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Tories say hospitals are fiddling A&E waiting times

BBC Health - 23rd December 2009 10:46 pm

Hospitals are fiddling a four-hour A&E wait target by using other wards as dumping grounds, the Conservatives say.

Data from 114 NHS trusts in England found many patients faced long waits in assessment units which did not count towards the waiting time.

Over a fifth of units reported keeping patients longer than the recommended 24 hours with the average wait being 17.

Doctors agreed the system was being abused in places, but the government said the research was “misleading”.

The Conservatives asked hospitals to provide data on their use of these wards under the Freedom of Information Act.

Shadow health secretary Andrew Lansley said: “Labour complacently claim that they have abolished long waits for patients being admitted to hospitals, but these figures show that all they have really done is fiddle the figures.”

Andy Burnham defends NHS targets after failings

HSJ - 2nd December 2009 5:53 pm

The health secretary has defended the government’s targets for the NHS in the wake of failings at several hospitals.

Andy Burnham told the Commons the best hospitals were providing “high quality, safe care” as well as meeting performance targets, such as seeing accident and emergency patients within four hours.

He was responding to criticisms from the Tories that clinical priorities were being “distorted” by targets, with waiting times put above patient care.

Burnham said patient safety was his “highest priority” as he made a statement to MPs following revelations about high death rates at Colchester Hospital University Foundation Trust and poor hygiene and standards of care at Basildon and Thurrock University Hospitals Foundation Trust.

A report by Dr Foster Intelligence rated a dozen hospitals as “significantly underperforming”, despite nine of them being rated good or excellent by official regulator the Care Quality Commission.

Seven hospitals were also found to have considerably higher mortality rates for the past five years.

I’m one year wiser, while the NHS is none the wiser

By Stephen Campion - 25th November 2009 1:55 pm

I woke up on Tuesday morning with the realisation that a further year had been added to my age. The next form I fill in will no doubt make me say “no surely that can’t be right” as I begrudgingly supply the required details.

But as I drove to a meeting outside Northampton I had time to reflect on the ageing process and suddenly realised how lucky I am. Compared to the NHS whose age is marginally older than my own, I counted myself fortunate that I have not needed cosmetic surgery to keep going, whilst the NHS has endured countless operations under the guise of service reconfigurations, organisational restructuring, strategic re-alignment or indeed performance management.

But if human beings get wiser with age, I wondered whether that also applied to the NHS? By the time I arrived at my destination I had worked out that we, mere mortals, do get wiser because we learn from experience. I wish the same could be said of the NHS. The NHS is a modern marvel when it comes to technology and its ability to promote scientific advance. But has it matured with experience?

If anything, the NHS is becoming less experienced as it gets older. Medical training is a case in point. Trainees’ hours in the log book are considerably less than a few years ago - that is not because there is less to learn, far from it.

Consultants are spending less time working in the wider interest of the NHS because trusts are fixed on short-term targets, blind to the longer term benefits consultants can bring to the NHS by active participation with their royal colleges.

There are few chief executives who can claim to have been in post for more than five years; and when it comes to NHS monitoring and quality standards the goal posts seem to move every season.

Getting older is no bad thing if we learn from our experiences, use them to shape the future and share them with those following on behind. But, as the NHS gets older, I worry that those following on will have no-one to learn from.

Tags: Targets, Training
Posted in HCSA | 1 Comment »

Hospitals use ploys to beat 4-hour A&E target

The Times - 20th November 2009 9:42 am

Patients are being admitted to hospital to avoid breaching a government target on waiting times, NHS figures suggest.

More than one in twenty patients attending hospital in an emergency are being admitted to wards just minutes before the maximum four-hour wait.

Health unions have complained that staff are being “pressured” into manipulating data and admitting patients unnecessarily to meet the target, which aims to treat or discharge all accident and emergency patients within four hours.

Figures from the NHS Information Centre show that almost all patients in England are seen within the four-hour deadline, but there is a peak in the number of people admitted to a ward with just ten minutes to spare. Two-thirds of those treated as the deadline approaches are admitted to hospital, compared to just over one in five patients coming from A&E overall.

It is the first time such analysis has been done and the statistics are categorised as “experimental”.

The Royal College of Nursing warned last week that the four-hour target meant some nurses were “pushed into practices” that were risky for patients.

It said that there were “negative consequences” for patient care, especially those needing treatment in A&E wards, but not necessarily requiring an overnight stay.

Tories offer deal that doctors should probably take

By Stephen Campion, HCSA chief executive - 9th October 2009 12:01 pm

Late last evening I received a text. The message from a friend of mine simply asked: “What did I think of David Cameron’s speech?”

I have not yet replied because the real answer is that I simply do not know what to make of it. Certainly the promise to end the target culture was encouraging - and indeed not surprising. Targets have done much to destroy the doctor/patient relationship.

We have consistently argued to government and the opposition that the competing priorities between clinical need and political targets have led to a dilemma for doctors almost impossible to reconcile. So, well done David Cameron.

