Sunday, 31 March 2013

As Maggie might have said, its the wrong answer to the wrong question

Five days before All Fools Day, came the announcement from JH that he plans to require pre-registration nursing students to have worked for up to a year as a healthcare assistant. All Fools' Day (or Poisson d'Avril in French) is a day when humour should reign and practical tricks get played on others, and often such tricks are played out for mass consumption. I had hoped that JHs announcement was just that; but I fear he was being serious. In his response to the second Francis Inquiry into the failings at the Mid Staffordshire NHS Foundation Trust, JH, the Secretary of State for Health said: ‘every student who seeks NHS funding for nursing degrees should first serve up to a year as a healthcare assistant, to promote frontline caring experience and values, as well as academic strength. They will also provide students with helpful experience for managing healthcare assistants when they qualify and enter practice’.
Now some readers of this blog might have realised over the years that my reading of the Daily Telegraph and the Iron Lady Portrait hanging on my bedroom wall, and the blue rosette pinned to my lapel during general elections might have provided a clue to my political loyalty – in the interest of fairness, there are other political parties that can be supported – but this policy announcement from the Tories really tests such loyalty – sorry Maggie, but its true! 
The new body for commissioning nurse education (and all other health professions education and training), Health Education England is to take this work forward. Ian Cummings, the HEEs Chief Executive, welcomed the initiative. And whilst we all agree that many NHS professionals lost their way at Mid Staffs, and perhaps for a number of reasons forgot what the underpinning values and beliefs required for compassionate care involved, this is not the way to tackle the problem. In my view it’s the wrong answer to the wrong question. And I despair for the future of our great NHS.   
The experience in our School, one of the largest Schools providing nurse education in England, is that many of our students are mature in age, have already gained a range of life experiences, often in health and social care settings. They have often worked hard at achieving the necessary academic qualifications to gain a place on the programmes, are very motivated, self confident individuals whose passion for nursing is articulated well in our values based recruitment processes. Nursing education standards were comprehensively reviewed in 2010 and include compassionate care as a core component.
Last year, nationally there were just under 200,000 applications for student nursing places. It’s difficult to see how the proposed initiative would work with this number of potential applicants. Finding places on wards and in community settings and expecting already stretched staff to provide learning opportunities seems to be adding a burden rather than providing a workable solution. It appears to me that rather than focusing on pre-registration students, JH would be better concentrating on getting the right numbers and skill mix of qualified nursing staff into clinical areas.
Most surprisingly to me, I found myself agreeing with Peter Carter of the RCN over the issue. Peter Carter is the Chief Executive of the Royal College of Nursing. He acknowledged the commitment from JH to review the staffing levels in clinical areas, but cautioned about leaving the decision as to what staffing levels might result in higher standards of compassionate care, to local managers. This was an approach that clearly didn’t work in Mid Staffs, so why would it work elsewhere post the Francis Report? Last year, the RCN commissioned the independent but somewhat ill conceived Willis Report into pre-registration nurse education. This report found no evidence whatsoever that current nursing education is failing, nor that it is associated with a decline in compassion. As for me, well I recovered my composure at finding myself in total agreement with the RCN by lying down in a darkened room for an hour. I bet Florence and Mary are turning in their graves. 

Sunday, 24 March 2013

Numbers and Texts that might Save Lives

My favourite read of last week was Nick Jones and Anita Charlesworth’sThe Anatomy of Health Spending 2011/12. This research report is based on work with 117 NHS Trusts. Not only did the title appeal, but it is 56 fact filled pages that examines the state of NHS finances. Anita Charlesworth, who is the Chief Economist at the Nuffield Trust was for many years the Director of Public Spending at the Treasury, where she led the team working with Sir Derek Wanless on his reform for NHS funding in 2002. When she speaks we need to listen. Last week she presented the outcome implications of her report and it made for uncomfortable reading. 

