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End Of Life care letting people down

Thousands of dying patients are being let down by poor End Of Life care provision according to the Parliamentary Health Service Ombudsman (PHSO)

End Of Life care letting people downThe health ombudsman’s report detailed “tragic” cases where people’s suffering could have been avoided or lessened.

The Parliamentary and Health Service Ombudsman has investigated 265 complaints about end-of-life care in the past four years, upholding just over half of them.

Its Dying Without Dignity report said it had found too many instances of poor communication, along with poor pain management and inadequate out-of-hours services.

One mother told the ombudsman how she had had to call an A&E doctor to come and give her son more pain relief because staff on the palliative care ward he had been on had failed to respond to their requests.

In another case, a 67-year-old man’s family learned of his terminal cancer diagnosis through a hospital note – before he knew himself. This “failed every principle of established good practice in breaking bad news”, the report said.

“There was an avoidable delay in making a diagnosis,” it added. “An earlier diagnosis would have meant opportunities for better palliative care.”

Ombudsman Julie Mellor said that the report made “very harrowing reading”.

She also urged the NHS to learn lessons from the report, adding: “Our casework shows that too many people are dying without dignity.

“Our investigations have found that patients have spent their last days in unnecessary pain, people have wrongly been denied their wish to die at home, and that poor communication between NHS staff and families has meant that people were unable to say goodbye to their loved ones.”

Macmillan Cancer Support chief executive Lynda Thomas said: “The report cites heartbreaking examples of a lack of choice at the end of life that are totally unacceptable.

“If we are to improve the current situation, we will have to see a dramatic improvement in co-ordination of care, and greater integration of health and social care.”

The chief inspector of hospitals at the Care Quality Commission, Prof Sir Mike Richards, said the organisation had seen examples of excellent end-of-life care, but also instances where it had not been given enough priority.

He said the CQC would continue to highlight those services that were failing.

Health Direct laments “These are appalling cases – everyone deserves good quality care at every stage of ones life- but at the very end of the life dignity should be paramount.”

Stepping Hill nurse guilty of murder

Stepping Hill nurse Victorino Chua has been found guilty of murdering patients.

Stepping Hill nurse guilty of murderA nurse has been convicted of murdering two patients and poisoning 20 others at a Greater Manchester hospital.

Victorino Chua killed Tracey Arden, 44, and Derek Weaver, 83, at Stepping Hill Hospital in Stockport by injecting insulin into saline bags and ampoules.

These were then unwittingly used by other hospital nurses on Chua’s victims, who were mostly elderly.

The father of two, 49, who was cleared of a third murder charge, left one patient with a serious brain injury.

Chua, who was found not guilty of the murder of 71 year old Arnold Lancaster but convicted of poisoning him, showed no emotion as the verdicts were passed.

Police and prosecutors have also now revealed concerns over whether Chua was even qualified to work as a nurse in the UK.

The poisoning took place on two wards, often used for treating elderly patients with complex illnesses, between June 2011 and January 2012.

After police were called in, Chua was said to have “changed tack” by sabotaging prescription charts, doubling and trebling dosages.

Among the evidence produced by the prosecution was a self penned letter found at Chua’s home in Stockport.

In the letter, described as “the bitter nurse confession” by Chua, he said he was “an angel turned into an evil person” and “there’s a devil in me”, who had things he would “take to the grave”.

The prosecution argued the Filipino national had decided to take out his personal frustrations on patients “for reasons truly known only to himself”.

However, after 11 days of deliberations, the jury at Manchester Crown Court found Chua had indeed murdered two of his patients and caused harm to many others.

Greater Manchester Police (GMP) said it was their “biggest case in a decade”. Police and detectives hugged members of the legal team after the jury left court.

Ben Southam, from the Crown Prosecution Service (CPS), described the “complex case” as an “enormous task” involving thousands of pages of evidence.

It took Greater Manchester Police three years to solve this case, which they said was like putting together a million piece jigsaw. They had to interview hundreds of staff members and monitor hundreds of hours of CCTV.

But every single incident of poisoning had one common denominator – it led to Victorino Chua.

The court was told Chua would become angry with the families of his patients, and when his professionalism was questioned he decided to take it out on the people under his care.

Chua always said he was a great nurse and the patients loved him. But the truth was in a letter found at his home, in which he said “inside of me is a devil and, if pushed, they will be sorry”.

