Deaths concern for 19 NHS trusts

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Report author Roger Taylor says transparency is crucial if problems are to be dealt with

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An analysis of deaths in English hospitals has found 19 NHS trusts have higher rates than would be expected.

But monitoring body Dr Foster's report on 147 trusts shows an improvement on 2009, when the figure was 27.

The survey also shows that four trusts had a higher than expected number of patients who died after surgery.

The NHS Confederation said the report showed where the NHS "could do better". The government says unsafe care will not be tolerated.

However, Patients Association chief executive Katherine Murphy said safety was still "clearly not the top priority" of every NHS organisation.

"We cannot continue with a situation where patients are stuck with poor healthcare because of where they live," she said.

Dr Foster's survey looks at overall death rates and deaths after surgery as well as a range of other indicators to try to build a picture of patient care.

Two trusts - Hull and East Yorkshire Hospitals and University Hospitals Birmingham - had higher than expected overall death rates and rates of deaths after surgery.

A spokesman for Hull and East Yorkshire NHS Trust said its figures reflected that it looks after a population with the highest rates of smoking in the country, along with alcohol problems, obesity and heart disease, and that many of the patents who walk through its doors are already very ill.

Meanwhile, Dr Dave Rosser, executive medical director at University Hospitals Birmingham NHS Foundation Trust, said the report's methodology was flawed. Figures may have been skewed by high numbers of patients with liver disease and could cause unnecessary distress among patients, he added.

The report acknowledges that figures cannot be taken in isolation but should act more like an alarm to point up possible areas of concern.

Roger Taylor, director of research at Dr Foster, said there seemed to have been an overall improvement since last year.

"Safety standards are improving, mortality rates are falling, the variation between the best and the worst is getting less.

Avoidable complications

"However, we do still have a long way to go in terms of involving patients in decisions about their care, enabling them to understand what their options are and ensuring they can always reliably and safely get the best quality care."

Richard Hamblin of the NHS safety regulator the Care Quality Commission says Dr Foster's figures were a useful tool if used properly.

"If a mortality rate is higher than we would expect, or higher than it is elsewhere, we need to start asking why is this?

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Health Secretary Andrew Lansley: "When something goes wrong, hospitals have a duty to report it"

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"Are the patients sicker? Is it that the care is worse? Is it something to do with how the details of the patients are being recorded?"

Of greater concern perhaps are more than 62,000 accidents, mistakes or avoidable complications recorded across all 147 hospital trusts, says BBC health correspondent Dominic Hughes.

The report says many incidents go unrecorded - so the true number may be much higher, he adds.

Nigel Edwards, acting chief executive of the NHS Confederation, which represents the majority of NHS organisations, said: "There are still parts of our health system where particular services are having problems, and for the hospitals concerned this report presents an opportunity to learn and improve.

"There will always be variations in any nationwide system but the golden principle must be that our NHS is safe for the patients who rely on it - this report shows where we can do better."

Health Secretary Andrew Lansley welcomed the report, saying such information was vital to allow patients to make informed choices about care.

But he said: "Unsafe care will not be tolerated. Patients have a right to expect the very best care from the NHS and when something goes wrong, hospitals have a duty to report it and make sure that others can learn from their mistake."

He said the government was taking measures to make the NHS more accountable.

"In future, clinicians will not only be responsible for designing and paying for local health services, they will also be held to account for the quality of care for their patients," he added.

Hospitals with higher-than-expected death rates were:

• Barking, Havering and Redbridge University Hospitals NHS Trust
• Buckinghamshire Hospitals NHS Trust
• City Hospitals Sunderland NHS Foundation Trust
• Derby Hospitals NHS Foundation Trust
• East Sussex Hospitals NHS Trust
• George Eliot Hospital NHS Trust
• Hull and East Yorkshire Hospitals NHS Trust
• Isle Of Wight NHS PCT
• Mid Cheshire Hospitals NHS Foundation Trust
• Northampton General Hospital NHS Trust
• Pennine Acute Hospitals NHS Trust
• Royal Bolton Hospital NHS Foundation Trust
• Shrewsbury and Telford Hospital NHS Trust
• South London Healthcare NHS Trust
• Southport and Ormskirk Hospital NHS Trust
• The Dudley Group Of Hospitals NHS Foundation Trust
• The Royal Wolverhampton Hospitals NHS Trust
• University Hospital Birmingham NHS Foundation Trust
• Western Sussex Hospitals NHS Trust

