton MP making a case for careful consideration of any reorganisation of PPIF support urging full consultation with PPIFs before considering any new proposals.
Graham Ixer of GOS Forum comments.
Reports from Forum members continue to come in of performance failure by FSOs. "Ever more horrified by the rudeness, unhelpfulness of people we have to deal with" writes one member. A meeting with the minister is being called for unless a clear improvement is seen in coming weeks. PPIFO reminds Support Organisations (from the governing regulations) "staff ... shall be under the direction of the members (of Forums)". Continued failure to comply with Forum members' proper instructions will result in their dismissal.
From Camden New Journal (CNJ 27th May 2004): "Failure to get through to over-stretched mental health services on the phone could be contributing to the borough's high suicide rate, a Town Hall investigation has heard." Camden Council is due to report in July.
Camden has the highest suicide rate in the country from June 3rd CNJ.
Camden PCT Health survey reports "There are about 34 deaths from suicide or undetermined injury each year, around 60% more than expected". The population is around 207,008 and around 1550 die each year, 8% more than might be expected.
On the day Health Secretary John Reid announced the future of Health Quangos, including CPPIH, to be reviewed Janet reports.
Despite reports Robin Redmile-Gordon is a mild mannered but concerned man. He recently resigned from his ppif and made criticisms which some may feel unjustified but some thought long overdue (see our News item "Health watchdog quits over focus on 'inane issues'"). He copied us his letter to the Independent describing the response of NHS officials when he had the commitment and persistence to complain about a nurse not wearing rubber gloves to take his blood.
He comments, exclusively to us, that criminal prosecution (rather than civil proceedings for negligence) would save the NHS a great deal of time and money. Tactically this would stimulate proper regulatory management of staff. Three written warnings of failure to comply with company practice before termination of employment is usual in industry unless there is injury in which case immediate health and safety and/or police investigation. Strategically, if mistakes were accepted as inevitable but the outcome of corporate failure to instruct or supervise, a culture of disclosure and learning from mistakes would be encouraged as is routine in the Engineering community. But managers would have to manage (see Harriet Sergeant "Managing not to Manage") and instruct as they do in all other sectors of the economy. Computing, for example, would not be possible because programmers make too many mistakes but discussion and pro-active detection ("debugging") of mistakes is routine and accepted practice. In the NHS denial and pretence is the norm as Robin's correspondence shows.
We look forward to hearing from members and readers of their experiences. How would you insist NHS complies with its own best practice guidelines? Should we call the police when lives are being threatened?
Robin Redmile-Gordon writes there is little risk to us from terrorism. The real risk is becoming a patient in the NHS. He calls the preventable NHS risk an assault on UK Civilisation. He recommends Harriet Sergeant to be read by all. He says if we can't deliver an NHS that treats patients "with respect and care" rather than "like ingrates in the workhouse" then privatisation and competition is the only way.
PPIFO shows Ken Cunningham, Chief Executive of Surrey & Sussex NHS Trust, who cannot issue a proper instruction to his own staff, the letter he should have written to his customer Robin Redmile-Gordon. Better management is simple and all it takes. To start with put honesty in the NHS this could lead to justice in the workplace for both staff and patients otherwise privatisation may start to look attractive.
Sir Ian Kennedy's Healthcare Commission (CHAI- Commission for Healthcare Audit and Inspection) might take over the Commission for Patient and Public Involvement in Health (CPPIH) in today's Times (20 May 2004). "The Commission for Health Care Audit and Inspection could take over most of the monitoring and inspection roles now taken up by a variety of bodies". In an announcement of plans to reduce the number of NHS Quangos by John Reid, Health Secretary, reports listed CPPIH and several others. More from Google News.
Thanks to Veronica Brinton (UCLH PPI Forum member) for bringing this to our attention who writes.
Downing Steet announces.
Mike Reddin asks "Feeling insecure? Are we in the list to go? Should I take an aspirin? Or call NHS Direct?" Mike writes
August is the cruellest month in the NHS. Cynics call it the killing season. It's the month when a fresh intake of junior doctors, their white coats crisp and their palms damp, come out of the lecture rooms and lay their hands on living patients for the first time.
The European working time directive will cut the number of hours junior doctors spend on the wards. It ought to make hospitals safer - but does the NHS have enough staff to cope? (see "Professional Activity" below) Mark Gould reports for the Guardian.
The postcode lottery continues but "We need to start looking at whether the way we treat people actually makes them better" says Nigel Edwards of the NHS Confederation. This report is in the Sunday Times May 16th 2004 "Frankly the government, chief executives and clinical directors have little idea what their hospital consultants do," says Alan Maynard, senior Prof of Health Economics at York University. "You may be doing more work but killing more patients. Equally, you may be doing less but helping more. We don't know."
Our member Mike Reddin writes "Maynard explores the different payment systems of professionals in the NHS - and the type of care we're likely to get from those different payment regimes. He exposes the extraordinary degree of ignorance - via hospital and GP practice managers - on just how much activity takes place in hospital and GP settings. He is author of the issue of 'Health Policy Matters' (no. 8). Mike recommends the York Journal
Our member Nick Green points out a properly kept Patient Health Care record (to be available on the Web by 2005) if used to formally alert staff will establish activity and greatly reduce risks for patients.
"The acquisition of timely and useful data is invaluable to us" says Mark Britnell chief executive of University Hospitals Birmingham NHS Trust speaking of the 2004 Dr Foster "Good Hospital Guide". He is right but the data is twelve months out-of-date and useless for day-to-day management or life-saving alerts."The devil is in the detail" says Dr Allenna Leonard, President American Society for Cybernetics, explaining why raw data is needed for alerting. Micromanagement must be monitored most closely but autonomy is promoted when these data are used to improve local working practice.
