The doctors' union claims that England's medical records database is being pushed through too fast, with details sometimes being uploaded without patients' knowledge. But those behind the new system say many patients are astonished that hospital doctors still do not have access to basic information, and the process to opt out is very straightforward. What are the issues?
Doctors leaders have called for a halt in the development of a medical records database for patients in England. The British Medical Association says the computer-based Summary Care Records are being set up at "break-neck speed", sometimes without patients' knowledge. Ministers have expressed surprise at fears of fast change after previous criticism that it was moving slowly. The NHS IT upgrade will link more than 30,000 GPs to nearly 300 hospitals through an online appointments system. It will also feature a centralised medical records system for 50 million patients, e-prescriptions and faster computer network links.
At least 100,000 non-medical staff in NHS trusts have access to confidential patient records, claim campaigners. Big Brother Watch, who based the figure on 151 responses from trusts, said it demonstrated "slack security". The group says hospital domestics, porters, and IT staff are among those with access to records in some trusts. The Department of Health says the report muddles paper files and the newer electronic systems for which access will be strictly controlled. Big Brother Watch asked every NHS Trust in the UK for the number of their non-medical staff who had access to confidential patient records.
Checklists that spell out exactly how to care for patients with common conditions have dramatically reduced hospital deaths, say doctors. The British Medical Journal reported a 15% fall in the number of people who had died at one north London hospital trust using so-called care bundles. These are checklists covering dozens of conditions including strokes, heart failure and MRSA infections. The researchers said death rates could be "halved" using the system.
This article examines the implications for patient care, and for the future of rationing within the NHS, of the recent decision to permit NHS patients to supplement their care by paying for medicines — mainly expensive new cancer drugs — which are not available within the NHS. The starting point is the recommendations of the Richards' Report and their implementation through new guidance issued by the DoH and NICE. Practical challenges arise from the insistence upon the 'separate' delivery of self-funded medicines, and more flexible cost-effectiveness thresholds for end of life medicines may have repercussions for other patients. While undoubtedly part of the trend towards explicit rationing, top-up fees might also represent a significant step towards regarding the NHS as a core, basic service. Finally, the issue of top-up fees is located within the broader context of current cancer research priorities and persisting health inequalities.
GPs are considering whether to abandon their involvement in a scheme to put medical records on a computer database. BBC News understands that talks are continuing to try to make it easier for patients to opt out of the system. Thirty million people in England have already been formally contacted about the computer record. Health ministers from the coalition government insist the rollout will continue.
Although the number of patients seeking treatment elsewhere in the European Union is small,3 this could easily change, especially if people are faced with growing waiting lists or other forms of rationing as the new groups seek to control their budgets. British residents have had the right to obtain treatment in another EU country since 1971.4 Initially, the opportunities were limited mainly to people who fell ill when abroad or, less often, when the NHS agreed that there were good reasons for patients being treated abroad (for example, a citizen of another country resident here returning home to give birth
Patients in England will be able to inspect and correct their NHS and social care records online from 2015 if the coalition government’s vision for the use of IT in the NHS becomes reality.
National efforts to improve care at the end of life should be speeded up to maintain the progress made in some parts of England, it has been claimed. The health policy think tank the King’s Fund has warned against a loss of momentum on England’s end of life care programme in a new report published this week and has questioned the government’s intention to leave a review of this area until 2013. Around 500 000 people die each year in England. More than half (55%) of deaths occur in hospital and only 20% at home. The government has said that several surveys have shown that most people’s preference is to die at home.
The medicines watchdog, NICE, is to lose its power to turn down new medicines for use on the NHS. It will give advice on which drugs are effective, but will not decide whether patients should be given treatments their doctor recommends, the Department of Health has confirmed. Instead, groups of GPs will decide whether a drug should be funded or not. Ministers hope to make new drugs affordable to the NHS by negotiating with pharmaceutical companies on price. The plans, called value-based pricing, are set to come into effect in 2014. They are subject to consultation.
All new IVF treatment will stop in Surrey as the NHS tackles a deficit this year of £125m. The board of NHS Surrey met in Cobham on Friday to look at how to tackle "serious financial challenges". A spokesman said current courses of IVF would continue and women nearing 40 would still be considered, with IVF policy to be reviewed next November. NHS Surrey is also no longer funding some treatments including acupuncture and some cosmetic procedures. Treatments which would no longer be funded included male baldness, facial blushing, tattoo removal and spinal epidural injections for chronic back pain.
