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Workplace unhappiness 'growing'
Thursday 4 September 2008
Underpaid, overworked, and fed up with work - those are the rising feelings of millions of employees, according to a new survey carried out by the TUC.
A survey of 2500 workers by pollsters YouGov, for the union movement, has suggested a mood of growing disenchantment in the workplace.
It painted a picture of workers having to work harder and longer while seeing their pay cut in real terms.
The TUC said the results would be "challenging" for employers.
Workload grievance
The TUC published the research ahead of its annual congress in Brighton next week.
Nearly half of workers, or 42%, questioned believe they are now worse off because their pay has not kept pace with the rising cost of living.
And nearly a third, or 31%, feel they do not get the same pay as people doing similar jobs for other organisations.
But the commonest complaint concerns workloads, with 46% saying the amount of work asked of them has risen.
This, in turn, is linked to an increase in both stress levels (39%) and working hours (23%).
Training and progression are other key areas of grievance.
While 30% complained of poor promotion prospects, 27% – which if extrapolated to the whole of the working-age population would be equivalent to seven million people – said they lacked training.
Significant minorities of the workforce complain of serious problems.
14% of those asked - which, if extrapolated would be equivalent to three and a half million people or one in seven of the active workforce - say they have been bullied in their current job.
Staff engagement
If other findings are extrapolated, just under two and a half million say where they work is unsafe while more than one and half million say they have been unfairly disciplined.
The most commonly reported discrimination is on the grounds of age which is complained of by 640,000.
Nearly six million say they suffer from boring or repetitive work.
"There are some challenging figures here for British employers," said TUC General Secretary Brendan Barber, "with a quarter of the workforce saying they are not satisfied with their jobs and almost one in three saying that their employers do not engage with them".
"While most employees are reasonably content with their lot, there is clearly a minority who are suffering from real problems such as bullying, dangerous workplaces and unfair discrimination."
"There may be no magic bullet for improving Britain's productivity, but without engaging staff and providing the training and advancement opportunities they want we do not have much chance".
Source: BBCOperating department practitioner struck off for failing to disclose convictions
Thursday 4 September 2008
Richard Cox, operating department practitioner, has been struck off the HPC Register for failing to disclose his conviction to the HPC and his employer, Sandwell and West Birmingham NHS Trust.
A panel of the HPC Conduct and Competence Committee heard when the lead practitioner for main theatres and surgical day unit theatres at the Trust had notified the police about missing drugs from the operating theatre, a list of all staff working on the relevant shifts was provided to the police. As a result of the police investigation the trust was informed that Richard Cox had a conviction.
The panel were also presented with a copy of the HPC registration/readmission form signed by Richard Cox and found that he failed to disclose his conviction.
Panel Chair, Martin Ryder commented:
The Panel concluded that the registrants conviction for matters of dishonesty and deception fell well below the standards of honesty and integrity expected of a registered health professional. It was a matter of serious concern that the registrant had secured registration as an operating department practitioner on the basis of dishonesty and deception
The panel decided the most appropriate action was to strike Richard Cox from the Register.
Richard Cox was not present at the hearing.
Time running out to apply for Eastwood Park's Medical Technologies Foundation Degree
Wednesday 27 August 2008
Applicants are urged to apply now for the new Medical Technologies Foundation Degree from Eastwood Park, which goes beyond the level 3 NVQs previously available in servicing and the decontamination of medical equipment. The closing date is end of September for those wishing to start the degree this October (2008).
Health and Safety law demands an appropriate level of competence and qualification for the decontamination and maintenance and repair of medical devices and gas technologies. Although NVQ levels 2 and 3 have been available for some years, the Foundation Degree was only developed last year in partnership with Kingston University and in association with the Sector Skills Councils for Health and SEMTA, the Department of Health, IHEEM and the IDSc.
Already over 25 students are taking part in the two-year programme, which is most suitable for current and aspiring managers, supervisors, test persons, authorised persons, engineers and senior technicians working in the areas of medical equipment, device decontamination and gas technology.
The advantage of this qualification is that it can be studied on a flexible basis through a blend of learning methods. Elements of the programme can be studied in the workplace, at home and at Eastwood Park.
All Foundation Degrees are university validated and provide a route to progression to the third year of one or more Honours Degrees. This foundation degree also relates to the Voluntary Register of Clinical Technologies and membership of relevant professional bodies.
For more information or to apply, call 01454 262 777 or visit www.eastwoodpark.co.uk/training.Roadshow aims to find technology to beat hospital bugs
Wednesday 27 August 2008
Healthcare businesses which have technologies that could help prevent the spread of MRSA or other hospital bugs are being invited to attend an NHS roadshow.
The events, at locations around the UK, are part of an NHS programme to find the most effective new solutions in the fight against healthcare associated infections (HCAIs).
The Smart Solutions for HCAI programme is targeting industry sectors including healthcare. It offers businesses the chance to have their product or technology assessed by a team of independent experts, with a view to evaluating it in a hospital setting and potentially supplying it across the NHS.
Events take place as follows:
- Wednesday Sept 3rd: Biopark, Welwyn Garden City
- Thursday Sept 4th: Brooklands Hotel, junction 37 off M1, near Barnsley
- Thursday Sept 18th: Liverpool Innovation Park
The events will give companies the chance to find out more about the programme and the application process. Project director Bryan Griffiths said: The Smart Solutions project is seeking new ways to combat HCAIs and is open to ideas from individuals or businesses in the healthcare and other industry sectors.
It is likely that there are some existing products or technologies which would be effective in preventing the spread of infection, but which have not yet been used in an infection control setting.
"The Smart Solutions programme is an opportunity for companies to have their products tested for use within the NHS, and potentially offers a fast track route to becoming a supplier to NHS hospitals and healthcare organisations across the UK."
For further information about events and the project see the website. Applications can be submitted online via the website on or before 26 September 2008.Early success as Trusts show support and sign up to Patient Safety First Campaign
Tuesday 12 August 2008
An impressive 185 Trusts and Organisations have now signed up to The Patient Safety First Campaign for England, pledging their support to an innovative campaign created to change the culture within the NHS; to one that ensures that the safety of patients is the highest priority, and works to eliminate all avoidable death and avoidable harm.
Stephen Ramsden, Campaign Director and Chief Executive of Luton and Dunstable Foundation Hospital, says:
Momentum behind the Campaign is building fast and as we countdown to mobilisation in September, the signed up Trusts from across England are already gaining support from the Campaign team. Here to help both the leaders of Trusts and those on the front line, the Campaign is making it easy for all to implement positive changes within their organisations. We urge more Chief Executives to come on board to help us build on this early success.Driven by peer-to-peer support the Campaign seeks to improve the safety of patients by changing practice in specific areas based on existing evidence. It seeks to create a movement rather than deliver against targets. Sign up to the Campaign is voluntary and asks for participation from individuals, Trust Boards and other health organisations.
Support is available now by emailing patientsafetyfirst@npsa.nhs.uk which includes:
- An introductory presentation to the Campaign to use within Trusts
- Campaign office support at patientsafetyfirst@npsa.nhs.uk
- Access to a member of the expert Campaign team for more a more detailed discussion about involvement.
But why sign up?
By signing up, Trusts and individuals gain access to a host of valuable information and resources to help them put the initial five interventions of the Campaign into action, making patient safety the priority in their trust. Each clinical intervention has been chosen because there is evidence that implementation saves lives.
The Campaign website goes live from mid-September, when trusts will have access to:
- A Campaign website providing a range of resources and putting you in direct contact with the wider Campaign community
- Online how-to guides for interventions and measurement
- Information about national supporting resources, including a range of learning events that will be available free of charge to any registered organisation; these include WebEx and teleconference sessions on the Campaign, implementing the Campaign interventions, and improvement methods.
The website will house information about ongoing support, including:
- Regional face-to-face meetings to support the implementation of the Campaign interventions
- Trust Open Days, which will focus on practical insight into organisations that have been successful in safety initiatives
- Tailored implementation support for individual Trusts and groups of Trusts
NPSA alerts healthcare workers to new guidance for injecting adults and adolescent patients with intravenous cancer drug
Tuesday 12 August 2008
The National Patient Safety Agency (NPSA) has issued a Rapid Response Report to healthcare professionals in England and Wales containing guidance on the prescription, distribution and administration of vinca alkaloids, a series of intravenous chemotherapy agents.
This is in response to four recent reports of fatal and serious incidents from hospitals outside the UK in which doses of vinca alkaloids intended for intravenous administration were injected in the spine, causing paralysis and death.
Previous guidance for the NHS in England and Wales was to dilute doses of vinca alkaloids to 10ml or greater in a syringe in order to reduce the risk of wrong route errors. However there were still incidents reported outside of the UK. The NPSA is therefore updating current guidance following the learning from these incidents in other countries.
The NPSA now recommends that when vinca alkaloids are prescribed, dispensed or administered in adult and adolescent chemotherapy units:
- Doses should be prepared and administered in intravenous 50ml minibags to minimise the risk of wrong route errors.
- Doses in syringes should no longer be used.
- The following warning should be prominently displayed on the label of all vinca alkaloid doses For Intravenous Use Only Fatal If Administered by Other Routes.
- The colour and design on the label, outer packaging and delivery bags should be well thought–out to differentiate vinca alkaloid minibags from other minibag infusions.
Chemotherapy policies and procedures should be amended to reflect these requirements and staff should be alerted to these recommendations and trained accordingly.
Speaking of the new Rapid Response Report, Professor David Cousins, Head of Safe Medication Practice and Medical Specialities at the NPSA, said:
Vinca alkaloids have been administered intravenously in 50ml minibags for several years now outside of the UK and so far there have been no reported incidents of wrong route errors. Clinical staff should therefore refrain from injecting vinca doses in syringes to adult and teenage patients in adult and adolescent chemotherapy units, as this is where the fatalities can occur with wrong route administration.
