NHS must ‘fundamentally change’

Stafford Hospital: NHS must ‘fundamentally change’

Robert Francis QC delivers his statement, saying: “It is a story of appalling and unnecessary suffering of hundreds of folk”

There should be a “fundamental change” within the culture of the NHS to be certain patients are cared for correctly, a public inquiry says.

The conclusion by the Francis inquiry comes after a £13m investigation into the Stafford Hospital scandal.

Previous investigations have already established in harrowing detail the abuse and neglect that contributed to the deaths of hundreds of patients.

This inquiry said the flaws went from the pinnacle to the lowest of the NHS.

The 1,781-page report catalogued missed opportunities at every turn between 2005 and 2008 – and said the findings still had relevance today four years when they first came to light in a 2009 report by the Healthcare Commission.

While it’s well-known the trust management ignored patients’ complaints, local GPs and MPs also did not speak up for them, the inquiry said.

The local primary care trust and regional health authority were too quick to trust the hospital’s management and national regulators weren’t challenging enough.

Meanwhile, the Royal College of Nursing was highlighted for not doing enough to support its members who were looking to raise concerns.

‘Remote’

The Department of Health was also criticised for being too “remote” and embarking on “counterproductive” reorganisations.

The report said the issues created a culture where the patient was not put first.

But the inquiry – chaired by Robert Francis QC – said the change needed failed to require further reform.

Instead, it urged everyone from “porters and cleaners to the secretary of state” to interact to shift the culture.

In particular, it recommended:

  • The merger of the regulation of care into one body – two are currently involved
  • Senior managers to receive a code of conduct and the facility to disqualify them in the event that they aren’t fit to hang such positions
  • Hiding details about poor care to become a criminal offence
  • A statutory obligation on doctors and nurses for an obligation of candour so that they are open with patients about mistakes
  • An increased specialize in compassion inside the recruitment, training and education of nurses, including an inherent ability test for brand new recruits and regular checks of competence as is being rolled out for doctors

Mr Francis said: “It is a story of appalling and unnecessary suffering of hundreds of individuals.

“They were failed by a system which ignored the indicators and put corporate self-interest and price control prior to patients and their safety.

“I even have today made 290 recommendations designed to modify this culture and ensure that patients come first.

“We want a patient-centred culture, no tolerance of non-compliance with fundamental standards, openness and transparency, candour to patients, strong cultural leadership, caring compassionate nursing, and useful and accurate details about services.”

In a letter to Health Secretary Jeremy Hunt accompanying his report, Mr Francis said there had to be a “fundamental change” in culture.

Target driven

The “appalling” levels of care that caused needless deaths have already been well documented by a 2009 report by the Healthcare Commission and an independent inquiry in 2010, which was also chaired by Mr Francis.

They both criticised the price-cutting and target-chasing culture that had developed on the Mid Staffordshire Trust, which ran the hospital.

Receptionists were left to choose which patients to regard, inexperienced doctors were installed charge of critically ill patients and nurses weren’t trained ways to use vital equipment.

Cases have also been documented of patients left crying out for help because they didn’t get pain relief and foods and drinks being omitted of reach.

Some staff have said they tried to boost the alarm but were silenced by senior managers.

Helene Donnelly, who worked as an A&E nurse on the hospital, said: “It went right to the head. People didn’t wish to grasp and that’s why things got so extreme.”

Data shows there have been between 400 and 1,200 more deaths than would were expected between 2005 and 2008, even though it is impossible to mention all of those patients would have survived in the event that they had received better treatment.

While the Francis inquiry has solely considering what happened at Stafford Hospital, there may be mounting concern within the wider NHS about basic standards of care.

Recent reports by the Patients Association and Care Quality Commission have both raised the difficulty.

At the beginning of the year prime minister David Cameron said he desired to make improving care one in every of his top priorities for 2013. He’s with the aid of make an announcement at the latest report later.

Mr Cameron pointed to the cash being made available for training, particularly around dementia, the additional ward rounds being introduced in hospitals and the roll-out of the recent “friends and family” test patient survey as evidence of this.

BBC West Midlands special investigation, The Hospital That did not Care, on BBC One at 10.35pm on Wednesday 6 February.