But the flip side is that doctors will be asked to trade-off the target culture against a new measure of patient satisfaction, and greater patient choice. The concept of patient satisfaction is in itself no bad thing. If you don’t like the service from the bank, then change bank.

As the Royal Mail is finding to its cost, if you don’t like the service then change to a different courier or use the electronic technology now available.

But how does a patient assess the quality of medical care and treatment? No matter how good the doctor, prognosis and treatment are not necessarily indices of success. And the environment is not one necessarily controlled by the doctor alone; the doctor may lead the team but health outcome is governed by a complex combination of factors often outside the doctor’s influence.

If we have to work through these issues as a price for losing the dreaded target culture it seems to me that is a price worth paying. I think I will reply to my friend’s text as follows: “Speech encouraging - the devil will be in the detail!”

Tags: Cameron, Patient satisfaction, Targets
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Cameron offers to scrap targets for more choice

By Mike Broad - 8th October 2009 3:53 pm

David Cameron offered to give doctors back their professional responsibility in exchange for more patient accountability at the Conservative Party Conference today.

In his leader’s address, he suggested the Conservative Party would lower the role of central government and empower NHS staff. He blamed “big” government for ongoing problems in the NHS.

He said: “With their endless targets and reorganisations, Labour have tried to run the NHS like a machine. But it’s not a machine full of cogs. It is a living, breathing institution made up of people - doctors, nurses, patients.

“This lever-pulling from above - it has got to stop. With Andrew Lansley’s reform plans, we’re going to give the NHS back to people.”

Cameron offered doctors a deal over greater patient choice. He said: “We’ll say to the doctors: those targets you hate, they’re gone. But in return, we’ll do more for patients. Choice about where you get treated. Information about how good different doctors are, how good different hospitals are.”

He also said he would improve patient information on the “things that really matter”, such as cancer survival times, the rate of hospital infections, your chances of surviving if you have a stroke.

He did pay tribute to the NHS and its staff. “My family owes so much to the National Health Service,” he said, referring to the treatment of his disabled son, who died earlier this year. “No, it is not perfect. But I tell you, when you’re carrying a child in your arms to Accident and Emergency in the middle of the night and don’t have to reach for your wallet it’s a lot better than the alternative.

“So we will never change the idea at the heart of our NHS that healthcare in this country is free at the point of use and available to everyone based on need, not ability to pay.”

Tags: Patient choice, Targets
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Tories to turn NHS into “world’s biggest quango”

The Guardian - 18th August 2009 10:11 am

David Cameron is planning to take a “major gamble” with the NHS by “turning Britain’s best loved institution into the world’s biggest quango”, the health secretary Andy Burnham has warned.

In an attempt to maintain the pressure on Cameron, after a high-profile Tory MEP described the NHS as a “60-year mistake”, Burnham declares that the Tories would also take the health service backwards by abandoning national targets.

Burnham writes in The Guardian that Cameron’s “bland protestations of love” for the NHS hide an approach that would threaten the improvement in health standards for the poor since Labour started to increase spending in the early part of this decade.

The health secretary highlights Tory proposals that have created what he describes as “three substantial dividing lines” between the two main parties:

1. Embarking on a major overhaul of the way the NHS is run by handing day-to-day control to an independent board.

Burnham writes: “For a party that has promised a ‘bonfire of the quangos’, turning Britain’s best-loved institution into the biggest quango in the world - responsible for a £100bn budget and 1.4 million staff - is a proposal that has had dangerously little scrutiny to date.”

2. The scrapping by the Tories of “Labour’s three flagship waiting targets”: that patients should receive treatment within 18 weeks of a referral by their GP; that all patients should be treated within four hours of arriving at an accident and emergency department; and that cancer patients should wait no longer than two weeks to see a specialist.

Burnham writes: “Now that these targets have been achieved, Labour will turn them into enforceable rights for patients. Removal of these standards, as the Tories propose, would inevitably see … a return to postcode variation.”

3. Raising the possibility that local pay bargaining would be reintroduced. “This would be a mistake,” Burnham writes. “National pay structures bring a stability to the system in terms of recruitment and retention.”

Burnham says Cameron is afraid to embark on a serious debate about the future of the NHS because he is not fully committed to it. “If you dig beneath the bland protestations of love, there is a genuine philosophical difference on the NHS between the political parties,” the health secretary writes. It needs to be debated because it will define the kind of NHS we have in 10 years’ time, he says.

“For Labour, it all comes down to defending the N in NHS. Our commitment to national standards and structures in health remains strong. Without them, the poorest areas tend to get the poorest services. The Tories are ambivalent about the role of the centre, preferring localism in health, as in other areas.”

Acute care system hits targets but lacks training

By Mike Broad - 6th August 2009 11:19 am

New full-shift, acute care systems being trialled for assessing and reviewing patients are compromising juniors’ training, a study shows.

The system at the Royal Liverpool University Hospital, which is in widespread use around the country, enables it to hit NHS targets but has reduced the opportunities for trainees to learn.

The hospital’s acute medicine model is a full-shift system with no integration to maintain unit links between the trainee and consultant on-call rotas.

