Friday, July 01, 2011

Doctors ask: did Great Ormond Street boss cover up hospital's role in Baby P affair?

Hospital management ignored strenuous warnings about deficiencies in care that led to the death of a toddler (below)

Senior doctors at Great Ormond Street Hospital have called for an independent investigation into their chief executive, following claims she helped cover up its role in the Baby P affair.

The consultants have written to The Lancet saying it is now "impossible" to raise questions over the conduct of Jane Collins internally.

They imply the matter has not been "properly or impartially investigated" within the hospital, and warn that this makes the famous children's hospital appear to be "an organisation that buries its mistakes".

Their letter comes three weeks after Lynne Featherstone, the Equalities Minister and MP for Haringey in north London, said Dr Collins "deliberately withheld" important information regarding the children's clinic where Baby P was seen two days before his death.

Ms Featherstone told the BBC that it appeared Dr Collins "attempted to cover up the fact that the situation" at the clinic, St Ann's Hospital, had been deemed "clinically risky" in an independent report.

Clinical staff at St Ann's, including the consultant paediatrician was saw Baby P and missed that he had a broken back, were employed and managed by Great Ormond Street at the time of his death in August 2007.

While Great Ormond Street passed on the full report to police, only a summary went to the author of the serious case review looking into the death of the child, whose name was Peter Connelly.

Calling for an "independent investigation", the doctors wrote: "We want the matter properly and impartially investigated, not because error is inexcusable, but because we do not wish GOSH to be seen as an organisation that buries its mistakes."

A spokesman for Great Ormond Street Hospital claimed the consultants were motivated by other concerns.

He said: "There are a minority of consultants who are unhappy at some of the changes that the trust is introducing to improve patient care.

"We are sorry that they have chosen to express their views through the media, when there are plenty of avenues through which to raise concerns within the trust. The vast majority of staff are clearly comfortable to use these."

100,000 terminally ill Britons 'do not get proper palliative care'

Almost 100,000 terminally ill people do not get proper care, according to a Government review which concluded that a new funding system would save millions of pounds and better serve individuals. A national payment structure would cut variation around the country in what the state pays for and what it does not, and support far more people to be cared for in their own homes, it said.

Experts behind the report say the move could reduce deaths in hospital by up to 60,000 a year by 2021, translating into savings of £180 million annually.

At the moment, the amount primary care trusts (PCTs) in England spend on end-of-life care varies widely, from £186 per patient in one area to £6,213 in another.

Access to services, including round-the-clock nursing care, also depends on where people live.

Far more people die in hospital than wish to, and experts estimate that more than 90,000 people are not having their palliative care needs met.

The Palliative Care Funding Review, ordered by Andrew Lansley, the Health Secretary, last summer, proposes a "fair and transparent" funding system where the money is linked to the individual patient.

Under the scheme, people would receive an initial assessment of their needs, which would then be combined with other factors such as their age and capabilities.

This "needs classification system" would have 25 separate classes (13 for adults and 12 for children), each with its own pot of funding.

The funding would take account of things such as personal care needs, including help with washing and eating, the provision of 24/7 nursing care to support people at home and a co-ordinator to help patients work out their state entitlements as well as access to local charitable services.

At present, some end-of-life care providers are paid regardless of how much work they do, offering poor value for money across the service, the review said.

Meanwhile, 97% of hospices do not receive all the funding they need for the NHS services they provide, and some patients are victims of "rationing" towards the end of the NHS financial year.

These latest proposals would guarantee funding regardless of where patients live and whether they are in a care home, hospital or in their own home.

Thomas Hughes-Hallett, chair of the review and chief executive of Marie Curie Cancer Care, said: "No other country in the world has introduced such a system for both adults and children, so the step is both a bold and necessary one."

Professor Sir Alan Craft, adviser to the review, said: "The Government must act on the recommendations contained in the review because evidence shows us that incentivising the provision of palliative care leads to better outcomes for patients, supports choice and is the most cost effective way of using NHS resources.

"We need to remove the barriers within the current system to enable this to happen."

Between 56% and 65% of adults would like to die at home but only 20% do so, with 55% dying in hospital.

The ageing population and the increased complexity of needs towards the end of life mean 90,000 more people than at present could be dying in institutions by 2030, the review said.

Ciaran Devane, chief executive of Macmillan Cancer Support, said people wanted a choice over where to die.

"Twenty-four hour community nursing services are crucial to the delivery of choice and to the realisation of these ambitious recommendations. "It will be up to the Government to ensure that these services are standard across the country. "We need to see a massive improvement on the 56% of PCTs who currently provide 24-hour community nursing."