Members of the Patients' Forum for the London Ambulance Service wrote to the Health Service Journal in March. They are critical of the level of support from Forum Support Organisations (FSOs) despite a £27 million first year spend by the Council for Patient and Public Involvement in Health (CPPIH).
Hilary Barnard of Camden PCT is critical of the 6th May meeting with the Commission (CPPIH). He sees them as trying to control without any vision. He urges us to work together at Borough level, addressing issues with Forum Support Organisations, CIDA, for example, and the Commission through a Steering Group of Forum members which could plan future meetings with the Commission. He urges better controls of our budgets and suggests we may have much to learn from the experience of the now defunct Community Health Councils (CHCs). Email Hilary with your views.
Alex Nunes Chair of Barnet and Chase Farm Hospitals NHS Trust PPI Forum asks for clarification of Hilary's use of "Top down practice".
Seton During of North Middlesex University Hospital NHS Trust PPI Forum comments on Hilary's email. Are we just a fig leaf? He lists his priorities and makes a plea for us to get seriously involved with costs in our Trusts.
Janet Albu of University College Hospital Trust PPIF comments pointing out extracts of CIDA's contract have been made available by Tim Modu
Exec Director (Strategy &Development)
Community Investors Development Agency (CIDA)
2 Factory Lane
Tel: 0845 658 6688
Hilary Barnard replies to Janet Albu "CIDA has good days and bad days". He suggests we have shared interests.
• Finance for Forum activities
• Transparency in dealings with the FSO
• Accessible information so that we have streams of information that we can use effectively
• Research to support Forum activities
Time for us to flex our muscles? Brian Godfrey of Barnet, Enfield and Haringey Mental Health Forum writes "Masses of bureaucracy and paper, bog them down and don't let them loose. The order of the day is 'confuse and confound'".
Private Eye's M.D, Dr Phil Hammond, the hero of the Bristol Heart Enquiry-`whistle-blower's advocate'- writes
Report in last October's Guardian about problems with FSOs and CIDA- including Haringey.
ACHCEW was the national voice of Community Health Councils (CHCs). ACHCEW provided a forum for CHCs; assisted them in the performance of their functions; and represented the interests of the public in the NHS at a national level. PPIF statutory powers of inspection distinguish them from CHCs and the soon-to-come management of the Independent Complaints Advocacy Service (ICAS). Do any ex-CHC members have a view?
The Chair at the last meeting of the CAIMHT PPIF, Peter Jones, asked the Forum Support Organisation (FSO), CIDA, to confirm official contact details and briefly state their responsibilities in writing to members. An annual budget of £29,500 per PPIF was mentioned. Concern was expressed at the volume of briefing papers for non-agenda items. There was a discussion and presentation on conflict of interest with particular reference to the Patient Advice and Liaison Service (PALS). A sub-committee was set up to plan the first Public Meeting scheduled for 10th June 2004 at 6.30 in Hampstead Old Town Hall, Haverstock Hill, NW3 2BE. (2 minutes from Belsize Park tube. 168 bus.)
The Chair of Camden PCT PPIF, Hilary Barnard, writes to CIDA, his Support Organisation, with his concerns about the scheduling and purpose of a meeting with the Commission (Commission for Patient and Public Involvement in Health-CPPIH). Perhaps it is the kind of thing PPIFO (if that is what we end up calling ourselves) should get involved with. We are not an inferior tier of Health bureaucracy. Our voluntary status makes us the Trustees of the Nation's Health.
Janet Albu of UCLH Trust Forum, and Age Concern Camden reports on a consultation with Paul Plant, Assistant Regional Director Public Health Group at London Voluntary Service Council on April 28th 2004. This is a consultation exercise due to end on May 28th to support the Wanless Report. " Choosing Health?" seeks views on the role that individuals, the government - both central and local - the NHS, the public sector more broadly, the voluntary sector and industry, the media and others can play in improving people's health.
A problem shared is a problem halved so do tell us how you are getting on. This is just the beginning but no doubt we all have similar experiences and there may be others who can dissolve the problems you may have. Contact us with your news, views, comments, suggestions and criticisms.
ISO 9000 is the International Standards Organisation quality standard. It ensures processes are properly documented so any deviation from standard can be corrected. This is what Activa, a UK ISO 9000 consultancy write.
The Institute of Medicine's 1999 report, "To Err Is Human," put the entire health-care community on high alert. It told us that medical errors in hospitals account for between 48,000 and 98,000 deaths per year in the United States.
Dr. Samuel Cramer writes in April 25, 2004 Cincinnati Enquirer. "Even at the lowest estimates, medical errors are the leading cause of death in this country."
Barbara Starfield, MD, MPH, "Is US Health Really the Best in the World?" Commentary from the Journal of American Medical Association (2000) .
Seven Steps to Patient Safety provides an overview of patient safety and an update on the tools the NPSA is developing to support improving safety.
One might reflect that in most industry if there is a problem one generally takes it up with the boss who sorts it out. Not in the NHS. Managers work as clerks perhaps but cannot control. Management is defined by Stafford Beer, the father of management cybernetics (the management of complexity with real-time statistics), as the profession of control.
Nick Green of CAIMHT PPIF is a consulting management cybernetician and software engineer. He reports
"With the coming of the NHS Care Records Service mandatory recording of all therapeutic transactions on a shared access, anonymysed, statistically oriented database could be the norm. This will establish the quality controls so overlooked in the past. With the context established a simple tick box noting no adverse reaction or satisfactory outcome to a previous intervention is all that is required. No NHS form filling required. The paperless office can be a liberating reality and a revolution in quality control for the patient. Stricter management control of staff should be anticipated until a safety critical, rather than circumvention, culture is established."
