Passport checks for patients is an abandonment of NHS principles | Zoe Stewart

Rather than use World Health Day to draw attention to global health priorities, this year, healthcare providers are being asked to implement racist government policies and compromise our professional values. Earlier this year, health minister Jeremy Hunt announced that, from April 2017, NHS trusts would be legally obliged to check patients’ eligibility for NHS services upfront, and to demand payment before providing care.

These checks lead to racial profiling and will prevent those most in need of care from getting the treatment they need. This is already evident with pregnant women delaying or avoiding seeking necessary medical advice or treatment because of fears they will be unable to pay or will be reported to the Home Office.

As doctors, we are acutely aware of the devastating impacts of delayed medical attention. In my field – obstetrics and gynaecology – we know that getting the right care at the right time is critically important for the health of women and their babies. In 2014, a woman thought to be carrying a dead foetus declined induction of labour because she feared she would be denied re-entry into the UK if she was unable to pay her bill of thousands of pounds.

The amount of money [lost to "health tourism"] is a drop in the ocean for the NHS

Dena Bryant, a lifelong resident of Grantham, had her eligibility for care at her local hospital questioned by a nurse who justified her questioning because Bryant was “not white” and did not “look English”.

The reality is that these policies represent yet another instance of the government attempting to blame migrants for the devastating impact of their austerity agenda. The Department of Health’s own estimate is that “deliberate health tourism” costs at most 0.3% of the NHS budget annually. This amount of money is a drop in the ocean for the NHS, while a £5,000 charge may be everything to a patient seeking treatment.

We should be concerned about the sustainability of NHS funding, but this focus is a distraction from the real issues, such as the billions of pounds spent annually on PFI repayments. Checking passports at the point of care will not rectify budget concerns, and directly contradicts the values on which the NHS was founded. We are being asked to prioritise recouping costs over providing care to those who need it.

Docs not Cops, a group comprised of NHS staff and patients, has been campaigning against these changes. On Wednesday, the group blocked the entrance to the Department of Health with a makeshift immigration checkpoint. We believe everyone has a right to access the healthcare they need, regardless of their immigration status or ability to pay. NHS workers should not be forced to police the people we treat.

The relationship between the doctor or health professional and a patient relies on respect and trust. A policy that demands we verify eligibility and report ineligible patients prioritises money over care, and jeopardises the relationship between a patient and their care provider. As a doctor, the Declaration of Geneva and the International Code of Medical Ethics require that my patient is my first consideration, and declares that I owe my patients complete loyalty. Policing people seeking my care would directly contravene these guidelines that say we cannot allow race, ethnic origin, or social standing, among other characteristics, to intervene between our duty and our patient.

As NHS staff and patients we will continue to fight divisive policies that fuel racism and threaten the values on which our NHS was built. Docs Not Cops is working with groups around the country to build a network of sanctuary GP surgeries, hospitals and wards. These would be sites of non-compliance with ID checks. We encourage wards, GP surgeries and individuals to sign a pledge to never ask to see ID or deny anyone healthcare, and to sign our petition calling for an end to bedside charging.

The National Health Service was built on the principle that healthcare is a right not a privilege. Almost 70 years after its inception, we are here to demand that this core principle remains.

Passport checks for patients is an abandonment of NHS principles | Zoe Stewart

One in four UK babies miss out on health visitor checks

One in four babies born in the UK are not receiving mandatory checkups from health visitors during the first two years of their life.

A fifth of babies do not receive the recommended reviews after they turn one, and one in four miss out at the age of two, according to the government’s commission on social mobility.

Health visitors, responsible for assessing a child’s early years development, are supposed to carry out checks straight after birth, at six to eight weeks, at one year and then at between two and two-and-a-half years.

However, the commission found that one in five children had not received the mandatory 12-month check by the time they reached 15 months old.

London children were the least likely to receive the right number of health visits, the report found, with fewer than half receiving the final two checkups.