Simon Chapman, director of policy and parliamentary affairs at the National Council for Palliative Care, said: "It is vital that the Government acts on the review's recommendations and creates a fair funding mechanism that will ensure people get high quality end of life care where and when they need it.

"We only get one chance to get it right for dying people, which is why it must be a priority to ensure everyone who needs it can access palliative care round the clock."

Susan Munroe, Marie Curie Cancer Care's director of nursing and patient services, said: "Far too many people at the end of their lives are still not getting the care and support they need nor do they know what they are entitled to.

"We welcome the recommendations of the review as the next big step. "We now want to see these recommendations implemented by the Government as a matter of urgency."

You can't join NHS post-natal depression support group, you're too sad: What mother was told by mental health nurse

A young mother suffering from post-natal depression was told she would 'bring down' other mothers if she joined an NHS support group. Rachael Dobson was told that she was too unhappy to be allowed to join other mothers in the same situation in a bid to regain full health.

The 22-year-old was shocked when a health visitor refused to refer her to the group while a mental health nurse also refused to help her, saying she should 'work through' her problems on her own.

Mrs Dobson, who suffered severe post-natal depression following the birth of her son Andreas, is now setting up her own charity to help other sufferers.

She said: 'The health visitor told me there was a support group where women suffering from post-natal depression would meet up but she said to me: 'You're two pegs above them and you'll bring them all down.' 'It was like being told I was too unhappy to go to the group but that was the whole point of the group. 'It would hardly be full of women joking around - all these women were suffering post-natal depression. 'I genuinely felt like I had been slapped round the face.

'Post-natal depression is very misunderstood but it had a devastating effect on me. 'Some days I couldn't physically get up and my husband would have to take the day off and drag me out of bed. 'I've always been very active and sociable but post-natal depression knocked me sideways.'

Mrs Dobson was struck down with post-natal depression just minutes after giving birth to her son Andreas on February 8 last year. She said: 'The birth wasn't exactly plain sailing. I had an emergency caesarean and I felt as if I was being attacked. 'When Andreas was delivered I was put in a side room on my own and looking over into the cot I was not met with love or joy, just nothing.'

Her fragile state got rapidly worse when she and husband Stuart, 26, took Andreas back to their home in Shrewsbury, Shropshire. She said: 'For the first few weeks I would cry when my husband walked through the door and would launch into rageful fits of anger.

'I wouldn't do anything with my son and when he cried at night I would bury my head in the pillow and Stuart would get up to help him. 'One morning I was overwhelmed with tremendous anger and I wanted him [Andreas] gone. 'I was then met with a sadness and horror because I couldn't believe I felt like this towards a baby.

'I rang my health visitor and collapsed into tears on the phone. She came round and I poured everything out. 'After that I was contacted by a community practice nurse from the mental health team but she just told me I had to 'work through it' on my own.'

Rachael and Stuart, who both work for Severn Trent Water, moved to a new house in Shrewsbury under the care of a different health visitor.

Social Services got involved and Rachael was banned from being on her own with Andreas for four months until her condition improved and she was deemed safe. She has now set up her own support group called the Pandas Foundation for other mums suffering post-natal depression.

She said: 'I feel like I was left on my own by the health visitor. 'I was lucky that I had my family to fall back on for help and I feel like I'm coming out the other end of the post-natal depression now which is why I want to help others. 'I want to create a support network and one-to-one sessions for women and men who are suffering like I did. 'Post-natal depression is a terrible thing to happen to anyone and it almost sent me over the edge.

'I feel let down by the health visitor who refused to help me and almost led me to lose my family.'

Hospitals leaking patient data to 'no win no fee' firms, claims MEP

Confidential patient data is being leaked from hospitals to 'no win no fee' accident claims firms, an MEP claimed on Tuesday night. Paul Nuttall, the UK Independence Party MP for the North West, has called for an inquiry into the alleged practice, saying if true it was "an outrage".

He made the claim after being contacted by members of the public upset at being "harassed" by such firms after receiving treatment at hospitals in Liverpool and The Wirral. Both hospital trusts have denied the claims.

Mr Nuttall said: "I have been approached by constituents who are angry that have been bombarded with text messages to their mobile phones after hospital treatment. "The only way the claims firms can have got the information that they had been a patient and also got their mobile phone numbers is from the hospital itself," he said.

"I don't know if that is being done with the connivance of the hospital trusts concerned - Wirral and the Royal Liverpool Hospital - or whether some staff are doing this off their own bat.

