NAPC News 5 November 2009

Poor Handovers And Working Time Directive Causing Hospital Deaths

The National Confidential Enquiry into Patient Outcomes and Deaths has concluded that poor communication between doctors, inadequate handovers at night and delays in contacting consultants are causing unnecessary hospital deaths.

Of 1,983 cases, researchers found 13.5% - 267 cases - showed ‘poor communication between and within clinical teams identified ..... as an important issue'.
The poor decision making and lack of senior input were a particular problem in evenings and at night, the report said.

UK GPs Put Highest Value On Better Patient Care

A study of health services in 11 nations, carried out by the US based Commonwealth Fund, has concluded that GPs in the UK rate improvements to the quality of patient care more highly than doctors in the other countries surveyed.

Judicial Review Begins Of Private Patient Income Cap

A judicial review of Monitor's interpretation of the foundation trust private patient income cap has begun, following a challenge by trade union, Unison.

Unison had accused NHS foundation trust regulator, Monitor, of failing in its legal duty in the way it capped income from private patient work. Their concern was that there would be weak interpretations of how foundation trusts conducted themselves, leading to profits rather than patients being more important.
The UK's largest public sector union said Monitor had issued legally flawed financial reporting instructions to NHS foundation trusts. As a result, the statutory limit on the amount of private patient income trusts are allowed to receive may have been breached, a judge was told.

Tory Funding Shift To Target Elderly Population

Experts have questioned the viability of Conservative plans to rewrite the NHS funding formula to redirect cash to areas with large elderly populations.

Shadow health minister, Mark Simmonds, recently said that there was a direct correlation between the age of the population and the burden of disease that was not reflected in the current formula. He accused Labour of deliberately over-emphasising socio-economic deprivation in order to transfer resources to their urban heartlands.

A Conservative government would take such decisions out of ministers' hands and transfer them to an independent NHS board, he continued.

But health economists said there was ‘no evidence' that areas with large elderly populations were underfunded. They noted that the formula that distributed money to primary care trusts was designed by the independent Advisory Committee on Resource Allocation.

John Appleby, chief economists at the King's Fund, said that Tory figures which purported to show five-fold variations in spending on certain treatments largely reflected the cost of running health services in different parts of country. He continued that the weighted capitation formula was possibly the most sophisticated way of allocating public money in the world. The allocation formula is designed with two aims: to share cash fairly on the basis of population need, and to reduce avoidable health inequalities.

Department of Health To Challenge Europe On Overseas Treatment

The Department of Health is preparing itself for a challenge through the European Court of Justices on the rights of UK citizens to be treated abroad at the NHS' expense.

Draft guidance issued by the Department of Health last week warned that a draft European Union directive on the internal EU market meant the NHS commissioners had ‘limited grounds' to refuse to reimburse UK citizens the cost of their care if they opted to have it elsewhere in the EU.

It said that, in general, primary care trusts must reimburse the patient up to the NHS price of the treatment. It said that should include treatment carried out privately, but PCTs should not pay for care that would not have been provided by the NHS, such as certain cosmetic surgery.

However, the guidance also suggested that the Department of Health was gearing up for a battle as it will insist that patients wanting expensive or ‘hospital treatment' should first seek their primary care trust's permission.

Although the European Court of Justice has ruled that a pre-authorisation requirement could be justified for ‘hospital care', it has not defined that.
Draft regulations from the Department of Health defined this as: ‘services requiring at least one night's stay; surgery, including dental surgery if under general anaesthetic; services using ‘specialised and cost intensive medical equipment', particularly diagnostics; expensive and specialist services and any other services specified by the PCT or health secretary.

CQC Wants Better Discharge Data

Nearly half of PCTs report that GPs do not receive hospital discharge summaries in time for them to be of any use, a Care Quality Commission (CQC) report revealed.

The report called on PCTs to assess whether hospitals sent the correct data to GPs in good time and to take action when they fell short of contractual obligations.

The CQC found that only 53per cent of PCTs reported that GPs were sent discharge letter quickly enough for them to be useful all or most of the time.

GPs also reported problems with the quality of discharge summaries, with 88 per cent of practices reporting that diagnosis summaries were incomplete or inaccurate all or most of the time.

