From here to Maternity.

I have posted numerous articles about the sexist attitude of NHS management to maternity services.

I have never understood why, after Accident and Emergency departments, that management, the NHS and government are so keen on closing maternity units.

The argument is always that bigger means more specialised and therefore more specialised staff available at all hours for emergencies. In fact there is no reason why there shouldn’t be specialist centres for dangerous births – but what pregnant people want is a maternity unit close to home, as a part of the community. And part of the community should be the midwife. Who knows, people might even want to have their baby at home, supported by a local midwife – when it’s safe.

This Guardian Society article shows how dangerous the cuts are getting, and doesn’t even deal with the closures.

By the way, this week it was revealed that the insurance premium the NHS pays for each birth is £700, such is the level of costly negligence.

Perhaps that’s why managers are so keen to close maternity units, rather than to improve them.

Oh and we should find a new job title – midwife is sexist and demeaning in this age. A new title would mean greater equality, respect and status – which would help with recruitment of both men and women for a start.

Half of NHS regions cut maternity funding despite baby boom

Five of 10 English regions see reductions of up to 15% in 2012-2013 compared with previous year

Denis Campbell, health correspondent

The Guardian, Wednesday 13 November 2013

 

The NHS has cut its funding for maternity care in half of England's health regions, despite births being at their highest in 40 years and childbirth services being understaffed.

The amount of money going to maternity units in five of the NHS's 10 English regions of the country fell by up to 15% in 2012-13 compared with the previous year. The East Midlands saw the biggest drop. NHS primary care trusts in the region spent £210m on maternity services in 2011-12 but that fell by 15% to £177m last year, according to official figures obtained by Andrew George, the Liberal Democrat MP for St Ives, in a parliamentary question.

London also saw a drop of 6% over the same period, from £526m to £494m, despite having one of the fastest rising birthrates in England. Spending also fell, though by smaller amounts, in the NHS's north-east, south-west and Yorkshire and the Humber regions.

The Department of Health disclosed to George, a member of the Commons health select committee, in a separate answer that only one NHS region has enough midwives to deliver the recommended staffing levels for mothers.

Health organisations recommend that each midwife should handle no more than 28 births a year in order to help ensure safe high-quality care for women. However, in 2012 only the north-east reached that level, with a rate of 28.1 births per full-time equivalent midwife.

Maternity units in the NHS South Central region are furthest away from meeting that target, with each midwife handling 40 births last year. But the south-east (36.2 births each) and east of England (35.8) were also nowhere near the figure.

In addition, although spending on maternity care across England rose from £2.53bn to £2.62bn between 2010-11 and 2011-12, it slipped last year to £2.58bn.

That represented 2.5% of total NHS spending, down on 2.6% in 2011-12.

Cathy Warwick, chief executive of the Royal College of Midwives, who published George's findings, said they were "worrying", given that the baby boom and increasing complexity of women giving birth was putting serious pressure on maternity units and midwives.

 

"There is not one midwife practising today who has seen this level of births and demands on maternity services. Midwives are far too often telling me of the unprecedented demands on their time and their struggle to deliver the safe, high-quality care they aspire to", Warwick added.

 

Health minister Dr Dan Poulter, who also still works part-time as an obstetrician at an NHS hospital in London, admitted that there was an "historical shortage on the ground in midwives" and that the best way to improve care was to "get more bodies on the ground".

The National Childbirth Trust, the baby and parenting charity, accused ministers of breaking pledges to improve maternity care. "It makes no sense that, while birth rates are rising, maternity services are being cut back", said Belinda Phipps, its chief executive.

"It is shocking to find that just one English region is meeting recommended staffing levels for maternity care and particularly disappointing after the pledges made by the government to increase midwife numbers", she added.

Andy Burnham, the shadow health secretary, said new mothers were paying the price of the coalition's £3bn controversial shakeup of the NHS earlier this year.

"Maternity units are already operating without enough staff and they fear what these budget cuts will mean. David Cameron promised thousands more midwives, but he's failing to deliver them."

