GP service had ‘bullying culture’

Serco out-of-hours GP service in Cornwall had ‘bullying culture’

Serco has provided Cornwall’s out-of-hours GP service since 2006

The company which gives out-of-hours GP care in Cornwall did not meet national standards, falsified data and had a “bullying culture”.

The parliamentary report by the general public Accounts Committee examined failings by private contractor Serco in 2012.

It also found the out-of-hours service was still “not ok”.

Serco said it had taken “swift and decisive action to place the location right” and it had a customer satisfaction rating of 95% or higher.

The company has offered to repay £85,000 in performance-related bonuses which have been awarded for its work in 2012.

The British Medical Association said the federal government must make sure the “disgraceful situation” in Cornwall doesn’t happen again.

‘Falling short’

The select committee report said: “The standard of the service being provided by Serco in Cornwall isn’t adequate.

“Serco has struggled to make sure enough staff are available in to fill all its clinic and car shifts, even though it has increased staffing levels in recent months.

“It has consistently didn’t meet the national quality requirements with reference to the responsiveness of out-of-hours services and function remains to be falling short.”

In 2012 whistleblowers raised concerns about staffing levels on the out-of-hours service and claimed staff were falsifying data to make the service appear faster.

The report said evidence had proved the whistleblowers’ claims were “substantially true”.

It said the corporate gave the impression to have had a “bullying culture and management style which inhibited whistleblowers from being open within the patients’ interest”.

Margaret Hodge, the committee chairwoman, said the corporate had responded to the claims in a “bullying and heavy-handed style” and it was “disgraceful” the general public had needed to place confidence in whistleblowers to be informed the reality.

The report said Serco searched employees’ lockers in an try to identify the whistleblowers.

Dr Louis Warren from Serco said: “The report refers to quite a few issues that we faced last year.

“After we discovered these problems we took swift and decisive action to position the placement right and apologised to the folks of Cornwall.

“The service delivers a high standard against the national quality requirements.

“Patients and users of the service over the last two years consistently give the service a satisfaction rating of 95% or higher.”

Andrew Abbott from NHS Kernow said “weaknesses” within the Serco contract have been addressed

The select committee report can be critical of Cornwall’s former primary care trust, which ceased to exist in April this year.

It said it was “deeply ineffective” in managing Serco’s performance.

It said it didn’t demonstrate it had the “appropriate skills” to barter with private service providers or hold them to account for poor performance.

Ms Hodge said: “The failures on this contract matter, for the reason that NHS could be making increasing use of non-public and voluntary providers to deliver NHS services.

“We have to have confidence within the ability of NHS commissioners to contract effectively, to observe rigorously, and to extract appropriate penalties and where necessary terminate contracts.

“None of those conditions were met in Cornwall.”

Andrew Abbott, director of operations for NHS Kernow, the clinical commissioning group which has replaced the first care trust, said the report had some “useful lessons” for the complete NHS in relation to contracts with private providers.

He said the contract “weakness”, which allowed bonuses to be paid to Serco despite poor performance, have been addressed.

“Now we have a way more open, constructive, honest but challenging… conversation with [Serco],” he said.

“We are able to understand what’s going on, what’s unlikely on, what’s improving and what must improve.”

The British Medical Association said the location in Cornwall demonstrated “an entire breakdown” within the system which was imagined to make sure that patient care wouldn’t be compromised when NHS services were taken over by a non-NHS provider.

It said: “The govt. must make it possible for this disgraceful situation doesn’t happen again.

“If we don’t get a grip at the problems exposed then we run the danger of seeing the failures in Cornwall becoming routine around the NHS.”

Serco has provided Cornwall’s out-of-hours GP service since 2006.

Its current five-year contract is worth £32m.

According to the select committee report, the 2 members of staff who were found to be falsifying performance had now left the corporate.

Smoking ban ‘cuts premature births’

Smoking ban ‘cuts premature births’

Exposure to tobacco smoke was associated with lower birthweights and early deliveries

The theory that public smoking bans cut the variety of children born prematurely was strengthened by new research.

The study of 600,000 births found three successive drops in babies born before 37 weeks – each occurring after a phase of a public smoking ban was introduced.

