PM to unveil measures to boost mental healthcare provision

Theresa May is set to announce major government action to improve support for people struggling with mental illness, including moves to help troubled young people and reduce the number of suicides.

In a rare speech on domestic policy on Monday, the prime minister will pledge that the whole of government will do more to improve the care received by the one in four people every year who develop anxiety, depression or other related conditions.

She will also detail how employers can play a much bigger role in helping staff who are forced to take time off work as a result of mental health problems. She is also finalising plans to outline steps schools can take to better identify and help the growing number of pupils who are becoming mentally vulnerable, sometimes as a result of sexting, bullying and pressure to do well in exams.

May’s move will be the climax of a concerted attempt by the prime minister, starting this weekend, to show that she is determined to make progress on the social justice agenda that she described on her first day in Downing Street as the “burning injustices” in society. “If you suffer from mental health problems, there’s not enough help to hand,” she said.

The prime minister has been interested in mental illness and its consequences since learning during her six years as home secretary how much police time is taken up dealing with the issue and the very high number of prisoners who have serious psychological or psychiatric conditions.

Mental health charities have praised May’s record on the subject, which included a big drop in the number of people in acute distress who are put in a police cell to undergo an assessment of their mental state because there is no other available “place of safety” nearby.

The speech will be her first on health, an area in which opponents have criticised her over her claim to be giving the NHS £10bn extra funding by 2020 and deteriorating NHS waiting times for A&E and cancer care and planned operations.

A key element will be an announcement of new measures to reduce the number of people taking their own lives. The number of suicides across the UK fell from 6,232 in 2013 to 6,122 in 2014. Although the rate of of suicide among men is going down, it is rising among women, although 45- to 59-year-olds of both sexes are the likeliest to take their own life.

Opposition MPs urged the premier to use Monday’s speech, in central London, to unveil meaningful plans to end long waits for mental health treatment and ensure patients did not become so unwell that they ended up in mental health crisis.

“Now is the time for the prime minister to demonstrate that the government’s actions match the rhetoric”, said Liberal Democrat MP Norman Lamb, who was the mental health minister in the coalition until 2015.

“Now they must end the intolerable discrimination which exists within the NHS. We can no longer tolerate people with mental ill health having to wait interminably for treatment or getting no treatment at all”, he added.

May should bring in maximum waiting times for mental health treatment to match those that already exist for physical health, such as A&E treatment, and make mental health a personal priority of her time in power, as her predecessor David Cameron did with dementia, he said.

Luciana Berger, a member of the House of Commons health select committee and president of the Labour campaign for mental health, said: “The inadequacy of our mental health services is one of the most perilous challenges our NHS and country faces. It can only be solved by tangible change felt in every school, workplace and community.

“It is vital that the prime minister breaks the tradition of broken promises which has so far characterised her party’s approach to mental health. The focus needs to be on early intervention and prevention – services which have been savagely cut since 2010”, she added.

Downing Street officials have been examining how to help schools cope with mental ilness. Jeremy Hunt, the health secretary, favours a system, being trialled in 225 schools in 22 parts of England, under which schools can seek advice from an expert working locally in NHS children and adolescent mental healthcare and ensure that pupils get seen more quickly. No 10 has also been looking at overhauling teacher training so that trainees are better able to spot telltale signs of distress and has been advised to ensure mental health is included on the secondary school curriculum to help prepare pupils for confronting what some experts say is an epidemic among under-18s.

May is expected to highlight the damaging role social media can have on young people’s mental welfare. Officials have been exploring potential curbs on the problem. Hunt recently called on mobile phone companies and firms such as Facebook and Twitter to stop under-18s sending sexually explicit images, including setting up parental blocks on their child’s account.

May’s speech will in part be the government’s formal response to the 58 recommendations made last year by NHS England’s mental health taskforce. She will acknowledge that many different departments have a key role to play in improving mental health, including the Department of Work and Pensions (welfare benefits), Ministry of Justice (offenders) and Department for Education (schools), not just the Department of Health and NHS, and pledge better pan-Whitehall action.

Mental health experts are keen to see if May accepts the taskforce’s plea for the Cabinet Office and Department of Health to create a body to provide “cross-government oversight” of how much progress ministers are making on improving care.