"But I want to know and this must be stopped. I know that hospital trusts everywhere are having to make budget cuts but if they are selling this highly private information to boost their coffers it is an outrage and must contravene the Data Protection Act." He went on: "People are being harassed by these claim firms, who apparently sell or pass on the information to other similar firms when they get no response."

However, both the Royal Liverpool and Broadgreen University Hospitals NHS Trust and the Wirral University Teaching Hospital NHS Foundation Trust have denied any wrongdoing.

A spokesman for the Royal Liverpool said the allegations were "completely false". She said: "We have not had any incidents where members of staff have sold patient information to claims firms. If we are made aware that any members of staff are not abiding by the Data Protection Act then they will be disciplined appropriately.

"If Mr Nuttall has been approached by patients who have concerns, then we urge those patients to contact us so that we can investigate this further."

A spokesman for Wirral hospitals said it could "categorically deny that is has supplied confidential patient information to accident claim firms".

Data on users - such as phone numbers of those who have been involved in accidents - are sold to claims firms by so-called "claims farmers". The collection and selling of such information is a grey legal area, but the subject must have given their explicit consent for their details to be passed on.

Rules on foreign doctors 'put patient safety at risk'

British patients are at risk from foreign doctors who are unfit to practise because EU laws put freedom of movement ahead of the safety of patients, leading clinicians have claimed.

Dr Hamish Meldrum, chair of the British Medical Association (BMA) council, said that European employment law and other countries' refusal to share information from their medical registers meant British medical regulators were sometimes powerless to guarantee foreign doctors' capability.

It raises the prospect that a doctor banned from practising in one country could be registered in Britain without the General Medical Council being aware of their prior record for incompetence.

EU laws mean the General Medical Council (GMC) can not test the clinical capability or language skills of European-qualified doctors as they can with those from other parts of the world.

Unlike the GMC, many European countries refuse to reveal information about malpractice hearings.

At a BMA meeting in Cardiff yesterday, Dr Meldrum said: "If a doctor was struck off and the GMC knew about it then I think the likelihood of them being able to practice is probably quite low, but the problem is whether the GMC always knows about it and also knows the reasons as to why it happened.

"We are aware of several cases where doctors have been removed from the medical register in this country because of fitness to practice problems, but are still practicing elsewhere in the EU. I am afraid EU law seems to put freedom of movement rather higher than protection of patients."

Daniel Ubani, a German-qualified cosmetic surgeon, was working as a locum out-of-hours GP in Cambridgeshire when he accidentally killed 70-year-old David Gray with a tenfold overdose of painkillers in 2008.

The GMC had been unable to verify whether Ubani had ever worked as a GP in Germany because his license automatically gave him the right to work in Britian. He can still practise in Germany.

Dr Meldrum added: "We saw with the Ubani case how he was found guilty in the UK and yet he is still practicing in Germany and that doesn't seem to be satisfactory."

Dr John Fitton, a GP from Kettering, Northamptonshire, said: "It should be unacceptable that a doctor who is found to be incompetent or untrustworthy in one jurisdiction of the country might equally be able to find employers in another."

The European Commission has launched a green paper consulting member nations on the prospect an international alert system when a doctor is found unfit to practise.

Niall Dickson, GMC Chief Executive, said: "This is about patient safety. When we take action against a doctor we actively tell other regulators.

"We want other regulators across Europe to do the same and have urged the European Commission to put a duty on them to do this. We believe all regulators must share this vital information in order to keep patients safe."

Britain's age timebomb: Cost of 1.4m extra pensioners means NHS cannot stay free, says think tank

Britain faces a bleak future of higher taxes and a rising deficit if ministers continue to increase spending on state pensions and the NHS, a hard-hitting report warns today.

The country is facing a demographic timebomb with the number of over-65s set to increase by 1.4million over the next five years. The report by think tank Reform warns that this ageing population threatens to overwhelm the Coalition's attempts to bring down the UK's biggest ever peace-time deficit.

The report calculates that the ageing population will impose an additional burden on the taxpayer of £32billion for pensions and nearly £40billion for healthcare by 2041, without allowing for inflation. This is set to force up both taxes and state borrowing during the next Parliament, 'swamping' Chancellor George Osborne's plans for deficit reduction.

The authors accuse ministers of 'burying their heads in the sand' about the scale of the impending crisis and call on individuals to take responsibility for their own futures. They go on to urge the Government to face down the unions by holding firm on reforms to public sector pensions.

The report also proposes a number of radical and controversial measures to prevent Britain from collapsing into a spiral of debt, including charging for the NHS.