Government spending on health across the UK in 2011/12 was £121.4b. Since the NHS was formed in 1948, the overall spend on health care has increased by an average of 3.8%. During this time, there have only been 8 years where there has been a real decrease in funding, and 2 of these years were 2010/11 and 2011/12. The latter was the first year of the current governments tightening of the finances for the NHS. 

Anita Charlesworth noted that the underlying economic situation and the current period of austerity will last until at least until 2017/18, and the NHS will continue to experience reduced funding. Only larger cuts in other public sector services and/or welfare provision or relatively large tax increases would allow NHS funding to grow at historic levels. Tax increases are likely to be politically unpalatable - 1p extra on income tax raises £4b a year (the NHS cost £300m a day to run). She noted that whilst the NHS is making headline savings it is not making progress on service productivity, and without unprecedented productivity gains, the gap between demand for care and the ability to provide service, this will grow exponentially.

Increasing workforce productivity was clearly in the minds of our North West Local Education and Training Board (LETB). This LETB is one of the 13 across the UK who will be responsible for spending over £5b each year educating and training the future health care workforce. Last week they published their priorities for the next 5 years. There were the usual suspects – develop an agreed approach to medical workforce planning – good luck with that one – but amongst the long list of priorities was one that caught my eye – this was one concerned with taking forward the North West Tele-health and M-health Strategy.

It appears m-health (using mobile technology, phones, and tablets and so on) has much to offer in terms of increasing productivity. For example, in the US, 75b texts are sent each month. Last week a report presented at the American Academy of Neurology conference by Dr Omran Kaskar described how the inability to write a text message may be a vital new ‘tool’ in diagnosing an ischemic stroke, in which clots cut off blood supply to particular areas of the brain. If untreated or not treated in a timely way, it is a condition that can be fatal or result in physical impairments.

The report focused upon a 40 year-old man who despite showing only slight facial asymmetry and having no other apparent symptoms, doctors at the hospital diagnosed the man as having suffered an acute ischemic stroke. Although he had no problems speaking normally he showed signs of ‘dystextia’ - the inability to write a coherent text message. The patient, could only produce garbled messages when asked to write a simple text message, but also saw nothing wrong with such a text. When asked to type “the doctor needs a new blackberry” at the hospital, the resultant message was “Tjhe Doctor nddds a new bb,” but he did not recognise any errors. Goodness only know what they would have thought if they ever received any of my text messages!

Sunday, 17 March 2013

Out of Manchester and In to Africa

According to the wonderfully entitled Knowledge and Intelligence office at the Department of Health there are 423 paediatric critical care beds available in the UK. For most of the time some 80% of these (331) are occupied. Additionally, there are some 1365 neo-natal critical care beds. I mention this as last Sunday; just a week ago, I was sitting by one of these beds in the 21 bedded Paediatric Intensive Care Unit at the Manchester Children’s Hospital.

I was there because my youngest grandson had been admitted a week before with pneumonia and he had spent the previous week sedated and ventilated. Pneumonia is a form of acute respiratory infection that affects the lungs. When an individual has pneumonia, the alveoli (little air sacs) become filled with pus and fluid, which makes breathing painful and limits oxygen intake.

Pneumonia is the single largest cause of death in children worldwide. Every year, it kills an estimated 1.2 million children below the age of 5 years old. These deaths account for 18% of all deaths of children under 5 years old worldwide. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa.

Whilst some types of pneumonia (that caused by bacteria) can be treated with antibiotics, around only 30% of children with pneumonia living in Africa receive the antibiotics they need. The cost of antibiotic treatment for all children with pneumonia in 42 of the world's poorest countries is estimated by the World Health Organisation at around £398 million per year. Treating pneumonia in South Asia and sub-Saharan Africa – which account for 85% of deaths – would cost a third of this total, at around £133 million. The price includes the antibiotics themselves, as well as the cost of training health workers, which strengthens the health systems as a whole.

