Wednesday, October 31, 2007

Out-of-hours NHS care 'failing'

The NHS is failing to offer sufficient out-of-hours GP care for severely ill patients, experts have said. Existing services are "inadequate and inflexible" and there is a need for better diagnostic facilities, the Royal College of Physicians taskforce said. The group also said hospital care needed to be redesigned for those with non-life threatening life conditions that none-the-less require treatment. The government said care was improving after record investment.

The taskforce, which included a range of health professionals, looked at acute medical care. This includes the care of patients with respiratory problems or chest pains or complications linked to epilepsy or diabetes, which are not yet emergencies but could become so. The taskforce said poor standards of weekend and evening GP cover, which is now done by co-operatives of health professionals and private firms after family doctors were allowed to opt out in 2004, was forcing some patients to turn up at hospital for "reassurance".

The report recommended that local navigational hubs be set up to sign-post patients to the right services. And it called for specialist outreach clinics to be set up in the community to bring expert care out of hospitals. It said out-of-hours cover needed better access to diagnostic facilities, which includes scans and blood tests, to create a "see and treat" culture rather than the "see and greet" one that currently exists.

The experts also said hospital services needed to be redesigned to ensure "rapid streaming of patients". The experts said that all too often even patients already in hospital can find themselves moving slowly through the system seeing nurses, junior doctors and then consultants when they really need urgent help. They said acute medical units, rapid assessment, diagnosis and treatment centres which are becoming increasingly common in hospitals, need to be located near other key services such as the emergency department and critical care.

RCP president Professor Ian Gilmore said NHS professionals were facing a challenge - "to change what we do, when we do it and how we do it". He added: "For doctors, nurses, managers and all those involved with the care of acutely ill patients, this task will not be easy, but the status quo is not an option if we are to give these patients a consistently high standard of care."

Health Minister Ben Bradshaw said the government welcomed the report but was already making sure that people have access to care around the clock. "Primary Care Trusts must deliver high quality out-of-hours care, and in addition, patients have access to a range of other services that can provide urgent care out-of-hours including NHS Direct and NHS walk-in centres," he said. "We have invested record amounts in out of hours services and patients are seeing the benefits - eight our of ten patients say that they are satisfied with the service, and six out of ten rated the service as excellent or good."


Australia: Another butcher doctor still operating in Queensland -- a "Professor", would you believe?

Queensland seems to specialize in "overconfident" doctors. The scum is now in private practice. Woe to Brisbane women!

A prominent member of the Brisbane medical establishment has been charged with manslaughter after he allegedly sliced open a woman's vein in a botched operation then prescribed blood-thinning drugs that hastened her death. Before the Dr Death scandal that brought about major health reforms in Queensland, Nardia Annette Cvitic, who was suffering from cervical cancer, went to Brisbane's Mater Hospital to have a hysterectomy performed by Bruce Ward. The 30-year-old collapsed in hospital three days after the operation, having lost half her blood volume. She died on February 22, 2002, despite having undergone emergency surgery, where Dr Ward's initial response of a double-dose of blood-thinning drugs was overruled by experts summoned by his worried colleagues.

Trained in Australia and Britain, Dr Ward - who maintains he is a good doctor - was working at the Mater and Royal Women's hospitals at the time of the death of the mother of two; he was a professor at the University of Queensland and remains a fellow of the Royal Australian College of Obstetricians and Gynaecologists. The Australian revealed last year that the Mater approached Cvitic's family to offer an out-of-court settlement in 2003 - eventually paying out $175,000 for her two young sons.

Dr Ward is understood to have been retrained after Cvitic's death. He has unrestricted registration through the Queensland Medical Board and was released on bail yesterday after Deputy State Coroner Christine Clements formally charged him with manslaughter. Ms Clements used the old Coroner's Act to charge Dr Ward with manslaughter, 18 months after the inquest into the death finished. In the inquest, Ms Clements heard evidence that the bloodied operating theatre at one point resembled the aftermath of the Granville train disaster in NSW in the 1970s.

While Dr Ward testified that he made reasonable, albeit incorrect, clinical decisions, Ms Clements found 13 instances where a properly instructed jury might find him criminally negligent and responsible for the death. Dr Ward declined to respond to the charge yesterday, leaving his barrister, David Tait, to continue his defence in the media, again extending his sympathies to the Cvitic family. Mr Tait said his client was devastated by her death and disappointed by Ms Clements's decision. "Over 20 years he has looked after thousands of women in Queensland for serious gynaecological cancers and, indeed, he has dedicated his life to medicine and to helping women in this position," Mr Tait told reporters, reading from a prepared statement. "Dr Ward is adamant that he has done nothing wrong, he has committed no criminal offence."

Cvitic's elder sister, Helen Liversidge, who was in court to hear Ms Clements's findings, said she was pleased with the result. Describing her sister as "very fun-loving, happy, vivacious young lady, full of life", Ms Liversidge said she had lost the opportunity to see her children grow up. "Her eldest son is now starting his first day as a butcher," she said.

Ms Clements was supportive of the reforms undertaken at the Mater, and across the health system, since the death, but lamented the lack of closer monitoring for blood and fluid loss. "If this had been recorded and coupled with so-called standard blood tests ... the problem of blood loss might have been identified earlier," Ms Clements said.

Ms Liversidge said she believed the reforms introduced after her sister's death were already saving lives. "My sister's death has helped a lot of people," she said. Under the 2003 Coroners Act, Queensland coroners are only able to recommend that charges be laid against a person. However, because Cvitic's death occurred before the law change, Ms Clements was able to charge Dr Ward under legislation passed in 1958.


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