Wednesday 29 January 2014

Six more NHS trusts on warning.


 

This is another NHS watchlist of failing hospitals – there are, of course, other indicators to watch out for as well. The last paragraph is a sign that things may be getting better.

Denis Campbell, health correspondent

theguardian.com, Wednesday 29 January 2014

 

Six hospital trusts are under fresh scrutiny after new NHS data revealed that more patients who had been treated there died during their stay or soon after.

 

Two of the six, Colchester Hospital University NHS foundation trust and East Lancashire Hospitals NHS trust, are already in special measures following NHS medical director Professor Sir Bruce Keogh's inquiry last year into 14 trusts with apparently high death rates.

 

Another of the six, Blackpool Teaching Hospitals NHS foundation trust, was also among the 14 but was not among the 11 put into special measures.

 

The NHS's Health and Social Care Information Centre (HSCIC) on Wednesday said that those three, plus Mid Cheshire Hospitals NHS foundation trust, Aintree University Hospital NHS foundation trust in Liverpool and Wye Valley NHS trust in Herefordshire, all had unusually high death rates in 2012-13, as judged by the summary hospital-level mortality indicator (SHMI).

 

The SHMI is one of the key ways of measuring if a hospital trust is seeing an average, higher or lower than average number of deaths among patients. It is one of four mortality indicators used by the healthcare information specialists Doctor Foster Intelligence to produce its influential annual hospital guide.

 

The SHMI captures and compares the number of patients who die while being treated as an inpatient or within 30 days of their discharge from hospital.The six were found to have "higher than expected" mortality rates under the SHMI.

 

The HSCIC explained that "the SHMI is the ratio between the actual number of patients who die following treatment at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there".

 

The centre was asked in 2010 by the Department of Health to develop the SHMI and publish data based on it after concerns were expressed that the hospital standardised mortality ratio (HMSR) was too crude and inadequate at capturing the complexity of hospital mortality rates.

 

The HSCIC stressed that its new SHMI data should not be taken "as a standalone verdict on a hospital trust's performance".

 

Overall hospital death rates as judged by the SHMI appear to be improving slightly, the new data show. Between July 2012 and July 2013 a total of nine trusts had a "higher than expected" SHMI value, two fewer than the year before, while 17 trusts had a "lower than expected" SMHI value, up from 16 a year earlier.

Neil Harris

(a don’t stop till you drop production)

Sunday 19 January 2014

The efficiency of free market competition.


 

 

This is a Guardian article about a Competion Commission ruling on the monopoly enjoyed by the 5 or 6 biggest providers of private hospital care in the UK.

It is, of course, missing the real point.

In an age where ‘State is bad, private is good’, the plan is that all NHS services should be put out to tender, so that these kind of companies with their restrictive practises, monopolies, and financial inducements to practitioners, should be the main suppliers of medical services to us;  

 Jennifer Rankin 

The Guardian 16 January 2014

Private healthcare groups have been ordered to sell off nine hospitals after an investigation by competition authorities found patients had been overpaying for medical treatment.

 

HCA, the largest healthcare group in the US, has been told to sell two hospitals in central London – London Bridge and the Princess Grace. Its rival BMI faces selling seven hospitals spread across London, the home counties and north-west England.

 

The recommendations from the Competition Commission follow an investigation last year, which concluded that prices were kept artificially high by the dominance of the largest private groups.

 

The commission said the market power of the three largest firms, HCA, BMI and Spire, made it difficult for rivals to open competing services and artificially inflated prices for patients and their insurers.

 

"'We've looked hard at how we can meet the challenging task of opening up this market to increased competition," said Roger Witcomb, chairman of the private healthcare inquiry group at the commission.

 

"We're now proposing those measures which we believe will offer practical and effective ways of improving competition and ensuring private patients get a better deal. Requiring operators to sell hospitals is a big step and we have focused on those areas where a sale will be effective in increasing competition – where a single operator owns a cluster of hospitals which face little rivalry."

 

The commission, which publishes its final recommendations in late March, estimates that the three largest hospital groups made excess profits of £173m-£193m a year between 2009 and 2011, equivalent to 10% of their revenues.

 

The private health insurer Bupa welcomed the proposals as "a decisive step forward for customers and patients". But the healthcare providers vowed to fight the plans.

 

Stephen Collier, of BMI, accused the commission of failing to grasp how the market for private healthcare worked. He said: "It is a fact that BMI Healthcare's shareholders have taken nothing out of the business they bought in 2006, instead reinvesting every pound earned back into our hospital operating business.

"It is therefore bizarre for the Competition Commission to claim that we are making excess profits and need to sell seven hospitals, a remedy that will have no benefit for patients because there is already sufficient competition and it won't lower costs."