Hospitals with higher-than-expected death rates after surgery were:

• Hull and East Yorkshire Hospitals NHS Trust
• The Newcastle upon Tyne Hospitals NHS Foundation Trust
• University Hospitals Birmingham NHS Foundation Trust
• University Hospital of North Staffordshire NHS Trust

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Weather check &#39;predicts injuries&#39;

26 November 2010 Last updated at 20:42 ET

Taking the temperature outside A&E could give staff an accurate way to predict number of injuries and who will suffer them.

Experts know that extreme weather can affect A&E patient numbers.

Warwick University researchers found that even 5C falls or rises could make a difference to injury rates.

Rates for children were up to 70% higher in summer compared to winter, the Emergency Medicine Journal reported.

Many trusts plan ahead for winter, when the arrival of frost, snow and ice, as well as flu and pneumonia, is traditionally linked to busier shifts.

The study of 60,000 patients found that each 5C drop in minimum temperature during the day meant a three per cent rise in serious accidents to adults.

Heat of summer

The arrival of snow and ice led to an eight per cent rise, as the number of slips, trips and car accidents rose.

However, the study found other increases linked to the heat of the summer, often viewed as a slightly calmer period in emergency departments.

Even among adults, every five degree centigrade rise in maximum temperature during the day, and additional two hours of sunshine, meant a 2% rise in the rate of serious injury.

Continue reading the main story

"Start Quote

We've always known that there is increased activity in emergency departments during winter, but in recent years, we've noticed that this doesn't really diminish during the summer months - we remain busy all year round"

End Quote Professor John Heyworth College of Emergency Medicine

This effect was particularly noticeable in children, who are more likely to get injured while playing outside during the warmer months.

For them, a 5C rise meant a 10% increase in injury cases, and two hours of extra sunshine boosted cases by six per cent.

While these connections were made by comparing records of hospital admissions with historical weather data, the researchers are convinced that the principle could be used to help emergency teams plan ahead for days when their workload is likely to be higher.

They wrote: "This model could clearly be used to provide predictions of daily admissions, with clear implications for the scheduling of staff and other resources at UK trauma-receiving hospitals.

"The challenge for the future is to improve forecast accuracy further in order to provide sufficient time for the detailed planning and allocation of resources that would be necessary to implement these models."

Professor John Heyworth, president of the College of Emergency Medicine, agreed that the detailed study could help clinical teams know what to expect on any particular day, although he questioned whether the current accuracy of medium-term weather forecasts was good enough to justify staffing changes.

He said: "We've always known that there is increased activity in emergency departments during winter, but in recent years, we've noticed that this doesn't really diminish during the summer months - we remain busy all year round.

"If you have your emergency department set up to deal with this expected load, then you can deal with extra cases due to weather conditions.

"However, this is a very helpful study."

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Quarter &#39;unaware of HIV status&#39;

25 November 2010 Last updated at 22:23 ET

A quarter of people with HIV in the UK, over 22,000, are unaware they have the virus, experts from the Health Protection Agency have suggested.

The 2009 estimate is based on anonymous blood samples supplied for other reasons but tested and found to be HIV positive.

It is at the same level as 2008's estimate.

The Terrence Higgins Trust said more investment was still needed in prevention and awareness programmes.

The Health Protection Agency said 6,630 people were newly diagnosed with HIV in 2009, down for the fourth year in a row.

The HPA's report also found over half of those were diagnosed after the stage when treatment should have started.

In all, the number of people living with HIV in the UK reached an estimated 86,500 last year.

'Test all'

Dr Valerie Delpech, consultant epidemiologist and head of HIV surveillance at the HPA, said: "We're very concerned that a large number of people in the UK are unaware of their HIV status and that half of all newly diagnosed people are diagnosed late, meaning they may not benefit from very effective treatments."

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It's vitally important we invest in targeted HIV prevention and awareness programmes"

End Quote Sir Nick Partridge Terrence Higgins Trust

She called for better access to HIV testing in areas where rates of HIV infection are high.

"Pilot studies have shown that in these areas testing all adults registering at GPs or accessing certain hospital services can make an impact."