There was no such trend within the period before the bans were installed place, the British Medical Journal reported.

The study, by Hasselt University in Belgium, comes after Scottish research in 2012 found an identical pattern.

But experts couldn’t fully state the smoking ban was the reason for the change because pre-term births had began to drop before the ban.

It is already well established that smoking ends up in reduced birth weight and an increased risk of premature birth.

Successive drops

In the most recent study researchers were ready to study the speed of premature births after each phase of a smoking ban came into force in Belgium.

Public places and most workplaces were first to introduce smoke-free rules in 2006, followed by restaurants in 2007 and bars serving food in 2010.

The rate of premature births was found to fall after each phase of the ban with the most important impact seen after the second one two bans with restaurants and bars introducing no smoking rules.

After the bans in 2007 and 2010, the premature birth rate dropped by around 3% on every occasion.

Overall it corresponds to a fall of six premature babies in every 1,000 births.

The changes couldn’t be explained by other factors – equivalent to mother’s age and socioeconomic status or population effects akin to changes in pollution and influenza epidemics.

There was no link found with birth weight.

Study leader Dr Tim Nawrot from Hasselt University said that even a delicate reduction in gestational age have been linked in other studies to adverse health outcomes in early and later life.

“Since the ban happened at three different moments, shall we show there has been a consistent pattern of reduction within the risk of preterm delivery.”

He added: “It supports the notion that smoking bans have public health benefits even from adolescence.”

Patrick O’Brien, spokesperson for the Royal College of Obstetricians and Gynaecologists said: “It’s very gratifying to work out further strong evidence that smoking bans have had a beneficial impact on pregnant women and their babies.”

MMR catch-up reaches 100,000 pupils

MMR catch-up reaches 100,000 pupils

More than 100,000 school age children had been immunised as a part of an MMR catch-up campaign, in keeping with Public Health England.

One million children who didn’t get either one of their MMR jabs are being targeted.

There are concerns about high levels of measles after an enormous outbreak in Wales and record figures in England.

There were 1,168 cases as much as May this year, in comparison to 712 within the same period in 2012.

Measles is a highly contagious disease characterised by a high fever and a rash. In a single in 15 cases it will result in severe complications corresponding to pneumonia and inflammation of the brain.

Two doses of the MMR jab gives near complete protection against the infection, in addition to mumps and rubella.

Children aged between 10 and 16 are essentially the most prone to have missed jabs when, now completely discredited, research linked MMR with autism and caused vaccination rates to plummet.

Missed injections

The most in danger are the 335,000 children in that age group, around 7% of the full, who failed to get both MMR jabs.

So far 56,000 have received their first MMR vaccination.

A similar number was vaccinated within the two other target groups – those aged 10-16 who had only 1 jab and other people in other age groups.

Dr Mary Ramsay, head of immunisation at Public Health England said: “There still remains a great number of 10-16 year olds, along with many younger children and adults who’re under-vaccinated.

“In the event that your child has not had the MMR vaccine, the imminent summer holidays is a superb time to contact your GP to get them vaccinated.”

Prof David Salisbury, director of immunisation on the Department of Health, said: “Tips on how to beat measles is to guard people before measles catches them.

“The easiest thing that fogeys can do, if their children haven’t had two doses of MMR, is to make an appointment with the GP now.”

Midwife struck off for patient abuse

Stafford Hospital midwife struck off for patient abuse

A midwife who called a dementia patient “an animal” while working as a healthcare assistant at Stafford Hospital have been struck off.

The Nursing and Midwifery Council (NMC) found Bonka Kostova had also pulled the guy, 73, out of a bathroom cubicle by his pyjama top.

Ms Kostova didn’t attend the hearing where all charges against her were proven.

Two nurses intervened after seeing the incident in July 2010.

Pushed patient

Ms Kostova, who trained as a midwife in Bulgaria, was working the night shift as a healthcare assistant when the incident happened.

She was found to have pushed the person, named as patient A, into his wheelchair when he stood up and pushed him right into a bathroom and onto a rest room.

The patient were at Stafford Hospital for just over a month and was receiving treatment for kidney stones, the tribunal heard.