They also include scrapping popular 'gimmicks' such as the Winter Fuel Allowance and free bus passes – and forcing people to save for their retirement.

The pro-market think tank also calls for the Coalition to reverse its decision to link the state pension with earnings and drop plans for a single tier pension – which has been estimated to cost an additional £11billion per year.

It says: 'Decisions such as indexing the state pension to wage growth not price growth should be reversed. 'Shifting forward the increase in the retirement age has not made this change affordable. It will only save money until 2021 after which the age will be back on its earlier trajectory.'

The report, called Old and Broke, says that between 2011 and 2016, the number of people aged 65 and over will increase by 1.4million while the working age population below 50 will decrease. There are currently 10.1million people aged 65 or over in the UK.

Population ageing will continue so that the ratio of workers to pensioners will fall from 3.9 in 2011, to 3.2 in 2021, and then to 2.5 in 2041.

The report adds: 'Change has to take place. Government programmes are largely funded on a pay as you go basis. 'With the ageing of the population ... younger people will face the prospect of paying more for less while the elderly population enjoys a heavily subsidised lifestyle and unearned windfall gains.'

The report continues: 'Research has shown that the UK has the largest pensions gap in Europe. Too many people “play chicken with the State” and assume that taxpayers will always be there to bail them out in periods of need.'

Pointing out that people in the UK make one of the smallest contributions to healthcare in Europe, the report calls for more charging in the NHS. It says: 'The service cannot remain free at the point of care. As well as increasing revenue for the services, charging will moderate demand and engage patients more in how they consume health services and how they manage their own health.'

The report's lead author, Dr Patrick Nolan, added: 'Starting long-term reform will give people time to make alternative plans for their future.'

British GP bonuses 'lead to poor patient care' as financial incentives boost some treatments... but caused a decline in others

Bonus payments for GPs mean some patients are missing out on improved care, say researchers.

The financial incentives have led to better measuring of high blood pressure and cholesterol levels, a study shows. But in other areas of patient care which are not in the scheme improvements were ‘significantly below’ what was expected. These included measurements involving people suffering from arthritis, dementia and back pain.

Pay-for-performance targets were introduced in 2004 as part of a new contract for GPs to reward them for taking better care of patients. The scheme had an annual price tag of £1.8billion at the time and is now worth around £1billion. Around a quarter of GPs’ average income – currently £105,000 a year – is linked to achieving the targets.

But the study says there may be ‘unintended consequences’ to the scheme, which is known as the Quality and Outcomes Framework. The study, published last night in the British Medical Journal, looked at data from 500 UK general practices and trends in quality of care for 42 activities.

Of these, 23 measurements or treatments attracted a bonus payment including measuring blood pressure and smoking habits. A further 19 activities did not lead to extra money, including measurement of thyroid function or blood sugar levels in certain categories of patients.

For all activities, there was a general improvement in quality before incentives were introduced.

When bonuses were attached to some measurements, there was a significant increase in quality during the first year after the scheme came in. This levelled off after three years to a 4 per cent rise above what would have been expected without incentives.

For measurements that did not attract extra money, quality was ‘significantly worse’ after three years, with a 5 per cent drop compared with the improvement that would have been expected without incentives.

Dr Tim Doran, who led the research team, said financial incentives resulted in a quicker rate of improvement in some activities. But it was questionable whether this lasted, and whether patients whose conditions did not attract bonuses were being neglected.

Dr Doran, a clinical research fellow at Manchester University, said: ‘It’s not possible to incentivise everything. It does improve quality in the short to medium term but it has a small detrimental effect on activities that do not attract financial targets. ‘In the medium term these may have been slightly neglected.’

Dr Doran said there were limitations to ‘bonus’ schemes because they set priorities for care that might result in other areas such as depression receiving less attention, partly because it was harder to measure improvements. Earlier this year research found that targets set to improve high blood pressure and cut heart attacks and strokes ‘had no impact’.

Researchers, led by Dr Brian Serumaga, a Harvard Medical School fellow working at Nottingham University, investigated 470,000 patients with high blood pressure. They found ‘little evidence’ of effectiveness of pay for performance targets.

The Government has pledged to reform the way GPs are paid for targets in the face of criticism.

The British Medical Association says the Quality and Outcomes Framework was designed to ensure that patients received uniform high-quality care no matter where they lived in the country, and, by doing that, to improve public health over the long term.

A Department of Health spokesman said: ‘The Quality and Outcomes Framework and other incentives for GPs are insufficiently focused on outcomes, including patient experience. ‘We therefore intend to reform the payment system so that GPs are rewarded appropriately for improving patient outcomes.’