Off target (again)

Patients are frequently bundled out of NHS hospitals' emergency units before their medical condition has been properly assessed, the Royal College of Nursing heard yesterday at its annual conference.

Peter Carter, the RCN's general secretary, said a poll of more than 500 frontline nurses in accident and emergency departments showed 93% felt under undue pressure from a government target to discharge or admit patients within four hours.

Three-quarters of those polled said patients were regularly admitted to inappropriate wards to meet the target. Carter told the conference in Bournemouth that women needing careful observation after an accident were wheeled off into gynaecological wards and men needing emergency surgery were transferred under sedation into orthopaedic wards.

Although nurses in these other departments did their best to care for patients until the correct facilities became available, they lacked specialist expertise.

The poll found 78% of A&E nurses believed the target led to some patients with multiple and complex needs having their care "rushed and compromised".

Sixty years of the NHS

It's amazing isn't it: in sixty years the Labour party created the NHS as a unique ocial experiment and then destroyed it.

The pity is that building a service takes a long time; wrecking it can be done rather quickly, as Hewitt, Gordon Brown and Darzi have just proved.

What would Sir Alan Sugar have said?

Last week this web site revealed the catastrophic news that Bedfordshire PCT were trying to withhold £4million that it owed to Bedford Hospital; this is a sum of money which will make a major impact on the hospital's financial situation.

The story had been an open secret for some time, but had only been made "official" by the medical director Ed Neale's e-mail to consultant staff. Not long afterwards, the Chief Executive released the matter to all staff in her weekly newsletter (although she gave the figure as £3.9 million).

Thanks to the action of the Save Bedford Hospital party the story was picked up by Bedfordshire on Sunday. The PCT, embarrassed by some searching questions immediately reduced the disputed amount to £2million.

So thanks to the Save Bedford Hospital party the hospital found itself £2million better off.

But how did they react? I suspect that if Sir Alan Sugar had found that one of his apprentices had saved £2million he would have expressed his gratitude. That doesn't seem to be Bedford Hospital's way : on Monday morning the Save Bedford Hospital party's prospective parlaimentary candidate Dr Barry Monk received a letter from Mr Neale threatening him with disciplinary action.

One can only speculate what Sir Alan Sugar might have said to Mr Neale : "You're fired" perhaps.

Make your mind up time

Labour MPs, such as our own Patrick Hall, face a challenging dilemma.

Do they do the right thing by the very poorest in society and vote against the abolition of the 10% tax rate, and thereby imperil their own jobs, or do cynically support Gordon Brown, and penalize the most disadvantaged in the land.

We shall watch Patrick with interest.

Poverty and health

The connection between poverty and ill-health is self-evident. The poor suffer more from chronic disease, and die younger.

So it seems extraordinary that a Labour government lead by Gordon Brown have decided to increase the taxes paid by the poorest, by abolishing the 10% starting rate of income tax; and they always pretend to have the interests of the weakest in society at heart.

Bombshell

Mr Ed Neale, medical director of Bedford Hospital NHS Trust, today made a bombshell announcement by e-mail to consultant staff at the hospital. He advised that the Bedfordshire PCT are currently refusing to pay for £4million of work done for their patients by the hospital over the past year.

Dr Barry Monk, the Save Bedford Hospital party prospective candidate for the Bedford parliamentary constituency said "This has the potential to be a financial catastrophe for the Trust, and could not have come at a worse time. The recent independent staff attitude survey has shown how poor staff morale already is. The underlying problem is that year after year clinical staff - doctors and nurses - have not been sufficiently involved in drawing up the Service Level Agreement between the hospital and the PCT; this has caused difficulties year after year."

Things can only get better

Dr Barry Monk has written this piece about his recent experiences:

Politicians keep telling us how wonderful the reforms to the NHS have been, but how do they affect real patients.

Let me tell you three illustrative tales, all from the same recent outpatient clinic, and then you can judge for yourself.

Firstly, a small child with eczema, brought along by a distraught mum. It certainly wasn’t the worst case of eczema that I’ve ever seen; it should have been entirely manageable within primary care, but Mum had found it impossible to get an appointment with any individual GP more than once, so she ended up having seen five different doctors in five weeks, and had become totally confused by the conflicting advice. Yes, you can be seen at the GPs without undue delay, but you can’t get an appointment with the doctor of your choice.

Then I saw a lady with an infected sebaceous cyst on the neck, referred as an emergency. In fact she had been referred six months earlier, but sebaceous cyst is a PCT exclusion, so the referral had been “rejected” (not by me, I never even got to see the referral letter). So, months later, she is referred up urgently when the cyst had become infected and the patient was in severe pain. By this stage, treatment would inevitably be more complicated and expensive, and the whole scenario was totally avoidable.