"The evidence shows that this testing is feasible to undertake and acceptable to patients. We would like to see this rolled out in areas where HIV infection is more common to reduce the number of people who are unaware of their HIV status and increase the chances of early diagnosis, when treatment is more successful."

The HPA added that those at higher risk of HIV, such as men who have sex with men and black Africans living in this country, should know their status and consider being tested regularly.

Sir Nick Partridge, chief executive of the Terrence Higgins Trust sexual health charity, said: "With more people living with HIV than ever before in the UK it's vitally important we invest in targeted HIV prevention and awareness programmes, particularly for gay men who are most at risk.

"We also need to re-double work to get people to test, to reduce the high numbers of people who don't know that they have HIV for far too long before being tested and prevent needless deaths."

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PE "failing" to provide a workout

25 November 2010 Last updated at 23:02 ET By Adam Brimelow Health Correspondent, BBC News

Leading sports doctors have strongly criticised the way PE is being taught in English schools.

Experts say many children do not get a proper workout which helps them develop coordination, strength and agility.

The British Association of Sports and Exercise Medicine wants all schools to use a short exercise routine called '5 in 5'.

But the government said PE was a matter for individual schools.

Specialists in sports and exercise medicine say that too often PE lessons focus on developing sports skills rather than encouraging flexibility and movement.

The British Association of Sports and Exercise Medicine has endorsed a quick training programme designed to address this.

'5 in 5' provides five exercises in five minutes. A leading international sports coach, Kelvin Giles, has devised more than 20 five-minute routines.

He has worked with elite sports men and women around the world, from athletics and rugby to football and tennis.

"Catastrophic" fitness

He also spends a lot of time in schools, and said PE lessons in the UK do not give children a proper workout.

Continue reading the main story

'HOT FOOT LIZARDS' AND MORE

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Zoe Biggs started the programme with her class of nine and 10-year-olds at Camps Hill Primary School in Stevenage last year.

The children have been delighted as their fitness has improved.

"Some of them really struggled at the beginning, and once they worked at it and persevered they really came alight", said Ms Biggs.

"They looked so happy they could do it and they'd achieved it and done it themselves".

Progress was closely monitored through the academic year.

The improvements - in terms of flexibility, coordination and strength - were dramatic.

Children said they enjoyed it.

"It's quite hard at first but when you do lots it's actually quite easy", said one.

Another said it was fun, but confessed that it sometimes left him feeling "hot and bothered".

They have worked their way through several sets of exercises, many of them with catchy names such as "upside-down bug" or "hot-foot lizard".

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"Out of the 40 minutes there's eight minutes of activity going on. Very often the kids are standing around and just listening to the teacher talk. So heart rates aren't being raised. Mechanical efficiency isn't being looked at."

As a result, he says, the level of fitness in most children is "catastrophic".

The '5 in 5' routines involve squatting, lunging, pushing, bracing and rotating.

"You can get stronger, you can get more stable, you can have a much better posture, by exposing yourself to five minutes a day", said Mr Giles.

The initiative has won the backing of the UK's leading sports doctors. To mark its annual conference in London, the British Association of Sports and Exercise Medicine has called on UK governments to incorporate the programme in all schools.

The Association's chairman is former Olympic gold medallist rower, and chief medical officer for the London Olympics, Dr Richard Budgett. He is deeply concerned about PE in schools.

"If you're not a natural athlete, not attracted to sport and exercise, there is a real problem. It's very easy to drop out."

"By using a programme like 5-in-5 in schools we can get young people with the skills that they can then use as they get older. So they can keep fit, keep their joints working properly and prevent all sorts of diseases, from osteoarthritis through to diabetes and heart disease."

The Department for Education in England says it will be up to schools to decide if they want to adopt this.

It wants them to focus more on competitive sport. Sports physicians say '5 in 5' will help gifted children to excel, while ensuring all receive a proper physical education.

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Private firm to run NHS hospital

25 November 2010 Last updated at 11:48 ET By Nick Triggle Health reporter, BBC News

Private company Circle is to take over the running of Cambridgeshire's Hinchingbrooke hospital.

The trust, near Huntingdon, becomes the first to be entirely run by a private business after it beat another bidder, Serco, to the contract.

Regional NHS bosses sought new management after the trust amassed nearly �40m of debts.