View the Rapid Response Report here.Medic allegedly collapsed while misusing gas in theatre at Castle Hill
Tuesday 5 August 2008
AN INVESTIGATION has been launched after a member of staff was allegedly found collapsed in an operating theatre at an East Yorkshire hospital after apparently abusing drugs.
Two operations had to be cancelled at Castle Hill Hospital, Cottingham, after the member of staff was discovered last Monday morning.
It is believed the man had been in the theatre since Saturday where he had been inhaling nitrous oxide, used as an anaesthetic and painkiller in hospitals and more commonly known as laughing gas.
Another hospital worker, who did not want to be identified for fear of losing their job, contacted the Mail about the incident.
They said: "He had been there since Saturday inhaling the gas and air which in modern hospitals is plumbed around the hospital."
"He's survived because the gas is mixed with oxygen, but obviously he was in a state."
Heather DuMughn, Head of Service for Critical Care and Theatres at Hull And East Yorkshire Hospitals NHS Trust, which runs the hospital, said: "The trust can confirm we are currently investigating an allegation of misconduct involving one of our staff members."
Union wants NHS pay deal review
Friday 1 August 2008
The UK's biggest health service union is to try to renegotiate a pay deal for more than a million workers because of the increase in the cost of living.
Unison says nurses and other NHS workers are struggling to cope with rises in food and energy prices.
The package for staff in England and Wales worth 8% over three years was accepted by its members in June.
The government says the deal is already been done, and any renegotiation will have to cover future years.
A spokeswoman for the Department of Health in England said: "The 2008/09 award has already been accepted and staff have received their increase in pay."
She said any renegotiation would cover 2009/10 and 2010/11.
'Safety net'
The pay deal gave staff an increase of 2.75% from April, followed by rises of 2.4% in 2009/10 and 2.25% in 2010/11.
But it was rejected by several smaller unions, including the Royal College of Midwives and Unite, representing ambulance workers, who said it amounted to a pay cut because of rising inflation.
Unison now says it would be submitting evidence to the NHS pay review body under a "re–opener" clause drafted in the event that inflation increased.
It says the deal was on the basis inflation would be around 2%, but the consumer prices index has risen to 3.8%, and Retail Price Index inflation is up to 4.6%.
"Nurses and other health workers are already struggling to cope with almost daily increases in the cost of basic necessities such a food and energy," said Unison's head of health Karen Jennings.
"The re–opener clause was central to this year's multi–year pay talks because it provided a much–needed safety net."
Source: BBCHPC launches consultation on the standards of education and training and guidance
Friday 1 August 2008
The Health Professions Council has today launched its consultation on the revised standards of education and training (SETs) and revised standards of education and training guidance.
The standards of education and training are the standards against which the HPC assesses education and training programmes. An education and training programme which meets the SETs allows a student who completes that programme successfully to meet our standards of proficiency. They are then eligible to apply to the HPC for registration.
The education, approvals and monitoring department at the HPC is responsible for conducting approval visits to education providers to ensure their programmes meet the SETs. If an education and training programme meets the SETs the HPC grants approval subject to ongoing checks via the annual monitoring and major change processes.
In May 2007 the HPC Council agreed a workplan to review the SETs. In order to conduct the review we invited organisations to be part of a professional liaison group (PLG). The PLG was made up of representatives of professional bodies, representatives of education and training providers, and HPC Council members. The group met a number of times and benefited from the input of all involved.
Michael Guthrie, HPCs Head of Policy and Standards, said:
We first published the SETs in 2004 and published guidance for the SETs in 2006. We are now reviewing the SETs to ensure they continue to be fit for purpose."
Its important that the SETS and SETs guidance are applicable to all professions that we currently regulate as well as those we may regulate in the future. I would encourage everyone to have their say on these standards by participating in the consultation.
The changes and additions to the SETs and SETs guidance have been proposed following the discussion of the PLG, which were informed by feedback the HPC has received over the last four years from those have been using the SETS and SETs guidance.
The deadline for responses to the Standards of education and training and Standards of education and training guidance consultation document is 14 November 2008. To download copies of the consultation document, please see the HPC websiteNew guidance issued following problems with infusions and sampling from arterial lines
Friday 1 August 2008
The National Patient Safety Agency (NPSA) has issued a Rapid Response Report to healthcare professionals in the UK to offer guidance for arterial line use following reports of problems with infusions and sampling.
From January 2005 to June 2008, the NPSA had reports of two deaths and 82 other incidents where the wrong infusion fluid was attached to the arterial line. A further 76 incidents, including one case of serious harm, related to faulty sampling technique. All of these incidents were reported to the National Reporting and Learning System (NRLS).
Arterial lines are routinely used in critical care areas to obtain samples of arterial blood, to test for blood gases, glucose and electrolytes. Slow infusions of sodium chloride or heparinised saline are currently used to keep the arterial line open.
Patients may be harmed if the wrong infusion is given to keep the line open or when poor sampling leads to delayed or inappropriate treatment.
This Rapid Response Report calls for immediate action by medical and nursing directors in the NHS and the independent sector to ensure the following:
- Sampling from arterial lines is risky and should only be done by competent, trained staff.
- Arterial infusion lines must be clearly identified.
- Any infusion (or additive) attached to an arterial line must be prescribed and checked before administration.
- Staff should use only sodium chloride 0.9% to keep lines open.
- Labels should clearly identify contents of infusion bags, even when pressure bags are used.
Linda Matthew, Senior Pharmacist at the NPSA, said: Arterial lines are routinely used in critical care areas and it is crucial that they are used safely and correctly in all instances. It is vital that staff are appropriately trained before using arterial lines and we want to see pharmaceutical manufacturers following our labelling design guidance to prevent confusion over medication type.
The NPSA is calling for the implementation of these recommendations by 30 January 2009.
Chief Medical Officer publishes Annual Report
Tuesday 15 July 2008
New focus on tackling the health of the teenage nation
The Chief Medical Officer, Sir Liam Donaldson, today published his 2007 Annual Report, in which he called for a new focus on teenage health. The report, which reviews key health problems and developments over the last year, highlighted the unique health needs of teenagers.
The teenage years are a risk taking period of life, closely tied to the rite of passage into adulthood. Although the majority of teenagers cope well, large numbers of teens take part in high risk behaviours such as binge drinking, drug taking and unsafe sex. There are also teenagers living with chronic illnesses.
Sir Liam's report urged health services to take better account of the specific health needs of young people and sets out Top Ten Tips for teenagers..
He also called for:
- A national summit to take stock of health programmes and services for teenagers.
- More involvement of teenagers in the design of health services for them.
- A young person's panel to be established to advise on national campaigns addressing risk taking in teenage years.
- The legal blood alcohol level limit for drivers aged between 17 and 20 years to be reduced to zero.
Speaking at the launch of his 2007 Annual Report, On the State of Public Health, Sir Liam said:
"Adolescence can be a challenging time. It is a period in which teenagers encounter risks and make hard choices. Young people are exposed to behaviours, opportunities and products that have the capacity to harm their health in the short and long term. In this Report I concentrate on the 'Big Six': smoking, alcohol and drugs, accidents and violence, diet, physical activity and sexual health."
"Habits adopted in the teenage years can form behaviour for a lifetime. For example, adolescent binge drinkers are twice as likely as their peers to be dependent on alcohol or taking illicit drugs by the time they reach 30 years, while someone who starts to smoke aged 15 years is three times more likely to die of smoking-related cancer than someone who starts smoking in their 20s. The effects of poor health in adolescence can last a lifetime, and even shorten it. Keeping teenagers well is a valuable investment for the health of the population in the future."
Sir Liam Donaldson is the Chief Medical Officer for England and the United Kingdom Government's principal medical adviser. He has held the post for nearly 10 years. His previous Annual Reports have called for action on key public health issues such as smoke-free public places (2002 and 2003 reports), the obesity 'time bomb' (2002 report) and an 'opt-out' system for organ donation (2006 report).
Understanding the rise in oesophageal cancer
This year's Report also draws attention to the rising levels of oesophageal cancer, which is the sixth most common cause of cancer deaths in England and Wales and kills 6,000 people a year. England has some of the highest rates of oesophageal cancer in Europe. Over the last 20 years, the rate of new cases in England has gone up by 86% for men and 40% for women, whereas the rate has sharply decreased in other European countries, such as France. The reasons for this are unknown.
In his Report Sir Liam calls for:
- A large scale national research study to investigate the risk factors associated with the rising rate of cancer of the oesophagus.
- Better educational programmes to improve public awareness of the symptoms.
- Research into better diagnostic techniques.
- The Chief Medical Officer to issue a public alert in circumstances where there is an unexplained increase of a serious disease.
Sir Liam said:
"As rates of many cancers in England are decreasing, oesophageal cancer is bucking the trend and going the wrong way. Levels of oesophageal cancer in England are amongst the worst in Europe, and whilst some other nations' rates are falling, ours are getting worse. Despite this worrying trend, not enough is known about why this is happening."
"If this disease is to be controlled and the trend reversed, it is vital that more is done to understand the complicated mix of factors that cause it, and the public are better informed about what to look out for."
Creating vaccines for the future
Vaccination has been a cornerstone of public health for the last 200 years. In this year's Annual Report, Sir Liam has highlighted work currently underway to develop new vaccines for a number of diseases, including C. difficile, MRSA and influenza. A vaccine for C. difficile is possible within three years, and a vaccine for MRSA within 10 years. A wider spectrum influenza vaccine could combat the threat of a pandemic of 'flu. The report also describes potential vaccines for chronic diseases, including type 1 diabetes.
Sir Liam said:
"Vaccination is arguably the most important public health development in the history of humankind. Over the last 200 years it has saved hundreds of millions of lives worldwide. The continuing work to develop new vaccines and potentially save more lives in the future is a testament to the work of Edward Jenner two centuries ago. New vaccines could not just prevent infectious diseases, but could also prevent or treat some cancers and other chronic conditions."