Tuberculosis vaccine hopes dashed

Tuberculosis vaccine hopes dashed

 
Tuberculosis is the leading explanation for death among individuals with HIV in South Africa

A major trial of a brand new booster vaccine has led to failure, marking an important setback within the fight against tuberculosis (TB).

It was the primary big study in infants because the Bacillus Calmette-Guerin (BCG) vaccine was introduced in 1921.

BCG is barely partially effective against the bacterium that causes TB, that’s why several international teams are engaged on new vaccines.

The latest, referred to as MVA85A, didn’t protect babies who had already had BCG.

The trial, in South Africa, involved 2,794 healthy children aged four to 6 months, half whom received MVA85A and remainder a placebo.

They were followed up for a normal of 2 years.

The researchers, reporting inside the Lancet medical journal, found 32 cases of TB in folks that had received the vaccine compared with 39 within the placebo group.

This gave an effectiveness of 17%, that is so low as to be statistically non-significant.

‘Disappointing’

Designed to lift the immune responses which were primed by the BCG vaccine, MVA85A have been undergoing human trials for greater than a decade, showing it to be safe and to stimulate a high level of immune response in adults.

Prof Helen McShane, from the University of Oxford, who developed the vaccine, said: “[It] induced modest immune responses against TB within the infants, but these were much not up to those previously seen in adults, and were insufficient to guard against the disease.

“That is the primary efficacy trial of a brand new TB vaccine since Bacille Calmette-Guérin, an important step in itself, and there’s much that we and others can learn from the study and the information it has produced.”

In an accompanying editorial Christopher Dye, of the arena Health Organization (WHO), and Paul Fine, from the London School of Hygiene and Tropical Medicine, said although the consequences were disappointing they were “not a terminal prognosis for MVA85A, or for any of any other tuberculosis vaccines in development”.

They added: “Now’s a key moment in tuberculosis vaccine research.

“If the history of tuberculosis vaccine research teaches us anything, it’s to expect surprises. We have to go on playing the high-stakes game.”

The MVA85A study was funded by AERAS, the Wellcome Trust and Oxford-Emergent Tuberculosis Consortium.

AERAS, a not-for-profit organisation, was install to develop new TB vaccines. MVA85A was probably the most advanced of six vaccine candidates it really is helping develop.

Dr Tom Evans, interim CEO of AERAS said: “As a result of urgency to manipulate the worldwide TB epidemic, and despite these trial results, we remain steadfast in our belief that a much better TB vaccine would be developed and represents the proper hope for eliminating the disease.”

TB is an enormous global sickness with an estimated 8.7 million cases and 1.4 million deaths a year, consistent with the WHO.

The disease is the leading reason for death among individuals with HIV in South Africa.

Historic

Dr Richard White, an epidemiologist on the London School of Hygiene & Tropical Medicine and Director of the TB Modelling and Analysis Consortium, said:

“This can be a very disappointing result, but this was just the primary of around 12 new tuberculosis vaccines currently being tested in humans and around 50 vaccine candidates currently being tested within the lab. It was a historic trial, the primary of a brand new TB vaccine for just about a century. It’s going to bring about much valuable knowledge to assist us design effective vaccines someday. “

Five-year-olds in self-harm calls

Self-harm: Childline reports calls in relation to five-year-olds

Bullying is usually a think about self-harming and this is often being made worse by technology, it’s claimed

Charity ChildLine has taken calls about self-harm with reference to children as young as five, its manager in Wales says.

While self-harming is most prevalent among older teenage girls, there are fears it also affects younger children.

But new figures commissioned by BBC Wales show an increase within the selection of 10 to fourteen-year-old girls continue to self-harm.

The Welsh government said it was investing millions in mental health and counselling services for kids.

Ann Pulling, ChildLine services manager for Wales, said there has been a growing pressure on adolescents to see and act a undeniable way.

“Nearly all of people that ring us are aged between 13 and 17 but we’ve had some as young as five – siblings or parents may make contact with us,” she said.

“It is not just girls but boys who find it hard to discuss it as there is a rise of 30% within the selection of boys who contact us about self-harm.”

Reasons for self-harming are complex and private and will be associated with bullying, abuse, or problems at home or school.

Recent research from King’s College London suggested children bullied during their early years are as much as 3 times prone to self-harm than their classmates after they reach adolescence.