 

Mike Neeb, the chief executive and president of HCA International, said the commission was "threatening unjustified and unfair remedies". He said: "The Competition Commission's provisional recommendations are plainly wrong. The CC's own report acknowledges there are nearly 50 competitors in Greater London. Our ownership of these hospitals encourages competition and drives a higher standard of care among hospitals in the UK."

 

Around 11% of the UK population are covered by private healthcare, mostly through employer schemes. This is the lowest level for more than 20 years, according to the health analysts LaingBuisson, although demand for policies has bounced back since the economic crash led many companies to rein in policies.

 

The Competition Commission also wants to restrict the widespread payment of cash bonuses to doctors for referrals – a practice that encourages clinicians to send patients to particular hospitals.

"Opening up this market to greater competition is not straightforward," said Witcomb. "Neither patients nor GPs have enough information, either on price or quality, to make informed decisions, and high costs and demand stagnation mean that new competing facilities are not going to spring up easily."

Neil Harris

(a don’t stop till you drop production)

Wednesday 15 January 2014

New Year, New Bart's? January 2014 Update.


Here’s the latest update on The Bart’s Health Trust. There is good in the report at last – progress made.

There have been a number of themes in this Blog and its sister over the last year;

1) That there are many indicators of problems in a hospital, one of which is the ‘Never Happen Events’, of which Barts Health had a record number.

2) There is an appalling level of bullying in the NHS and the wider medical profession; of subordinates, women and ethnic minorities which is wrong and outdated.

3) From my experience in a different profession bullying is a useful cover for the dishonest and the incompetent – fearful or intimidated staff are less likely to expose failing colleagues. Bullies are also very unlikely to learn from others.

4) I don’t have proper evidence but in the light of 3) I believe there is a correlation between bullying and low morale and failing hospitals.

Staff at Barts trust living in fear of bullying

 

Ross Lydall, Health Editor

London Evening Standard

 

Published: 14 January 2014

 

Low staff morale and a fear of bullying were today highlighted at London’s biggest NHS trust after a visit by hospital inspectors.

The Care Quality Commission said it was approached by “too many members of staff” about bullying at Barts Health. An internal survey found one in three staff were bullied.

 

Patients using the trust’s six hospitals, which include the Royal London, St Bartholomew’s and Newham, were “at risk of harm” due to equipment not always being “readily available”.

 

However the CQC lifted three warning notices placed on Whipps Cross hospital last June after an earlier inspection had found major concerns in its maternity and older people’s wards.

 

It said the trust, which serves 2.5 million people in east London, provided generally “safe” services but highlighted concerns about staffing levels. It ordered improvements in 15 areas.

 

Professor Sir Mike Richards, CQC’s chief inspector of hospitals, said: “We found that Barts Health NHS Trust was, in the main, providing services that were safe.

My team identified a number of areas of good practice and the majority of patients we met were complimentary about the way they had been treated by staff.

 

“On a more negative note, we found that staff morale was low. Too many members of staff of all levels and across all sites came to us to express their concerns about being bullied, and many only agreed to speak to us in confidence.

 

“The trust needs to take action to make sure people feel confident to speak up.”

 

The trust, formed in April 2012 by merging three hospital groups, is axeing more than 200 nursing and managerial posts and downgrading 460 further nursing posts.

 

It had been targeted because of poor outcomes for cancer patients, delays in accident and emergency, financial troubles and a high number of “never events” — clinical blunders that should never happen, such as swabs being left inside patients.

 

Inspectors were informed that, because some staff spoke limited English, communication was difficult and could place patients at risk.

 

A healthcare assistant at the Royal London was asked to contact an anaesthetist in an emergency but did not do so because they did not understand the term.

 

Barts said the report was “tough but fair”. The trust said in a statement: “It recognises our challenges, where we have made progress, some of our areas of good practice, and confirms the care, commitment and compassion of our staff.

 

“We are reaffirming very strongly that bullying has no place at Barts Health, and staff are strongly encouraged to raise any concerns they have about their workplace or the care provided to our patients.”

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Contact: neilwithpromisestokeep@gmail.com
 

Friday 3 January 2014

A third of G.P's are lazy so and so's - survey result.


This article from ‘Pulse’ and the survey result really worries me – on a number of levels.

1) Delays at Accident and Emergency departments are not caused by people attending with a sore throat. These days most A and E’s have a triage system which means that a nurse diverts those problems away. The delay’s are caused by lack of beds (that is a lack of wards, nurses, doctors) to admit patients. If you attend with a cut finger, you aren’t going to get onto the 4 hour time limit in the first place.

2) It is sad that a third of G.P’s want to abandon the central ideal behind the NHS that it is free at the point of contact and that patients are treated according to need and not to ability to pay.

3) The charge only works if it dissuades people from attending for treatment – that means a percentage will not seek treatment when they really need it.

4) Surveys have revealed a similar % of G.P’s want to charge patients from attending their surgeries for the same reasons. That third obviously would rather sit around noodling on the net rather than treating any patients at all.