Chua was found guilty of a total of 33 charges: two counts of murder, 22 counts of attempting to cause grievous bodily harm, one of causing grievous bodily harm, seven of attempting to administer a poison and one of administering a poison.

The other victims of saline poisoning were Arnold Lancaster, 81, Josephine Walsh, 69, Jack Beeley, 72, Linda McDonagh, 59, Joseph “Eric” McDonald, 66, Antony Smith, 47, Joyce Atherton, 81, Beryl Hope, 70, Doreen Brace, 87, Kathleen Murray, Lillian Baker, 85, Beatrice Humphreys, 84, Mary Cartwright, 88, Lillian Armstrong, 83, Philip Jones, 67, William Dickson, 82, Daphne Harlow, 86, and 24 year old Zubia Aslam.

Younger people having more strokes

There has been a big rise in the number of working age men and women having stroke.

big rise in the number of working age men and women having stroke.In England in 2014 there were 6,221 hospital admissions for men aged 40-54 – a rise of 1,961 on 14 years earlier according to reserach by the Stroke Association.

Experts said unhealthy lifestyles were partly to blame for the rise, though the growing population and changes to hospital practice also played a part.

Researchers say based on their findings strokes should not be considered as a disease of the old.

Strokes are caused by blood clots or bleeds to the brain and can lead to long lasting disability.

The majority occur in people aged over 65, and though rates are decreasing in this group, this report suggests growing numbers of younger people are at risk.

Experts analysed national hospital admission data spanning 2000 to 2014.

These findings highlight the importance of ensuring your blood pressure and cholesterol are under control, as well as having a health check at the age of 40.

Trends for people in their 40s and early 50s appeared to be getting worse. In women aged 40-54, there were an extra 1,075 strokes recorded in 2014, compared with 2000.

Experts said growing obesity levels, sedentary lives and unhealthy diets – which raise the risks of dangerous blood clots – all played a part.

And they argued strokes among this age group had long lasting personal and financial impacts on individuals and their families, as well as on the economy.

Recovering patients can find it difficult to return to work and should have more support from employers, the report suggests.

Jon Barrick, of the Stroke Association, said: “These figures show stroke can no longer be seen as a disease of older people.”

“There is an alarming increase in the numbers of people having a stroke in working age. This comes at a huge cost, not only to the individual, but also to their families and to health and social care services.”

The Stroke Association said that even younger people should be aware of the warning signs such as dizziness, difficulties with speech and changes in the face.

The NHS- how big should the National Health Service be?

The National Health Service was founded in 1948 with 144,000  health professionals.

The NHS- how big should the National Health Service be?In less than seven decades that figure has risen tenfold to over 1.4 million staff across the UK.

But with all the political parties promising more health workers in the coming years -just how many doctors, nurses, porters, therapists and managers does the NHS need?

Ask the experts and they will say something like 8,000 more GPs, 20,000 more nurses and 3,000 more midwives.

Unsurprisingly, these are the figures that are – more or less – being promised by politicians in this election campaign.

But how certain can we be that this right? After all, we live in an era of huge technological change that surely could revolutionise the way the system works?
NHS staff and workforce pressures in numbers

  • When the NHS was created nearly half of people died before the age of 65, today just 14% do.
  • In 1948 the NHS employed 144,000 staff. There are now about 1.4 million.
  • The consultant workforce grew by 54% between 2002 and 2012 and annual growth of 4% is predicted until 2020.
  • In 2012, almost 50% of the nursing workforce was aged 45 or over, compared to 33% in 2002.
  • The number of over 85s has more than doubled since 1981 to 1.4 million. In 20 years time there will be 3.6 million.
  • The NHS in England spends £5 billion a year on education and training.
  • Currently, face-to-face contact accounts for nearly 90% of all healthcare interactions.

But the potential for digital technologies and even simply increasing the amount of email, Skype and phone consultations could make a big difference.

In the US, the health company Kaiser Permanente has reduced the amount of GP visits being made by a quarter through greater use of phone and email.

Meanwhile, hospital doctors and nurses in West Yorkshire have set up video linkups with local care homes and reduced admissions by 35%.

There is also the potential for more self management of illness, while the use of sensors and alarms in the home can make a big difference to the amount of home visits needed to check in on the frail elderly.

Even so, some have doubts about just how much of a revolution there will be.