It found that half 12-year-olds who harm themselves were frequently bullied.

Ms Pulling said the difficulty of bullying was being made worse by technology.

“For ladies, there’s that pressure that comes from boyfriends sometimes to have interaction in sexual intercourse or perhaps they’d be pressured to send an explicit photo after which regret it,” she said.

She said pressure on children “can come from their peers and it’s going to come from families who expect them to do well”.

“Bullying never stops now. With social media, it doesn’t stop on the school gate to any extent further,” she said.

She said it was “quite a step” for youngsters stressed to show to self-harm.

“But i believe that kids become so unhappy and frightened that they could take care of the physical pain greater than the emotional pain. They generally tend to show that during and harm themselves.”

New figures commissioned by BBC Wales and produced by Public Health Wales Observatory shed some light at the more serious end of the matter.

Children counselled

The figures, which have a look at three-year periods, suggest the largest percentage increase in self-harming leading to hospital admission since 1999-2001 is among younger women, aged 10 to fourteen.

The increase is from about 100 admissions per 100,000 to around 200 for 2009-11.

There is a few better news though because the figures suggest falls in admissions, for both boys and girls, across a number of age groups, since 2006-08.

However, there’s just a tiny reduction among girls aged 10 to fourteen.

ChildLine released figures in December which showed the collection of children counselled in Wales who were self-harming increased from 809 in 2010/11 to one,214 the subsequent year.

Ms Pulling said the jump in calls was probably right down to more awareness of the service than a rise in children self-harming.

Dr Ann John, a professional on self-harm and suicide prevention with Public Health Wales, said there tended to be an issue among young girls but added a protracted-term study in Australia offered hope.

“It showed there’s a peak among girls of their mid and late teens on the time when there is a lot of turmoil happening of their lives – family issues, issues in class,” she said.

“As these children went into adulthood, about 90% doesn’t continue to self-harm.”

She said there has been now more help available and it was positive more were making the most of that.

‘Complex issue’

“There are such things as parenting programmes, mental health first aid, and helping people talk and have interaction on these issues,” she said.

Chris Leaman, from YoungMinds, a charity which goes to enhance the emotional wellbeing and mental health of youngsters and adolescents said there has been an “almost epidemic” of self-harm among children in some parts of the united kingdom.

“Society places an excellent amount of pressure on youth and infrequently we do not recognise what we’re actually doing to young people’s lives,” he said.

The Welsh government said it was firm to be certain “children and teenagers with emotional and mental health needs receive the appropriate care and support possible”.

“Since 2008, we now have invested an additional £6.9m in children and adolescent mental health services and allocated £8m to develop a college-based counselling service,” a spokesman said.

“Moreover, £4.5m might be provided annually from 2012-2013 for accessible counselling services for pupils of secondary school age, year six primary school pupils and 16-18 year olds.

Emergency hospital admissions of patients in Wales with any mention of self-harm (Produced by Public Health Wales Observatory)

Fear of music safety limit override

Fears that music volume limits ‘could be ignored’

Marc Nicholson’s chronic tinnitus was due to loud music in his job as a DJ

A safety limit on volume levels which comes into force on all new personal music players this month will be ignored by 40% of adolescents, says a hearing loss charity.

All personal music players and cellphones sold inside the EU must now have a valid limit of 85 decibels (dB), but users can increase it to 100dB.

Action on Hearing Loss says overexposure to loud music can trigger tinnitus.

Experts say the limit is “good news”.

Tinnitus is a medical term used to describe a ringing or buzzing noise that people can hear permanently in one ear, both ears or in the head.

It is often caused by exposure to loud music and can be accompanied by hearing loss.

Paul Breckell, chief executive of Action on Hearing Loss, said the new EU standard is important because increasing numbers of young people listen to music through a personal music player.

Survey results

“I urge music lovers to consider the long-term risks of overriding the safe setting as overexposure to loud music can trigger tinnitus, and remember that a good pair of noise cancelling headphones can make all the difference.”

A survey of more than 1,500 16 to 34-year-olds by Action on Hearing Loss suggests that 79% of young people are unaware of new standards coming into force this month.