Last Friday it was Red Nose Day and among the music and fun of the night there were very moving films on the effects of malaria, pneumonia and starvation in Africa. The last Red Nose Day, 2 years ago, raised £74.3 million, a figure exceeded this year by the on the night total so far of £75,107,851. At least £5 million of this figure is to be dedicated for vaccination programmes for pneumonia.

Thankfully, my grandson is slowly on the mend and now rapidly passing through the various levels of in-patient care. Its interesting to see that as the dependency level of each clinical area is reduced so the number of nursing staff per patient also gets smaller, 1-1 in the ICU, 1-2 in HDU, 1-4 in the general medical ward. But many thanks to all the staff at Manchester Children’s Hospital – it was so good to see our University of Salford nurses, students and qualified staff demonstrating such high quality care. And huge thanks to neighbours Mac and Judith, who over the past 2 weeks have ensured the chickens got their daily greens, Billy the parrot, his sunflower seeds and Cello his daily walks and fat free yogurt when work and hospital visits made all of these things difficult to achieve. 

Sunday, 10 March 2013

Bright women, clever hens, confounding facts and a good old fashioned chat over a pint or two

Last night I came back from a week’s holiday in Scotland. One of the great things about being away on holiday without internet or TV access is that one has to revert to that old fashioned form of media communication, the humble newspaper. After many years now of reading my newspaper largely on line, it was interesting to see that the ink still rubbed off onto my fingers. 

Also interesting was one of the stories read last week. Women, it appears have a hippocampus, the part of the brain that plays a central role in memory, intelligence and emotion, that consumes less energy and uses fewer brain cells than in men. Women’s brains are 8% smaller than men, yet show no difference in intelligence. The study carried out by neuroscientists at the University of California showed that women out performed men in inductive reasoning were much better at keeping track of a changing situation and at some numerical skills.

And in all my years 40 years experience of keeping chickens I would have to say that the same is true for chickens. It is the hens, not the cockerel, that find the food, are the first to notice danger, take care of the young and do so with a great deal more ferocity than the cockerel, and of course, unlike the cockerel, lay wonderful life giving eggs.

Good to see that Tesco are now using their considerable might to ensure that all their chickens come from farms in the UK and from farms that rear chickens using humane and non factory methods. However, if we want to be self sufficient in home produced meat we are a way off –we only produce 40% of the beef eaten, 60% of the pork, 50% of the chickens. Lamb however; we are almost there, 85% of what gets eaten in produced in UK. Thankfully, being a vegetarian, this is a somewhat academic discussion.

And vegetarians were in the mid week news. Vegetarians apparently drink less alcohol, are more active, and more unlikely to smoke. These are so called 'confounding facts' that need to be taken into account when comparing the life threatening consequences of eating meat or not. Yes it’s that annual 'cut back on the number of sausages, meat pies and bacon butties you eat if you want to live longer' story. Apparently if meat eating people were to reduce their consumption of processed meat to a single chipolata a day, it could prevent 3000 early deaths a year in Britain.

The Scottish version of the Daily Telegraph chose to situate this story alongside one reporting the  Food Standards Agency setting up citizens forums to gauge what level of contamination in meat is 'achievable, detectable and acceptable'. In other words how much horse meat are you happy to eat.

And up there in Scotland, the talk was all about whether the NHS will still be available to Scots if the Yes vote is successful. Sally Russell was the catalyst. She has suffered from cystic fibrosis since birth and had opted to undergo a rare double lung transplant in Freemen Hospital - Newcastle. The 7 hour procedure is not available anywhere in Scotland. Interestingly, none of the people I have met this past week, plumbers, electricians, barmaids, aerial fitters, tar macadam technicians, BT engineers, and a farmer who wanted me to pay half the repair cost of a fence between his land and mine, had a good word to say about Alex Salmond and his plans for a independent Scotland.