Nigel Edwards, chief executive of the Nuffield Trust think tank, says: “It doesn’t look like technology will be the breakthrough it has been in other industries. Health and care is pretty labour heavy – that means having people on hand.”

Instead, he says, perhaps the more pressing issue is what sort of staff are actually needed.

The NHS review is a question posed by Health Education England’s 5 year workforce strategy document published in October and posted by Health Direct at: NHS needs extra cash and overhaul claim health bosses

It doesn’t make any firm predictions and instead acts as a discussion document, listing a host of factors likely to mean more staff have to be taken on, including the ageing population and the high numbers of staff reaching retirement age.

But it says if the drive to move care out of hospital and into the community is to be successful, it will require staff roles to change.

Alcohol detox centre saves NHS millions

The NHS could save £27 million a year by changing the way it deals with alcoholic patients.

Alcohol detox centre saves NHS millionsAlcohol abuse costs the NHS £3.8 billion a year, £145 for each UK household. One in three of all A&E admissions are alcohol related- but on a weekend that can rise to 70%.

Dr Chris Daly, the lead consultant at the unit, believes the NHS is wasting money by often treating people for the effects of alcohol problems without dealing with the underlying problem.

“We were very surprised that a significant proportion, maybe as much as 50% of the patients that we see, were not open to any services and some of them had never been seen by alcohol services before, so it’s almost as if we’re dealing with a different sort of population,” he says.

“These are people who are maybe only using their A&E department as their main source of treatment for their alcohol problems.”

The Radar ward at Chapman Barker is the first of its kind in the UK. Set up three years ago it takes alcohol dependent patients directly from 11 A&E departments across Manchester.

Some 75% of the people who come through the unit do not go back to hospital for at least the next three months.

The Radar ward is split with separate eating and living spaces for both sexes. Four in 10 of the places here are taken by women, from teenagers right up to pensioners in their 80s.

Patients are treated with talking therapies, support and counselling, but also specialist medical care they would not always get in a large hospital.

Around half of all alcohol dependent patients can develop clinical symptoms when they try to quit, including seizures, fits and hallucinations.

Without the right support the most severe cases often end up back in hospital.

An independent analysis of the unit by academics at Liverpool John Moores University published in April 2015 found it saves the NHS £1.3 million a year.

If the same approach was taken across the country the researchers say it could save the NHS £27.5 million in England alone.

This unit has secured funding to operate for another year but the future is always uncertain. The people working there say ignoring these patients will cost the NHS more in the long run.

Health Direct repeats numerous research warnings that alcohol is the drug that causes the most damage to the UK population- so anything that curbs preventable crisis is to be welcomed.

GP services face retirement crisis

GP services are facing a crisis- with a third of doctors considering retirement in the next five years a BMA poll suggests.

GP services face retirement crisisThe survey of more than 15,000 UK GPs also found over a quarter were considering working part time and one in 10 said they were thinking about moving abroad.

BMA GP leader Dr Chaand Nagpaul said the findings showed some of the promises being made about doctors by politicians were “absurd”.

Improving GP care has been one of the major themes of debate in the election, with the Conservatives promising seven day access to services and Labour pledging a 48-hour waiting-time guarantee.

The findings are in the second tranche of results from the BMA’s poll of GPs, in which nearly a third of doctors in the UK took part.

Last week the BMA released figures suggesting excessive workloads were harming care. This batch of results focused on the effect those rising demands were having. It suggests:

  • 34% of GPs are considering retiring from general practice in the next five years
  • 28% of those working full-time are thinking about moving to part-time
  • 9% are considering moving abroad
  • 7% are considering quitting medicine altogether

They also cited various factors that had a negative impact on their commitment to being a GP, including:

  • excessive workload – 71%
  • unresourced work being moved into general practice – 54%
  • not enough time with their patients – 43%Dr Nagpaul said: “This poll lays bare the stark reality of the crisis facing the GP workforce.

“It is clear that incredible pressures on GP services are at the heart of this problem, with escalating demand having far outstripped capacity. GPs are overworked and intensely frustrated that they do not have enough time to spend with their patients.”

“In this climate, it is absurd that in the recent leaders’ debate, political parties were attempting to outbid each other on the number of GPs they could magically produce in the next Parliament. Since it takes five to eight years to train a GP, it is not possible to create thousands of GPs in this timeframe.”