Making surgery safer
Surgery is generally very safe but has many inherent risks that are not always fully appreciated. The report highlights the nature of some of these risks and presents new data showing the National Patient Safety Agency received 129,416 reports of potential errors involving surgical procedures during 2007. Most errors do not result in harm or the risk is averted. Sir Liam also highlights 14 cases of burr holes being drilled on the wrong side of the head during brain surgery in the last three years.
He argues that more attention needs to be given to reducing the impact of errors in surgery and suggests a number of measures including:
- The establishment of a clinical board for surgical safety.
- Routine use of the World Health Organization's Surgical Safety Checklist before, during and after the operation.
- More use of risk scores to estimate the risk to patients before the operation.
- Regular collection and analysis of death rates 30 days after operations, which should be made available to the public.
Sir Liam said:
"Surgery for patients in this country is generally very safe, but we can and should make it even safer. Errors do still occur. Further improvements will need a more detailed understanding of how often errors occur, a change in culture and the use of innovative new tools, such as surgical checklists."
Achieving racial equality in medicine
Also examined is the issue of racism in medicine. Historically, ethnic minority doctors have suffered notable discrimination when applying to medical school and throughout their careers. The report uses data from a number of sources to examine the current situation.
In recent years there has been improvement, but concerns remain. The report presents evidence that doctors born outside the United Kingdom (particularly in Africa) but working here have higher mortality rates than their United Kingdom born counterparts. It also shows evidence that doctors from ethnic minorities are living in the more deprived areas of the country.
Sir Liam calls for a series of measures to combat these remaining concerns, including:
- The establishment of a mentoring scheme for ethnic minority doctors.
- - Better training on equality and race awareness issues for selection panels.
- - More support for doctors raising concerns about racial discrimination.
Sir Liam said:
"Examining the relationship between ethnicity and doctors is complex. Whilst many institutional barriers have been removed and much has improved, there are still areas that cause concern. Addressing these issues will require cultural and behavioural change."
Professor Sir Liam Donaldson is the Chief Medical Officer for England. His 2007 Annual Report can be found hereSIGN UP TO THE PATIENT SAFETY FIRST CAMPAIGN FOR ENGLAND
Friday 11 July 2008
'Can anything be more important than the safety of our patients?'
So asks Stephen Ramsden OBE, Campaign Director of the new Patient Safety First Campaign for England and Chief Executive of Luton and Dunstable NHS Trust.
More than a million people are treated in the NHS every day. This daily activity includes 1.5 million patients seen by 1.3 million staff, with 1.9 million prescriptions issued, 124,000 outpatient consultations, 50,000 accident and emergency attendances and nearly one million general practitioner consultations (CMO Annual Report 2006). Research, however, has shown that on average across the world around 1 in 10 in–patients are unintentionally harmed by the care that they receive (Brennan et al 1991, Wilson et al 1995, Vincent et al 2001). Estimates also suggest that 50% of this harm could be avoided.
What will the Patient Safety First Campaign for England accomplish?
The Patient Safety First Campaign has been created to change the culture within the NHS; to one that puts the safety of patients as the highest priority. No avoidable death or avoidable harm is acceptable.
Campaign cause: 'To make patient safety everyone's highest priority'
Campaign aim: 'No avoidable death and no avoidable harm'.
Through the provision of a support network online and in the field, NHS staff will be given peer-to-peer advice alongside the tools they need to improve patient safety. The Patient Safety First Campaign also aims to influence other key organisations such as Royal Colleges, professional organisations, and regulatory bodies to engage them in this life saving cause.
The Campaign is part of an international move to make hospitals safer. Similar campaigns in the US, Canada, Scotland, Wales and Denmark are saving lives. Working alongside a Core Team of experienced professionals, who all have experience of patient safety initiatives within their own NHS organisations, the Campaign is taking what has been learned internationally and applying it here.
"It has been recognised internationally that there is much avoidable harm happening in hospitals across the world. Campaigns across several countries have shown that there are methods to successfully reduce the number of these incidents. The Patient Safety First Campaign for England will be providing health service workers with access to these methods and the support needed at a local level to put them into practice."
"Working together, we are looking to change the culture within the NHS to one that puts the safety of patients as the highest priority. We need to stop accepting the unacceptable" says Stephen Ramsden.
This Campaign is unique in its aim and approach towards achieving its goals. The Patient Safety First Campaign:
- Seeks to improve the safety of patients by changing practice in specific areas based on existing medical evidence – interventions
- Seeks to create a movement. Sign up to the Campaign is voluntary and asks for participation from individuals, Trust Boards and other health organisations. So far well over 140 Trusts and PCTs have signed up for the Campaign.
- Is not a government led campaign. It is supported by the NHS Institute for Innovation & Improvement, the National Patient Safety Agency and the Health Foundation but is delivered 'by the service for the service'
- Is led by a team of dedicated clinicians and managers from across England, all experienced in and passionate about improving patient safety in their own field.
How will change be achieved?
The Campaign's cause and aim are applicable to the whole of the NHS. The campaign will promote five key methods known to make a positive impact, in the first instance. These are:
-
Leadership for safety – getting Boards on board with patient safety with the aim of demonstrating it is the highest priority
- AIM: Ensure a leadership culture at Board level that promotes quality and patient safety and provides an environment where continuous improvement in harm reduction becomes routine throughout the organisation
-
Care of deteriorating patients in acute care
- AIM: Reduce in-hospital cardiac arrest and mortality rate through earlier recognition and treatment of the deteriorating patient
-
Critical care bundles (central lines, ventilator care)
- AIM: Improve the care of patients receiving critical care through the reliable application of care bundles
-
Perioperative care, including prevention of surgical site infection and World Health Organisation's Safe Surgery Checklist
- AIM: Improve care for adult patients undergoing elective surgical procedures in the hospital setting
-
Reduction of harm from high-risk medications (this includes anticoagulants, narcotics, insulin & sedatives)
- AIM: To prevent harm from high-risk medications.
There is already published evidence from other countries and UK organisations on how to improve practice in these areas. In addition, many Trusts are already doing work in these areas, and through this Campaign, they will be supported and aided in their efforts, whilst being encouraged to share their success with other Trusts.
The Campaign is calling for even more Chief Executives to pledge their support, and for individuals to sign up in September.
For more information on the interventions and to find out how to sign up to the Campaign, email patientsafetyfirst@npsa.nhs.uk'New CJD type' discovered in US
Thursday 10 July 2008
A new form of Creutzfeldt–Jakob disease (CJD) may have been uncovered in a handful of patients in the US.
Ten people have so far died from a fast–advancing form of fatal dementia called PSPr, New Scientist reports.
Patients develop the trademark brain damage associated with CJD – the type not linked to BSE – but scientists believe there may be a genetic cause.
Experts in the UK are now checking records to see if any cases have happened across the Atlantic.
There are between 50 and 100 new cases of so–called sporadic CJD diagnosed in the UK every year.
Unlike "variant CJD", the human form of BSE in cows contracted by eating contaminated brain tissue in the 1980s and 1990s, the cause of most cases of sporadic CJD is unknown.
The new cases were referred to CJD surveillance units in the US because they were a suspiciously fast–advancing form of dementia with additional symptoms such as the loss of the ability to speak and move, even though traditional tests that normally help diagnose CJD proved negative.
Post–mortems on those who died revealed the familiar "spongy" brain tissue, covered with tiny holes.
These are thought to be caused by the accumulation of "prions", a misshapen version of a normal brain protein.
'Unnoticed'
Dr Pierluigi Gambetti, director of the US National Prion Disease Pathology Surveillance Center, in Ohio, said that he believed the newly discovered type had probably "been around for years, unnoticed".
He suggested one interesting common factor was that the patients came from families with a history of dementia, suggesting a genetic cause, but did not carry the gene traditionally associated with a small number of sporadic CJD cases.
Dr Mark Head, from the UK's National CJD Surveillance Unit, in Edinburgh, said the finding had prompted scientists to start reviewing cases of sporadic CJD in this country to see if there were any of the newly discovered version.
He said: "What is interesting about this is that it may mean there are other genes out there waiting to be found which are associated with prion disease, and looking at these patients in the US could help find them."
Source: BBCStudy shows NHS Hospitals are cleaner
Thursday 10 July 2008
Standards of cleanliness and food in NHS hospitals throughout England have improved according to the annual Patient Environment Action Team (PEAT) data for 2008, published by the National Patient Safety Agency (NPSA).
Patient Environment Action Teams were established in 2000 to assess NHS hospitals. Under the programme, every hospital in England with more than ten beds is assessed annually and given a rating of excellent, good, acceptable, poor or unacceptable.
The teams inspect standards across a range of patient services including of food, cleanliness, infection control, and patient environment (bathroom areas, décor, lighting, floors and patient access) to give the hospital an overall rating. This years results show a significant improvement in standards with 98.5% of trusts scoring acceptable or above for their patient environments and 99.5% of trusts scoring acceptable or above for standards of hospital food.
Each site is inspected by a Patient Environment Action Team which consists of teams of NHS staff, including nurses, matrons, doctors, catering and domestic service managers, executive and non–executive directors, dieticians and estates directors. They also include patients, patient representatives and members of the public.
Martin Fletcher, Chief Executive of the NPSA said:
This years PEAT results show a welcome improvement on the environmental standards of NHS hospitals across the country.
The PEAT results are clearly a tribute to the ongoing hard work of the NHS staff involved. I hope they will also encourage all hospitals to keep on improving their standards for the future.
Both NHS trusts and the public can now view how their local hospitals have performed on making their facilities clean, comfortable and safer for patients.
