Cameron and Hawking defend the NHS

David Cameron and Professor Stephen Hawking are among those who have defended the NHS from ludicrous and inaccurate criticisms made in America. David Cameron sent an email to supporters saying that he and his family had been grateful for the work of the NHS.

The most absurd of the attacks made by US critics of the NHS was the claim in an American newspaper that 'People such as Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.'

Professor Hawking himself, while in Washington to receive America's highest civilian honour, the Presidential Medal of Freedom, hit back at these attacks on the British health service, saying 'I wouldn't be here today if it were not for the NHS. I have received a large amount of high-quality treatment, without which I would not have survived.'

A British woman, Kate Spall, who was quoted in adverts for an American group calling themselves 'Conservatives for Patients' Rights (CPR) opposing the President's health legislation, said that she had been misrepresented and felt duped by these adverts.

She told the Times: "It has been a bit of a nightmare. It was a real test of my naivety. I am a very trusting person and for me it has been a big lesson. I feel I was duped."

No organisation should be above constructive criticism, but some of the attacks on the NHS in the USA have been disgraceful and inaccurate.

I mostly reserve party political comment for my main blog rather than this one, but I will make an exception by quoting David Cameron's email here to confirm that the Conservative Party is totally committed to the NHS: an effective National Health Service which is free at the point of delivery is one of the things we wish to conserve.

David Cameron writes:

"I've been enjoying the sun and touring my beautiful constituency of Witney today. But it goes without saying that just because I and most other politicians are not in Westminster at the moment, politics isn't somehow put on hold.

People still care about the issues they care about, and thanks to the internet they can voice their concerns whenever they want. Just look at all the support which the NHS has received on Twitter over the last couple of days. It is a reminder - if one were needed - of how proud we in Britain are of the NHS.

Millions of people are grateful for the care they have received from the NHS - including my own family. One of the wonderful things about living in this country is that the moment you're injured or fall ill - no matter who you are, where you are from, or how much money you've got - you know that the NHS will look after you.

That's why we as a Party are so committed not just to the principles behind the NHS, but to doing all we can to improve the way it works in practice. So yes, we will spend more on the NHS, but we will also improve it so that it is more efficient and responsive to patients. People working on the frontline will actually be able get on with the job they signed up for, without getting tied up in a web of targets. And we will put more power in the hands of patients by giving them better information about the care they can expect to receive.

Underlying these reforms, and our whole approach to the NHS, will be one big ambition - that future generations will be even prouder of the NHS than we are today."

Diagnosing Swine Flu

A survey of 251 Doctors in General Practice reported on the ITN website this morning found that 90% of them are concerned that diagnosing swine flu over the phone could lead to other diseases, like meningitis, being missed.

It's a small sample, but the overwhelming nature of the response is enough to be statistically significant and to suggest to me that the fears described by the NHS Blog Doctor and referred to in my post below "How not to deal with swine flu-or anything else" are shared by a large number of doctors.

While the levels of suspected swine flu are above what normal NHS capacity can deal with, it may be regrettably necessary to keep the current special measures such as internet and telephone diagnosis in place, but this survey reinforces my view that we should return to normal methods of diagnosis as soon as practical when infection rates trend down.

In the survey, 87 per cent of family doctors questioned, answered yes when asked: "Does diagnosing swine flu over the phone mean other diseases may be missed?"

Of the 251 polled, 10% were unsure and just 3% said no.

The associated report highlights their concerns, one stating that they had seen a case of measles misdiagnosed as swine flu. Again, this echoes the concern of the NHS blog doctor: he gives details here of a case where a teenager with life-threatening meningitis was misdiagnosed with swine flu and had to invent a false medical history to get a hospital to look at her.

West Cumberland Hospital Meeting

This post will focus on the discussion which took place in the Boardroom at West Cumberland Hospital on 24th July. I have addressed the political controversy over the meeting on my blog at Chris4Copeland.blogspot.com or see link at right.

I have heard from several people who were there that it was a positive and constructive meeting.

Highlights included:

Out-of-hours emergency services.

The lead surgeon at the hospital, Mike Walker, said that the trust is exploring a less than 24/7 emergency surgery service for the West Cumberland Hospital, as agreed in Closer to Home.

He said it would be based on need but that no detail had yet been discussed.