Katherine Murphy, of the Patients Association, said: “We know from the many calls to our helpline that patients are not able to access GP services at times when they need to.”

“What patients want is a clear and firm commitment that GPs now and tomorrow will have the resources to meet their needs.”

“Anything less is just not acceptable. We need a 21st Century primary care service with access 24/7.”

There are currently 9,000 GPs in training, although 14,000 doctors – about four in 10 – are over the age of 50.

Hospital charges to rise for non EU patients

Visitors from outside the EU who receive treatment in NHS hospitals in England are now charged 150% of the cost.

Hospital charges to rise for non EU patientsThe charges however only apply to non EU citizens settling in the UK for longer than six months. The new rules from the Department of Health came into force on 6 April.

However primary care and Accident and Emergency treatment will continue to remain free.

Permanent residents of 32 European countries qualify for NHS treatment, which is then billed to their country of residence, but this new ruling applies to foreign migrants or visitors based in other countries, mainly those outside the EU.

These patients can be treated in an NHS hospital but are expected to repay the cost of most procedures afterwards.

But up to now, the DoH has only sought to reclaim the actual costs, without adding any extra charges.  The DoH hopes the changes will help it recoup up to £500 million a year by 2017-18.

The new guidelines do not require patients on trolleys in hospitals to produce passports before getting access to urgent care. Nor do they apply to accident and emergency or a visit to a GP.

What is covered is ongoing treatment on the NHS after an initial diagnosis or referral – for example an outpatient appointment.

The Department of Health is incentivising hospitals to be more vigilant in checking patient credentials by allowing them to charge more for treatment of people “not ordinarily resident” in the UK.

The department can recoup those costs from the patient’s member state if they are from the European Economic Area.

In the paperwork filled in by the patient before the appointment they will be asked for proof they are “ordinarily resident”.

This could be a utility bill, national insurance number or passport details. Some hospitals were doing this already but many were not.

The guidelines are designed to increase the chances that the treatment costs for a non UK resident can be recovered. Critics may ask why it has taken so long for the initiative to be launched.

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

Similar charges can be imposed by the NHS in Northern Ireland, Scotland and Wales for hospital care received by non-EU residents.

Patients using hospital services have been required to show their passports and other immigration documents if their UK residence status was in doubt.

The “health surcharge” on visa applications for non-EU citizens comprises an annual fee of £200-a-year, which is reduced to £150 for students.

Certain individuals, such as Australian and New Zealand nationals, are exempt from the surcharge.

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

New government should boost nurse numbers

Immediate action must be taken by the next government to increase the number of NHS nurses, a report has warned.

New government should boost nurse numbersThe Royal College of Nursing (RCN) said there were fewer nurses now than in 2010 if midwives, health visitors and school nurses were not included.

It said government cuts to nurse training places in 2010 were a significant factor in the shortage.

The Conservatives and Liberal Democrats said they were committed to investing £8 billion each year in the NHS.

The RCN said that while the government claimed the number of nursing posts has increased the actual headcount figure for nurses fell from 317,370 in May 2010 to 315,525 in December 2014.

It described this as “remarkable” given the continued increase in demand for the NHS.

While 50,000 people applied to become nurses last year, there were only 21,000 places – meaning there is no shortage of people wanting to do the job, the RCN said in its report.

It said cuts the coalition government made to student nursing commissions in 2010 led to a reduction of 3,375 places.

The report said that as it takes three years for student nurses to qualify, these cuts are impacting on the supply of nurses right now.

Dr Peter Carter, chief executive and general secretary of the RCN, said: “We warned that cutting the workforce numbers to fund the NHS reorganisation and to find the efficiency savings was the wrong course to take.

“The cuts were so severe that we are only just catching up with where we were five years ago.  Many areas, like district nursing and mental health, are even worse off. While the health service has spent the last five years running on the spot, demand has continued to increase.”

“Whoever forms the next government must learn from this report and take immediate action to grow the nursing workforce, and ensure it can keep up with demand with a sustainable and long term plan.”

The report also said the community nursing workforce had been cut by more than 3,300, despite NHS plans to move care from hospitals to the community.

From May 2010 to December 2014 there has been a 28% reduction in the number of specialist district nurses, a loss of 2,168 posts across England.

A reliance on using agency nurses means that the NHS would have spent an estimated £980 million on them by the end of the 2014/15 financial year, the RCN said.