Privately, specialists in the field recalled the creation under Cameron on a Cabinet committee to oversee mental health policy, which was disbanded soon afterwards. One leading figure, who asked not to be named, said: “This focus on mental health is welcome and there’s potential for Theresa May to lead on mental health in a way no other prime minister has done. But is there something big she can do to help schools or is that just talk? And can she change the benefits system to help people, or is that just window dressing?”.

May will not announce any extra mental health funding beyond the £1bn extra for the sector generally and separate £1.4bn for children and young people’s care, both due to arrive by 2020. One Whitehall source with knowledge of the speech said: “This isn’t about providing new money. It’s about re-evaluating what the priorities in mental health are.”

PM to unveil measures to boost mental healthcare provision

Nice proposes "smooth driving" measures to cut air pollution

Speed bumps should be removed, speed limits made variable on England’s motorways, sometimes dropping as low as 50mph, and a congestion charge considered in more cities to cut air pollution and save lives, health experts have said.

The National Institute for Health and Care Excellence (Nice) released a series of recommendations on Thursday which it said would “promote a smoother driving style” and help keep emissions down.

Health officials said vehicles created more emissions when they were speeding up and slowing down, as on congested motorways. To keep a more consistent speed, they said, the limit could be temporarily lowered to 50 or 60 mph when traffic is stop-start. That represented a “more sensible” approach than having lower fixed limits, Nice’s Prof Mark Baker said.

The officials added that some speed bumps encouraged people to speed up, then slow down. They urged planners to consider using average speed technology on the roads to promote smoother driving. Figures released earlier this year by the RAC Foundation showed that cameras measuring average speeds were now monitoring drivers on more than 250 miles of Britain’s roads. Sections covered range in length from a quarter of a mile on London’s Tower Bridge to 99 miles on the A9 between Dunblane and Inverness in Scotland.

On top of that, they want towns and cities with pollution problems to consider implementing clean air zones and look into the possibility of introducing congestion charging zones.

The draft guidance for England also contains proposals for “no-idling” zones around schools to prevent parents leaving their cars running during school drop-offs. Air pollution is a contributory factor to about 25,000 deaths a year in England, almost 5% of all deaths, Nice said, and road traffic is estimated to contribute to about a third of air pollution in urban sites.

Provisional figures show that road usage is at record levels, with an estimated 320bn vehicle miles travelled on Britain’s roads in the year ending September 2016.

Health campaigners welcomed the draft proposals, which were devised for local authority staff and are out for consultation, but environmental groups called for more stringent measures.

The British Lung Foundation said it backed the plans because “air pollution contributes to tens of thousands of early deaths every year” and the British Heart Foundation called them a “step in the right direction”.

Jenny Bates, a Friends of the Earth air pollution campaigner, said the proposals were to be welcomed but that “we must deal with the real crux of the issue and reduce air pollution levels”.

She said: “Action is needed both to ensure vehicles on the road are clean and that there are fewer of them. Diesel vehicles, which are the most polluting, must be phased out and our transport and planning policy needs a radical overhaul.”

Nice officials called for a review of trees lining streets in urban areas. “In some cases, they restrict street ventilation, causing poorer air quality. In others they improve it”. It also warns that solid barriers placed next to roads to mitigate noise can actually lead to a wider dispersal of pollution.

Other suggestions by Nice included:

• Town planners should avoid putting cycle routes on heavily polluted roads but, where this was unavoidable, they should consider using foliage to screen cyclists from vehicles. .

• Local authorities may want to look into setting a standard for the types of cars used for taxis.

• Some areas should consider public awareness initiatives such as “car-free days”. Those could be similar to measures sometimes used in Paris, which only allows drivers with a number plate ending in an odd or even number into the city on given days when pollution reaches high levels.

• House builders should place living rooms at the back of houses away from roads and hedgerows should be grown to protect cyclists using cycle paths.

Nice proposes "smooth driving" measures to cut air pollution

Watchdog puts "unsafe" Cornwall care homes in special measures

Elderly people have been living in “grim, shoddy and unsafe” conditions in four care homes run by a private company in Cornwall, the health and social care watchdog has found.

Residents of the Morleigh Group homes lay in urine-soaked bedclothes, sat in chairs for hours with plates of unfinished food in front of them and waited weeks to receive medical attention, the Care Quality Commission said.