 

Poulter said that hospitals had to ensure that they had enough staff to ensure mothers got good care. Midwife numbers had risen by 1,300 since the 2010 election, and those in training by 5,000, he said.

Neil Harris

(a don’t stop till you drop production)

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First study on the non-emergency 111 scheme.

Hangin’ on…

V 111

I protested, then I grumbled – it didn’t do any good. The excellent NHS Direct was closed down at great expense by NHS England to save money and reduce the numbers attending Accident and Emergency.

Now Sir Bruce Keogh has recommended that the 111 non-emergency line be upgraded with adequate numbers of clinical staff – in effect going back to a poorer version of of NHS Direct.

Now we know why;

The next day out comes a properly researched report from, of all places The Department of Health who evaluated the 4 pilot areas results.

Of course, you and I would have carried out a pilot, evaluated it and then decided whether to roll it out nationwide.

The findings were that emergency ambulance call outs did not fall (why would they?) in fact they rose by 3 %.

The numbers attending A and E rose.

Nice one.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Sir Bruce Keogh - could do better.

Some of you will realise that compared to the truly dreadful Sir David Nicholson (Chief executive NHS England) so often described as ‘The Man with no Shame’ I hold Sir Bruce Keogh in some regard. He’s the NHS England Medical Director and has different priorities.

He’s just issued a report on Accident and Emergency treatment and it’s quite good. ‘Quite’ because I have some issues, good because it is at least intended to improve things.

1) Reduce the number of A and E’s dealing with Strokes, Heart Attacks and Trauma.

Great idea – in London the number of Stroke units were reduced from over 20 to 8 with the result that the death rate fell dramatically and outcomes improved.

For these three areas specialising works really well, getting early, good treatment is vital.

Before stroke victims waited all weekend for someone to turn up – by then it was too late. Heart Attacks are not the killers they were because of specialisation. Complex trauma needs highly skilled surgeons.

2) A revamped and improved 111 service – with more clinicians and Nurses available on the phone to reduce the number of A and E admissions. Great idea – that’s what we were arguing for when NHS England closed down NHS direct which did that.

Sir David Nicholson – well done again. You just finished off NHS Direct and still have time to watch the failing 111 service being turned back into a pale shadow of NHS Direct at enormous public expense to try and put right another mistake of yours.

3) Improved paramedics, dealing with more cases at home rather than taking them to A and E – who could object to that.

Problems;

1) Where I have a real problem was watching Sir Bruce on a ‘Newsnight’ interview last night. He repeated the nonsense that 40% attending A and E do not need to do so.

It’s nonsense because no one knows that until after the event. The 40% includes all who attend with suspected broken bones for an X-Ray, the abdominal pains, the suspected thrombosis etc. All require tests no Doctor does or paramedic can do. Failing to send those people in for the tests is just negligent; no Doctor would take the risk. So the 40 % includes those who needed a test but luckily they then didn’t need treatment.

2) Keogh expects to downgrade 70 out of 170 A and E’s.

The problem with that is that we have a pretend market not planning. It won’t be the best A and E’s that survive it will be the pushiest, grabbiest Foundation trusts. The others will lose the revenue from admitted patients and decline further.

Losing Cardiology, Stroke and Trauma will remove a massive proportion of any hospitals revenue and that means more closures.

No planning means no concern for local communities and no real search for expertise.

PFI contracts are so binding (an act of parliament could easily unbind them) that being lumbered with a catastrophic PFI is likely to safeguard a poor and inefficient hospital rather than ensure that quality survives.

So Sir Bruce, this paper doesn’t get full marks from me, which is a shame. You were doing quite well up till now. Don’t forget that while you may be thinking about best practise, the managers are only thinking about money.

Neil Harris

(a don’t stop till you drop production)

If you also look at helpmesortoutstpeters.blogspot.com I warn you that tomorrow this article will be repeated - I'm not so well at the moment and the Doctors seem to be out for revenge! Normal service will soon be resumed.

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NHS nursing shortages.