As with GPs, the nursing workforce is ageing, with around 45% being over 45, the RCN added.

Skin cancer linked to package holiday boom

A boom in cheap package holidays in the 1960s is partly behind the “worrying rise” in skin cancers in pensioners, Cancer Research UK suggests.

Skin cancer linked to package holiday boomThe charity says that although all ages are at risk, many older people would not have been aware of how to protect themselves four decades ago.

Figures show that 5,700 over 65s are diagnosed with the condition each year, compared to just 600 in the mid-1970s.

The condition can often be prevented by covering up and avoiding sunburn.

Around 13,300 people are diagnosed with malignant melanoma – the most serious form of skin cancer – each year in the UK. And 2,100 lives are lost to the disease annually.

Numbers are increasing across all age groups but the steepest rise is seen in over-65s.

The charity said all ages are benefitting from public health messages explaining the dangers of holiday sun.

Professor Richard Marais of Cancer Research UK (CRUK), said: “It is worrying to see melanoma rates increasing at such a fast pace, and across all age groups.”

“It is important people keep an eye on their skin and seek medical opinion if they see any changes to their moles or even to normal areas of skin.”

Research suggests that getting sunburnt just once every two years can increase the odds of developing malignant melanoma.

Dr Julie Sharp, head of health information at CRUK, said: “You can burn at home just as easily as you can on holiday, so remember to spend time in the shade, wear a T-shirt and a hat to protect your skin and regularly apply sunscreen that is at least factor 15 and has four stars.”

Johnathon Major, from the British Association of Dermatologists, said: “The increasing incidence of skin cancer within the UK is alarming.

“As people are living longer, more people are reaching an age where they are at a higher risk. Interest in package holidays and in fashion tanning are among the reasons that more people are developing skin cancer.”

“But it’s crucial to remember that you don’t have to go on holiday or use a sun bed to heighten your risk. Skin cancers can develop as a result of both short term and long term overexposure to the sun’s rays within the UK.”

Cameron promises seven day health services

All hospitals in England will provide “a truly seven day NHS” health service under a future Conservative government.

Cameron promises seven day health servicesMr David Cameron said that more hospitals must provide top-level treatment at the weekend, starting with emergency care.

In a wide ranging speech, he said his party’s message to various sections of the population was: “We’re with you.” This spring forum is about fighting back against Labour on the NHS.

The Conservatives are committing to providing full weekend hospital care in England – in line with the NHS’s own five year plan.

This is an attempt to try to neutralise the NHS and enable the Conservatives to return to what they want to be talking about – the economy.

Speaking at the forum in Manchester, Mr Cameron warned that figures showed patients were “more likely to die” if they were admitted at weekends.

According to the Conservatives, official studies suggest mortality rates for those admitted on Saturdays and Sundays are 11% and 16% higher respectively than for those admitted on Wednesdays.

“For years it’s been too hard to access the NHS out of hours. But illness doesn’t respect working hours. Heart attacks, major accidents, babies – these things don’t just come from nine to five,” Mr Cameron said.

At weekends, he said, “some of the resources are not up and running. The key decision makers aren’t always there.

“With a future Conservative government, we would have a truly seven-day NHS. Already millions more people can see a GP seven days a week but by 2020 I want this for everyone, with hospitals properly staffed especially for urgent and emergency care, so that everyone will have access to the NHS services they need seven days a week by 2020 – the first country in the world to make this happen.”

The Liberal Democrats said NHS England already had plans to open hospitals and GP surgeries seven days a week, while UKIP said the Tories had “degenerated the NHS beyond all recognition” during the last five years in government.

The Conservatives have pledged to guarantee a real-term increase in funding for the NHS during the next Parliament, extending the ring-fence in place for the past five years. Labour has said it will spend £2.5bn more than its opponents.

Health Secretary Jeremy Hunt said government reforms of the NHS were saving £1.5bn a year but that the NHS “will need more money”.

He added that the NHS’s own sums suggested the predicted £30bn annual shortfall could be “reduced with efficiency changes, and we’re backing that plan”.

New clinical standards set out in 2013 require hospitals to provide seven-day access to diagnostic tests, such as X-rays, ultrasound, MRI scans and pathology, as well as providing access to multi-disciplinary teams, which include expert nurses and physiotherapists.

In its blueprint for services over the next five years, published last October, NHS England said hospital patients should have access to seven day services by 2020. “

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