"2.4 million unnecessary surgeries performed annually resulting in 11,900 deaths at an annual cost of £3.9 billion"
From Life Extension Magazine: "No one had ever analyzed and combined ALL of the published literature dealing with injuries and deaths caused by government-protected medicine. That has now changed. A group of researchers meticulously reviewed the statistical evidence and their findings are absolutely shocking. This fully referenced report shows the number of people having in-hospital, adverse reactions to prescribed drugs to be 2.2 million per year. The number of unnecessary antibiotics prescribed annually for viral infections is 20 million per year. The number of unnecessary medical and surgical procedures performed annually is 7.5 million per year. The number of people exposed to unnecessary hospitalization annually is 8.9 million per year. The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year."
NCAA manages concerns over the performance of an individual doctor or dentist.
Mike Reddin of Epsom and St Helier Hospital Trust PPIF recommends this online Journal especially issues 8 and 9. Issue 9 is concerned with measuring outcomes and issue 8 whether new contracts will increase quality and activity in NHS. The paper concludes "NHS pipers may continue to call their own tune". The new contracts may only marginally shift Doctors to transparent accountability.
Mike notes premiums are paid for diagnosis of heart disease, cancer, diabetes, stroke, hypertension, lung disease, epilepsy, hypothyroidism, mental illness and asthma. An increase in incorrect diagnosis of these conditions might be expected.
The PPIFs have a big job ahead. Nick Green has suggested recording age at death in real time with a moving average to check trends. In a properly managed facility this should show an improvement of several parts per million every day. Knowing this would gear staff morale to performance. In a culture resistant to accident reporting this could become a sensitive indicator of bad practices by new staff, for example. Depending on specialisation a good one thousand bed hospital expects less than ten thousand deaths per year. This approach would quickly catch a Harold Shipman or Beverly Allitt. In U.K. hospitals Death rates vary from 3.4% of all admissions to a maximum of 13.6%, with an average of 8.5% (see in Jarman above).
Mike is seeking opinions about the practices in Centre for Reviews and Dissemination. They have worked for the National Instiute for Clinical Excellence (NICE). Mike also draws our attention to NHSDirect - 'Best Treatments' and "A responsive and high-quality local NHS: Primary care progress report 2004" by David Colin-Thome.
Luton PPI Forum chair Josephine MacLean said: "We spoke to a young mum worried about her children, not knowing where to go. This was the second time she had been turned down by the NHS that morning. She had tried to get help at her GP surgery but was told that all the slots had been filled. more>>
Ben Wallace, MP for Lancaster and Wyre, and Michael Jack, MP for Fylde, joined with the Blackpool, Fylde and Wyre Hospitals PPI Forum in criticising bad management "It's a tragedy NHS staff are being made redundant, when it should be incompetent managers and bureaucrats facing the axe." said Ben Wallace Mr Jack said: "My view about reports like this is they don't address the real problems." more>>
Chairmen of three Bedfordshire forums reject "stronger local voice" proposals.Trevor Gash, chair of Luton and Dunstable PF, said: “Rather than amending certain things, the recommendations are to scrap everything and start again." They have written to DoH. more>>
The Doctor had disclosed the fee of experts hired to advise on savings. Forums should be alert to abuse of suspension as institutionalised bullying. The practice of "commercial confidentiallity" is fundamentally unsound, for the gullible only. Investigate! In a free market prices are openly competitive. If they are not suspect corruption or incompetence.
Janice Kent of the Brighton and Sussex University Hospitals PF said "They are looking at reducing staff so patient care is going to be very severely affected if there are more cutbacks, and staff can't continue like this forever." more>>
Peter Packer, chair of Barnet PCT PF, explained that many of the surgeries remained in converted houses, a legacy from when doctors often used to practise from home. more>>
There was never a true shortage of capacity in the NHS and Ravenscourt Park has lacked the patients to make the investment work. In a letter the Forum says that “an absolutely outstanding patient experience” was provided. It has a clean, pleasant and tranquil environment, low levels of MRSA, good public transport access, dedicated theatre space and no cancellations. Proper consultation may not have been carried out. more>>
The James Paget University Hospitals NHS Foundation Trust is a 613 bed acute hospital in Gorleston with Northgate Hospital, Lowestoft Hospital, the Newberry Centre Children's Clinic and community dental services on several sites.
Patrick Thompson, PF chair, said: "This is brilliant news. The forum has been fully involved in the application from the start and we will be continuing to take an active part."
The announcement came from Monitor, the independent regulator for NHS foundation trusts. This allows freedom from Department of Health control and tens of millions pounds in investment. Chief Executive said the money would be spent with local contractors. more>>
John Hunt, from the hospital's Public and Patient Involvement Forum, thinks she will be on familiar ground when it comes to controversial decisions.
He said: "In February the trust issued letters to staff warning of redundancies but since then they have backed down and said they were only taking soundings and that no one had been made redundant yet."
He added: "They have closed wards here without consulting with us and increased the hospital car park fees." more>>
Members of South Manchester Primary Care and Hospitals PF present their findings from patient experiences of using Breast Care Services in South Manchester. Download the report (.pdf).
Mollie Manthorpe East Lancashire PF chair said: "I don't think our problems will be solved by borrowing. Common sense says you don't borrow money to alleviate your financial problems. People get into trouble when they do that. The Government needs to take a good look at why hospitals are getting into these problems. We have been working hard to make sure we can work more efficiently without reducing the number of patients we treat or reducing the quality of the care and treatment we provide. more>>
Led by the ex-London Region manager Rosie Newbigging, CPPIH has reported on the "Unheard Voices" of Immigrants. A good practice guide is included.