Finally, a somewhat more complicated story, but one with potentially catastrophic consequences. A lady is referred to me with a story of an unusual lesion on the leg; she tells me that she is also attending a rheumatologist at a hospital 50 miles away because that is the nearest option that came up on Choose and Book (we have an excellent rheumatologist, but if her waiting list reaches five weeks, her name disappears from the C and B menu); the rheumatologist has diagnosed a non-specific arthritis. She has also been sent to a hand surgeon, at a third hospital twenty miles in a different direction who has diagnosed “tight tendons” in her hand, but who was unaware of the skin or rheumatology referrals. On examination of her skin it is apparent that she has a rare, and potentially very serious skin disorder, scleroderma, which accounts also for the tight tendons and the joint symptoms. Yet having made the diagnosis I have no access to the investigations that have been done elsewhere. What she actually needs is to be seen jointly by a dermatologist and a rheumatologist, but our PCT rules prevent me from referring her to my colleague who consults just 10 metres away.

Patients may indeed be being seen quicker, but I leave to you to judge whether they are being offered a better quality of care.

A culture of bullying

The Healthcare Commission has just published its independent review of the annual staff attitudes survey in the NHS.

At Bedford Hospital, based on a 58% return of questionnaires (which were sent to all staff) 17% said that in the previous year they had been abused, harrassed or bullied by a manager or other member of staff. However, apparently Bedford Hospital rated as "average" within the NHS on this criterion.

So there you are, there is an endemic culture of abuse, harassment and bullying within the NHS. What a way to run a public service.

Hurting the poor

This article is, amazingly, from Socialist Worker:

Gordon Brown has declared war on many of his own voters by abolishing the 10p starting rate of tax.
While some of the poorest workers in Britain are now forced to pay hundreds of pounds more in tax, in the London boardrooms of the world's richest companies there was joy as corporation tax was slashed.
This is Labour's third cut to the tax on profits since 1997. Under Margaret Thatcher's Tory government, corporation tax was 52 percent. This week Brown reduced it from 30 percent to 28 percent – the lowest of the G7 leading industrialised countries.
New Labour's double standards make a mockery of its claim to be "lifting people out of poverty" and has sent a wave of anger among Labour supporters, even those who think of themselves as loyal to the party.
Millions of Labour voters rightly believe that the tax system should be used to help the poorest by redistributing wealth from the rich to the poor.
They think that those at the bottom end of the income scale should be paying a lower rate of tax, while those at the top should be paying the highest. This week's changes reveal that Brown's government is determined to do the opposite.
The abolition of the starting rate will hit young workers without families particularly hard. Those earning less than £18,500 a year stand to lose up to £232 a year – a lot of money when you are scrimping to put food on the table while paying the rent.
But it is not just the young and single who will be out of pocket. Around 1.2 million double income couples with no children and 700,000 double income couples with children will also be paying more. As will 300,000 women aged between 60 and 64.
Brown's startled response to the political furore over tax has been to claim that his regime of tax credits and child tax credits will make up for the shortfall. But he knows this is a lie.
Lack of information and a cumbersome application process means that only 40 percent of those entitled to tax credits claim them – dropping to just a quarter of single people on low incomes. Those under 25 without children are not even eligible.
Those who do manage to obtain tax credits often find that they become caught in a trap where any extra money they earn can be wiped out by taxes.
The Treasury's own figures show that 1.9 million people – including about half of all pensioners – whose income exceeds £6,500 a year are allowed to keep just less than 40p of every extra £1 they earn.
When the total of all deductions, including national insurance, are taken into account those people are paying rates of tax on extra earnings of between 60 and 90 percent.
This week's tax changes will mean a million more people are caught in this trap. The number affected is equivalent to more than the population of Birmingham and Manchester combined.
However Gordon Brown's world is full of stark contrasts. Multi-millionaire Labour donor Lord Sainsbury showed how New Labour is working for the rich. Last week he transferred most of his 8 percent stake in the Sainsbury's supermarket to a company he controls, in the process avoiding a £27 million tax bill.

How to waste money

MORE than eight out of 10 operations which NHS bosses paid a private health company to carry out never happened.

Tameside health bosses paid the Greater Manchester Surgical Centre to carry out 777 operations last year but sent only 101 patients to the unit.

New figures, obtained under the Freedom of Information Act, show health bosses across Greater Manchester have forked out around £10m to South African company Netcare for operations which haven't been carried out since it opened in May 2005.

Three years ago regional health bosses signed a five-year £70m deal with the company on behalf of the 10 local trusts.

But as waiting times have fallen at the region's hospitals fewer people have opted to go to the Trafford private unit - in 2007 less than two thirds of the operations paid for were actually carried out.