And in a form of community communication even older than newspapers, that is having a good old fashioned chat over a cup of coffee, they all had plenty to say about the changing world they found themselves in. Mind you others seem oblivious to the desire of Scotland and its people to maintain their identity. Richard Branson's latest wheeze in air travel is something called ‘Little Red’ a new short haul service running between London and Edinburgh. Branson’s party invites, to the Little Red launch party promised there would be plenty of 'whiskey' for party goers to imbibe. And as we all know, to many 'e' additives are bad for your health.

What is good for promoting the health of many though is the new bar (called Shebeen) in Melbourne, Australia. See Shebeen is operated by Melbourne entrepreneur Simon Griffiths. It sells beer from around the world, and depending on what beer you drink, a charity in that country benefits by receiving the profit. Last year, Griffiths made headlines for sitting on a toilet for two days straight to raise AUD$50,000 (£24,000) for 'who gives a crap' (sorry Mum) a socially conscious start up which directs 50% of the money made on each roll of toilet paper toward sanitation for the development world. Hmmm, so looking forward to being able to watch the Andrew Marr show later on this morning!

Saturday, 2 March 2013

Getting to see your Doctor at any cost

It’s that time again; an Ipsos MORI poll undertaken on 11th Febuary, revealed that 89% of the 1,018 adults surveyed trust doctors to tell the truth, 9% said they didn’t trust them to tell the truth and a further 2% said they didn’t know. Teachers came second with 86% of people trusting them to tell the truth followed by scientists with 83%. This compares with the ‘ordinary man/woman in the street’ who scored 64%. Only 23% of the people polled trust politicians to tell the truth.

Interestingly Dr Peter Holden said: ‘This doesn’t surprise me. It is very much what we have always known. Doctors sacrifice that trust at their peril. I would be worried if we weren’t at the top. Governments should listen to doctors more. The nature of the health service is that it is long term and politicians are short-term opportunists.’ Yes this is the same Dr Holden a general practitioner based in Matlock, Derbyshire who back in 2010 earned a salary of £106,000. Yes this is the same Dr Holden - who was part of the British Medical Association (BMA) team which negotiated the current GPs' remuneration package. He insists he is worth every penny.

However, GPs contracts are being overhauled and that has not pleased Dr Holden and his fellow GPs. Findings from a BMA poll also show that more than half of GPs (54%) believe their practice would have to reduce patient access if the contract changes go ahead, and 88% of GPs believe ‘they personally’ will be less able to offer good quality care to their patients as a result of the changes. The Department of Health plans to impose GP contract changes from 2013.

So what’s the fuss about? Well details released by the DH in late 2012 revealed that the current deal, which provides top-ups to core pay for around 60% of GP practices across the UK, will be phased out over 7 years. At the same time extra services to be commissioned from GP practices will cover: Improving the assessment of people with dementia; Improving care management for frail older people and other high risk patients at risk of unplanned hospital admissions; Using technology to help monitor the health of people with long-term conditions and improving online access to services.

The DH confirmed this means GPs will be delivering more to retain the money they were getting under the old contract. And while the BMA are concerned with the possible impact these changes will have on the overall salaries of GPs, Sir Bruce Keogh, (Medical Director NHS) is calling for senior doctor’s to support 7-day working. Keogh believes the shift to 7-day working for consultants is essential if standards are to be raised. There is hard evidence; he says that patients are more likely to die if they are admitted over a weekend. Paul Flyn, chairman of the British Medical Association's consultants committee, rejects the idea, asking who will pay for senior doctors to be on the wards seven days a week. Hmm, Paul, I think you will find it’s us, your humble tax payer and potential patient, that man and woman in the street talked about above . And there was me thinking the NHS was a 24/7 service.

So is it just me who wonders whether all of this is just a smoke screen, an excuse not to face the unpalatable truth of Mid Staffordshire. As I have said to this blogs readers many times in the past, if I need health care I tend to go to the local Walk – In - Clinic, where I will be guaranteed to be seen by a knowledgeable, skilled and caring nurse. No appointment necessary.

This week’s blog sent care of Nicos@Blackwater, the only free WiFi cafe in Castle Douglas. Many thanks