The National Institute for Health and Clinical Excellence (NICE) has confirmed there will not be NHS funding in England and Wales for the anti-cancer drug Avastin. It is used to combat advanced bowel cancer and research shows the drug can give an extra six weeks of life. About 6,500 people per year may be eligible for the drug. But the health watchdog argued that at a cost of nearly £21,000 per patient, the drug is just too expensive.
In the recent White Paper, Equity and Excellence: Liberating the NHS, there is a commitment to providing better value from the resources available to healthcare. This requires the NHS to address variations in activity and spend. Such variations indicate the need to focus on appropriateness of care, and to investigate the possibilities that there is overuse of some interventions and that some lower value activities are undertaken. In the Atlas, Right Care presents a series 34 of maps of variation selected from topics which National Clinical Directors and others have identified as being of importance to their clinical specialty. We have worked with a wide range of teams in the Department of Health, Observatory network and primary care organisations to create this Atlas.The Atlas also contains a guide to the tools and data available for analysing health investment.
Hospitals in north Merseyside are planning to use the anti-trespass powers used to ban “hoodies” from shopping centres to shift patients who are blocking beds. NHS Sefton board papers say that from this month patients deemed fit for discharge but who refuse “transitional” care home placements will be given 48 hours’ written notice to make their own arrangements. If a patient still refuses to leave, the hospital could seek a court order for possession of their bed. A well-placed legal source told HSJ the primary care trust’s approach would rely on trespass law, which allows owners to regulate the terms on which visitors occupy their premises.
An investigation is under way into how two transplant patients were given kidneys from a donor with a rare and aggressive form of cancer. The incident at the Royal Liverpool University hospital involved organs from a woman who died at another hospital, and was later found to have had a hard-to-identify disease called intravascular B-cell lymphoma. Both patients had been preparing for live transplants from their sisters but accepted the donor kidneys instead. The recipients are now receiving chemotherapy treatment. Although cancer transmission is a known risk of transplantation among clinicians, the case raises questions about guidance to patients and whether sufficient checks are made. One senior of
NHS Blood and Transplant associate medical director Professor James Neuberger said transfer of malignancy was a very rare occurance but more organs were likely to carry diseases as donors get older. He admitted the scale of the problem was not known. A research fellow has now been appointed to find out how often infected organs are passed on to patients. Professor Neuberger said his first role was to try and get all the data together from transplant centres and then to work out strategies with clinicians to reduce risk.
A cancer patient who was supposed to receive regular check ups says he was devastated when he was finally seen and told the disease had spread. Retired teacher Henry Clark from Narberth, Pembrokeshire, needed three-monthly check ups at West Wales General Hospital, Carmarthen. But "serious failures" meant he was not seen for more than a year. Hywel Dda Health Board has been criticised for what happened and has apologised.
'A new pathway for the regulation and governance of health research' was published in January 2011. The report was prepared by a working group, chaired by Professor Sir Michael Rawlins FMedSci, convened in response to an invitation from Government to review the regulation and governance of UK health research involving human participants, their tissue or their data. The report proposes four key principles that should underpin the regulation and governance framework around health research in the UK, and makes recommendations to: * Create a new Health Research Agency (HRA) to rationalise the regulation and governance of all health research. * Include within the HRA a new National Research Governance Service to facilitate timely approval of research studies by NHS Trusts. * Improve the UK environment for clinical trials. * Provide access to patient data that protects individual interests and allows approved research to proceed effectively. * Embed a culture that value
Frances Swaine and Merry Varney are instructed by David Tracey, whose wife, Janet Tracey, sadly died in Addenbrooke’s Hospital on 7 March 2011. Following her admission to Addenbrooke’s, a ‘Do Not Attempt Cardio Pulmonary Resuscitation Order’ (known as a DNACPR or DNR) was placed on Janet’s medical notes. Janet was unaware of the DNACPR and when she became aware of it several days later, she clearly stated it was against her wishes and that she wanted to be resuscitated. As a result the DNACPR was cancelled. Several days later however a further DNACPR was entered onto her records. We have issued a judicial review and human rights claim against the NHS Trust responsible for Addenbrooke’s and against the Secretary of State for Health seeking Declarations from the Court that the Trust’s policy on the use of DNACPR is unlawful, and for the Secretary of State for Health to issue national guidance for patients and their families to know their rights concerning the use of DNACPRs.