He was said to be aggressive in his speech or manner about 80% of the time and normally had a one-to-one carer, who was on a break on the time of the incident, leaving Ms Kostova responsible.

She was struck off the NMC register in any case charges against were found proved “and consequently her fitness to practise was found to be impaired”, a spokeswoman for the council said.

Robert Courtney Harris, medical director of Mid Staffs Trust, said Ms Kostova was suspended following the incident and “never returned to work at our trust”.

As the incident happened in July 2010, it was after the period covered by last week’s Francis inquiry into Stafford Hospital.

Over-90s ‘defying mental decline’

Over-90s ‘defying mental decline’

Old individuals are defying expectations

Today’s 90-year-olds are surviving into very old age with better mental performance than ever before, Danish research suggests.

People born in 1915 scored higher in cognitive tests of their 90s compared with those born a decade earlier, in keeping with a study within the Lancet.

Better living standards and intellectual stimulation can be key factors, experts say.

The variety of people reaching very old age is at the rise globally.

In the united states, for instance, the quantity of individuals aged 90 or above has greater than doubled in 30 years.

In Denmark, where the study occurred, the prospect of surviving into the 10th decade of life has gone up by about 30% each decade for folks born in 1895, 1905 and 1915.

However, there was little research at the quality of life that folks reaching such an old age can watch for.

The researchers, led by Prof Kaare Christensen, of the University of Southern Denmark in Odense, surveyed all Danes born in 1905 who were still alive and living within the country in 1998 (3,600 people, aged 92-93).

They assessed their physical strength, mental functioning, ability to hold out daily living tasks comparable to walking outside and inside, and any symptoms of depression.

Twelve years later, they repeated the study with Danes born in 1915 (2,509 people, aged 94-95).

The researchers found that humans born in 1915 performed better than those born in 1905 on the subject of cognitive ability and activities of daily living, even after correcting for changes value more highly education.

Prof Christensen and associates said: “Our results show that the Danish cohort born in 1915 had better survival and scored much better on both the cognitive tests and the activities of daily living scale than the cohort born in 1905, despite being two years older on the time of assessment.

“This finding means that more individuals are living to older ages with better overall functioning.”

The research addresses the foremost question of whether living into very old age is accompanied by more years of poor health, or whether overall health at a complicated age is improving.

Improved education

Commenting at the study, Prof Tom Kirkwood, associate dean for ageing at Newcastle University, said the information from Denmark was “encouraging”.

“It appears among those born in 1915, cognitive function in advanced old age is measurably better than for those born in 1905, even if underlying changes like improved education are taken under consideration,” he said.

In the united kingdom, the main complete picture of health in advanced old age comes from the Newcastle 85+ study, which was people born in 1921.

The investigations might be repeated in those born a decade later, giving the possibility to determine if the Danish findings apply in other populations.

Call to prohibit gluten-free food on NHS

Call to scrap gluten-free food prescriptions

Bread, pasta, cereals and cakes all contain gluten

A medical journal is looking for prescriptions of gluten-free food to be scrapped as they’re costly and outdated.

The Drug and Therapeutics Bulletin says that now such food is quickly available it will not be a medical issue.

Around 600 thousand people within the UK have coeliac disease- attributable to intolerance to gluten present in wheat.

The charity Coeliac UK says prescriptions are essential as a result of high cost of gluten-free staple foods.

These can cost three to four times greater than their gluten equivalents.

The journal, which reviews medical treatment, asks if one of these prescription, which costs the NHS in England £27 million a year and involves various administration, is the foremost up-to-date one.

Prescriptions were introduced in the late 1960s when access to gluten-free foods was limited. These are now available in most big supermarkets.

The NHS health regulator, NICE (The National Institute for Health and Clinical Excellence), is due to review the best way of treating people with coeliac disease in the most cost effective way later this year.

Food voucher fraud

The researchers in the journal said: “We would urge commissioners to consider redesigning services to ensure that there is ongoing support for people with coeliac disease and to remove the bureaucratic process of prescribing food from primary care.

“Is it time to consider the use of food vouchers that could be redeemed against gluten-free foods at any outlet, or the provision of personalised budgets for people with coeliac disease, so that the supply of food would no longer be a medical issue?”