Publishing reports on the four homes on Friday, the CQC said all the homes had been rated inadequate and placed into special measures after separate inspections.

Andrea Sutcliffe, the chief inspector of adult social care, said:“These reports make horrifying reading – people in distress being ignored by staff; a person lying in a urine-soaked bed for two hours; people sat in the same chair all day with uneaten meals in front of them, and no help to eat or drink; someone needing medical attention waiting weeks to be referred to their GP.

“These and so many other examples show why we have rated each of these homes as inadequate and are taking further action to protect the safety and welfare of the people living there.”

Clinton House nursing home, in St Austell, closed earlier this month after an undercover investigation by BBC’s Panorama.

The CQC reports concluded:

• At Clinton House, there were not always enough staff on duty. Inspectors noticed one person in distress and crying for 90 minutes while staff walked by three times without speaking to the person to find out if they needed anything or to comfort them. The management of medicines was not robust. One person had not been given one of their prescribed medicines for three days. Inspectors had to intervene when one person – who had previously been assessed as being at risk of falls – was left unattended and nearly fell out of their wheelchair.


• At Elmsleigh care home, in Par, inspectors found one person who suffered from incontinence and was at risk of pressure sores, but was not routinely turned or checked by staff. Records showed that for several days the person often received no personal care – exposing them to the risk of urine burns to their skin. People sitting in the same seat all day, with their meals left in front of them uneaten, even though most needed encouragement to eat. Some appeared not to realise it was mealtime. Some people had sustained substantial weight loss but it was not clear what action had been taken to help them maintain a healthy weight.


• At Collamere nursing home, in Lostwithiel, inspectors witnessed people with dementia calling out repeatedly for some time with no response. One person shouted throughout the day and night. It was only after the inspection that their GP was asked to review their pain relief – and then they appeared to sleep without signs of distress.


• At St Theresa’s nursing home, in Callington, inspectors identified one person who had pressure sores, but had not been repositioned for eight hours. There had been a delay of five days in seeking appropriate specialist advice. Medicines were not being managed safely, the premises and equipment were not being maintained, and the collection of soiled laundry from bedrooms and cleaning procedures did not ensure suitable standards of cleanliness.

Sutcliffe added: “These services were providing grim, shoddy and unsafe care – the sort that no one should ever have to put up with. I am sorry that people have had to endure this poor level of care.”

The CQC said the Morleigh Group, which is family owned, had been supported by Cornwall council and the NHS Kernow clinical commissioning group to make improvements. But it said the company had failed to listen.

CQC inspectors visited Collamere on 10 October in response to concerns about the service. They visited Elmsleigh on 25 October to follow up on improvements required by a previous inspection. Planned inspections of Clinton House and St Theresa’s were brought forward following information received from Panorama.

The BBBC investigation included undercover filming showing one nurse threatening to give morphine to a resident “to shut her up”.

Panorama

Watchdog puts "unsafe" Cornwall care homes in special measures

NHS teaching trust to go into special measures after inadequate rating

A large NHS teaching trust is to be placed in special measures after inspectors rated it inadequate.

St George’s University Hospitals NHS foundation trust in Tooting, south-west London, will enter special measures after the Care Quality Commission (CQC) said it was inadequate for safety and on the issue of being well-led.

The trust was also told it requires improvement for being effective and responsive, although it was rated good for caring. Eighteen NHS trusts in England are in special measures.

An inspection at St George’s in June and July revealed that several of the buildings, including operating theatres, were so poorly maintained they were not fit for purpose. Other problems included staff not following infection control policies and about half of staff working with children had not completed the required safeguarding training.

Two years ago, the trust was ranked as good.

Prof Sir Mike Richards, the chief inspector of hospitals, said: “I am disappointed that we have found a marked deterioration in the safety and quality of some of the trust’s services since we inspected two years ago, as well as in its overall governance and leadership.

“Our inspectors found that several of the trust buildings – including operating theatres – were in a state of disrepair, which meant they were not fit for purpose. There were poor fire detection systems and a heightened risk of water contamination, which meant that people were put at risk.

“We also observed that not all staff followed infection control procedures, even when challenged by colleagues.