Norma Rodgers, PF chair said: "I think this is the way forward. Lots of doctors' practices are limited by space and cannot do the things they want to. A whole new building with different services under one roof would be brilliant. It would make it easier for patients, they will be able to make less journeys for treatment." more>>
Midland-wide mergers are set for West Midlands, Coventry and Warwickshire and Hereford and Worcester ambulance services. Dudley-based West Midlands Ambulance Service PF vice-chairman Del Gibson, said: "We have no idea what's going to happen here." more>>
Patients have voiced their concerns about West Middlesex Hospital as growing debts are reported. This financial year the Isleworth hospital's shortfall was £1.4 million and the accumulated deficit over the last few years stands at £10million. more>>
Critics in East Lancashire said people didn't want to choose between two "virtually identical" options put forward by bosses while others hadn't bothered because they saw the consultation as a "done deal". People were being asked which hospital should lose key women's and children's services such as consultant-led births. Bob Simpson of the PF is disappointed. more>>
Alex Nunes, chairman of the Patient forum, agreed. "It's the right outcome and we are delighted," he said. more>>
"It is clear that the new 28 bedded facility will not be in place until after all three of the existing facilities have closed in their current form, again in direct contradiction to assurance that new services would be in place before existing services are closed." said Marianne Walker from the PF. "Its participation in decision making is often not sought and its views are often ignored by the Trust." more>>
Dr Bob Heys, a former consultant at the hospital and a member of Calderdale and Huddersfield Public Patient Involvement Forum, said: "My concern is that this sort of overspending and consequent cost cutting happens every year but no provisions seem to be made to stop it happening. more>>
Janet Albu, University Colege London Hospital PF said: "I am astounded at how big the deficit is. It is rather larger than any figures we have seen. I hope that any recommendations from the management consultants are to cut down on administration staff rather than patient care." more>>
Lewisham PPI Forum chairman Alan Hall said: "If the hospital says this technique works I don't understand why it can't continue to use it." more>>
Peter Howard, of the Mayday NHS Trust PF, attacked the cost saving strategy as "the accountancy of a madhouse". more>>
RFH is one of the best yet dirtiest hospitals in the country. PF Chair Arthur Brill said "It gives us great concern that three quarters of a million pounds has been paid out without us knowing.The forum will be investigating the impact this will have on patients." more>>
South Warwickshire is to make a Patient and Public Involvement Award to go to the person or team who have shown a readiness to engage patients and/or the public in shaping their health care. more>>
Next year patients in Barnet and Chase Trust will be offered a choice of hospitals for their treatment. Peter Packer and Alex Nunes of the Patient Forums comment. more>>
“I am very worried about those people who suffer from asthma who will need help at night, or people who get assaulted on the seafront and need treatment quickly,” said Jenny Brabazon of Suffolk Coastal PCT PF more>>
Amidst some confusion Camden PCT is planning to move Royal Free children's treatments to the Whittington Hospital.
PPI Chairman Arthur Brill commented "It's all very well saying the Whittington is just down the road', but it's not. If you come on a Friday afternoon, you can forget it." more>>
Stricter control of Consultant practices was promised in 2002. An NHS manager told Society Guardian: "This deal will stop the kind of practice where operations are cancelled because the consultant is taking Friday afternoon off at short notice to go and play golf." The not working culture is unreformed.
Jonathan Broad, chairman of the North Devon PPIF, said: "The Trust has said that it can significantly lessen its deficit through cuts to agency nursing staff and by reducing bed numbers through better bed management and by getting people into community care quicker." more>>
Ralph Eshwege was a Royal Free PPI member. He resigned because the Board would not take responsibility for the deficit which led to the closure of 100 beds more>>
Shagufta Khan, chairwoman of the Patient Public Involvement Forum at the hospital and a radiology practitioner at Walsgrave Hospital, said she was deeply concerned for those who used the day care centre. more>>
After coducting a survey Ruth Clapham, the forum's chairman, said: "It is overwhelming support for staying put. They thought Addenbrooke's was already looking like an industrial site." more>>
Lives will continue to be at risk because of the bitter row between North East paramedics and NHS bosses, it was warned today. Chairman of the North East Ambulance Service Patient and Public Involvement Forum, Michael Dalton, said: “I am very disappointed this situation has not been resolved." more>>
Visiting hours at Bridlington Hospital have been almost halved in a bid to reduce the risk of outbreaks of diseases such as MRSA. The trust said it has made the decision after extensive consultation with patients, its Patient and Public Involvement Forum, visitors and staff. more>>
Copies of the forum's report, Catering and Nutrition in Peterborough and Stamford Hospitals, will be available to the public at the forum's meeting on October 12. It runs from 6.30pm to 8.30pm at the Salvation Army Centre, Bourges Boulevard, Peterborough. Forum members will be available to talk to members of the public. more>>
The performance of Driffield's zero star Primary Care Trust will be put under the spotlight at a public meeting next week. A public PF meeting is being held at the New Rink, Eastgate North, on October 10 at 7pm. more>>
Anna Dugdale, director of resources at the Norfolk and Norwich University Hospital, said the cleanliness and hygiene of the wards, waiting areas and corridors was down to patients as much as it was cleaners and other staff at the hospital.
"We have seen spillages that have dried out because they have been there for so long," said Sandie Johnson of the PF. "It seems there are excellent management systems in place but people are not actually following them." more>>
A cartoon, artist unknown, arrived at our offices. What can it mean? Maybe one of you can tell us...