Sarah Sleet from Coeliac UK said they have considered vouchers but this type of scheme does have concerns.

She said: “People with coeliac disease would ideally like to shop for their food like everyone else.

“If we can address the cost and availability issues in retail shops there would not be the need for prescriptions.

“In the past we have had problems with food vouchers – fraud was a big concern and the sheer administration and impetus needed to get all supermarkets signed as much as it makes it difficult.”

Coeliac disease is an autoimmune condition caused by intolerance to gluten – which can be found in foods like pasta, bread, cakes and cereals.

One in 100 people within the UK have coeliac disease for which there’s no cure and the only treatment is a strict adherence to a lifelong gluten-free diet.

Left untreated coeliac disease can lead to serious health complications including malnutrition, osteoporosis, cancer of the small bowel and infertility problems.

A Department of Health spokesman said: “A limited range of basic gluten-free food products are available on the NHS to help patients with coeliac disease to stick to a gluten-free diet.

“This will prevent them from developing more serious illnesses, which could not just affect their quality of life but be way more costly for the NHS.”

Organ donor wish ‘must be honoured’

‘Stop families’ from overriding donor consent

19.5m people within the UK are at the organ donor register

The NHS is thinking about preventing families from overriding the consent of people that have signed the organ donor register.

NHS Blood and Transplant (NHSBT) says it desires to ensure a person’s want to donate is honoured in the event that they die.

In a technique document it also asks whether those at the organ donor register should receive higher priority at the transplant waiting list.

The strategy has the backing of the four UK health ministers.

It aims to construct at the 50% increase in deceased donation rates since 2008.

NHSBT says it wants a “revolution in public attitudes and behavior” in order that individuals and families could be proud to support donation.

It says knowledge of organ donation remains low outside the NHS but this may be increased through education and publicity campaigns.

The aims of the method are to:

  • Improve consent rates from relatives to above 80% (currently 57%) in all cases (families are asked to provide consent whether their relative has signed the organ donor register or not)
  • Bring the deceased donor rate as much as 26 per million of the population (currently 19 pmp)
  • Increase the selection of patients receiving a transplant to 74 per million of the population (currently 49 pmp)

Almost everyone would accept a transplant organ in the event that they needed one – but only 57% of families conform to donation when asked.

Grieving relatives sometimes overrule the desires of patients who’ve signed the organ donor register – although this usually happens when families aren’t privy to a loved one’s wishes.

NHSBT says a shift in behaviour is required corresponding to the changes achieved in preventing drink-driving or smoking cessation.

It says the united kingdom will examine systems – similar to inside the US – where families aren’t permitted to override pre-existing consent so people may be confident their pledge to donate shall be respected.

Dr Paul Murphy, from NHSBT, said: “When a family says no to donation it means someone’s hopes of a life-saving transplant are dashed. They must understand the results of refusal.”

Although there are greater than 19.5 million people at the Organ Donor Register, most will die in circumstances where organ donation shouldn’t be possible.

NHSBT says it will even be possible to extend the numbers of people that may be able to donate by reviewing end-of-life care procedures. One example is a pilot study in Scotland which provides the choice of donation following cardiac arrest and failed resuscitation.

Serious debate

The strategy demands a countrywide debate on proposals to extend organ donation. As an example it desires to know whether the general public would support a system just like the single in Israel and Singapore where those at the organ donor register get higher priority in the event that they ever want a transplant.

Sally Johnson, Director of Organ Donation and Transplantation at NHSBT said: “We have to have a significant debate in our society about our attitudes – is it fair to take in case you won’t give? Is it acceptable that three people die an afternoon wanting an organ? Is it right to permit our organs to be buried or cremated with us once they could save or improve the lives of as much as nine people?”

Last week the Welsh assembly voted to modify to law to usher in an opt-out system of organ donation in 2015. Wales would be only UK country where individuals can be presumed to have consented for his or her organs to be donated unless they opt out.

There are around 7,300 people within the UK looking forward to a transplant. Last year there have been 1,212 deceased donors.

NHSBT says the waiting list “considerably under-represents the real choice of those who may gain advantage from an organ transplant”.

It says evidence suggests the demand for transplants is probably going to continue to extend in years yet to come.