“Worryingly, we found that areas in which children and young people with mental health conditions were cared for had not been checked for ligature points, and that half of the medical staff working with children and young people had not completed level three safeguarding training, which is a requirement for all staff working with children.

“We took urgent action requiring the trust to address the most immediate of our concerns, and the trust has now introduced a range of supportive measures as a means of stabilising the organisation.”

The trust, which operates hospitals at the St George’s and Queen Mary’s sites, serves about 1.3 million people.

The interim hospital trust chairman, Sir David Henshaw, said progress had been made but added: “There will be no quick fix to the problems we face. Many of these challenges are due to very poor board and senior management decisions in the past and a failure to tackle the big challenges head-on.

“We owe it to our staff and patients to make St George’s better again. The CQC’s report is a key part of this improvement journey.”

The other 17 trusts in special measures for quality of services are Barking, Havering and Redbridge NHS trust; Barts; Brighton and Sussex; Cambridge University; Colchester University; East Kent; East Sussex; London Ambulance; Medway; North Cumbria; Princess Alexandra hospital; Sherwood Forest; South East Coast Ambulance; Walsall; West Herts; Worcestershire Acute and Wye Valley NHS trust.

Eight more trusts are in financial special measures owing to large deficits and poor management.

NHS teaching trust to go into special measures after inadequate rating

Hospitals trust put in special measures after botched operations

A number of occasions where surgeons operated on the wrong part of a patientwere among incidents flagged up by a damning watchdog report which recommended that a hospital trust should be put in special measures.

The four cases involving the surgeons in 2015 were among seven “never events” – serious incidents that are wholly preventable – according to a report by the Care Quality Commission (CQC) into Brighton and Sussex University hospitals NHS trust.

The report also highlighted problems with a culture of bullying and discrimination.

Other issues included patients being kept in surgical recovery rooms – usually just a temporary stop before being returned to a ward or intensive care unit – for up to three days. These areas were also used for emergency medical patients because of an overcrowded A&E and “to help meet the emergency department’s targets”.

The CQC inspectors said there had not been enough staff to ensure patients were receiving safe care and that the culture at Royal Sussex County hospital was one where poor performance in some areas was tolerated.

As well as the safety issues, the report highlighted a culture of bullying at the organisation, where people from black and minority ethnic backgrounds reported that “discrimination was rife”.

The CQC document highlights a 2015 NHS Workforce Race Equality Standard report which concluded: “Following job application, the relative likelihood of white staff being appointed was 1.26 times greater than for BME staff.” It added: “BME staff felt very undervalued and bullied.”

Some lesbian, gay, bisexual and transgender staff also told inspectors they did not feel they were treated equally and felt discriminated against.

Prof Edward Baker, the deputy chief inspector of hospitals for the CQC, said: “It is clear that the problems we have found on this inspection go right through Brighton and Sussex University hospitals NHS trust.

“It is a matter of some concern that we found there was a distinct disconnect between the trust board and staff working in clinical areas, with very little insight by the board into the main safety and risk issues, and seemingly little appetite to resolve them.

“For some time the trust has been failing to meet national standards on waiting and treatment times, there were high numbers of cancelled appointments and operations, and delays in providing diagnostic results. We found that the executive team had failed on multiple occasions to provide resources or support to clinical staff in critical care and there was no acknowledgement that they understood the problems staff identified.

Dr Gillian Fairfield, the trust’s interim chief executive, apologised for the failures identified by the CQC, which she described as “completely unacceptable”.

“The NHS as a whole is seeing growing demand for services and, like many other trusts across the country, this has caused us significant challenges which has affected the standard of the care we are providing our patients. These challenges have been made worse by the fact that our older buildings are not fit for purpose.

“It would be wrong for us to use these pressures and challenges as excuses, however, and we know we should and need to be doing better for our patients and staff.”

Hospitals trust put in special measures after botched operations

Detecting dementia: the initial measures towards dignity | Tania Browne

As a teenager, I misplaced my grandfather. But he wasn’t dead. He even now had his favourite music, he nevertheless loved to stroll in the woods and name the flowers and plants, and he loved his soap operas. He was alive, but gone. A dignified guy, a former aircraft engineer and oil firm salesman, diminished to the standing of a bewildered toddler lost in a buying centre. When he died, our family felt an odd mix of relief, then guilt at the relief. The man we loved had left his body years before the body gave out.