Chief executive, Cynthia Bower, said there needed to be a change of attitude in the NHS in recognising how important it was for clinicians to pass on the baton smoothly between services in order to offer person-centred integrated care.

Balanced Scorecards To Replace GP Contract

Balanced scorecards could eventually replace the GP contract, the project director of the King's Fund Inquiry into general practice has warned.

King's Fund senior fellow, Nick Goodwin, said that PCTs were using scorecards to commission series and monitor quality. The Department of Health had made it clear that the balanced scorecard was its preferred model to commission primary care services. It seemed in future that a lot of primary care was going to be commissioned by PCTs looking to bypass the national contract, Nick Goodwin commented.

Initially, they were talking about using scorecards to make enhanced service payments. It was possible that, in the future, a position could be reached where there was no GP contract and balanced scorecards were used instead.
The Department of Health is developing a national balanced scorecard, and many PCTs were performance managing practices using scorecards of their own. Mr. Goodwin warned that widespread use of scorecards would lead to ‘big problems'. At practice level, it became a very crude tool and meant practices were rated down when really they just had a difficult population.

A Department of Health spokesman said there were no plans to link practice income to balanced scorecards, but in a recent policy document ‘Improving Quality in Primary Care' it said that PCTs might want to introduce incentives for practices based on scorecard ratings.

Mr. Goodwin said the national scorecard was likely to contain about 85 indicators, on factors such as QOF, access, prescribing and patient-reported outcomes.

The King's Fund is currently seeking views of GPs on how to measure quality as part of its first phase of its 18-month inquiry into the quality of general practice in England.

Memory Test Spots Pre-Dementia

Memory and language tests can reliably reveal ‘hidden' early dementia, according to UK experts.

Most dementias are missed for years as the symptoms can be elusive until considerable brain tissue is lost. But doctors from Oxford found they were able to spot very early warning signs when they looked closely enough.

The findings in Neurology could help doctors diagnose dementia sooner, which is crucial since treatment is most effective when given early.

Over a span of 20 years, the researchers studied a group of 241 healthy elderly volunteers, giving them regular tests designed to measure their thinking or cognitive powers. When they scrutinised the test results, the doctors found subtle clues that, in retrospect, hinted at ensuing impairment.

Specifically, the patients who went on to develop mild cognitive impairment or pre-dementia stumbled on tasks involving language expression, learning and recall. For example, they had greater difficulty remembering the name for common objects or animals and explaining the meaning of a given word. Those who were older and who scored lower on the language or memory tests tended to deteriorate more quickly.
Professor David Smith and his team said their findings fitted in with what was already known about dementia.

Experts have noted that the early stages of dementia were associated with linguistic problems, such as word finding difficulties.

Early literary works by authors later diagnosed with Alzheimer's disese showed similar changes in language use - simpler narratives and a smaller vocabulary.

Drug Can Kill Leukaemia Cells

Scientists claim a new drugs has been developed which kills leukaemia cells. Researchers say that the drug, PBOX-15, can destroy cancerous cells in adult patients with a poor prognosis who have shown resistance to other treatments.

Professor Mark Lawler of Trinity College, Dublin said it could be three to five years before the drug could be used as a potential therapy. Belfast City Hospital also played a role in the development of the new leukaemia drug.

The study was carried out by academics at Trinity College, Dublin in partnership with the University of Sienna in Italy, St James' Hospital in Dublin and Belfast City Hospital and is published in the Cancer Research journal.

Professor Lawler said that in samples given by patients, the drug attacked and broke down the skeleton in leukaemia cells. It was also successful when used in the treatment of Chronic Lymphocytic Leukaemia (CLL), a type of cancer of the blood and bone marrow, the most common leukaemia among adults in the Western world.

Life Or Death Case Of Baby Boy

The mother of a baby who has been in intensive care since birth is currently in legal proceedings agaisn the child's father in the High Court in London to fight for the child's right to die. ‘Baby RB' was born with a rare neuromuscular disease, which means that he cannot move his arms or legs and has difficulty breathing on his own.

His mother support the NHS' doctors' view that the child's life support machine should be switched off, while his father thinks that every power should be taken to keep his son alive.
If the NHS hospital wins the case, it will be the first time a British court has ruled against the wishes of a parent whose child does not suffer brain damage.