Mr Walker said: “All patients will come to the West Cumberland Hospital whether it is in or out-of-hours and be assessed here.”

If a decision was made that emergency surgery was required and it was out-of-hours then, he said: “If they are unstable to travel (to the Cumberland Infirmary) then a consultant will come here (to the West Cumberland Hospital).”

Normal working hours could be, for example, 8am-9/10pm weekdays and 8am to 5pm weekends, he said.

Consultant anaesthetist, Ian Ulyett, asked if such a patient required an intensive level of care would they have to go via ambulance to Carlisle.

Mr Walker said: “It will be decided on a case by case basis, in some cases they will go there and in other cases the surgeon comes here. It will not be the case that surgeons won’t come here.” He said if someone was unstable then the surgeon would come to the patient.

It would mean that West Cumberland Hospital would still provide a 24-hour consultant-led emergency medicine care but not 24-hour surgery. “The frequency to transfer patients for out-of-hours operations will be very small.”

He said only a very small number of patients are ever operated on out-of-hours, that the aim for any hospital is always to operate in-hours.

The Reverend John Bannister, the Save Our Services spokesman, asked about the reasons for this. Mr Walker explained that it was to ensure there was a clinically safe service and robust out-of-hours rota for vascular and emergency surgery. He said there would be eight surgeons on the rota for out-of-hours surgery (with two on at any one time) that will cover the whole of North Cumbria. He said the hospital would still have a resident operating team available 24/7.

Charles Brett, A&E consultant, said there has never been any suggestion the A&E service would be reduced, that it is consultant-led and would remain so. “We are signed up to deliver the services outlined in Closer to Home and look forward to being an integral part of that.”

The subject of emergency out-of-hours surgery would be discussed at length and a plan agreed with consultants, said Mr Walker, before being tested on, for example, a nine month basis.

Microbiology and Pathology

It was confirmed that some microbiology services are being centralised in Carlisle which means that certain tests would be transported there to be analysed on behalf of patients at West Cumberland Hospital instead of being done on site. A ‘hot lab’ facility however would remain to ensure that emergency specimens could still be done there and then on site.

Consultant orthopaedic surgeon, Mahesh Dhebar, said: “I think we should retain this service.” And a hospital physician said he did not want to have to telephone around for test results for a suspected acute meningitis patient as he would require them within 30 minutes. “We are very stretched on the floor with regard to juniors and seniors and if juniors are required to ring Carlisle for results then that is not an efficient service.”

Mike Walker said that would be sorted out to make sure the service remained efficient.

Regarding pathology, Mr Clarkson said: “It is not a loss of service. There will be a quicker turnaround time for people in West Cumbria and for cancer work.”

Nick West, said he thought there was a drip drip of centralisation of services regarding histopathology and microbiology. “It’s a loss to this hospital and this community. Each one is a little drip drip which demoralises staff and doesn’t help recruitment.”

Mike Walker said services needed to be safe and that occasionally it would mean that services have to be delivered from another site.


What is planned for the new and refurbished hospital

Gerard Richardson, of the Save Our Services group, asked “Is the hospital we are planning now any different to the hospital we were promised?"

Carole Heatly, Trust chief executive, said: “No. We are committed to everything in Closer to Home.” She said the only changes there would be is if they were for clinical safety reasons, and such a decision would be made by the clinicians themselves."

David Hounslea, project director for the £100million hospital redevelopment, said visible work would be evident by the end of the financial year.

He said there would be an improved environment on wards, efficiency changes so that services were grouped together properly and that views from the hospital would be maximised on wards.


The need for support

Concern was expressed about the impact on morale, recruitment and retention of the perception that services are gradually slipping away to Carlisle.

Soonu Verghese, consultant ophthalmologist at West Cumberland, said: “All the drip drip has been towards Carlisle. Why can’t management think about services coming this way? It has to be a two-way process. People should be made aware of the fact that they will have to travel. A lot of my patients are elderly.”

Liz Twist, Unison regional representative, added: “There is a real concern over here about the drip drip of services. People fear that even with a great building that the hospital may not provide all the services. So it would be good to open early dialogue with staff and address issues.”

Kevin Clarkson said: “People are not applying to Cumbrian posts. We are not down-grading the service, we are trying to build it up and make things sustainable for the workforce. We are continually advertising.”