On Tuesday 12 November 2013, The Royal College of Nursing issued a valuable report on nursing vacancies. Using Freedom of Information legislation the union found that average vacancy rates at hospitals are around six per cent.

Extrapolating the figures from the 61 NHS trusts that replied, the College said this would amount to nearly 20,000 full-time equivalent nursing, midwifery or health visitor vacancies over the whole country.

Dr Peter Carter, chief executive and general secretary of the RCN, said: “Understaffing remains a real issue across the NHS, and we know that many trusts are down to the bone in terms of the number of frontline nursing staff they have due to cutting posts to save money.

“Unsafe staffing levels have been implicated in a number of high-profile investigations into patient safety. We call on employers in the NHS to put an end to boom-and-bust workforce planning and develop clear standards to ensure safe staffing levels are met, supported by robust inspection based on reliable data.”

 

All the reports into NHS scandals – The Francis Enquiry, the investigation onto the 14 failing trusts, have all highlighted that inadequate staffing levels result in poor care and worse outcomes. They also stress out staff.

The Francis report argued for minimum levels of staffing – something the government has refused to consider.

As the waiting times in Accident and Emergency grow, the reason is not a ‘shortage of beds’ as is often said – this is not true. There are plenty of empty beds and empty wards. Every so often they shut a hospital because there are so many closed wards. The shortage of beds is because there is a shortage of nurses – staff who leave aren’t replaced.

Worse than that, the RCN pointed out that “the Department of Health stopped collecting vacancy data in 2011, when vacancy rates for nurses stood at 2.5 per cent”.

Neil Harris

(a don’t stop till you drop production)

Janice Harry gets away with it.

There you are, you are a nurse and you rise to become Director of Nursing and Quality Assurance, then you get made Director of Clinical Standards as well as becoming Chief Nurse and Infection Prevention and Control Director.

These aren’t everyday nothing jobs: in a hospital they matter. They are well rewarded with a salary and benefits that matches the responsibility.

In fact the nurse was Janice Harry and she did those jobs for Mid-Staffordshire NHS Foundation Trust and its predecessor between 1998 and 2006. She was a bully to her fellow staff and presided over a culture of neglect and cruelty towards her patients.

This week she was convicted by the Nursing and Midwifery Council of misconduct – she failed to ensure there were enough staff on wards, put patients lives at risk, failed to ensure patients were fed or given water.

People died – between 600 and 1200 of them according to statistical analysis and government reports and while she was not responsible for all of those deaths, she was certainly responsible for a number of them.

The penalty? - ‘A caution’ for five years.

That means she can continue to practice as a nurse, be an NHS manager or do similar work in the private sector or care industry.

It is unbelievable that she will enjoy comparable earnings, have a big fat NHS pension and be able to go on as if she had done nothing wrong.

My heart goes out to the bereaved relatives and Janice Harry’s unfortunate work colleagues as once again someone like her walks away unpunished.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Another guilty verdict from Mid Staffordshire Hospital Trust.

This is another case from Mid Staffordshire Hospital, taken from The Independent newspaper today based on a Press Asssociation report.

At least this is a ‘manager’ in the firing line – but no sentence yet.

Also where were the Doctors when this was happening?

 

 

Stafford Hospital former chief nurse Janice Harry found guilty of misconduct

 

Ella Pickover  

Wednesday 06 November 2013

 A former chief nurse at scandal-hit Stafford Hospital has been found guilty of misconduct.

Janice Harry's fitness to practise is "currently impaired", a Nursing and Midwifery Council (NMC) panel ruled.

 

Yesterday the disciplinary panel concluded that Mrs Harry had exposed patients to danger during her time at the hospital.

 

By not ensuring that there were adequate nursing staff on a number of wards, Mrs Harry put patients at risk, the panel ruled.

 

Between 1998 and 2006, Mrs Harry failed to ensure there were adequate numbers of nurses working in the accident and emergency department, the emergency admission unit (EAU) and another ward, they said.

 

Mrs Harry was criticised for not ensuring that her colleagues provided patient dignity and privacy in the EAU between 2004 and 2006.