This was thirty years in the past. But even though a remedy is nonetheless far away, two new tactics may at least be able to forewarn us of dementia, and enable us to plan treatment for ourselves or loved ones prior to any outward symptoms are obvious.

In accordance to Alzheimer’s Study United kingdom, my knowledge is at the moment shared by 24m family members and shut friends of the 800 000 diagnosed dementia sufferers in the United kingdom. In December last yr, a G8 summit was advised by Alzheimer’s Ailment Global that the worldwide figure was 44m and set to treble by 2050, as the life expectancy of individuals in middle and decrease income nations soars – precisely the nations who have either depleted or non-existent healthcare techniques. Dementia is a serious time bomb.

“Dementia” covers about one hundred situations, all resulting from huge scale brain cell death. Men and women frequently feel that when they are diagnosed they are in the early phases. But cell death can be happening for ten-15 many years or more prior to any outward signs and symptoms take place, and by the time they are diagnosed many dementia patients have currently misplaced 1 fifth of their memory cells. Dementia affects language, your judgement and your standard sense of who and in which you are, amongst other things. The most typical type of dementia is Alzheimer’s, accounting for about two thirds of situations, but it’s at present not possible to detect what kind of dementia a person has even though they are alive. The behaviour of all dementia sufferers is significantly the same, and we can only narrow it down to particular sorts by examining the brain following death.

Any person interested in population health will tell you that no condition has a single result in. Epidemiologists perform with several threat aspects – aspects linked with the likelihood of acquiring a disease – in the genetic, behaviour and environmental realms. Typically health circumstances arise as a result of all 3 in a variety of proportions, but in the case of dementia no one knows. It truly is like possessing a recipe exactly where the three major substances are offered, but no person has informed you how much of every, what approaches to use, and that each and every oven is fully unique.

This also can make creating remedies challenging. The final drug, Memantine, was authorized in 2003. Two far more current medication have failed to present a significant result in clinical trials. There is hope that a single of them, Solanezumab, may support delay onset in mild situations of dementia, but significantly investigation nonetheless requirements to be accomplished.

Despite the fact that we never know what leads to dementia we locate equivalent patterns in the brains of sufferers, and two proteins seem to be particularly substantial. Proteins are produced of lengthy chains of amino acids, every of which demands to be in exactly the proper spot so the protein can fold up into a complex, specific shape – a bit like genetic origami. It is their special shapes, and the reality that they can only attach to very particular receptor websites in the physique, that make these proteins the essential to so several crucial entire body functions. So if some thing goes wrong, the genetic message mutates in excess of time and a chain isn’t going to fold up the way it should… properly, it truly is rather like folding up your stunning origami swan and realising the guidelines have advised you to make 3 wings – except with genes you can’t adjust or disregard the guidelines.

In dementia individuals, two proteins in particular are always found to have mutated and “folded wrongly”. A single, called tau, is found all more than the central nervous method where it has a function in stabilising microtubules, but it seems to be “tangled” in dementia patients. In September 2013 scientists at the Nationwide Institute of Radiological Sciences in Japan devised a chemical which could “bind” to tau and then be detected in the brain utilizing a PET scan, and it really is hoped this may possibly also present results on tau in long term clinical trials.

But PET scans are even now expensive and challenging, and the cheapest and easiest testing might be in seeking for the second crucial protein, beta amyloid. This protein has a number of roles in the entire body, but in which it varieties component of the brain fluid, it can fold wrongly, tangle and cause a layer of “plaque” to build up. It really is considered that the protein mutation might also bind with insulin receptors and stop glucose from being properly absorbed in the brain, lowering function even more.

But it’s been identified that due to the fact it plays a number of roles, “clumps” of beta amyloid in the brain are mirrored by “clumps” elsewhere, specifically the lens and retina of the eye the place it can be detected via bio-markers which bond with it. Two separate scientific studies, from the US and Australia, were presented at the Alzheimer’s Association Conference in Copenhagen final week, which showed that levels of beta amyloid in the eyes mirrored individuals in the brain. The outcomes are preliminary and the tests have not yet been carried out on adequate men and women to be confident, but in this early stage it appears promising.