The National Patient Safety Agency (NPSA) oversees the management of the PEAT programme. As with the approach taken by the Healthcare Commission, the PEAT programme is an entirely self–assessed system and sites are measured on their food, as well as their patient environment, which covers their:
- Specific cleanliness and toilet and bathroom cleanliness
- Infection control
- Environment (wards, rooms, waiting and reception areas, stairwells, lifts, corridors and other public areas)
- Access and external areas.
NHS hospitals throughout England have already had access to their individual scores for 2008; however from today they will able to compare this years score with other local hospitals.
View the 2008 assessment resultsOperation success rates help patients choose treatment
Thursday 10 July 2008
The NHS has today taken a significant step towards greater patient choice with the publication of national operation survival rates.
The data for four common operations for each trust in England comes from the Healthcare Commission's published cardiac survival data.
The figures, which are published in a user–friendly format and as raw data, reveal that all hospitals are performing within acceptable guidelines and five hospitals are above average.
The figures are published alongside the Health Informatics Review – a review of how information can be better used across the Department and NHS.
The Health Informatics Review sets out a vision, supported by a number of key proposals, that describe how coverage and quality of information can be enhanced to meet these needs and help transform health and social care and will be followed by a more detailed, technically based Health Informatics Review Implementation Report in the autumn 2008.
Publication of the survival rates immediately puts into action one of the report's key recommendations - to give patients a greater say in the care they receive by extending choice on treatment options. It also builds on the Department's commitment, to enhance quality and choice, which was outlined in the NHS Next Stage Review, published on 30 June.
The data, which indicates the success of an operation, is published on the NHS's website, NHS Choices, as part of the 'hospital scorecard', which allow patients to compare hospital treatment options from a range of clinical and non-clinical data such as length of stay and MRSA rates.
NHS Medical Director and interim Director General for Informatics Sir Bruce Keogh said:
"Whilst we are rightly proud of our NHS which offers good, evidence based and innovative clinical services there is a view that we have lagged behind other industries in providing sophisticated IT infrastructure to support NHS staff to deliver a 21st century service which enables to patients engage more fully in their care."
"There is a strong appetite in the NHS to develop a coherent informatics infrastructure to address the issues of data transfer and security between multiple organisations using a myriad of different systems in Europe's largest organisation, but this is not going to be easy. To get it right will take time but good information is fundamental to modern healthcare."
The first data to be published is for Abdominal Aortic Aneurysms (elective and emergency), elective hip replacements and knee replacements and will be followed in the coming months by a series of clinical outcome data being made available for a wider range of elective and emergency surgery.
Alongside the new data, NHS Choices will publish Health Guides to help manage depression, dementia, diabetes and asthma. Each contains useful information on prevention, diagnosis, treatment and living with long-term conditions.
The Health Informatics Review takes forward the commitments outlined in the NHS Next Stage Review to extend choice and realise the potential of our technology capabilities to enhance healthcare.
The Health Informatics Review Implementation report will set out how the measures identified in the review will be put into practice.
These include:
- Developing better systems of securely sharing information across organisational boundaries;
- Developing a 'Myspace' type interface that allows staff to access information about education and training, clinical information and research, and career progression through a single site;
- Piloting systems such as clinical dashboards that allow clinicians to monitor the performance of a service and quality of care by combining many sources of clinical information from the hospital and local health community in single display. It allows health professionals to get a clear picture at a glance of a several indicators of a patient's condition; and
- A renewed focus on reducing the time taken and the resources needed to collect data while ensuring it is used to maximum benefit.
NHS Connecting for Health, which now incorporates NHS Choices, is delivering these key elements of the Review, including the development of clinical dashboards, which will improve the quality of patient care.
Commenting on the outcome of the Health Informatics Review, chief executive of The NHS Information Centre Tim Straughan said:
"We welcome the outcome of the Informatics Review which firmly establishes The NHS Information Centre as the central, authoritative source of health and social care information in England."
"High–quality, relevant information is crucial to enable the NHS to deliver world class services and to enable patients to make decisions about their health and care. We are delighted the review so clearly establishes our role in both providing and encouraging the availability of such information across the service."
NHS staff win petrol cost fight
Monday 7 July 2008
NHS unions have won a battle to compensate staff for rising fuel costs.
The deal will give one million staff a 10% increase in mileage allowance effective from 1st July.
Staff have been feeling the pinch with rising fuel costs and unions had warned the government that many are struggling financially to travel to and from work.
The Royal College of Nurses welcomed the agreement but are still calling plans to increase fuel costs by 2p a litre in October to be scrapped.
The agreement reached with NHS employers, which includes everyone except doctors and very senior managers, also means an increase in cycle and public transport rates.
Gill Bellord, director of pay, pensions and employment relations, at NHS Employers said: "We are now working with the trade unions to finalise the details and will advise employers as soon as these have been agreed."
Dr Peter Carter, chief executive of the RCN said: "This agreement is a step in the right direction and forms part of a bigger picture in delivering a better deal for nurses."
He added the RCN was still pushing for the annual mileage allowance payment threshold to be increased.
Spiralling costs
Earlier this month, the RCN wrote to Chancellor Alastair Darling to warn that the UK's 60,000 community nurses could not afford the extra cost of running a car.
Nursing Standard magazine said petrol costs 32% more than it did when nurses' mileage allowances last rose in 2000.
The current system of NHS reimbursement is complex, and based on the size of the car and average mileage.
However, an example provided by the RCN suggested that a nurse clocking up 3,500 miles a year in a 1,500cc vehicle costing £14,000 new would typically receive £1,445 a year less than that recommended by the AA.
Under the deal, the regular user rate will now be 44p, a 4p increase, and the top standard user rate will be 58.3p, an increase of 5.3p.
The passenger allowance will also increase from 2p to 5p, the cycle rate from 6.5p to 10p, and public transport rates from 23p to 24p.
Source: BBCEU ORGAN DONATION DIRECTIVE MUST REFLECT CLINICAL NEED
Sunday 6 July 2008
The House of Lords European Union Committee has today welcomed EU proposals for a European directive on the quality and safety of organ donation and transplantation but has stressed that, in establishing minimum standards across Europe, the EU must not impose requirements beyond those which are clinically justifiable.
The Committee stress that any directive should include significant flexibility to allow scope for clinical judgement and patient choice.
They point out that a for a patient who requires an urgent organ transplant to avoid imminent death, the clinical criteria for judging the acceptable quality of an organ will be different from those for a patient who can afford to wait longer for a transplant.
In conducting their inquiry, the Committee looked at the current state of organ transplant provision in the UK and other European countries.
They found that Britain lags far behind some other countries in the level of organ donation. Britain only achieved an organ donor rate of 12.8 per million population compared to an EU average 18.8. The leaders in the field, Spain, achieved a rate of 35.1. They call on the Government to act urgently to address the shortage of available organs for transplantation in the UK.
In comparing the British and Spanish organ donation and transplantation systems, the Committee conclude that the reason for the vastly different performance has more to do with effective organisation of organ donation services, and the selection and training of staff, rather than legal differences. The Committee welcome moves by the Department of Health's Organ Donation Taskforce to draw on the Spanish model. This included the establishment of a centralised office for coordination, the appointment of regional organ donation coordinators and the appointment of organ donation coordinators in each hospital.
The Committee stress that organisational changes are the most effective way of improving the UK's organ donation rate. They argue that at this stage it would be premature to introduce an "opt–out" or presumed consent system for organ donation. They point out that a system of presumed consent would be ineffective without the numbers of skilled staff and coordinated system needed to deal with the greater volume of donor organs that this might generate.
The Committee state that before a decision is taken to introduce presumed consent, the Government must do more to raise public awareness of the importance of organ donation and to encourage more citizens to sign up to the existing organ donor register, which operates on an "opt–in" basis. They also argue that, if in the future a decision is taken to move to presumed consent, the system should not be implemented until considerable progress has been made in strengthening organ donation services.
The Committee heard evidence relating to the views of different ethnic minority, faith–based and other groups about organ donation issues. They recommend that the European Commission should support Member States in exchanging information about the views of such groups across the EU, especially those which are hard to reach, and in developing public awareness campaigns designed to engage them with the urgency of raising organ donation rates.
The Committee concluded that a standardised EU donor card would not command public support. Nevertheless, they suggest that the Commission should explore the options for a common format of donor card which is compatible with the donation consent process in force in the Member State of the holder's origin. Within the UK, they recommend that the Government should explore innovative means of expanding the extent of donor registration.
Commenting, Baroness Howarth of Breckland, who chairs the EU Sub–Committee on Social Policy and Consumer Affairs which conducted the inquiry, said:
"While we welcome the Commission's attempts to improve organ donation rates across the EU, we believe the measures which are introduced should not in any way undermine clinical judgement. Attempts to introduce common standards for organ quality and safety must not stop people in desperate need of a donated organ from getting a transplant."
"We looked in detail at the organ donation regime in the UK and concluded that we must do much more to emulate successful schemes such as that in Spain. We believe that all parts of the NHS must accept organ donation as a usual, not an unusual event, and that many more, and better trained, medical staff should have the role of providing organ donation services. This would go a long way to increasing the availability of organs for donation without needing to adopt a system of presumed consent."
The report will be available online shortly after publication hereNew DVD to combat superbugs
Sunday 6 July 2008
Today a new guidance video will be available to all NHS trusts in England and Wales to educate and inform healthcare workers on the importance of good hand hygiene in preventing infection.
The DVD has been produced by the National Patient Safety Agencys (NPSAs) award–winning cleanyourhands campaign has been sent to all NHS trusts, as well as being available to download via the NPSA website.
The campaign is currently in its third year in NHS acute hospitals in England and Wales, and is about to begin its first year in primary care, mental health, ambulance and care trusts. It aims to reduce the spread of preventable healthcare associated infections, such as MRSA and Clostridium Difficile, by improving the hand hygiene of healthcare workers.
The video, which includes demonstrations of how healthcare workers should clean their hands, was produced after surveys and feedback from trusts revealed that their staff did not always know when to use soap and water and when to opt for the alcohol handrub.