A survey of parents found that the vast majority wanted the health visits to continue, with just 5% saying they did not feel they required advice during their first six months as a parent.

“Despite the conventional wisdom that parents fear interference from the ‘nanny state’, in reality many say that they welcome advice in the early years of their child’s life,” the commission said.

It said it was concerning that one in four two-year-olds did not have their health and education needs reviewed by a professional. “Despite this being a crucial period for families, there is still too little support for parents in the earliest stage of their child’s life. With the socioeconomic gap in outcomes emerging early, providing support to parents at this point could reap dividends for social mobility later on in life.”

The Conservative party’s 2010 manifesto included a key pledge to increase the number of health visitors. NHS Digital figures show the number of full-time or equivalent health visitors in England fell by almost 1,000 between October 2015 and August 2016.

In December a survey of health visitors by the Institute of Health Visiting found that 85% of respondents felt their workload had increased in the last two years. Some were having to look after between 500 and 1,000 children, when the maximum recommended is 250.

Labour said the commission’s figures showed the government was failing to invest in early years support. Emma Lewell-Buck, the shadow minister for children and families, said: “Becoming a parent for the first time is an exciting but scary time and it is shocking that not all parents are getting the support they need.

“The Tories promised more health visitors by taking away money from Sure Start Centres. Six years later we have lost over 700 centres and we are still waiting for the health visitors. The Tories have completely failed to invest these crucial early years.”

A spokesperson for Public Health England said: “Ensuring every child has the best start in life is one of our key priorities. We are supporting local authorities in commissioning services that support families and provide early help when needed.

“We are also working with councils to give health visitors professional guidance and leadership, as well as evidence of what works, to help them meet their public health responsibilities.”

The commission also said parents were finding it more difficult to access local children’s centre services, citing a 2015 survey which found more than 60% of children’s centre managers said they were cutting back on services to meet their budgets.

Government figures in December revealed that 156 Sure Start children’s centres had closed in England in 2015, almost double the number in the previous year.

One in four UK babies miss out on health visitor checks

GPs not carrying out basic checks on children with fever, study shows

GPs are failing to carry out basic checks on children with fever that could flag up life-threatening illnesses, research suggests.

A study found that most under-fives with a high temperature were not checked properly for signs that could indicate sepsis, meningitis or pneumonia.

The National Institute for Health and Care Excellence (Nice) published guidelines in 2007 and again in 2013 urging GPs to carry out four simple tests. But evidence suggests they are still not being done and charities say lives are being needlessly lost as a result.

The Nice guidance says GPs must measure and record temperature, heart rate, respiratory rate and capillary refill time as part of the routine assessment of a child with fever.

Capillary refill is when doctors press on a patient’s nail bed and then count the seconds until it returns to its usual colour – normally under two seconds.

In the study, Dr Alice Lee, from Pennine Acute Hospitals NHS Trust, looked at data for 47 under-fives in a Stockport GP practice. She found just 13% of consultations included all four checks, with about one in three children receiving no tests at all or only one.

Despite the fact abnormal respiratory rate was often the first sign of serious illness, Lee said it was the lowest-recorded test, with only 30% of children being checked.

Almost half of youngsters also missed out on having their pulse taken, while a quarter did not have their temperature recorded.

But when GPs were given crib sheets as reminders, there was a marked improvement in performance, with the number of children receiving all four tests almost doubling.

Lee said most children with a high temperature had a self-limiting viral illness, which would fully resolve without any harm to the child. “However, differentiating these children from the ones who then go on to develop the serious infections, the serious illnesses, can be incredibly tricky,” she said.

“Despite everything that we are doing, sepsis still continues to be an issue, and infection is the leading cause of death for children under the age of five. There has been a really big push recently to recognise sepsis and serious infection as a medical emergency.”