Although 70% of survey respondents said they would take steps to protect themselves against tinnitus, nearly 40% said they would override the new default setting on their music devices.

In October 2008, the European Commission warned that listening to personal music players at a high volume over a sustained period could lead to permanent hearing damage.

As a result, the European Committee for Electrotechnical Standardisation (CENELEC) amended its safety standard for personal music players.

Now all personal music players sold in the EU after February 2013 are expected to have a default sound limit of 85dB.

The user can choose to override the limit so that the sound level can be increased up to maximum 100dB. If the user overrides the limit, warnings about the risks must be repeated every 20 hours of listening time.

The European Commission’s assessment said: “Listening to music at 80dB or less is considered safe, no matter for how long or how often personal music players are used. This sound level is roughly equivalent to someone shouting or traffic noise from a nearby road.”

But turning the volume control to 120dB, which is equivalent to an aeroplane taking off nearby, is exceeding safe limits, it said.

The commission said an estimated 20% of young people are exposed to loud sounds during their leisure time – a figure which has tripled since the 1980s.

An estimated 5-10% of of people in the EU are thought to be at risk of permanent hearing loss if exposed to unsafe noise limits for five years or more.

Dr Michael Akeroyd, from the MRC Institute of Hearing Research in Glasgow, said of the new EU standard: “This is excellent news for the amounts of private music players. The volumes they could give have been of shock for decades, going back to at the very least the appearance of portable cassette players.”

He added that headphones can vary in quality and design.

“Few designs of headphones remove background sounds, and indeed some designs remove none. But ear-defenders or ear-plugs can remove an excessive amount of noise. Earplug design has advanced greatly in recent times.”

‘13,000 cancer deaths might be saved’

‘13,000 cancer deaths is also prevented’

Being active is a technique of cutting your risk of cancer

At least 13,000 premature deaths from cancer may very well be prevented per annum within the UK, says the arena Cancer Research Fund (WCRF).

It says the govt could do more to elevate awareness of ways people can reduce their cancer risk.

The announcement comes as a survey showed that a 3rd of Britons still believe that developing cancer is because of fate.

About 157,000 people die of cancer annually within the UK.

Although the mortality rate is expected to continue declining, because of a growing and ageing population the collection of deaths is predicted to rise to about 182,000 deaths by 2025.

The WCRF survey of greater than 2,000 adults suggested that 28% of individuals think there’s little that may be done to avoid cancer.

Cancer myths

But Dr Kate Allen, executive director of science and public affairs at WCRF, said: “These results are an actual concern because they show that an important proportion of folks don’t realise that there is a lot they could do to attenuate their risk of cancer.

“By eating healthily, being physically active and keeping to a healthy weight, we estimate that a couple of third of the most typical cancers can be prevented.

“Everyone has a task to play in preventing cancer but governments and health professionals are key to raising awareness and making it easier for people to switch their lifestyle habits.”

The Union for International Cancer Control, a non-governmental organisation working across 155 countries, estimates that 1.5 million lives may be saved worldwide if urgent action is taken to boost awareness about cancer.

Otherwise, it says, there can be six million premature cancer deaths by 2025.

The UICC and the WCRF want governments and the general public to dispel four important myths and misconceptions about cancer, namely that cancer is solely a health issue, that it’s a disease of the rich, developed countries, that it’s a death sentence and that obtaining cancer is right down to fate.

Staffing danger on wards, say nurses

Wards dangerously understaffed, say nurses in survey

Patient to nurse ratios on hospital wards came under the spotlight inside the survey

More than 1/2 nurses believe their NHS ward or unit is dangerously understaffed, consistent with a survey.

The Nursing Times conducted an internet poll of nearly 600 of its readers on issues which includes staffing, patient safety and NHS culture.

Three-quarters had witnessed what they considered “poor” care during the last one year, the survey found.

The government said it had increased staffing and hundreds of latest nurses were still being taken on by the NHS.

‘Increasingly difficult’

The survey comes in advance of a public inquiry report into care failings at Mid Staffordshire Foundation Trust.

More than 57% of these asked within the survey described their ward or unit as sometimes or always “dangerously understaffed”.

Of those that had witnessed poor care, nearly 30% said they’d seen it happen regularly.