Martin Fletcher, Chief Executive of the NPSA said:
The DVD has been designed with all healthcare settings in mind, from primary care, to mental health, to hospitals to encourage good hand hygiene practice across the NHS. The strength of our campaign so far has been getting hand hygiene high on everyones agenda and raising awareness of its vital role in preventing infection. The DVD continues this commitment to educate all healthcare workers, regardless of their discipline.
By making the video available online we have ensured that all healthcare workers can access the important guidance and it has been divided into sections to make it easier for training purposes.
We have come a long way since our campaign began in 2004 to reduce the spread of healthcare associated infections but these still pose a challenge to all NHS organisations, not just hospitals. I urge that all infection control leads utilise this video, whether it is via the DVD or our website, and make the necessary arrangements for this to be filtered down to frontline staff.
View the video onlineNEXT STAGE FOR NHS: HIGHEST QUALITY CARE FOR ALL
Monday 30 June 2008
Darzi: Giving patients more say and staff more freedom to shape high quality care round patients' needs.
Ambitious plans were unveiled on the 30th June 2008 by leading surgeon and Health Minister Ara Darzi, to raise the quality of healthcare for patients right across the NHS.
By putting patients' wishes first and giving doctors and nurses the freedom to respond to those wishes and offer the safest and most effective treatments, his proposals will transform the quality of care that patients receive.
After a 12–month review, led by 2,000 clinicians and staff across the country and involving 60,000 patients, public and staff, Lord Darzi has set out proposals that will give patients more choice, and information, reward the hospitals and clinics that offer both the highest quality of care, and provide the most responsive services.
The enormous investment that the health service has seen over the past eight years has led to more staff, faster access to care and a dramatic reduction in waiting lists. The final report of Lord Darzi's review entitled "High Quality Care for All", sets out plans that build on this progress and show how innovation and creativity of staff can further improve services.
The changes will be driven not through top–down targets but by giving responsibility to the staff at local level. The values that led to the creation of the NHS 60 years ago will be enshrined in a new Constitution, as well as setting out for the first time the rights of all patients.
Lord Darzi said:
"This report will enable frontline doctors, nurses and patients – who provide and use NHS services – to put into practice their visions for high quality care."
"As a surgeon I know how vital it is to balance the quality of the patient's experience – a clean and safe environment, being treated with compassion dignity and respect – with the success of the treatment they receive."
"By measuring this quality across the service and publishing that information for the first time, both staff and patients can work together to make better informed choices about their care."
"By setting clearer standards, and recognising and rewarding innovation in quality, we can keep pace with the very latest advances in medicine and technology. By investing in additional health centres and services for GPs the NHS will diagnose illness faster and help people to stay healthy, as well as treating them when they are sick."
"Today we are also publishing a new workforce strategy for the NHS that will ensure the service continues to have the most talented staff, fully supported to deliver quality care for patients. We are committed to making career progression clearer, easier and more flexible for all staff and having clinical leaders at every level in the service. By unlocking their talent we will enable them to provide a level of care which was unimaginable even 20 years ago."
Secretary of State for Health Alan Johnson said:
"There are big challenges ahead but the NHS is clearly in much better shape than it was ten years ago – borne out by increasing satisfaction rates among patients and public. My first job as Health Secretary was to launch this review with the Prime Minister and I'd like to thank Lord Darzi for his outstanding work over the past year, reaching parts of the health service never reached before."
"These locally driven, clinically led plans show how quality of care will be raised right across the country, with doctors and nurses supported to offer big improvements in treatment at the bedside. Quality of life will be improved and more lives will be saved."
The report sets out how the NHS will -
Give patients more information and choice:
- The NHS Constitution will put privacy, dignity and cleanliness at the heart of care, with tough new enforcement powers coming in to tackle, for example, healthcare infections, and a checklist for all hospitals to reduce catheter–induced infections.
- Measuring quality of care and outcomes of treatment right across the service and publishing that information for the first time.
- Most effective drugs for patients with new right to all NICE–approved drugs, faster approvals process and transparent decision making.
- A patient's legal right to choice of any provider, including choice of GP services.
- 5000 patients with complex long–term conditions will pilot new personal budgets.
- Personal care plans for all 15 million patients with a long–term condition.
Help people to stay healthy, as well as treating them when they are sick:
- Supporting family doctors to help patients stay healthy and investing record amounts in new or improved wellbeing and prevention services that are easy to access.
- Launching a nationwide 'Reduce Your Risk' campaign to raise awareness of free vascular checks for 40 – 74 yr olds and help people to know when they need to get help.
- Piloting new approaches to help family doctors, community nurses, hospitals, local authorities and others work across traditional boundaries to provide more joined–up services and better health outcomes for people with conditions such as diabetes.
Enable frontline staff to initiate and lead change that improves quality of care for patients:
- No additional top–down targets beyond the minimum standards. Targets have been vital in driving up minimum standards of care across the NHS, but new accountability faces increasingly outwards to patients and the public and is based on the quality of care delivered.
- Every provider of NHS services will need to systematically measure, analyse and improve quality, displaying it to staff through 'clinical dashboards' to measure their performance and use the information to make continuous improvements.
- A clinical voice at every level – to ensure decisions are based on the best medical evidence.
- Enhancing professionalism. There will be investment in new programmes of clinical leadership, with all clinicians encouraged to be practitioners, partners and leaders in the NHS.
Fully support NHS staff:
- Establishing NHS Medical Education England – an independent, advisory non-departmental body that will scrutinise workforce planning proposals for doctors and dentists, as well as bringing a coherent professional voice on matters relating to education and training. Work will be taken forward with other professions to decide what other national advisory bodies are required.
- Tripling investment in foundation periods for nurses – a new period of preceptorship for nurses at the start of their careers, which will provide newly qualified staff with protected time and support as they move into practice for the first time.
- A new tariff–based system for education funding – for the first time education funding will follow the trainee, which will improve transparency, promote fairness and reward quality.
The Department of Health has published:
- 'High Quality of Care for all' The NHS Next Stage review final report by Lord Darzi
- A consultation document on the NHS Constitution
- NHS Next Stage Review : A High Quality Workforce: the Workforce, planning, education and training strategy
Anaesthetics could exacerbate pain
Sunday 29 June 2008
New research from the USA, published in Proceedings of the National Academy of Sciences, suggests that some anaesthetic agents could exacerbate pain by stimulating nerves to cause irritation long after the end of surgery.
It has long been known that certain anaesthetics, such as isoflurane, while being effective at inducing and maintaining unconsciousness, are also irritant substances.
This latest finding, by Ahern et al. at Georgetown University Medical Center, suggests that the irritant effect can be sustained long after the anaesthetic and any perioperative pain medications have worn off.
These anaesthetic agents activate pain receptors on nerve cells. If these receptors are over–stimulated, this can give rise to a sustained over–sensitisation of pain pathways, so in patients this could result in a significant increase in post–surgical pain. These researchers showed that mice bred without these pain receptors were unaffected by the so–called "noxious" anaesthetics.
Dr Ahern said:
"It was not really recognised that use of these drugs results in the release of lots of chemicals that recruit immune cells to the nerves, which causes more pain of inflammation. The choice of anaesthetic appears to be an important determinant of post-operative pain".
He added that while this effect could be reduced by using other types of anaesthetic, these might not perform as well in other ways.
Professor Ian Power, from the University of Edinburgh, made the point that postoperative pain remained a serious problem, despite the recent advances in anaesthesia. He said:
"We are very aware that acute post-operative pain can persist and become chronic and long–lasting, and we have been looking for reasons for that – perhaps this research may provide those. If this research were to be validated and proved correct, it would be fairly easy for anaesthetists to move from one type to another".
Professor Richard Langford, a consultant in anaesthesia and pain management at Bart's and The London NHS Trust, commented that while the findings were interesting, it could not be assumed that there would be a similar effect in humans undergoing surgery. He said:
"There are a myriad of different factors that combine to produce the experience of pain, including the degree and size of the surgery, and the mood or level of anxiety in the patient".
Source: Anaesthesia UKPatients told of infection fear
Sunday 29 June 2008
A hospital has recalled 96 patients because of concerns that they were treated with contaminated equipment.
Leicester Royal Infirmary said between 30 May and 6 June a machine in the endoscopy unit used to decontaminate instruments was not working properly.
"The trust immediately set about recalling the 96 patients involved, to reassure them and rule out any risk of infection," said a trust spokeswoman.
Experts said the risk of potential infection was minimal.
Pauline Tagg, chief nurse at University Hospitals of Leicester NHS Trust, said: "We can confirm that we have found a fault in one of the decontamination units in our Endoscopy Unit at the Leicester Royal Infirmary."
This was a machine error, not a human error.
"The trust takes patient safety very seriously and has started an investigation into the incident. In the interim the machine is not being used."
"We would like to reassure patients that the advice we have received from the Health Protection Agency is that the risk of any infections is, and remains, extremely small."
An endoscopy test looks inside the body using is a long flexible tube that can be swallowed.
It is most often used to examine a patient's oesophagus, stomach or colon.
Source: BBCSafety checklist for ops launched
Sunday 29 June 2008
A safety checklist designed to cut the risk of surgical complications is to be circulated to doctors world–wide.
The list has been drawn up by the World Health Organization (WHO), which says half of complications resulting from major surgery may be preventable.
A Lancet study found that basic safety measures were often overlooked at hospitals around the world.
The WHO estimates that up to 16% of surgical procedures in industrial nations result in major complications.
In developing countries the death rate during major surgery is estimated to be as high as 10%.
In parts of sub–Saharan Africa the death rate from general anaesthesia alone is estimated to be as high as one in 150.
Margaret Chan, WHO director general, said: "Preventable surgical injuries and deaths are now a growing concern."
