Sepsis, and spotting serious illness

The NHS England report into the tragic death of one-year-old William Mead from sepsis shows how disjointed and dangerous the NHS frontline can be. Sepsis is a hard enough diagnosis to make in ideal conditions but UK general practice is now so threadbare and splintered that continuity of care has been lost and patients are seen and assessed in disparate ten minute blocks without anyone having time to join up the evidence. The pressure on GPs not to prescribe antibiotics and not to refer patients to busy emergency departments doesn’t help, and research by the Commonwealth Fund recently found that UK GPs are the most stressed in the western world. Under such circumstances, difficult diagnoses are more likely to be missed.

The failure of NHS 111 call-handlers is equally understandable when people with no medical training and limited experience are using simplistic and imperfect algorithms (Eyes passim). Even if William had made it to hospital there is no guarantee his sepsis would have been quickly picked up. The excellent Sepsis Trust highlights the 44,000 deaths that occur each year in the UK including a thousand children, when the body mounts an extreme reaction to infection

[…..] Read More

What next for junior doctors?

The first junior doctors’ strike in 40 years could be the making or the breaking of the NHS. The optimistic view is that the bravery of junior doctors in speaking up in such numbers will inspire all frontline staff to find their voice, expose the spin, tell the truth and get involved in improving the NHS. The NHS is unusual in that it has so few clinicians in senior management, and yet the best hospitals globally tend to be run by clinicians. The less optimistic view is that doctors are being de-professionalised to line them up as employees in a more corporatised NHS, and that the breakdown in trust between this government and the frontline is irreversible. Applications to medical school dropped by 11% in 2015, and also fell in the two years prior. 52% of junior doctors who finish foundation years currently take a break from NHS training and some will never return. If too many ditch the NHS, its future will indeed be bleak.

Many doctors have lost all trust in health secretary Jeremy Hunt to present data accurately and fairly (Eyes passim), and they simply don’t believe that more NHS services

[…..] Read More

Healthy Mind, Healthy Body

Why is the physical health of those with mental illness so poor? A study published by the Nuffield Trust and Health Foundation in October found that those with mental ill health have almost five times more emergency hospital admissions compared to those without. And yet the vast majority of these emergency admissions were for physical health problems.

Despite the government’s promise of ‘parity of esteem’ for mental and physical illnesses, those with mental illness have much higher rates of physical illness and struggle to get adequate help for both their mental and physical health problems. Hence, far too many mentally ill patients end up in emergency departments and prison cells. And there are clear links between austerity and the increased number of male suicides since 2008.

Research by the King’s Fund published in November found that 40 per cent of mental health trusts had their income cut in 2013/14 and 2014/15, despite rising demand. To reduce costs, many trusts are trying to shift patients away from acute services to ‘recovery-based care and self-management programs’ that sound good on paper but don’t always have a solid evidence-base, don’t have the resources to

[…..] Read More

Social Scare

The unseemly collapse of Cambridgeshire and Peterborough’s older people’s services contract is another smoke alarm for the NHS and social care – and highlights the folly of putting highly complex care out to tender. The £800 million contract over five years sounds a lot until you realise it’s supposed to transform care for frail, vulnerable older people often with multiple diagnoses across England’s largest clinical commissioning group. The plan was to join up services and keep the neediest patients well and out of hospital (particularly emergency departments) – and to discharge those patients who neither need nor want to be in hospital more quickly.

Cambridgeshire and Peterborough CCG spent over a year and £1 million on ‘the tendering process’ with the help of assorted management consultants and NHS England’s Strategic Projects Team (SPT). Part of the payment for the contract was to be dependent on successful outcomes (such as keeping patients out of hospital). Several private companies looked at the deal and pulled out, and the tender was awarded to the NHS, or rather ‘UnitingCare’, a limited liability partnership established by Cambridgeshire and Peterborough Foundation Trust, and Cambridge University Hospitals FT. It began running services in April 2015

[…..] Read More

What is a ‘truly 7 day NHS?’

Jeremy Hunt’s belated U turn on ACAS mediation with the BMA over the junior doctors’ contract postponed strike action but came too late to prevent the cancellation of 600 operations and 3,500 outpatient appointments. This could have been avoided had Hunt taken up the offer of ACAS talks on November 19, rather than a week later. Hunt may have been teasing George Osborne, using the threat of a strike to force a better than expected deal for the NHS from the spending review. Or he may simply have blinked first when he realised junior doctors were serious about strike action.

Osborne was also pressured by NHS chief executive Simon Stevens who publically asked for £4 billion of the £8 billion promised by 2020 to be ‘front-loaded’ next year, and then secured himself a slot on ‘Any Questions’ on Friday in case it wasn’t. Osborne had the last laugh by claiming to give £3.8 billion next year and making lots of absurd claims about how many more doctors, nurses and operations it would buy. In fact, £1.5 billion has been stolen from existing Department of Health budgets, cutting the budget for public health

[…..] Read More