Dr Ron Daniels, chief executive of the Sepsis Trust, said the failure of doctors to carry out all four checks had been implicated in several deaths, including those of three-year-old Sam Morrish from Devon and 12-month-old William Mead from Cornwall.

He said: “We are aware this is a problem and we are seeing this not only with children but with adults too. Basic observations are not being done routinely and, where observations are being done, they are not being done as a complete set. In the majority of cases, GPs will be able to make the right decision but it’s clear we are still missing some cases.”

A Health Service ombudsman’s report into the death of Sam Morrish was highly critical of the way GPs had failed to follow the Nice guidance and had not checked his breathing or heart rate.

Melissa Mead, William’s mother, said: “Two of the four basic observations were not carried out during the last consultation with the doctor before William died. Had these been done, the pneumonia and sepsis that William was suffering with would have been detected and he would have received life-saving treatment.

“I am disappointed to hear that the basics are still being ignored. Until those in frontline primary care observe the basics, life-threatening conditions will be missed and people will continue to die in preventable circumstances.”

Scott Morrish, Sam’s father, said: “Six years on from Sam’s death, it’s disappointing that these basic checks are being ignored.” He said there was a need to raise awareness among parents of the four checks alongside symptoms to look out for.

Mellor said since her 2013 report into sepsis, the government and NHS have taken steps to improve diagnosis and treatment, including new guidance from Nice and a commitment to improving awareness of the condition.

“This will be vital in order to save lives. Too many people are still dying unnecessarily from sepsis,” she said.

GPs not carrying out basic checks on children with fever, study shows

FGM professional calls for gynaecological checks for all ladies in Sweden

A female genital mutilation professional who found that all the women in a group of 30 newly arrived immigrants to Sweden had been lower has called for compulsory gynaecological checks for all young children in the country.

Anissa Mohammed Hassan, the Somali girl who co-led a pilot FGM session with the young girls in the heavily immigrant district of Norrköping, referred to as for the introduction of genital examinations for all ladies in Sweden aged six, just as all boys have their testicles checked.

“The issue we have in Sweden is that there are no checks,” she stated. “Going to your regional doctor’s surgical procedure is optional and visiting a school nurse is also optional.”

The pilot in Norrköping, which grabbed headlines when it was wrongly reported that an whole college class of girls had been subjected to FGM, 28 in the most severe style, has trialled a new hardline policy in which college nurses are trained to routinely question young women about whether or not they have been circumcised every time they come in for treatment method or a checkup, bypassing their mother and father.

Hassan called for the policy to be rolled out across Sweden. “We want all communities in Sweden to do what Norrköping does, with all college nurses routinely asking ladies if they have been mutilated.”

“If they have been reduce, we then straight send them to social services, the place we ask them when they had been operated on, and regardless of whether they have smaller sized sisters.”

She mentioned the ladies in the group briefed in April had been shocked that their wellness difficulties could be treated.

“They believed that their difficulties – how they can not pee, how they are in pain – have been shared by all the ladies in the entire planet. But when I explained that in Sweden you can get aid for this, many ladies came to the college medical doctor, saying ‘please can you support me’, and one following one more they asked for assist themselves, and that was great.”

But the method in which the unique story was portrayed has brought on tension in Sweden. When Norrköpings Tidningar reported that each and every single lady in a college class of thirty had turned out to be circumcised – with 28 of them obtaining their clitorises and labia reduce away and their vaginas sewn virtually shut – it was picked up by the media across the world, which includes by United kingdom broadsheets.

Petra Blom Andersson, the nearby training department overall health official who gave the numbers to Norrköpings Tidningar, would not be interviewed, even though Juno Blom, head of the nearby region’s FGM programme, refused to comment on exactly where the number came from.

“I will not want to talk about that for a whole lot of various causes,” she explained. “Does it matter for the girls who are abused if they are in the identical class or not?”