So just as your normal eye test can provide early warning signs of glaucoma, it’s feasible that in potential your optician may possibly be in a position to refer you for more tests for indications of dementia. And the earlier we can detect dementia, the earlier treatment method interventions we can make to plan treatment and to slow the progress of the illness. It may possibly not be the “cure” for dementia, but it could effectively give us the initial step to providing sufferers with optimum independence and dignity for the longest time.

Detecting dementia: the initial measures towards dignity | Tania Browne

Jeremy Hunt strategies specific measures for medical doctors who fail their sufferers

Jeremy Hunt, health secretary, was buoyed by what he sees as the accomplishment of putting 11 hospital trusts into specific measures final yr. Photograph: Oli Scarff/Getty Images

Jeremy Hunt is preparing programs to place GPs into specific measures if they are judged to be failing their individuals, in a substantial extension of the accountability method in the NHS.

The British Health-related Association is warning that the move, to be announced imminently, could unfairly damage patients’ believe in in their neighborhood practice and says the health secretary could sensationalise the few surgeries the place troubles have been discovered.

Hunt, buoyed by what he sees as the accomplishment of putting eleven hospital trusts into special measures final yr, ideas to extend that regime to GP practices and suppliers of grownup social care, such as care residences.

He is anticipated to announce on Wednesday that the Care Good quality Commission (CQC), the regulator for health and social care, will be adopting the tougher method 1st for care residences.

That could consequence in properties that CQC inspectors deem to be providing unsafe or inadequate care currently being closed or handed above to another operator.

Officials have nevertheless to finalise how the new technique will work in relation to England’s 8,000 GP practices.

The move follows the scandal in excess of 19 unexplained deaths at the Orchid View care residence in Copthorne, Sussex, and revelations that some GP surgeries are dirty, mishandle health-related data or do not store vaccines at the appropriate temperature.

Hunt told MPs final month that the lessons of the official report into the Mid Staffordshire NHS scandal “need to have to be utilized to the care residence sector, to general practice, to all out-of-hospital care, every bit as significantly as they apply to NHS hospitals”.

But Dr Chaand Nagpaul, chair of the BMA’s GPs committee, urged Hunt to keep away from running down GP solutions and to consider twice about an approach that could force some surgeries to shut.

“It is important not to generate a counterproductive blame culture based on isolated examples that would wrongly damage patient believe in in wider GP providers,” Nagpaul mentioned. “We should not sensationalise isolated examples in which there may possibly be inadequate care.”

Practices providing an inadequate services may possibly be carrying out so due to the fact they have been struggling to recruit GPs or nurses or were becoming denied necessary sources by the NHS, Nagpaul additional.

GPs are currently voicing considerations about latest reports that personal GPs who fail to spot indications of cancer will be named and shamed and that surgeries that fail to preserve enough over-60s out of hospital will have a red flag place on their entry on the NHS Choices site.

Eleven hospital trusts have been place into unique measures final year following the NHS healthcare director, Prof Sir Bruce Keogh, discovered care failings at them, and 6 other people followed following CQC inspectors were anxious by what they identified.

3 of the 11 have recently been taken out of the regime, which can involve adjustments to the trust’s leadership and a buddying arrangement with a profitable trust to drive up requirements.

Hunt is expected to announce this week that, following accelerated enhancements to the quality and security of care, other folks are exiting the regime as well. A spokesperson declined to comment.

Senior NHS sources say there are doubts about the CQC’s capability to subject adequate care suppliers to its beefed-up forensic inspection regime and control the extra scrutiny involved if much more of them in basic practice and social care are deemed to need to go into special measures.

Jeremy Hunt strategies specific measures for medical doctors who fail their sufferers

Beleaguered wellness believe in place into specific measures

As part of the special measures, NHS regulator Monitor will appoint an improvement director whose role will be to provide support and expertise but also to hold to account the trust which runs Furness General Hospital in Barrow-in-Furness, Royal Lancaster Infirmary, Westmorland General Hospital in Kendal and Queen Victoria Hospital in Morecambe.

An inspection team which included doctors, nurses, and hospital managers, trained members of the public, CQC inspectors and analysts spent three days at Furness General Hospital, Royal Lancaster Infirmary and Westmorland General Hospital in February.