Carole Heatly said: “There are national shortages of histopathologists. We also cannot get anaesthetists and it is a major worry. We are really trying to promote the area and get doctors to come and work here.” She said the Trust had even made a DVD to send out promoting its hospitals and the area.

Mahesh Dhebar said: “Unless you guarantee the future of this place (West Cumberland Hospital) you will not recruit. Unless you have a hospital that will be there 40 years from now, you will not recruit. Also, there are problems recruiting to a split site (ie two separate hospitals).

Rev Bannister said there were underlying and historic reasons why hospital staff and the community were often concerned about hospital services. “For the 10 years I have been here there’s been fear over this hospital. I am not sure we will actually be able to alleviate that until the day the (redeveloped) hospital opens its doors.

“We have a responsibility not to hijack this process with issues that do not warrant public concern. But," he added: “The Trust needs to look at its communication policies.”

Trust chairman, Mike Little, said: “Our Trust Board is committed entirely to this hospital here at West Cumberland and all its services. There is £100 million coming to this hospital.

“We need support for moving this hospital forward. We have got a contractor, we are making a start. But as we go through the next few years there’s going to be far more problems than we are discussing here,” he warned. “There are always financial issues, we have to live with them. Our board has turned around this Trust.”

Carole Heatly added that nationally there was going to be a significant reduction in the amounts of government money coming into the NHS so it would mean that things would have to change.

“We can do this together and we can make this a success. If we don’t, it will be a disaster,” she added.

The main source of information for this post was the Whitehaven News report which can be read in full here.

Contractor chosen to rebuild WCH

Tomorrow's Whitehaven News reports that Laing O'Rourke has won the contract for the rebuild/refurbishment of West Cumberland Hospital in Whitehaven.

Earlier this month I met NHS Trust CEO Carole Heatly with Cllr Yvonne Clarkson, chair of the Copeland council overview and scrutiny committee dealing with health. We had a constructive discussion about a number of issues, and one thing which Yvonne and I were keen to see was that the hospital project went forward as quickly as was compatible with due diligence and getting the rebuild right to deliver a safe and effective service. We were assured that progress was happening to achieve this this and this week's announcements backs up that statement. This his progress on assigning the contract is most welcome.

The Trust told Speaking exclusively to The Whitehaven News, health bosses announced that they have chosen construction giant Laing O’Rourke. The company has given an undertaking that the majority of the workforce needed for the £100million redevelopment will be sourced locally through its approved contractors and supply chain.

North Cumbria University Hospitals Trust said it would generate a significant boost to the local economy and contribute to the regeneration of West Cumbria. Carole Heatly said: “In selecting Laing O’Rourke, we have an understanding that they will use the local workforce as much as possible – this is good news especially in times of economic recession and should do much to strengthen the local economy of West Cumbria.”

It is expected that early preparatory work on the site will start before Christmas this year to allow for the major construction to begin in 2010. The hospital will include a new-build emergency care centre, new theatres, new outpatient area and new wards.

Laing O’Rourke is the largest privately-owned construction firm in the UK. It owes its own foundations to Cumbria where it was started by John Laing, in Cockermouth, in 1848. It was acquired by O’Rourke in 2001 and is said to be the premier health contractor nationwide with projects including the recent redevelopment of the Freeman and Royal Victoria Hospitals, in Newcastle.

The redevelopment of West Cumberland Hospital will be a publicly-funded capital project and will not be through the Private Finance Initiative which was used to fund the construction of the Cumberland Infirmary.

Health chiefs say they are committed to three ‘givens’ – providing all the services as agreed following the Closer to Home consultation; providing a facility to ‘modernise, improve and deliver care to all patients in West Cumbria’ and to move the development forward quickly.

Mike Little, Trust chairman, said: “This major project will provide a new healthcare facility that will see great improvements for all our patients in West Cumbria along with providing a great boost to the local economy.”

Ms Heatly added: “This is an immensely exciting time for healthcare in West Cumbria. £100 million is a significant investment and the first significant investment into healthcare for West Cumbria in over half-a-century. Working closely with our clinical staff and stakeholders, we will develop a healthcare facility that will offer the best to our patients.”