In truth the women, aged 13-18, were part of a group of newly arrived immigrants from FGM high-danger nations brought with each other for an educational session as part of a new pilot task being launched in Norrköping. They had all been circumcised in their home nations.

Sara Johnsdotter, an anthropologist at Malmö University specialising in female genital mutilation, stated the headline grabbing figure was not surprising. “I have worked in this field for the previous 15 years and every few many years there is a new drive from the government to finish it, and there is an accompanying report in a newspaper to give it much more attention,” she explained.

“Personally, I believe it is harmful. It is harmful to the women and women impacted. It is the wrong kind of focus and it’s stigmatising them even more.”

She sees the way the Swedish media reported the story as symptomatic of “a disappointment about immigration in a multicultural society”.

“We have to be so tolerant all the time,” she mentioned. “But [when it comes to FGM] you can say what you want and even now be morally superior.”

At the Somali cultural centre in Hageby, a heavily immigrant district of Norrköping, a single Somali female took offence at how the story had been told.

“It truly is not accurate that girls cannot pee,” said Nora Dore, whose son Abdinasir runs the centre. “The total time you are speaking about the clitoris getting thrown away. Why are you carrying out it? You are speaking about cutting, cutting, cutting, the entire time. It really is a Muslim woman’s dilemma, it is not your problem.”

She stated all Somalis residing in Sweden now understood that FGM was a adverse practice. “In Somalia, right here, all over the place they are stopping it. The Qur’an says ‘don’t do it’. The entire time on the Somali channels nowadays they say you have to cease it.”

She stated she herself was circumcised and had ensured that her now 25-year-outdated daughter was before they moved to Sweden in 1994.

“We utilised to believe that it was better, and the youngsters, they needed to do it,” she mentioned. “We considered that people who are not minimize would chase after males ahead of they had been married, and that they would have a baby with no a father.”

Other ladies at the centre supported the county government’s selection to introduce automatic queries about FGM for ladies from practising countries. “That’s extremely crucial,” said Amina Mire, 41, whose eight-year-old and sixteen-year-previous daughters are not circumcised. “As prolonged as there are people who are ignorant, you can only find out it in the course of a overall health verify.”

But even if it is suspected that women are minimize while resident in Sweden, both although going to their country of birth or in their adopted nation, it it challenging to prosecute, Anna Nedvik, a detective in the local police, explained. She has worked with Andersson to prosecute the mother and father of a single neighborhood schoolgirl, but the case by no means manufactured it to court.

“We couldn’t demonstrate that it [the circumcision] had took place even though there was a connection with Sweden,” she mentioned. “If you’ve accomplished it whilst you are in an additional nation, there should be some sort of connection with Sweden when it was carried out.”

Sweden was the first nation in the globe to ban FGM in 1982, and in 1999 the ban was extended to contain circumcision carried out in other nations. But police have struggled to apply the law, securing only two convictions in a lot more then 30 many years.

But, as the pilot demonstrates, the days when health, police and social companies might have been reluctant to tackle FGM since of cultural sensitivities are over, explained Johnsdotter. “That is not the situation in Sweden, people in truth say the opposite that it is racist not to protect African youngsters from abuse, or feel they do not merit the very same protection.”

FGM professional calls for gynaecological checks for all ladies in Sweden

Diabetes charity concerns warning in excess of well being checks

Diabetes View unveiled less than half of patients in 27 places of England get all of the checks. Photograph: Hugo Philpott/PA

A charity has expressed concern that numerous diabetes individuals are not currently being provided vital well being checks made to avoid critical issues.

The proportion of sufferers in every region who acquire all eight recommended annual overall health checks varies wildly across the country, Diabetes Uk explained.

In some spots less than a single in 5 folks with the issue get all eight checks advised by the Nationwide Institute for Wellness and Care Excellence in contrast with 78% in other places.

These assessments can avoid patients from building “devastating” complications of diabetes such as amputation and blindness, a spokesman said.

