PPIF Organisation

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.

PPIFO Hibernates

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.

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.

The National Audit Office said despite pay rising by 27% to £110,000, doctors were not providing more flexible care or spending more time with patients. BBC Reports

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

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 organisations, £45 for voluntary and charitable organisations, £25 for members of the Association (including members of affiliated organisations such as Amicus and Unison). Unfunded individuals and organisations 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.

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.

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.

Local Government and Public Involvement Bill second reading

Tucked away in The Times' January 20th "News in Brief" our correspondent Veronica Brinton spotted this:

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.

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".

Health Minister can compel if LINk access denied

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.

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.

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...

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-organisation 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 organisation 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.

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

Organisations 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 healthcommem@parliament.uk. Full guidelines for submitting evidence to the Committee.

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?

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.

Queen's Speech

"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.

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 organisations 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."

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.

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.

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.

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

A series of meetings are being organised with a proposal to put fairness and equality at the centre of Labour party policy. Socialist Health Association Director Martin Rathfelder writes.

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

"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."

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 organisations 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 organisation 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.

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.

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.

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

"False diagnosis: How ministers mishandled the contracts for NHS consultants" Times leader.

Patient Perspectives on Change: Safety and Justice

Patient Safety and Empowerment: An Agenda for Change

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."

"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 han

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