The full report is on the Whitehaven News website here.

Cumbria LINk survey on WCH rebuild

Cumbria LINk is carrying out a survey into the views of local residents about the rebuild of West Cumberland Hospital.

They are asking

a) WHAT IS THERE

With regard to the existing design and layout of this hospital, they are asking residents to give details of three problems or issues (NOT including the well known parking issues)

b) WHAT YOU WOULD LIKE TO SEE

They are asking residents to suggest up to three new facilities or services they would like to see provided in the rebuilt/refurbished hospital


c) Any other comments

They have asked for any other comments on the rebuilding of the hospital

Comments can be made via the Cumbria LINk website at

http://www.cumbrialink.org.uk

or via email to link@cumbriacvs.org.ul

or by post to

Cumbria LINk support team
27 Spencer Street
Carlisle CA1 1BE.

How not to deal with Swine Flu - or anything else

I was deeply concerned to read posts by the NHS Blog Doctor and Guido Fawkes about how inquiries about Paul Staines' daughter were dealt with by his local NHS when she developed a fever.

"Doctor Crippen" writes that

"I am ashamed to say that swine flu is being seen by some of my cynical colleagues as a perfect excuse with which to fob off a large number of patients."

As he points out, during the current fuss about swine flu, "other illnesses continue as normal. Children still get meningitis, and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get bacterial pneumonia and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get pyelonephritis (kidney infections) and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get acute appendicitis and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get acute leukaemia and may well present with high temperatures, tummy ache, headaches and a dry cough."

Unfortunately the symptoms which small children present when they get ill can be very similar for a wide variety of illnesses, some minor, some presenting a risk of permanent injury, and some life-threatening. That's why we must avoid the trap of diagnosing over the phone that every child with a fever has swine flu, prescribing Tamiflu, and assuming that this will deal with it.

Otherwise as he points out, we will have a tragedy like this:

“Mrs Jones phoned the GP/the hospital/the walk-in centre and was told over the telephone that her daughter, Mary, had swine flu. They left out a prescription for Tamiflu but Mary died the next day from meningococcal septicaemia.”

You can read the NHS blog doctor's comments in full here, and he expresses his disapproval of some of his NHS colleagues a lot more strongly than I have.

Putting Patient Safety First

The Conservative’s five-point plan to avoid a repeat of the tragic events at Mid Staffordshire NHS Foundation Trust

1. Tougher inspection to root out failure

Mid Staffordshire failure. The Healthcare Commission’s report raises concerns about weak patient and public involvement in the activities of the trust. It said that:

‘One of the former members of the forum, however, considered that the [patient and public involvement] forum had not been sufficiently robust in scrutinising standards’ (p.35). There were also concerns about the trust not being sufficiently open with the forum. The Healthcare Commission said that the trust ‘did not welcome concerns being raised by individual members of the forum’ (p.109) and that: ‘A former member of the patient and public involvement forum (PPIF) commented that it was difficult to obtain information from the trust on C. difficile. He felt this should be in the public domain. He obtained a copy of the infection control minutes for the meeting on 21 September 2006, which recorded that there had been 341 cases in total, of which 285 were inpatients, averaging 36 per month between January and September 2006. The minutes were not marked as confidential. When this information was released by him to a newspaper, he was expelled from the forum for breaching the code of conduct of the PPIF. He told us that the chair of the trust met with the chair of the PPIF and said that confidential documents would not go to the PPIF any more’ (p.89).

Conservative plan. Under Labour there has been constant upheaval in public and patient involvement in the NHS, with three different mechanisms for patients and members of the public to engage and involve themselves in the development of NHS services in just five years. Labour are currently establishing Local Involvement Networks (LINKs) in place of Patients’ Forums. In keeping with our commitment to avoid organisational upheaval, we will not abolish LINKs. However, LINKs – as currently planned – are too weak and will have too few powers to command the confidence of patients and members of the public. For example, they cannot summon documents in their own right, only access them through the Freedom of Information Act which has a number of exemptions built in.

Conservatives will make sure that LINKs are made independent of local authorities so they are not swayed by local politics, as Labour are proposing. And they will be given tough powers of inspection to hold the NHS accountable and the ability to act as advocates for patients who complain about NHS services. We also want serious NHS complaints (second-stage) complaints to be dealt with by the health regulator (the Care Quality Commission) not the Health Service Ombudsman, as the Government has said. The regulator is the body best placed to take action if complaints raise concern about systemic failings, as was the case in Mid Staffordshire.