Frieda Gosling, chair of the Hospital Forum of the Peterborough PPIF said "I am in favour of anything that helps reduce MRSA infection in our hospitals, but it is important nobody is inconvenienced by any changes". A decision to end visiting sessions earlier in the evening would be unfair on those who work during the day, she explained. more>>
Suffolk's NHS and Primary Care Trusts struggle to come to terms with debts of £74.3m. Lorene Baker, a member of the Ipswich PPI acute forum, said: "The public concerns about the situation are great but she does not seem to be listening." more>>
Missed GP surgery appointments are costing the NHS at least £180m each year, according to a survey of doctors. more>>
Commenting on the situation in Fylde coast hospitals Maureen Horn, from the PPIF, said: "The hospital does have a part to play and has put in place systems to remind people about appointments. more>>
Tom Wallace of West Sussex PPI Forum found MRSA patients in Bury St Edmunds hospital mixed in with others and fewer than one in 10 doctors washed their hands. more>>
"I am delighted they have decided not to go ahead with this proposal." said John Hellings of Southwark PPI. more>>
Carlisle's Cumberland Infirmary is to be comprehensively "deep cleaned". In June the Patient Forum spotcheck found evidence of dirtiness which could fuel infections. more>>
A Youth Health Survey by the Easington PPI Forum found 68% of girls and 62 per cent of boys aged 11-13 believe it is easy for them to access illegal drugs. 43% of 11-13 year old boys thought it not important to use contraception. PPI Forum Member Ron Lamb said: "This may well indicate why Easington has the fourth-highest rate of under-18 conceptions in the North-East, and is 11th highest throughout the north at 58.5 per 1,000 girls." more>>
Western Cheshire PPI Forums (patient and public involvement) are calling for the Countess and other hospitals to abolish their monopoly and allow patients to use mobile phones which may be cheaper. more>>
Health Action International (HAI) Europe reveals how privileged access to European Union (EU) fora has been accorded to the European Patients' Forum despite its links to the pharmaceutical industry being couched in secrecy. more>>
After Huddersfield PF bugwatch report was leaked CPPIH accused of "cloak and dagger" approach. There are fears for the future of the Forum.
Gordon Penney, who left the group in May, said: "...began to wonder for just whose benefit the forum existed. It certainly did not appear to be for the benefit of the public." more>>
There were angry scenes at the Patient Forum as managers were held to account. more>>
Job threats were discussed by Trust Chief Executive at the Patient Forum more>>
"The decision, which is rightly causing consternation in the community, as has happened in Saxmundham and elsewhere, shows that the NHS is not fulfilling the stated aims of Government policy" said Jenny Brabazon, forum chairman. more>>
Arthur Brill, PF chair, said:"You don't start a consultation by telling people this is what we want. Don't tell people what you want - ask them what they want." more>>
David Maxwell, spokesman for Public and Patients Involvement Forum, said he fears that once again the town and its people will miss out. more>>
A new superhospital is targetted for 2011. With local MPs involved the West Herts Hospital Trust PPI Forum has organised a Public Meeting in Redbourn to tackle a £13 million trust deficit. more>>
North Cumbria Acute Hospitals Trust PF reports in some cases "the situation appeared to have deteriorated" more>>
Tim Holland-Smith, chairman of Suffolk West PPIF, said of the 20p per charge rise "It is diabolical. How will people afford it?" more>>
John Biggs, chairman of Bedford Hospital PPIF, said: "As long as the closures do not affect the hospital's performance, I am not concerned. more>>
Waiting times, cleanliness, pain relief, improved access all feature more>>
Arthur Brill, chairman of the Royal Free Trust patient and public involvement in health forum, said: "The Royal Free is not getting the direct investment it needs because it is not a foundation hospital and is not scheduled to be one in the near future." more>>
DH has a list of hospital cleaning sub-contractors. Trust contract managers are not enforcing quality standards. PPIFO asks "Why?"
Westminster PCT PF presented a report to their Primary Care Trust about access to services. more>>
Members of North East London MHT PF will take part in ward watch visits between this month and mid-May as part of a London-wide visiting scheme. more>>
The Alice mental health ward at the Royal Free Hospital is to get a check-up
The inspections are part of the Ward Watch scheme, launched by mental health charity Mind, together with the London Mental Health patient public involvement forums. more>>
The East Anglia Times launched a "Stamp out MRSA" Campaign after the death of a 36 hours old baby. "We will be asking for a full report of up-to-date figures of MRSA and related deaths, also coroners' figures stating MRSA as the cause", said the Patient Forum spokesman commenting basic nursing care was victim of report writing. We ask are nurses becoming "Too posh to wash"? more>>
From a 47 page report by the Huddersfield and Calderdale Forum, Huddersfield Royal Infirmary scored 11% whereas Calderdale was 100% with hand washing and cleanliness of Ward furniture.
Blood, faeces and dirty laundary were found in one ward. Director of Nursing Helen Thomson welcomed the support of the Forum more>>
Eastbourne PF hosted a proposal by Liz Wake to reuse the All Saints Hospital site more>>
At Mayday Hospital in Croydon the Infection Control nurse Jennifer East told the Forum "Please do not stop challenging us. It is the only way we are going to improve."
PF Vice Chair, Ethel Dixon, said: "On several of our visits we have come across nurses who are not carrying or using any form of alcohol bottles". more>>
North Herts and Stevenage PF next meeting at Bedwell Community Centre, Stevenage, on March 29 at 2pm. Chairman Eric Eatwell said: "We have a good relationship with the PCT and early on we agreed that we would take a non-confrontational approach." more>>
Department of Health shows that 1,107 operations were cancelled in Norfolk, Suffolk and Cambridgeshire in the last three months of 2004 making it the worst in the country. The PF accepts staff illness blamed. more>>
Staff at Drifield's Alfred Bean Hospital supported by the Patient Forum welcomed the new initiative. more>>
Bob Heys, of Calderdale PF said "The fact we found blood on medical equipment and faeces on the floor is completely inexcusable."