Tom Condliff, who weighs 22st, was not considered fat enough to have a gastric bypass operation by his local Primary Care Trust and both the High Court and the Appeal Court ruled that its decision was lawful. But less than a month after his latest setback, the 62 year-old from Staffordshire has been told that his latest “individual funding request” has been successful on the grounds of his exceptional circumstances and he will now be treated. He told the BBC: “I am very, very pleased about the PCT's decision but at the same time I am rather concerned that I haven't changed since the last time the request for IFR in September last year, was put in. “It was turned down then. So I don't know why it has been granted this time. “I am looking forward to being able to get out of the house and to enjoying myself and having a decent quality of life.”
A woman died after an experienced surgeon unintentionally attempted to take out the wrong organ during an operating theatre complication. Amy Joyce Francis, 77, was due to have a kidney removed at the Royal Gwent Hospital in July 2010 but instead the surgeon tried to remove her liver. The woman from Newport suffered a fatal heart attack after a loss of blood. The coroner recorded a narrative verdict which was fully accepted by the Aneurin Bevan Health Board.
Satisfaction with NHS is high but it may be bad news Satisfaction with the NHS has been rising steadily for the past decade and is at an all-time high – but that could spell bad news for patients. The more satisfied patients are with their medical care, the more likely they are to die, US researchers have found.
GPs have been paid for thousands of patients on their lists who have moved practice, died or been forced to leave the country, according to a report by the Audit Commission.
The paper discusses the issue of family involvement in the process of obtaining consent to treatment. Legally, doctors have a duty to inform the patient, and the patient has a right to be informed before making a decision. In this context, however, there is no requirement to involve relatives or to take into account their interests or requests. Yet, findings from in-depth interviews with NHS general practitioners presented in the paper indicate that in reality relatives have a substantial impact on the process of informed consent. Their presence may lead the doctor to provide more information to the patient and help the patient better understand the information conveyed by the doctor. Ultimately, the relatives' involvement enhances the patient's ability to make an informed decision, even though in some cases – when the relative is dominant – this may have a negative impact on the channel of communication between doctor and patient. These findings reflect a relational approach to patien
Doctors' leaders warn situation could diminish patient trust and lead to more NHS services being run by private operators. GPs preparing to take charge of £60bn of NHS funds have been found to have shareholdings in private healthcare firms, prompting alarm about family doctors profiting from direct conflicts of interest.
Survey finds 54% of doctors think the NHS should have the right to withhold non-emergency treatment A majority of doctors support measures to deny treatment to smokers and the obese, according to a survey that has sparked a row over the NHS's growing use of "lifestyle rationing".
When CQC board member Kay Sheldon spoke out against the health watchdog, it immediately began a concerted campaign to discredit her, she tells Nina Lakhani
One in three GPs in clinical commissioning groups are linked to private firms, study finds One in three GPs who are running new organisations that are about to be given £65bn of the NHS's budget also help run or hold shares in a private healthcare firm, a study shows. The disclosure has sparked concern that such widespread conflicts of interest will threaten patients' trust in GPs, who they may see as lining their own pockets out of public funds.
Robert Francis, the inquiry chairman, said that one of his top priorities was for the NHS constitution to be rewritten, making it explicit that “patients are put first” and “everything done by the NHS should be informed by this ethos”. He recommended that the Health Secretary also consider stipulating that NHS staff “put patients before themselves”.
This article examines the Health and Social Care Act 2012 and associated reforms to the National Health Service in England. It focuses on the Act's policy of making the NHS market more ‘real’, by both encouraging and compelling NHS bodies to act as ‘market players’. The article considers whether the reforms are compatible with the constitutional requirements of accountability for the provision of a public service such as the NHS. It argues that the reforms threaten accountability for three reasons: they make the Secretary of State for Health's relationship with the NHS more complex, they create opaque networks of non-statutory bodies which may influence NHS decision-making, and (especially in relation to competition) they ‘juridify’ policy choices as matters of law. Taken together, these arguments suggest that there is force in the claim that the reforms will contribute to ‘creeping’ – and thus unaccountable – privatisation of the NHS.