The charity’s instrument, Diabetes Watch, which permits patients to evaluate care in their location with surrounding spots, exhibits that significantly less than half of patients in 27 places of England acquire all of the checks.

At the other end of the scale there are 25 areas where 70% of sufferers acquire all eight checks.

In mid Essex, just 18.5% of individuals obtain all eight checks, the charity said.

But in Stafford 78.three% of individuals are receiving the advisable amounts of care.

Barbara Young, chief executive of Diabetes Uk, stated: “It is critical that everyone with diabetes gets these checks at least as soon as a yr, so it is deeply worrying that the proportion getting them varies so broadly from spot to area.

“Taking into consideration how they can support stop devastating well being problems this kind of as amputation and blindness, possessing a fourfold difference among the best and worst carrying out places is basically not good sufficient. If more than 70% of men and women with diabetes in places with considerable overall health issues are receiving the checks then there is no good cause why this ought to not be occurring all over the place.

“But as things stand, the postcode lottery of diabetes checks means many 1000′s of folks are missing out on essential healthcare that has the likely to identify troubles early ample for them to be treated.

“We want clinical commissioning groups that do not give these checks to sufficient individuals at the moment to set out how they program to boost the predicament and for the Government to describe how it is going to guarantee people with diabetes can be assured they will get excellent good quality care, wherever they dwell.

“We also hope that by providing individuals with diabetes details about how care in their area compares to other places, our Diabetes Observe instrument can help empower them to hold their local NHS to account.”

Diabetes charity concerns warning in excess of well being checks

Alder Hey children"s hospital fails 4 in five standards checks

The Care Quality Commission identified ‘very worring problems’ at Alder Hey, like managers allegedly not listening to theatre workers complaints. Photograph: Christopher Thomond for the Guardian

A single of England’s 4 kids-only hospitals has “extremely worrying troubles” in its working theatres, in accordance to security watchdogs.

Alder Hey in Liverpool failed to meet 4 of five nationwide standards checked by inspectors from the Care High quality Commission (CQC) in December. There was a faulty emergency phone alarm method, possible safety incidents, and “close to misses” went unreported, while operations had been cancelled due to the fact of employees shortages.

There were also issues in the theatres about lack of ample gear to keep track of patients and poor maintenance checks.

Staffing problems meant that individuals in the theatre recovery spot following surgery had been at improved risk, too.

There have been also complaints from theatre workers that managers did not pay attention to their “repeated issues”. Some wards at the hospital did not have ample certified, skilled and experienced staff, in accordance to the CQC.

The CQC’s regional director, Malcolm Bower-Brown, said: “The troubles we recognized at the Alder Hey hospital are very worrying. We have advised the believe in the place more action have to be taken to make sure national specifications are met and that patients acquire the good quality of care they are entitled to assume.”

The unannounced pay a visit to by the CQC in December came right after it was alerted by theatre workers more than their issues about standards. Its report fails the hospital on care and welfare of individuals making use of its services, staffing, support of employees and high quality monitoring. Cleanliness and infection management met nationwide specifications.

A report by the hospital’s director of nursing, Gill Core, had presently warned of shortcuts in security processes, “restricted reporting of incidents”, and a belief among staff that senior managers condoned the working circumstances.

Two years ago, the Royal University of Surgeons warned that relations within the surgical department had broken down, even though total surgical efficiency was protected.

Louise Shepherd, chief executive of the basis hospital trust, explained there was “no evidence that individuals have been harmed as a consequence of these concerns and we continue to be assured that we are providing a safe service for our youngsters and youthful people”. An action plan had already been created and “many” components of it implemented.

But Shepherd stated it was regrettable that a small number of the theatre staff felt they had had to speak to the CQC about how they had been supported at operate. “Theatres by nature are extremely stressful, demanding operating environments and we are also facing an increased demand on our solutions,” she added.

Alder Hey children"s hospital fails 4 in five standards checks