"Using a checklist is the best way to reduce surgical errors and improve patient safety."
Extensive consultation
The WHO checklist has been drawn up by a team at Harvard School of Public Health, following a consultation with more than 200 medical organisations from around the world.
Its primary aim is to target the three biggest cause of mortality in surgery – preventable infections, preventable complication from bleeding, and safety in anesthesia.
It includes six basic steps in care, including verifying that it is the correct patient, ensuring equipment is not left inside the patient, and administering an antibiotic before making an incision – which cuts the risk of infection by half.
Preliminary results from patients at eight pilot sites – including London, Seattle and Toronto – indicate that the checklist has nearly doubled the likelihood that patients will receive proven standards of surgical care, leading to a significant cut in complications and deaths.
The study, published in the Lancet, found that before the checklist was used there was a 64% chance that at least one of the procedures was forgotten – with no difference between rich and developing countries.
There have been major improvements in surgical operations in recent years.
But Professor Atul Gawande, of Harvard, said: "The quality and safety of surgical care has been dismayingly variable in every part of the world."
"What we identified was that the idea of a checklist to make sure the basic steps are taken, could make a big difference not only in the poorest part of the world but even in the rich ones."
Doctors enthusiastic
Dr Isabeau Walker, of London's Great Ormond Street Hospital, was consulted during the drawing up of the checklist, and has been using it.
She said: "It is brilliant. A very simple intervention to help people talk to each other, and work better together as a team."
"These are things we do all the time as routine as a team, but having a checklist just gives pause for thought before the start of an operation for us to say 'yes, we have done all that'."
Health Minister Lord Darzi, a practising surgeon, said: "I feel confident that the introduction of the surgical safety checklist will improve the safety of patients who undergo surgery in the UK."
World–wide, an estimated 234 million operations are carried out a year, and about one million people die each year following major surgery.
According the National Patient Safety Agency, there were 129,000 reported incidents in which patients were put at risk in the UK last year.
Source: BBCClean your hands in Northern Ireland
Wednesday 25 June 2008
The National Patient Safety Agencys (NPSAs) cleanyourhands campaign launches in Northern Ireland today in all acute Health and Social Care bodies.
The campaign, currently in its third year in NHS acute hospitals in England and Wales, aims to help reduce the spread of preventable healthcare associated infections, such as MRSA and Clostridium Difficile, by improving the hand hygiene of healthcare workers.
The campaign will be implemented in all hospitals in Northern Ireland and marks the first time that the Department of Health, Social Services and Public Safety (DHSSPS) has linked with the NPSA.
Launching the campaign at Mater Hospital, Belfast, Health Minister, Michael McGimpsey said:
This campaign is about reinforcing the message that good hand hygiene is absolutely essential in the prevention of infection. Staff and visitors are being reminded that the benefits of the simple act of cleaning your hands must not be underestimated and that by just taking a minute to stop and clean your hands, you are helping to prevent and control infections.
Although we will never be able to totally eradicate healthcare associated infections, we must do all we can to minimise the risk. Hand washing must become a habit that is integral to healthcare culture and openly discussed. Patients should be encouraged to feel comfortable to ask staff if they have washed their hands before treating them. Equally, staff should also ensure that visitors wash their hands and should provide advice where necessary.
Since its launch in 2004, the campaign has been adopted by all NHS acute trusts in England and Wales and remains a top priority, with independent research revealing that there has been a two–and–a–half fold increase in alcohol handrub and soap usage since the campaigns implementation.
Martin Fletcher, Chief Executive of the NPSA said:
Encouraging good hand hygiene practice in all healthcare settings is one of the NPSAs key tasks and it is very encouraging to know that the work that has been developed here can be shared more widely.
While the success of the campaign depends heavily on the level of local support, it will be helped by the strength of the materials and the clear messages that stress the importance of good hand hygiene at the point of care.
The NPSA has highlighted the WHOs suggestion that greater impact in reducing healthcare associated infections can be gained by following five moments of care and these are outlined in the staff guidance that accompanies the toolkit.
A range of resources have been developed to support the campaigns implementation, including posters for wards, signs to direct to highlight hand-cleaning facilities, leaflets for patients and healthcare workers and an implementation handbook, designed to educate, prompt and enable healthcare workers to clean their hands at the right time, every time.
Health workers reject pay offer
Monday 2 June 2008
Thousands of health workers have overwhelmingly rejected the government's three-year 8% pay offer, the GMB union has said.
The union, which represents 30,000 NHS staff in England and Wales, said more than 96% of its members had voted against the deal.
It comes days after the Royal College of Midwives also rejected the offer.
Unison and the Royal College of Nursing, which represent more NHS staff, are balloting their members.
The Royal College of Nursing (RCN) is urging members to accept the deal, but Unison members are being balloted without a steer from their leaders.
Members of the union Unite have already rejected the deal by six to one.
One year deal
The GMB, which represents ambulance crews, porters, catering staff, cleaners, laboratory workers and maintenance staff, has said it will now seek an immediate meeting with Health Secretary Alan Johnson.
The union's Sharon Holder said: "The ballot result is a resounding no."
"This result vindicates the position of the GMB negotiators, who knew instinctively that GMB members would not tolerate this unacceptable, long-term pay offer."
"The Department of Health must be instructed to put a one-year deal on the table that GMB members can accept."
Midwives have already argued for a one-year increase of 2.75%, which was recommended by a pay-review body before the government intervened to press for a longer deal.
Dame Karlene Davis, general secretary of the Royal College of Midwives (RCM), said earlier this week: "We have strongly argued that, given the outlook for the economy in future years, acceptance of the three-year deal would represent a vote for a real-terms pay cut."
RCM leaders will meet next month to consider the ballot result, by which time Unison and the RCN will also have the results from the ballots of their members.
A Department of Health spokesperson the offer was "a good deal".
He added: "A multi-year deal ensures security for staff and allows them to plan for their future and the future of their families."
Source: BBCHospitals cancel more operations
Monday 2 June 2008
More NHS operations were cancelled in England at the last minute in the first three months of the year compared to the same period in 2007, figures show.
In all 16,800 operations were cancelled for non-medical reasons - around 5,000 a month - up from 14,600 last year.
Leeds Teaching Hospital had the most cancellations, 539, while in many parts of the south-west there were none.
The Department of Health said the cancelled operations represented 1% of all planned surgery.
Overall, 6% of patients affected were not treated within 28 days.
That is a slight increase on the previous year when 5% of patients had to wait more than 28 days for their treatment to be rescheduled.
Professor John Appleby, chief economist at the King's Fund thinktank, said: "There is a slight increase year-on-year, but overall the trend is that the number of cancellations is coming down."
"But, the variation between trusts across the country isn't good."
Professor Appleby said non-medical cancellations could be due to problems like operating theatres being over-booked or staff shortages.
"There is also a lot of seasonal variation in the number of operations cancelled with the most around Christmas and New Year. Nobody wants to be in hospital at Christmas."
Liberal Democrat health spokesman Norman Lamb said: "This is simply unacceptable and will have caused enormous distress to patients waiting for vital treatment, bringing further costs to hospitals having to rearrange operations."
Source: BBCNew blow for NHS e-record system
Monday 2 June 2008
Plans to computerise the NHS in England could face further delays after a contract with a key supplier was terminated, the BBC has learned.
The IT programme, which is already four years late, will create a single electronic records system for patients.
But negotiations have broken down with Fujitsu, who had been due to implement the plan in the south of England.
The Department of Health said an agreement over Fujitsu's contract could not be reached.
The estimated final overall cost of computerising the NHS in England is currently £12.7bn.
Financial penalties
While the NHS's Connecting for Health programme has overrun, tough contracts have so far kept it broadly within budget.
However, these have caused tensions with the companies tasked with carrying out the work.
As the programme has developed, contracts have been renegotiated to include strict local specifications.
They state that contractors will only be paid when services are delivered and working.
If deadlines are missed, payment is deducted, although it can be earned back.
Fujitsu was one of three main suppliers of the system and had held a contract worth £895m for the south of England from Kent to Cornwall.
Fujitsu withdrawal
But now its involvement has ended after the parties failed to agree on the specifics of its contract.
The DoH told the BBC it terminated Fujitsu's involvement "with regret" because it had not been possible to reach agreement.
In a statement, Fujitsu said it had withdrawn from negotiations as it did not feel there was any prospect of an acceptable conclusion.
Existing computer programs installed by Fujitsu in the south of England will continue to be supported, but what happens to those not yet up and running may now be the subject of a legal dispute.
A recent National Audit Office report said an unspecified amount had been withheld from the Fujitsu contract.
The NHS IT programme was launched in 2002 and had been due to be completed in 2010.
The Conservative shadow health minister Stephen O'Brien said the government's attempts to "ram through a top-down, centralised, one-size-fits-all central NHS computer system" had come "crashing down around their ears".
Source: BBCUnite To Ballot Members On Multi-Year NHS Pay Deal
Monday 2 June 2008
Unite, the third largest union in the NHS, is to ballot its members on the proposed three-year NHS pay deal, with a recommendation for rejection.
This increase in militancy follows the refusal of the employers and Health Secretary, Alan Johnston to reopen the negotiations on pay with those unions, including Unite, that had rejected the three-year pay proposal.
Unite (Amicus section) Health Sector National Committee (HSNC), which met today (Thursday, 29 May), called for the ballot on the offer, worth 7.999%, over three years.
It is also asking its members that, if they vote against the deal, whether they wished to have a further ballot on taking various forms of industrial action.
The Unite ballot closes on 11 June, and the NHS Employers and negotiators from the NHS unions are due to meet again on 1 July.
The HSNC passed unanimously a vote of confidence in the Unite negotiating team.
Last month. Unite asked for further negotiations with the government for a one-year deal, but this was rejected out-of-hand by Alan Johnston.