On the other hand, why did none of the major newspapers report that two thirds of Doctors did not want to change the system?

One in three GPs believe charges are most cost-effective way to cut unnecessary A&E attendances

 

3 January 2014 | By Sofia Lind

 

A third of GPs would support charging patients a small fee every time they attended A&E and only refunding it if the visit was found to be necessary, according to a new survey.

 

The poll of more than 800 GPs by Doctors.net.uk found 32% believe a charge of between £5 and £10 would be the most cost-effective way to reduce unnecessary attendances.

 

Some 39% said that placing a GP surgery with extended opening hours alongside every A&E department would help cut unnecessary attendances and hospital admissions, while 11% backed more walk-in centres and 8% called for an improved 111 service.

 

The results come after a Pulse survey conducted last summer found that half of GPs would support charging a small fee for routine GP appointments.

 

But the GPC and the RCGP were both quick to argue against the introduction of charges as a way of managing demand.

 

GPC chair Dr Chaand Nagpaul said: ‘We will not solve the problem by penalising less well off patients by erecting financial barriers within the health service. It could be counterproductive as patients who are deterred from seeking medical attention at A&E may end up becoming more ill, requiring greater hospital care later on.’

 

‘Patients could also inappropriately seek treatment at their GP practice, even if they genuinely need hospital care. This could act as a perverse incentive that sends patients in the wrong direction for their care.’

 

Dr Helen Stokes-Lampard, an RCGP spokesperson and a GP in Lichfield, said: ‘The overwhelming majority of GPs still respect the founding principle of the NHS: that healthcare should be provided free at the point of need.’

 

‘Charging patients for the use of emergency departments would put us on the slippery slope towards the Americanisation of healthcare - where only those who can afford it get the care and attention they need. Doctors have a duty to provide healthcare to patients regardless of their ability to pay.’

Neil Harris

(a don’t stop till you drop production)
Home: helpmesortoutthenhs.blogspot.com

Thursday 2 January 2014

The cost of 111 is getting clearer.


Hangin’ on…

V 111

 

It’s always a bad sign when my Blog produces another bad logo. The NHS 111 service has been a running sore and it will get worse. This article from the Independent misses the point rather.

The service was launched before the pilot schemes to test it out had been completed. The point was to save money – a clinician led service (NHS Direct) was to be replaced by a call centre (111) which had a few back up clinicians.

End result? If in doubt send them to Accident and Emergency.

Solution? More Nurses and Doctors at the Call Centres. Result? It costs a lot more.

 

Cahal Milmo   

 Thursday 02 January 2014

 The service designed to lessen the burden on hospital casualty units by assessing non-emergency cases was thrown into chaos last summer when NHS Direct, one of the main providers, pulled out of its contracts saying it could no longer afford them.

 

An investigation by the British Medical Journal has now established that the cost of re-tendering the contracts is likely to run into millions as managers attempt to reshape the service to meet concerns that it is diverting people to hospitals and needs to improve access to trained clinicians.

In the West Midlands, just one of 11 regions where NHS Direct had won contracts, the cost of securing a new operator has been put at £500,000, leaving the health service with a potential bill of £5.5m if the charge is repeated across the country.

 

Doctors’ leaders and Opposition politicians said that the public was paying the price for the premature launch of NHS 111 and problems persist with the quality of call handling and an over-reliance on computer algorithms. NHS England said it had acknowledged initial difficulties and insisted 111 was now “a stable and improving service”.

 

Andrew Gwynne, a Labour Health spokesman, said: “It is now clear that ministers wasted millions on flawed contracts. We warned the Government at the outset that 111 was fundamentally flawed but they pressed ahead with the rollout regardless.

 

“Now, profits are being put before patient care as private companies run the advice line – with call-centre operators directing too many to A&E. Patients in large parts of England still face uncertainty over their 111 line.”

 

NHS Direct, which ran the original health service helpline, won nearly a quarter of the 46 contracts across England to provide the 111 service from Merseyside to Cornwall. But it announced in July that the contracts, which covered more than a third of the population, were “financially unsustainable”.

 

The organisation, which will now close after running up a £26m deficit, denied that it had deliberately underbid for the contracts despite evidence unearthed by the BMJ that it had underpriced the cost of running NHS 111 by as much as £30m and launched in some areas with a quarter of the recommended staff.

 

Dame Barbara Hakin, chief operating officer at NHS England, acknowledged that at the launch of the service some NHS 111 call centres had not been properly staffed and there had been an increase in A&E attendances but the issues had been “very shortlived”.

 

She added: “NHS 111 is now a stable and improving service and we are confident it will continue to get better.”

 

The award of the new contracts has been delayed until 2015, leaving a number of “step in” providers, dominated by NHS ambulance trusts, to manage 111.

Neil Harris

(a don’t stop till you drop production)