GPs and A&E SpRs refer patients to the hospital’s acute medical unit and heart emergency centre. SpRs perform reviews of patients overnight and between consultant ward rounds in the day. There are two formal consultant-led post-take ward rounds per day in the units, ensuring consultant review of all admissions within 24-hours.

Waiting times in A&E and time to assessment by a consultant in acute settings improved with the new system. However, restrictions in working hours prevented junior doctors from being present when the patients they admitted to the wards were reviewed by a consultant. At this stage, around half of all diagnoses are changed and the current system has no mechanism for feedback to the initial assessing team.

The authors of the research, published in Clinical Medicine this week, note that the patterns of work and systems employed at the Royal Liverpool are likely to be found in other hospitals struggling to balance government targets for waiting times with the new target for reducing junior doctors’ working hours. Since 1 August, trainees are restricted to working a 48-hour week.

Dr Solomon Almond, consultant physician at the Royal Liverpool, said: “The results of our audit highlight the benefits for patients of being seen by consultants soon after admission. However, the restriction of junior doctors’ hours meant there is less time for consultants to discuss their decisions with the doctors in training.

“Ideally all emergency admissions would be seen straight away by consultants accompanied by the junior doctors. This would re-establish the link between hands-on clinical medicine, training and experience that was for many years the foundation of post graduate medical education in this country.”

Commenting on the research, Dr Andrew Goddard, director of workforce planning at the Royal College of Physicians, said: “This study shows that increasing the input of consultants into the care of medical patients admitted to hospital changes the way doctors are trained. The short term benefits to the patient of seeing a consultant first may be offset by loss of training opportunities for the consultants of the future.”

Tags: Acute medicine, Targets, Training, WTD
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18-week target makes it a dog’s life

By Katherine Teale - 4th August 2009 8:59 am

You know things are serious when a summons arrives from the chief exec for a “pep” talk. The first part of the talk consists of the swine flu plan. Ten days ago we were told that we could expect 8% of the local population to be infected. In fact that estimate has turned out to be 50% too high - and the sum total of patients in our hospital afflicted with the virus is four.

The main problem, as expected, has been staff going off sick, mainly because anyone who’s even slightly ‘off colour’ gets sent home by OH with a box of Tamiflu and instructions to on no account return for at least 5 days. It’s tempting even for those with the strongest work ethic.

At least those of us left holding the fort can comfort ourselves with the thought that, even if our less robust colleagues weren’t feeling particularly ill already, they certainly will once they’ve started the anti-virals.

The second, and considerably longer, part of the talk concerned our ‘financial doom’ i.e. after next year we’re not going to have any money.

This is because of the following factors:

1. The DoH is broke because hardly anyone is paying taxes any more

2. This also means that the PCT will not have any money to commission work from us

3. Our hospital isn’t paid for yet and we have to start servicing the PFI loan.

Health service inflation (i.e. the cost of drugs, etc) is greater by a factor of two than normal retail price inflation.

So, basically, even if we survive the swine flu crisis, we’re screwed. To cap it all, the DoH has decided that we still have to keep to the 18 week elective surgery target because, apparently, the plans we originally drew up to achieve this target should have taken into account the possibility of an influenza pandemic and global financial meltdown occurring simultaneously. Oooops! Caught us out there, I’m afraid.

The gist of the CEO’s message was that in order not to fail our target, consultants would have to “pull together” - perhaps giving up leave and doing extra lists in SPA time in order to reduce our waiting list before the second wave of swine flu hits (this is scheduled in the dairies for September). So there we have it.

We have to work like dogs now to save the target and then in September we have to work like dogs again to save patients from swine flu. Meanwhile, our respected politicians, who dreamed up these targets, are enjoying relaxing breaks. I doubt whether there was a doctor in the room who wouldn’t pull out all the stops to save acutely sick patients. However, expecting similar superhuman efforts to save our 18 week target doesn’t really push the right buttons for me, especially given that most of our waiting list consists of bariatric patients.

Evidently it is now a ‘medical emergency’ for a patient to wait an extra couple of weeks for a bypass. Roll on September, at least we all know where we are with a simple old-fashioned pandemic.

Tags: Swine Flu, Targets
Posted in Katherine Teale | No Comments »

Second inquiry launched into care at Mid Staffs

BBC Health - 22nd July 2009 2:35 pm

A second inquiry is to be held into Stafford Hospital where a health watchdog found “appalling” emergency care led to patients dying needlessly.

Health Secretary Andy Burnham said current and ex-NHS staff would be expected to co-operate with inquiry.

The Care Quality Commission said there had been progress, but some areas had to be addressed “urgently”.

In March the Healthcare Commission said about 400 more people died between 2005 and 2008 there than would be expected.

The regulator, the successor to the Healthcare Commission, said mortality rates had been “showing early signs of improvement”.

It added it was satisfied Mid Staffordshire NHS Foundation Trust had made an acceptable start in “implementing the systems, resources and people it needs to make the improvements recommended” by its predecessor.

In March, the Healthcare Commission identified deficiencies at “virtually every stage” of emergency care and said that managers pursued targets to the detriment of patient care.