They examined the care provided in accident and emergency, medical care, surgery, intensive/critical care, maternity and family planning, children’s care, end of life care and outpatients. Inspectors also visited Royal Lancaster Infirmary and Furness General Hospital out of hours unannounced.

Inspectors acknowledged that care in some services, such as maternity and A&E, had improved since previous inspections but in other areas – despite previous concerns being raised by CQC – care had still not been addressed effectively, said the CQC.

Overall, the inspectors conclude that the quality of care provided by Furness General Hospital and the Royal Lancaster Infirmary both required improvement, while the Westmorland General Hospital overall was providing a good service.

Sir Mike said: “There is a long history of concern with the quality of service provided by University Hospitals of Morecambe bay NHS Foundation Trust – so it is disappointing to report that a number of the issues that have been identified in the past remain unresolved.

“I do not believe that the trust is likely to resolve its challenges without external support. This is why I am recommending that the trust is placed in to special measures. I am looking to Monitor and the other organisations responsible for healthcare in the area to work together to support improvement.

“Despite the reorganisation of the trust’s clinical services, we have found a lack of clarity about the trust’s plans for the future that has left the staff feeling disengaged and remote from the executive team.”

Sir Mike added: “The trust and partner agencies will be developing an action plan to address the identified shortfalls and my inspectors will return to the trust to follow up on improvements in due course.”

Adam Cayley, regional director at Monitor, said: “The trust has co-operated with Monitor in making some improvements in recent years but the Chief Inspector of Hospitals has reported on wider failings in care that must be addressed.

“The level of care and the quality of senior leadership at this trust has not been good enough, that’s why we’ve put Morecambe Bay into special measures.

The regulator said it would take further action if improvements were not made.

An independent inquiry into care provided by the trust’s maternity and neonatal services from January 2004 to June last year is currently taking place following a “high number of serious untoward incidents” including patient deaths.

The report from chairman Dr Bill Kirkup is due to be submitted to the Secretary of State for Health in the autumn.

David Morris, Conservative MP for Morecambe and Lunesdale, said: “Naturally I am disappointed to read the contents of this CQC report. I regularly meet with the chief executive and the Secretary of State for Health and I do feel that the University Hospitals Morecambe Bay NHS Foundation Trust is making progress. I should state that the trust has experienced considerable pressures since it was granted foundation trust status in 2010 under the previous Labour government, a status that Andy Burnham should not have allowed to be granted.”

Mr Morris added: “Baroness Young, former chair of the CQC, has said that Mr Burnham withheld information prior to the 2010 election allowing trusts to self-assess, instead of being properly investigated. I discovered this last summer, as a result the CQC was restructured which I welcome.”

The trust’s chief executive, Jackie Daniel, said: “We are all incredibly disappointed to receive the overall (inadequate) rating for the trust. The reports reflect the fact that we are part-way through a process of significant improvement which is still going to take a number of years to complete.

“It isn’t an overnight job to change the culture of a large complex organisation, but through the hard work and commitment of our staff, governors and partners, our hospitals are now much safer, with improved standards of care in a number of areas from two years ago when we started to turn them around.”

She added: “Over the last two years we have seen significant improvements in areas such as mortality, staffing levels, A&E, complaints management, maternity, record keeping and appointments, many of which are recognised in these reports. It isn’t all fixed and there is much more to do but I am confident that we have progressed, although at times not at the pace needed.

Beleaguered wellness believe in place into specific measures

How I took Basildon hospital out of specific measures | Clare Panniker

A nurse advised the well being secretary earlier this 12 months that workers at Basildon hospital now felt listened to when they raised worries. Photograph: Steve Meddle / Rex Features

There have been cheers – and tears – of joy final week when I broke the information to colleagues at Basildon hospital that we had been eliminated from specific measures. The announcement follows a “excellent” rating from the NHS regulator, and marks the starting of a new chapter for the hospital.

It was the knowledge of one particular couple, whom I met two months right after I was appointed as chief executive of the NHS basis believe in in September 2012, that really drove us to enhance. They had been the mothers and fathers of a 10-year-old woman who had died simply because of our failings.