The report said most of the bathroom and toilet facilities at the hospitals were dirty. The Trust welcomed the Report. more>>
"We are inviting everyone in the Narborough area who uses that surgery [The Maltings part of Swaffham's Manor Farm Medical Centre] to come along to the meeting so that there is a full and open discussion," said Dave Routledge of West Norfolk PF. more>>
Mark Oley, chair of East Birmingham PF, said: "We think four hours is unfortunately still too long to wait. We need more resources and cash to help staff treat people quicker." more>>
A spokesman for Ipswich PCT PF said he fears using Bluebird Lodge as a substitute for St Edmunds will not help the problem and see the PCT come "full-circle". more>>
David Maxwell, chair Bracknell Forest PCT PF, said he would be "reserving judgement" until he had seen the effects of the new system. more>>
Downing street announce, 24th February 2005, premium rate charges by around 290 GP practices to be illegal, from April.
Facing a debt of £6 million Barnet Hospital PF has enlisted a former accountant, Stanley Ash, to join their ranks. "We are very concerned about the hospital's finances and how it affects the care and treatment patients receive," said forum chair Alex Nunes. more>>
Surprisingly Charles Brooker, of the independent QMS patients' forum said "In any organisation there is always the possibility that perhaps things might not have worked out in a particular case as well as they might have done." We are sure his Trust will be delighted to hear this but his Patient was horrified. more>>
PPI Forum Member Brian Storey said the forum was delighted and Patient power has spurred on health chiefs to recruit more midwives, introduce new midwifery assistants and look at using travelling incubators for Tynedale's babies. more>>
Les Hanley Chair of North Cumbria Acute Hospitals Trust's PF has a £10,000 from CPPIH for a study. "I am extremely confident that this would work, it's getting people to fund it and make it work," said Mr Hanley. more>>
Chair of Chase Farm Hospital PF Enfield, Alex Nunes, said: "This kind of incident occurs rarely, and we have to accept the fact that medicine is not always an exact science. My sympathies are with Mr Bailey." more>>
Waiting list tampering at Sutton Colefield Good Hope Hospital led to the sacking of Chief Executive Jeff Chandra and early retirement for both finance and nursing director. They received compensation payments totalling £400,000 according to the Evening Mail.
Mark Oley of the PF called for open assessment of the impact on Patient care. more>>
Members of the Forum will be in the Lanes, Carlisle from 11.30am to 1.30pm on Wednesday 19th Januray. Further events are planned for Cockermouth and Whitehaven. more>>
Roy Oliver, chair of the PPI forum, said: "The PPI Forum meeting is your chance to learn more about this and other developments at St Mary's, and to have your say about what works and what doesn't." The event will be held on 17th January at 6.30pm, St. Anne's Community Centre, 55 Dean Street, Soho. more>>
Norwich Patient and Public Involvement Forum met to scrutinise plans by the Norfolk and Waveney Mental Health Trust Partnership. Maureen Walker of the PF said there were a reported 12,700 people in Norfolk with some form of dementia. "Can the trust explain how a 28-bed unit is supposed to accommodate these people?" she asked. "What else is available for elderly people with dementia?" more>>
N Yorks Emergency Doctor Service is short of money. Mark Husler chair of Scarborough, Whitby and Ryedale Primary Care Trust PF said: "We are very concerned about the financial concerns of NYED" more>>
Chandra Gupta of Ashford and St Peter's Hospitals NHS Trust PG, said: "New guidelines have been issued by the government but it is a piece of paper and how far they are being enforced we will have to wait and see." more>>
PF Chair Jean Horwood was back in the spotlight branding uncollected waste bags strewn outside open pathology lab windows of Wexham Park Hospital "Not acceptable". more>>
On the same day PPIFO was told about uncollected rubbish in a Liverpool Hospital Lab. Time for a "Managing not to Manage" award?
Sir Nigel Crisp should note that Forums will not tolerate this continued indiscipline by his employees.
Slough PF plans 40 visits over the next four months. Chairwoman Jean Horwood said "We will look everywhere". more>>
A PPIF survey of the district's local practices found they were short-staffed and most doctors had already cut or were thinking about working fewer hours. more>>
Welcome to the Alice in Wonderland World of the NHS. Run out of pillows? Pop out to the shops and get some- well no. One 89-year-old woman was given two rolled up blankets to prop herself up with and told she should have her own pillow from home if she wanted a good night's sleep. One wonders how many staff meetings were required to produce that advice. Margaret Allen of the PF said "We are perturbed...". Full story. more>>
Forum member Pat Botrill said: "We gave ourselves the task of consulting as widely as possible with new mothers and pregnant women whose experiences and concerns were, and are, fresh in their minds." more>>
West Hertfordshire PPIF will hold a public inquiry into Child Health services on December 1st. more>>
The Older Peoples Forum produce a 2500 name petition more>>
New policies appear sound but "we need to see how they are implemented." said the Forum spokeswoman after a visit by the NHS Modernisation Agency more>>
"For three years it was a dreadful environment". Then SW Yorkshire MH Trust took over more>>
Norfolk and Waveney Mental Health Trust PF call officials to account. "Just a front, something put on to make us think they [the Trust] are listening to us" said one participant. more>>
BMA co-ordinated opinion survey to stop under 16 and public smoking more>>
"It is a mistake to assume that voluntary and community groups have both the capacity and the skills to provide day care", said Mark Oley Chair of Eastern Birmingham PF more>>
Chair Nick Pizey said: "Our role is not just a straightforward listening to the public and then shedding all the criticisms at the health service." more>>
Speaking for South Liverpool PF Jane Martin said: "The consensus from our group is that NHS dentists are few and far between and that there are difficulties with access." more>>
Lorraine Baker of the PF seeks to determine if the policies dealing with times of high demand are adequate more>>
PF chair Peter Roach calls for the Manor Way surgery to be kept open with a new doctor until a replacement practice is opened nearby more>>
A timid target of 48% of hospital staff carrying out basic hygiene techniques between patients came under fire. Slough PPIF Chair ex-nurse Jean Horwood calls for 100% more>>
Claims of watered down disinfectant are contained in an official report by East Birmingham's Patient and Public Involvement Forum.