Some 85% of these who worked on general wards said the patient to nurse ratio was eight or more to 1, and 44% said the ratio was 10 or more to 1.

Howard Catton, head of policy on the Royal College of Nursing, told the BBC the ratio level in lots of hospitals was unacceptable.

“We must always have clear national guidance on what safe staffing levels are. One registered nurse to 8 patients is stepping into very risky territory, it may be around one in five.

“We’ve got ratios for our children in nurseries…why can’t we’ve them for our patients in hospitals?

“Cutting nurses may have a negative impact at the quality of care that’s provided and inside the worse case scenario yes it could result in untimely deaths.”

Unison head of nursing Gail Adams told the Nursing Times the findings of the survey echoed their very own research at the issue, finished in 2012.

“On the time not up to 10% of nurses said they may deliver safe, dignified, compassionate care all the time.”

Low morale

Joyce Robins, co-director of Patient Concern, told BBC Radio 5 Live nurses felt they might not keep their patients safe because there have been not enough staff.

“The quantity of labor they’re expected to do goes up on a regular basis but staffing levels don’t rise,” she said.

“You hear a lot of these stories that nurses don’t care anymore but really it’s that nurses can’t care because they do not have time because there aren’t enough of them.”

Also chatting with Radio Five Live Jenni Middleton, editor of the Nursing Times, said morale was very low amongst nurses.

“If you’ve gone into that job to care and to see after people and not to manage to do this is heartbreaking and intensely very stressful since you feel you’re incapable of doing what you have been trained to do since you do not have the resources to back you up.”

Care standards

Prime Minister David Cameron has acknowledged the govt still has some distance to visit raise standards around the NHS.

Mr Cameron encouraged the postulate of nurses checking on patients every hour, as portion of a package of nursing measures in January.

Some 31% of nurses on general wards within the survey said they weren’t accustomed to this being introduced where they worked.

The issue of care standards will come to the fore again when the Francis report into the Mid Staffs Trust is published on Wednesday.

Inquiry chairman Robert Francis QC will present the overall report back to Health Secretary Jeremy Hunt, before the minister makes a Commons statement.

The £13m inquiry was establish after a Healthcare Commission report in 2009 found “appalling standards” of care.

In response to the survey, the govt said there have been more clinical staff working within the NHS now than when it came to power in May 2010.

About 2,500 new nurses got to work inside the NHS in October 2012 alone, it added.

Midwife ‘role’ to focus on mutilation

Midwife ‘role’ as NHS targets female genital mutilation

The procedure is claimed to be finished in additional than 28 countries

Midwives can be asked to routinely raise the topic of female genital mutilation with women from communities where it’s known to ensue, the dep. of Health has indicated.

The partial or total removal of external female genitalia is illegitimate inside the UK however the practice occurs in parts of Africa, the center East and Asia.

The DoH says the NHS has a “key role… in supporting anyone affected”.

It also hopes to spot girls who might be in danger sooner or later.

Guidelines for health professionals in England and Wales on the way to safeguard children and adults laid low with FGM were published by the DoH in 2011.

The possibility of midwives asking their patients more questions on the procedure comes after the Crown Prosecution Service launched an action plan in November to focus on FGM and moves by the Royal College of Midwives to enhance its own monitoring efforts.

FGM is alleged to be typically inflicted on girls aged between four and 13 and ladies who’ve been cut can even experience problems during child birth.

No prosecutions

A DoH spokesperson said: “FGM is a significant criminal offence. Health professionals must always take action once they believe a baby or young person have been assaulted by any means, to offer protection to them and others from further harm.

“The health system plays a key role in identifying and supporting anyone stricken by FGM.

“Because of this we’re exploring the gathering of FGM data within the NHS, including inside the maternity and children’s dataset.”

FGM is understood to be performed in additional than 28 countries, mainly in western and southern Asia, the center East, including Yemen and Saudi Arabia, and parts of Africa similar to Somalia, Egypt, Ethiopia and Sudan.

According to the Metropolitan Police, there isn’t a evidence of FGM being performed in UK, however it says anecdotally it’s reported to have happened.

There were no prosecutions up to now within the UK.

But it also includes illegal for British nationals or permanent residents to be taken to a different country for the procedure. Anybody convicted of involvement in FGM is additionally jailed for as much as 14 years