 

The nurse also failed to ensure there was appropriate food and drink in the unit, the panel concluded.

 

She will also be reprimanded for using inappropriate language towards a colleague after telling her that she was a "waste of space".

 

Mrs Harry was employed by Mid Staffordshire NHS Foundation Trust and its predecessor Mid Staffordshire General Hospitals NHS Trust from 1998 to 2006. From 1998, she was director of nursing and quality assurance at Stafford Hospital and in 2002 was appointed director of clinical standards and chief nurse as well as director of infection prevention and control.

 

The panel will now decide what sanctions to impose on the nurse.

 

Stafford Hospital was at the centre of a major public inquiry after it was found that poor care could have led to the deaths of hundreds of patients as a result of maltreatment and neglect.

 

The inquiry highlighted the "appalling and unnecessary suffering of hundreds of people" at the trust and investigations into the scandal revealed that many patients were left lying in their own urine and excrement for days, forced to drink water from vases or given the wrong medication.

I don't think we should quickly forget Janice Harry’s contribution to human well being.

Neil Harris

(a don’t stop till you drop production)

The Colchester General Scandal.

This article from BBC News is, as their medical correspondant says “Truly shocking”.

Colchester General Hospital escaped ‘Special measures’ in the Keogh review even though it had worrying death rates.

Union activists have been trying to get some things changed without success but a whistleblower exposed the Trust to the Care Quality Commission – they were altering cancer patients waiting times because there are national targets that patients are seen within time limits or the trust gets into trouble.

What does management do? It fixes the figures.

I’ve (up till now) opposed the police being called in – not this time.

We’ve had ‘coding’ scandals, we have the scandal of Accident and Emergency finding tricks to avoid triggering the 4 hour time limit by keeping patients out side as long as possible or dumping patients in ward corridors.

It’s all about fixing the figures not fixing the medical problems.

This cost lives;

Nick Triggle

BBC Health correspondent

Colchester General Hospital was tampering with records, inspectors say

News that a hospital has been tampering with patient records to improve its waiting times for cancer treatment, potentially putting patients at risk, is truly shocking.

The issue is so serious that the police have been asked to investigate Colchester General Hospital.

Such a situation is unprecedented in the NHS - and as a result the temptation is to dismiss it as a one-off that should be seen in isolation.

Unfortunately, it would be complacent to do so.

What this case demonstrates is the problem inspectors have in identifying some issues in organisations as complex as hospitals.

The Care Quality Commission did not find the dodgy records. It was told where to look.

During the spring Colchester was subject to an inspection as part of the Keogh Review into mortality rates.

The review - launched after the Stafford Hospital public inquiry - investigated the 14 trusts with the highest death rates.

Problems were identified, including with the ways complaints were handled, staffing rates and leadership weaknesses, but not this.

The concerns that were identified were not even considered important enough for Colchester to be placed in special measures.

When the results of the review were announced Colchester was one of only three trusts that escaped the sanction.

But towards the end of the Keogh process a whistleblower raised concerns about the tampering of records.

This was passed on to the CQC which carried out its own inspections in August and September.

These led to Tuesday's report that showed different information was being entered into the hospital's system than was on the patients' notes so their cancer performance data looked better than it was.

The trust has now been placed in special measures and the management of the trust is being reviewed.

But to make matters worse, the trust had also carried out its own probe in early 2012 after concerns were raised by admin staff in the cancer department.

It did not identify serious problems, but the trust now accepts the issue was "not properly investigated".

The fact that concerns had been aired but not properly looked into has chilling echoes of the Stafford Hospital scandal.

Christina McAnea, head of health at Unison, whose members raised the alarm, says: "They raised their concerns repeatedly and in emails to senior managers, right up to the chief executive, but they were ignored."

Last week a review of complaints by the Labour MP Ann Clywd said the culture of "delay and denial" had to end.

The Colchester case shows just how far the NHS has to go.

Neil Harris

(a don’t stop till you drop production)