Undercover reporter Andy Shipley took a cleaning job and found insects crawling around the hospital, bloodied bandages left in a clinic's bins overnight and a memo warning that some surgical tools had been returned to theatre dirty. Health Secretary John Reid is to view the Evening Mail's findings from our two-week undercover investigation at Heartlands Hospital. more>>
Liz Clegg, West Cumbria Forum member, is concerned about continuity of the £510,000 budget more>>
The survey includes dementia in the elderly, dentistry, maternity services and out-of-hours provision. Member Carol Chapelhow said "We hope that we become a very strong voice so the health and social needs of the local community will feed back to Northumberland Care Trust," more>>
Small Heath PF Chair Darren Smith said the threat of closure had led to self-harm among patients. It is intended to refurbish for teenagers with mental health problems. more>>
Alan Hall Lewisham PCT PF Chair said "We want to find out the extent of the problem" more>>
Norfolk and Norwich Hospital PF member Marilyn Skirn said "We want to provide as many people as possible with advice and information about infections". more>>
Forum member Robert Heys, speaking at the meeting at Halifax Fire Station, said: "It's time to stop talking about the problems of care home inspections and do something about it." more>>
Forum member Evelyn Bitcon found issues concerning cleanliness, general hygiene and supervision of infection control on some of the checked wards.
The volunteers were part of team of many who carried out checks on 36 hospitals in the North West.
"It can be hard for people to access services - you have to put a really good case to see a doctor quickly. This is why some people use the out-of-hours service inappropriately," said Maddie Parkinson Evans from the West of Cornwall Patients' Forum more>>
Forum spokesman Stephen Smart said: "Staff and patients are being made aware of the problem." more>>
Sutton and Merton PCT, together with East Elmbridge and Mid-Surrey PCT, have developed the plans and said it would bring "better healthcare closer to home". Mike Reddin of Epsom St Helier PF suggested "...care at home and in the community through to critical care it is still dominated by a desire to spend capital and build new hospitals. more>>
Cyril Wood of the Patient and Public Liaison Forum for Derby's hospitals, said: "You have got to welcome any steps that are taken. But it is sad that the stable doors are being shut after the horse has bolted." more>>
Three Lincolnshire Forums looking for more members in Primary Care, Acute and Mental Health Trusts. more>>
Geoffrey Smith, of the University Hospitals of Leicester patients' forum, said: "I think this decision has been taken solely with the patient in mind". more>>
The North Cumbria PPI committee which has membership drawn from patient forums for West Cumbria, Carlisle, Eden, the ambulance service, acute hospital and mental health, aims to ensure the public have a greater opportunity to get involved in health. more>>
North Warickshire PF has developed a questionnaire on patients under the influence of drink or drugs who have been taken to the George Eliot's accident and emergency department. more>>
Chairman of the PPFI Paul Marlow says "We would like to have more members from all sections of the community so the forum can reflect their views." more>>
PPIF spot checks at the hospital with only two hours warning of a visit seem to have "improved levels of cleanliness but have highlighted areas for improvement such as replacing older basins and toilets" said Director of Nursing Jant Shepherd. more>>
The Plymouth Hospitals NHS Trust team includes matrons, consultants, bosses from private cleaners ISS Mediclean, members of the hospital's infection control team and a member from the Patient and Public Involvement Forum more>>.
Dirty equipment at Royal Manchester Children's Hospital is blamed. Karen Coupe of the Patient Forum said she was appalled and called for an investigation more>>
Emma Wicks, chairman Surrey and Sussex trust patient forum, reacted with "absolute horror" to the rating. "It's obviously not good enough. Otherwise you wouldn't be able to go to another 163 trusts in the country and get better service," she fumed. more>>
Health watchdog Mark Oley of the East Birmingham patient forum which monitors Good Hope Hospital in Sutton Colfield, said today If people are waiting longer than six months, the hospital should have another permanent theatre more>>
Coventry and Warwickshire Ambulance NHS Trust PPIF is seeking public feedback on how well the trust is operating. more>>
Just one chief executive is to head three primary care trusts in the county in a bid to cut huge debts. Ipswich, Suffolk Coastal and Central Suffolk's PCTs are to be run by one person instead of three, but the three trusts will not merge. Jenny Brabazon Suffolk Coastal PPIF said "It is important that as stakeholders the forums should be involved in the consultation process." more>>
Peter Ward for Wexham Park and Heatherwood hospitals for the Patient and Public Involvement in Health Forum, said HC ratings were becoming more valuable. "They have been going for two or three years and there is a consistency taking them year on year," he said. "You don't want to look at them in absolute terms, but they are a good measure of the direction a Trust is going in." more>>
Sue Cowperthwaite, of Cockermouth, serves on the West Cumbria Primary Care Trust forum. She appeals for more members. As the debate about the future of hospital and health services in West Cumbria continues, she added, the forums were even more important because of the input members could have. more>>
Norfolk's three main hospitals have been downgraded in the annual star ratings tables published today.