Unite Head of Health, Kevin Coyne said: There was considerable anger and an increased sense of militancy at the national committee today at the governments refusal to contemplate a one-year deal. And there was also a very strong feeling that the three-year pay offer was woefully inadequate, hence the national ballot of our members.
The three-pay deal currently on the table is in effect a substantial pay cut when you consider the very real inflationary trends in the economy, such as soaring petrol prices, increased mortgage payments and runaway utility costs.
For example, food prices have risen by 6.6% over the past year the highest rate since 1997 according to the Office for National Statistics.
The three-year pay deal has been heavily promoted by the government and NHS Chief Executive, David Nicholson, who has warned that this years award could be staged, if unions dont accept the three-year package.
Unite (TGWU section), representing 12,000 members working in the NHS as ancillary and para-medic staff, have already overwhelmingly rejected the government's three-year pay deal. In a ballot, ambulance staff and low paid workers, including porters, caterers and cleaners resoundingly rejected the deal by 6-to-1.
Kevin Coyne also said that Unite wished to defend and strengthen the independence of the Pay Review Body (PRB) to arbitrate pay on an annual basis. The PRB recommended a 2.75% pay award for this year, 2008/9.
Kevin Coyne has already stated that last years 2.5% staged award in England – while NHS colleagues in Scotland, Wales and Northern Ireland received the full amount from 1 April 2007 – created an atmosphere of seething and simmering resentment that must not be repeated.
Polyclinic plans trigger first 100 GP surgery closures
Thursday 29 May 2008
Up to 400 to go in London alone as plans are rolled out
Primary care trusts have drawn up plans to axe more than a hundred GP surgeries across London to make way for the first wave of polyclinics, Pulse has learned.
As many as 400 surgeries will be facing closure across the capital if the eight PCTs to show their hands so far are representative.
London is set to be followed by Birmingham, Liverpool and Yorkshire and the Humber, all of which are developing their own plans for polyclinics.
A series of further SHAs are calling for greater integration of services.
But the plans are moving fastest in London, where eight of the 31 PCTs have already begun identifying practices to be consolidated (see table, below).
Patients at some of the first practices affected have already received letters informing them of the proposed relocation, as health minister Lord Darzis radical vision becomes reality.
Kensington and Chelsea PCTs board last week approved the business case for a hub–and–spoke polyclinic at St Charles Community Hospital, due to open in September 2009. Five practices will be relocated to the hub, with a further 12 practices remaining as spokes.
Elsewhere, City and Hackney PCT is planning to relocate 18 practices, at least 11 surgeries are thought to be under threat in Enfield and in Haringey PCT, there are plans to close 37 surgeries.
Dr Kambiz Boomla, a GP and chair of City and East London local medical committee, warned polyclinics could create enormous access problems.
People don't expect to take a bus to go and visit their doctor, he said. People do expect their GP surgeries to be in walking distance of where they live.
Richard Hoey, deputy editor of Pulse, said: The Government keeps insisting local surgeries will not be forced to close to make way for polyclinics, but the reality on the ground is that closures are already in motion.
Polyclinics will have some advantages, certainly, but the benefits of flash new buildings and access to specialist services come at a cost, in terms of travelling time and continuity of care. The pros and cons need to be properly debated, and its incredible that changes are coming at such a breakneck pace.
Surgeries to be closed
Haringey 37 surgeries to be closed, as PCT consolidates GPs into six polyclinics and 14 larger health centres
City and Hackney 18 surgeries to be closed as PCT plans four Primary Care Resources Centres
Ealing at least 15 practices to relocate into a merged polyclinic, a hub–and–spoke polyclinic and three GP–led health centres
Enfield at least 11 practices with below–par premises to be relocated, with further surgery closures likely
Lambeth at least 8 practices to be relocated into four Neighbourhood Resource Centres
Camden 5 practices understood to be moving into University College Hospital polyclinic no word on relocations to a further four health centres
Kensington and Chelsea 5 practices have already told patients they will be relocating to hub–and–spoke polyclinic at St Charles Community Hospital
Waltham Forest 2 single–handed surgeries planned to close, with the practices joining an existing practice in the redeveloped St James Health Centre
About PulsePulse is the market–leading magazine for GPs in the UK. It has a controlled circulation of 43,000 and is consistently the best read medical paper in the UK.
Launched in 1960, Pulse is published by CMP Information.
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Hospital surgery death rates to be made public
Thursday 29 May 2008
The government is preparing to publish for the first time the death rates of patients undergoing major surgery at NHS hospitals in England, the Guardian has learned.
- UK first in world to publish data
- Major variations will be exposed
The move will expose alarming variations in the mortality rates of NHS trusts carrying out commonplace procedures, including hip and knee replacements and surgery of the oesophagus and abdominal aorta, the main blood vessel.
It will be the first time anywhere in the world that a government has systematically exposed the work of rival hospital teams, giving patients an opportunity to choose to be treated where their lives are least at risk.
The data, which is to be put up on the NHS Choices website during the summer, is expected to reveal a disproportionately high death rate in hospitals carrying out fewer operations, where the surgeons have less opportunity to hone their skills.
Ministers think publication of the figures will drive up standards by forcing trusts to improve performance or withdraw from medical specialties at which they do not excel. At this stage the published data will give results for hospital units, not individual surgeons. But Ben Bradshaw, the health minister, has instructed that the NHS Choices website should eventually let patients compare the performance of individual surgeons and GPs, heralding a big switch in the balance of medical power in favour of the patient.
Until recently surgeons resisted the disclosure of mortality rates, arguing that it might discourage them from taking on riskier cases and lead to the loss of lives among patients who could have benefited from treatment.
The surgeons also disputed the accuracy of –hospital episode statistics– submitted by trusts to the Department of Health.
But ministers were impressed by a pioneering experiment by the Society of Cardiothoracic Surgeons, which published the mortality rates of consultants carrying out heart bypass operations.
Since the data was made available two years ago, the surgeons have taken on more risky cases without any increase in the death rate.
They have acknowledged that they were persuaded to reveal the risk–adjusted mortality rates of individual surgeons after the Guardian lodged 36 applications under the Freedom of Information Act in 2005.
Sir Bruce Keogh, a heart surgeon and former president of the society, was recently appointed medical director of the NHS with responsibility for introducing openness to other branches of medicine.
At a private seminar at the Royal College of Surgeons on Tuesday he made it clear that ministers were no longer prepared to put up with excuses for continued medical secrecy. "There is no going back," he warned representatives of the medical colleges. "The department is not seeking your permission. It is merely seeking your help."
Keogh told the Guardian that the first batch of mortality data would be published "within weeks or months" – at the latest by September.
Disclosure of the mortality data of hospitals will be followed by the publication of a wider range of indicators showing the outcome of treatments across many branches of medicine.
Keogh has asked the medical directors of every hospital and mental health trust in England to send in examples of the performance statistics they use internally to assess the quality of their clinical teams. The department will select about 50 for debate within the medical community.
Once any statistical snags have been ironed out, they will be published on the NHS Choices website, probably during the spring of next year.
Keogh said the desire for openness was being driven by three imperatives for the next stage of NHS reform: health commissioners need better data on the quality of hospitals' performance; doctors need to demonstrate the quality of their work; and patients need information about quality to exercise choice about where to go for treatment.
"We hope to identify a series of measures that could be combined in a scorecard, which becomes a composite measure of quality for each specialty in each institution."
Keogh added: "Some will squeal that the data is not good enough, but the only way we can improve it is by using it."
"We want people to submit to us what they think are useful measures of the quality of treatment and, if we agree, we will apply those measures across the board in the NHS. They will not be targets, but they will be benchmarks showing how people perform."
"The writing has been on the wall since the inquiry into the deaths of children at Bristol Royal Infirmary 10 years ago, [which showed how poor practice was allowed to persist because the mortality rates were not disclosed]. There has been a lot of talk about more openness, but we as a profession have not made much progress. So I am now inviting the institutions of medicine to step up to the plate and help us accelerate the process. We want their help."
Bernard Ribeiro, president of the Royal College of Surgeons, said: "This is going to happen and the college has to be the vehicle to make it happen. I have urged the government to use data about hospital units, not individual surgeons at this stage."
"Outside the field of cardiac surgery it is difficult to determine the outcome we should be measuring. Surgery is not just about whether patients live or die. It is also about mobility and quality of life."
Source: The Guardian.Patients wrongly certified dead
Monday 26 May 2008
Patients in five English hospitals have been incorrectly diagnosed as being dead over the past five years, the BBC has discovered.
The information was obtained under the Freedom of Information Act by the Donal MacIntyre programme.
In each case the mistake was later realised, the programme reports.
A policeman told the show how he gave a woman heart massage after a doctor said she was dead; an undertaker nearly took her to a mortuary, he said.
Det Con Philip Shrimpton was called to a remote house in Thwing, East Yorkshire, in 1996 where Mrs Maureen Jones had slipped into a diabetic coma.
She was found lying face down in her bedroom. A doctor had incorrectly diagnosed her as dead and had left the scene – but Det Con Shrimpton had his doubts after his colleague thought he had seen her body move.
He told the Donal MacIntyre programme: "She didn't have the characteristics of someone who was dead in her eyes - it was almost as if there was some soul there."
"I started giving her heart massage and after a couple of moments she took an intake of breath. I noticed there was some shallow breathing. I didn't panic – but I was very shocked."
"Knock at the door"
Moments previously, Det Con Shrimpton had told Mrs Jones' son that his mother had died.
"I've thought about what it must have appeared to him. The doctor told him that his mother was dead and he comes into the room and there are two police officers – one astride his mother."
"At the same time there was a knock at the door and I can only imagine it was the undertaker."
"If we hadn't recognised the fact she was alive, I am absolutely sure that the undertaker would have come upstairs."
"She would have been placed in a coffin and taken to the mortuary and placed in a fridge. She would almost definitely have died as a result."