2. A strong voice for patients

Mid Staffordshire failure. Overall, the Healthcare Commission report shows that patients did not have enough say over services at their local hospital, and although they were suffering from its failings, it took to long for the patient voice to be heard.


Conservative plan. Conservatives will establish a strong, independent, national consumer voice for patients: HealthWatch. HealthWatch will provide support to patients at a national level. Crucially, it will work closely with LINKs so that concerns raised at a local level can be escalated nationally, where necessary. It will also provide help for patients in dealing with complaints. HealthWatch will have a clear statutory right to be consulted over guidelines issued nationally concerning the care NHS patients should receive (‘commissioning guidelines’); and over decisions which affect how NHS care is provided in an area.

3. Power for patients to hold failing hospitals accountable

Mid Staffordshire failure. The Healthcare Commission’s report makes clear that local GPs were aware of problems at the hospital. It says that: ‘Just prior to the Healthcare Commission’s investigation… the PCT then contacted its two local commissioning groups to ascertain the views of GPs on standards of care. The responses were highly critical and further raised the concerns of the PCT’ (p.119). However local GPs and their patients had little power to do anything about the problems because it was the local Primary Care Trust that was responsible for purchasing services from the hospital and therefore setting standards for patients. It failed in its duties, with the Healthcare Commission reporting that: ‘it was initially distracted by the organisational change following the merger that created the PCT in 2006, and then focused on the number of patients treated and the cost. They had few measures of the quality of care or outcomes at the trust’ (p.11).

Conservative plan. Conservatives would put real power in the hands of patients, together with their GPs. Instead of Primary Care Trusts, GPs will control the funding that hospitals receive when they treat their patients and the contracts that go alongside this funding. They are best placed to do this because, unlike Primary Care Trusts, they have a personal relationship with their patients so they know their needs, can keep an eye out for problems and are in a better position to withhold payment if things go wrong.

Together with their GP, patients will be given the right to go to any hospital they choose for treatment. That means that they will be able to go elsewhere if a hospital is failing.

4. An end to box-ticking and targets

Mid Staffordshire failure. The Healthcare Commission’s report found that: ‘Many staff that we interviewed volunteered their view that the approach of the trust meant that the care of patients had become secondary to achieving targets and minimising breaches’ (p.49).

Conservative plan. Conservatives will scrap Labour’s costly, bureaucratic targets, such as the four hour waiting time target in Accident and Emergency and instead focus on what really matters to patients, which is the results of their treatment. This does not mean there will not be any standards, but instead of these always being determined centrally we would give local GPs the power to agree standards with the hospitals where they send their patients. These standards would have to be kept as part of the contracts for their treatment. Doctors and nurses should never be put in a position where they have to choose between meeting a target and doing what is best for their patients.

5. Exposing hospitals to public scrutiny

Mid Staffordshire failure. The Healthcare Commission’s report shows that the awful treatment of patients in Mid Staffordshire only came to light as a result of concerns about mortality rates at the hospital. Mortality rates are not routinely published and were only available as a result of ‘internal’ analysis by the Healthcare Commission and independent analysis by the Doctor Foster group (p.4).

Conservative plan. Conservatives will make sure information on the outcomes of patients’ treatment at individual hospitals is freely available to the public, so that it is clear which hospitals are not doing well. We want to put power back in the hands of patients by ensuring that all the information necessary to them to assess the performance of their local hospital is made available. This will include more information on mortality and survival rates at each NHS trust. We are calling on the Government to include information on outcomes in the new quality accounts they are planning to introduce for hospitals in their current Health Bill. At the moment these are to be focussed on targets like the four-hour waiting time target for Accident and Emergency.

More detail on the above proposals can me found in

- our paper on Primary Care, ‘The patient will see you now, doctor’, published in September 2007;

- our Health Green Paper, 'Outcomes not targets', published in June 2008; and

- 'Renewal' Our plan for NHS improvement, published in September 2008. These documents can be found at:

http://www.conservatives.com/Policy/Where_we_stand/Health.aspx