Norman Cooker, a spokesman for the public and patients' involvement forum, said "Although we are set up to look at what happens in the hospital and, I suppose to be critical, I do think it is important with these sorts of artificial targets to take a balanced view." more>>
Barbara Hewitt Silk, vice chairman of the patient and public involvement Forum for the Central Cornwall Primary Care Trust, said: "...I hope that more people will take the opportunity to express their opinions through this consultation." more>>
Tony Carroll, chairman of the Torbay Primary Care Trust Patient and Public Involvement in Health Forum, recently wrote to Dr John Reid, but the reply he received did not address his queries. more>>
Barbara Marshall, vice chair of Gloucestershire Hospitals NHS Trust Patient and Public Involvement Forum, who will inspect cleanliness levels under the new proposals, thought they were a good idea. She said: "The forum is looking at how all infections, not just MRSA, are controlled through the hospitals, but I think these measures should help reduce infection levels. more>>
Jayne Salter-Scott, the chair of the Patient and Public Involvement Forum for Sandwell and West Birmingham Hospitals, told BBC Radio WM: "We will be as members of the forum discussing with hospital officials the issues of patient care arising out of this tragic incident." more>>
Mrs Albu, acting chair for UCLHTPF said: "We have the right to go into the hospitals with very little notice and talk to anyone who is around.
"We are not going to invade consultations or force people to talk to us but we can go into the snack bar or into the waiting areas and talk to patients and if something is concerning them, we can try and help." more>>
West Suffolk Public and Patient Involvement in Health Forum said: "Many patients won't be able to travel that far and patients lives could be put at risk." more>>
Rod Mellor of Calderdale PCT Forum says "about 3,200 patients for each GP". Time to get a locum perhaps? more>>
Dr Brian Keeble, director of public health in Suffolk, talks about health inequality in the Town at a public meeting of the Patients' Forum. The acrylamide of junk food and smoking, perhaps. more>>
The first Whipps Cross Patient and Public Involvement Forum (PPI) meeting held last week has been hailed a success. more>>
First Public Meeting on June 12th, 12noon to 1pm at the Methodist Church Centre, Stratford Road more>>
Hoteliers are being asked to send out a reminder to tourists with their booking information not to forget their medication, and warning of the need for sun protection.
The chairman of the recently-formed Torbay Patient and Public Involvement Forum, Tony Carroll, said: "If hoteliers could remind their guests, it would take a lot of the strain off GPs and hospitals." more>>
Concerns were raised in a survey conducted through the Patient and Public Involvement Forum. more>>
Twelve lay people have been appointed to have "direct input" to BMA policy making. more>>
The bosses of Newham General Hospital have been hit with the worst scores nationwide for patient satisfaction, treating them with dignity and their confidence in doctors.
Trust Chair of the independent Patient and Public Involvement Forum, Eutal Spence, said: "This result is not about now -it is a legacy from the past." Much hard work is needed to shake it off, he added. more>>
"The health service is stocked from top to bottom with people who don't care, who don't know, who are incompetent, arrogant and downright condescending."
Mr Redmile-Gordon said: "The problem is how do you get something like this being developed by people without that attitude, who won't be intimidated and fobbed off by the medical profession." more>>
Surrey Mirror comments
A city surgeon was forced to leave a patient on the operating table after being called to help under pressure casualty staff hit government targets.
Mark Oley, of the Public and Patient Involvement Forum's Midland branch, said "That is extremely dangerous protocol. I am concerned that targets are being treated as more important than people's lives. This should not be happening." more>>
Hertsmere Primary Care Trust (PCT) and Moorfields Eye Hospital discussed proposals to build Hertfordshire's first community treatment centre.
Peter Roach, chairman of the Hertsmere Patient and Public Involvement Forum, said: "I am pleased that this meeting was arranged and that local people had a chance to hear the proposals. So often the voices of local residents are not heard in developing new services and I would like to congratulate the PCT for taking the initiative and involving the community." more>>
Amy Wilson one of the country's most senior surgeons has questioned a decision to send patients from Bath for operations in France.
Nick Westbrook of the Patient and Public Involvement Forum said: "We have had a call from one person involved. We will talk about it at our next meeting and asking people to tell us what happened. We want to know how the RUH compares with other hospitals."
The meeting is on Tuesday, June 1 at 12.30pm at Bridge House Conference Room in Stallard Street, Trowbridge. more>>
Paul Tovey, of the Patient and Public Involvement Forum, today slammed the trust for not consulting with patients and their families over the closure.
More than 70 patients are being left high and dry after mental health bosses decided to close and demolish a recovery centre while building themselves a new headquarters in its place more>>
First public meeting at Harrow Baptist Church, College Road, Harrow, from 3pm to 5pm on Tuesday 12th May
To confirm attendance at the meeting and to receive a copy of the agenda, call Caroline Moran on 020 8861 9190. more>>
Members of the public can have their say on mental health services in Lincolnshire at a special meeting tomorrow (May 12th)
For more information contact (01522) 551751. more>>
A new walk-in Centre at Teddington Memorial Hospital has opened and the First Public Meeting of the PPIF is announced for May 17 at the Civic Centre, Hounslow between 7.30pm and 9.30pm. Cherna Crome says:"We want to know what local people think about the quality of services in West Middlesex University Hospital and, bring to the fore, issues that in their opinion need addressing." more>>
First Public Meeting more>>
Meetings coming but "shortage of care homes in the county for people with specialist needs such as dementia, challenging behaviour or brain damage and that needed to be tackled", reports the Evening Star, Suffolk. more>>
He says giving people the right to choose their services is the only way to tailor local health services to suit individual communities
"The DoH is getting smaller - we are losing a third of our staff nationally - and our role will be to set standards and preserve the values of the NHS." more>>