In a further case uncovered by the investigations, a decision was made to withdraw active treatment on a patient.
The patient was reviewed by a doctor who confirmed verbally that the patient had died.
A short time later it was noticed that the patient was still breathing and when the patient was reassessed it was discovered that cardiac activity had returned.
'Rare events'
Dr Jan Bondeson, Professor of Rheumatology at Cardiff University and author of Buried Alive: The Terrifying History of Our Most Primal Fear believes that these cases could be more widespread.
"There have been some near misses where people have woken up in a body bag in the morgue. So it is very likely that others have been buried alive," he said.
However, Dr Jonty Heaversedge of BBC One's Street Doctor said that cases of misdiagnoses are rare.
"These are cases where doctors haven't spent enough time confirming death. The vast majority of diagnoses are obvious and clear and there are very few exceptions."
"All doctors are very well trained in diagnosing death and spend a lot of time making the correct diagnosis. People should not be worried about these extremely rare events."
The Radio 5 Live investigation was broadcast on the Donal MacIntyre programme on Sunday 25 May.MRSA 'cut by stopping injections'
Friday 9 May 2008
A hospital trust has claimed to have eliminated MRSA bloodstream infections by stopping the routine practice of administering intravenous injections.
Winchester and Eastleigh Healthcare NHS Trust has instead begun prescribing the insertion of cannulae – a small tube used for giving intravenous fluids.
Doctors are able to monitor the tubes more closely for signs of infection.
The trust said since the introduction last November there have been no new cases of MRSA infections.
This figure covers all forms of MRSA, including bloodstream infections (also known as bacteraemia) and wound infections.
This compares to 2007/08 when there was 11 reported bloodstream infections. The maximum level set as acceptable by the government is 12.
'Big improvement'
The trust, which runs the Royal Hampshire County Hospital in Winchester and the Andover War Memorial Hospital, believes that if the same practice was adopted nationwide MRSA levels would drop dramatically.
Previously, patients who were likely to need intravenous fluids or drugs in this way were given a cannula as a routine part of their medical care.
But now the technique can only be prescribed by specialists trained in their insertion and they are signed off by a doctor.
Once inserted, the cannula tube is flushed with a saline solution and inspected on a daily basis.
A scorecard is then used to regularly rate its appearance and spot any irregularities or signs of infection.
Dr Chris Gordon, consultant physician and divisional director for medicine at the Trust, said: "It is well known that cannulae can cause bloodstream infections, such as MRSA, which is why we were so keen to make these changes."
Derek Butler, chair of MRSA Action UK, said: "It is an excellent step forward, a big improvement. I applaud what they are doing and I would like to see it rolled out nationally."
"It will help fight MRSA levels as another piece of best practice."
Source : BBCBlood of 2,500 donors thrown away
Friday 9 May 2008
Blood from more than 2,500 donors has had to be thrown away after a refrigeration unit broke down, costing the National Blood Service £350,000.
The refrigeration unit at the service's centre on the site of Southampton General Hospital broke down last week.
Quality regulations stipulate blood must be stored at between 2C (36F) and 6C (43F), the service said.
The blood "breached our rigorous quality standards and, therefore, has had to be discarded," it added.
No patients were directly affected.
"Due to a problem with the refrigeration plant, we were unable to issue red blood cells from our Southampton centre last week (Monday–Thursday)," a spokeswoman said.
"The supply of platelets and other products was unaffected and normal service for red blood cells was resumed on Friday 2 May."
"No patients were affected by this event."
Emergency contingency plans to ensure the hospital continued to be supplied with blood had been tried and tested, she said.
"These were put into effect on discovery of the problem, with emergency deliveries continuing to operate from our Southampton centre throughout this period."
"We should emphasise that the regular maintenance checks carried out across all our centres make events such as this a very rare occurrence."
She added: "Finally, we do value our donors very highly."
Source : BBCSurge in cases of superbug that is harder to tackle than MRSA
Friday 9 May 2008
Cases of a hospital superbug more difficult to treat than MRSA have soared by 40 per cent, experts are warning.
Stenotrophomonas maltophilia, or Steno, thrives in the black 'gunk' that lines shower heads and taps. It kills around 300 Britons a year.
Some strains of the bug are resistant to all available antibiotics, making it harder to treat than the highly–publicised MRSA and C diff infections.
With the number of cases in British hospitals rising by around 40 per cent between 2001 and 2006 to around 1,000 a year, scientists say there is an urgent need to find new ways to combat it.
Bristol University researcher Dr Matthew Avison said: 'There are a number of drugs which can be used to treat MRSA but with Steno, in many cases there is only one drug that works'.
'We are seeing increasing resistance abroad to that one drug and there are no new drugs going through clinical trials. There is a desperate need for a new way of approaching the problem,' he added.
Although found in many homes, Steno only causes a problem in hospitals, where the seriously ill are unable to fight it off.
Those at risk include the elderly, intensive care patients and cancer patients whose immune systems have been weakened through chemotherapy.
After entering the body through tubes used for feeding, breathing or draining urine, the bug quickly multiplies, causing blood poisoning that proves fatal in around 30 per cent of cases.
Dr Avison, who has unravelled Steno's genetic sequence, said: 'This is one of a number of organisms that is becoming increasingly common as we keep people alive longer in an iller and iller state'.
'The immune system breaks down and, if you haven't got a competent immune system, the infections can strike.
'If your immune system is strong, these organisms are perfectly harmless.
'Anecdotal evidence is that there are increasing numbers of infections and, more importantly, the infections we are seeing are becoming increasingly difficult to treat up to the point where we now have strains which are completely resistant to everything we can throw at them.'
The sequencing of Steno's DNA, published today in the journal Genome Biology, could help scientists develop new ways of fighting it.
Researcher Dr Lisa Crossman, of the Wellcome Trust Sanger Institute near Cambridge, said: 'If we know which proteins cause it to stick to surfaces, we could try to develop compounds that interfere with this action'.
'If we understand its antibiotic resistance mechanisms, we might be able to design inhibitors that block them.' The inhibitors could then be given alongside antibiotics, to ensure they work properly.
The Department of Health said a 'clean and safe' NHS was a top priority and added that millions of pounds had been invested in infection prevention, training, upgrading isolation facilities, new equipment and better surveillance.
Source : Daily Mail By FIONA MacRAELord Darzi sets out tough rules for changes in the NHS
Friday 9 May 2008
Five pledges will ensure that change is transparent and driven by the best evidence
Leading clinician and Health Minister Lord Darzi today issued five pledges to the public and staff on how the NHS will handle changes to services. He set out a rigorous process requiring any change to be transparent, clinically evidenced, locally led and for the benefit of patients.
Lord Darzi's report 'Leading Local Change' comes ahead of his final report on the next stage of NHS reform.
This new report, aimed at the public, patients and staff, signals that whilst the NHS must never back away from necessary change to improve services and save lives, there should be important checks which any change has to undergo before it proceeds. That is why today we are making five pledges on change in the NHS, which PCTs will have a duty to have regard to:
1. Change will always be to the benefit of patients. This means that change will improve the quality of care that patients receive – whether in terms of clinical outcomes, experiences, or safety.
2. Change will be clinically driven. We will ensure that change is to the benefit of patients by making sure that it is always led by clinicians and based on the best available clinical evidence.
3. All change will be locally–led. Meeting the challenge of being a universal service means the NHS must meet the different needs of everyone. Universal is not the same as uniform. Different places have different and changing needs – and local needs are best met by local solutions.
4. You will be involved. The local NHS will involve patients, carers, the public and other key partners. Those affected by proposed changes will have the chance to have their say and offer their contribution. NHS organisations will work openly and collaboratively.
5. You will see the difference first. Existing services will not be withdrawn until new and better services are available to patients so they can see the difference.
Lord Darzi said:
"The nature of healthcare means services will always need to change, and sometimes that means re-organising how services are provided".
"Our nationwide listening events have shown me that patients, the public and NHS staff are not opposed to change in principle but want to ensure it is done to save lives and improve quality and is not driven by cost or politics".
"This is not about change for change's sake. It's about change for the right reasons, improving quality of care for patients and saving lives. These pledges mean change will be locally–led, clinically–driven and evidence–based. And an independent high clinical bar for change should reassure local people everywhere that we mean what we say".
"The right way of doing this is to put local clinicians in the lead, with the public and relevant independent experts consulted and involved at an early stage. Ensuring that changes are based on the strongest clinical evidence and are relevant to their local communities. The role of national bodies has to be to support local clinicians with the best evidence".
"We are putting in place a process that ensures the local NHS rigorously checks proposals for change to ensure they meet the highest standards. The principles and guidance published today sets out how, where necessary, the NHS will make changes that will lead to real improvements for everyone – changes that are based on clinical evidence and supported locally by patients and the public".
"The focus of my report on the next stage of NHS reform will be how we can enable local clinicians and patients to be the driving force of improvement and change in the NHS. These proposals I am setting out today are only the first part of that. Empowered patients and empowered staff are the key to world-class standards".
The detailed operational guidance also published today, Changing for the Better, builds on the work set out in Sir Ian Carruthers review of service change and reconfiguration proposals published last year.
Since the start of the Review in July last year, Lord Darzi and his team across the country have been engaging widely with patients, the public and staff working in the NHS and other local organisations. Over 60,000 people have participated in the Review including nearly 2,000 frontline clinicians and other staff who worked as members of the clinical pathway groups.
Every area of the country will publish a clinicially led vision document over the next month, setting out priorities for improving health and healthcare over the next decade. Lord Darzi's final Review report will be published in June. It will focus on enabling and supporting the changes agreed locally by patients, the public and NHS staff.
Leading Local Change, can be found hereNHS 'chaos' over surgical tools
Friday 25 April 2008
Operating theatres are being thrown into chaos and operations cancelled because of broken, missing or dirty surgical instruments, surgeons say.
The Royal College of Surgeons of En