They said the move would improve the running of the hospital, but unions warned it heralded a new era of privatisation.

The involvement of private companies in the health service is nothing new.

Risks

They have already lent management support to hospitals, as well as winning contracts to provide specific services such as pathology.

The private sector also runs a number of treatment centres, which carry out minor non-emergency surgery.

But this move breaks new ground in that the company, which is partly owned by its employees in a John Lewis-style model, will be entirely responsible for running the hospital and the risks involved.

Under the terms of the deal, the staff and assets will remain part of the NHS.

Dr Stephen Dunn, director of strategy at the East of England Strategic Health Authority, said Circle had been chosen as they were a "cutting edge" partner.

Continue reading the main story

What is Circle?

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Circle is not new to the NHS.

It has already won contracts to run what are called independent sector treatment centres.

These were set up to carry out non-emergency surgery, such as knee and hip replacements when the government was trying to get waiting lists down.

Circle also runs a private hospital in Bath.

It treats NHS patients at this site as under the patient choice initiative the private sector can treat NHS cases if providers are willing to see them at NHS prices.

The company calls itself a social enterprise - although it is not formally registered as one - because it is half owned by its employees.

The other half is owned by private investors.

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He added: "Hinchingbrooke has major debts and might have had to close, or receive a large subsidy paid for by the taxpayer. Thanks to this process this is not the case."

Ali Parsa, Circle's managing partner, said he wanted to liberate doctors and nurses "to deliver the best services for the patients they know best".

Circle is due to take over the running of the hospital in June, subject to government and regulatory approval.

The hospital was built in 1983, but has spent recent years struggling for money.

There are a variety of reasons for this. Management of the trust has been criticised at various points, although the hospital has undoubtedly suffered from the creation of a more competitive market in the NHS.

The hospital serves a relatively small population of about 160,000 people, but with NHS trusts now largely paid per patient treated it has struggled for funds.

Paul Flynn, of the British Medical Association, said: "This could be the start of much greater privatisation. There are quite a few other trusts with debts and private companies want to get a foothold into the NHS. But my concern is that they do not have the wider interests of the health service in mind."

But Professor John Appleby, chief economist at the King's Fund, said: "I'm not sure we will see a wave of these. There could well be more, but private management is not the only option, there are also mergers or reorganisation of services that can solve problems."

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BMA ex-leader cleared to operate

25 November 2010 Last updated at 08:11 ET By Dominic Hughes Health correspondent, BBC News

An ex-head of the British Medical Association has been cleared to return to work after a disciplinary hearing.

A General Medical Council panel had earlier rejected many allegations involving the clinical and surgical practice facing James Johnson, 64, a Cheshire-based surgeon.

But he was found to have not involved himself properly with the post-operative care of some patients.

His lawyer said the hearing had been a "chastening and humbling" experience.

'Lurid' headlines

Mr Johnson, who worked at two hospitals in Runcorn and Warrington in Cheshire, had been accused of "acting with arrogance", and of carrying out amputations when other operations should have been considered.

But Martin Ford, representing Mr Johnson, said that despite "inappropriate and lurid" headlines, the panel had found no patient had suffered because of Mr Johnson's care, that he had not carried out any unnecessary amputations and any allegation of clinical incompetence was proved wrong.

The panel agreed and decided that Mr Johnson's fitness to practice was not impaired.

It also decided against issuing him with a warning given that he has apologised, the incidents were isolated and he has already modified the way he worked.

In a statement after the hearing Mr Johnson said he was delighted with the outcome.

But he added: "I have nevertheless reflected upon the issues raised in the hearing and have either modified my practise or will do so where appropriate."

"I remain dedicated to my patients and look forward to continuing to practise as a surgeon."

It had been claimed Mr Johnson had spent too much of his time in his role as chairman of the BMA, and too little time caring for his patients and keeping his surgical practice up to date.

The GMC did find Mr Johnson sometimes did not properly involve himself with the post-operative care of his patients because he was away in London on BMA duties.

It said that "at the very least", he should have "picked up the telephone" in order to find out how his patients were faring post-operatively.

It was also found that, on occasion, Mr Johnson did not involve himself in discussions with other healthcare staff prior to surgery.

But the GMC panel cleared him of most of the charges, including all the more serious ones.

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