Soon after the youthful patient suffered an epileptic fit, medical professionals were unable to give her the anti-seizure medication she necessary since our stock was out of date. To make issues worse, there had been no senior staff on duty to treat her simply because it was five.30pm and consultants have been on call but not on site right after 5pm.

As I am a mother of three, their story struck a personalized chord. I was appalled by the standard of our care and by no means needed any other dad and mom to be so let down by the hospital. This was the catalyst for a modify in culture that was extended overdue. Only by recognising and acknowledging exactly where things had been going incorrect could we begin to put them right.

Following a 2nd serious incident in October 2012, the Care Top quality Commission (CQC) severely criticised the leadership and culture of the children’s services. Meanwhile, in a survey, half the hospital’s employees said they would not advocate it to their buddies and family members.

The organisation required to place compassion, care, openness, transparency and learning at its core. These are worthy aims but, to translate them into action, the hospital’s bosses had to be a lot more visible. We went out on to the wards to hear the views of patients and employees at 1st hand. We invited individuals to share their experiences, excellent and poor, at our board meetings.

We changed our structures to place physicians and nurses at the heart of management and determination-making, guaranteeing security that was our top priority. We overhauled governance processes to make certain we realized from severe incidents.

We employed 200 much more clinical employees and put wonderful emphasis on delivering the greatest care 24 hrs a day, seven days a week, with consultants’ rotas guaranteeing senior cover out of hours. Recruiting much more everlasting employees has enabled the trust to lessen investing on agency workers.

But in the wake of the Francis Report into the devastating failings at Mid Staffs, the spotlight on trusts this kind of as Basildon had become even a lot more extreme. The government asked the NHS medical director, Sir Bruce Keogh, to inspect trusts that have been deemed to be among the worst-executing in the country. Regardless of all our improvements, we were dealt a huge blow when the wellness secretary, Jeremy Hunt, announced last July that we were a single of 11 trusts to be place into particular measures.

It was disappointing, as our turnaround was under way. Morale was improving, employees have been raising issues and we have been listening and altering.

We caught to our path and, during their 2nd go to in November 2013, Keogh’s inspection team endorsed our transformation, saying they would be happy for their friends or family to be handled at Basildon hospital.

Following a CQC inspection in March, we received our “excellent” rating final week. Our maternity care was the initial in the nation to be rated “exceptional”. Professor Sir Mike Richards, chief inspector of hospitals, advisable to Keep track of, the regulator of basis trusts, that we should be the very first to be taken out of unique measures.

The well being secretary praised our turnaround in parliament. He quoted a nurse whom he had met on his visit earlier this 12 months, who said the difference at Basildon hospital was that workers now felt listened to when they raised concerns.

Our task is far from full – like all NHS trusts, we have to proceed improving services despite a substantial reduction in funding. But for now it truly is wonderful to see patients, politicians and media speaking about Basildon hospital for all the right reasons. And I am determined to keep listening.

• Clare Panniker is chief executive of Basildon and Thurrock University Hospitals NHS Foundation Trust

How I took Basildon hospital out of specific measures | Clare Panniker

NHS reform: Special measures | Editorial

The question of how to make change happen to a National Health Service that is beloved to the last bedpan has been preoccupying health secretaries for at least 50 years. As each one has to find out for themselves, change in healthcare is extraordinarily complex, not least because no one quite knows what it ought to look like. Now it is Jeremy Hunt’s turn.

The regime that will prevail if the care bill goes through the Commons unchanged is one more botched effort to deal with the unintended consequences of a crisis that originates in failure. Clause 119, which deals with hospital closures, means that good hospitals that are functioning well could have their best services asset-stripped in order to prop up a neighbouring trust facing bankruptcy. It could end up shaping the way healthcare is provided without paying proper attention to the wider needs of the community that it is supposed to serve. It is a failure regime that will almost certainly make failure more likely.

Clause 119 is a rapid rethink after a court ruled that the trust special administrator – in effect, the receiver – of the South London healthcare NHS trust couldn’t force neighbouring Lewisham hospital to run down some services to make the South London trust more financially viable. What is happening in South London now will be coming soon to a dozen or more of the scores of hospital trusts across England that – after the fierce budget squeeze – are teetering on the edge of collapse. Reconfiguration of the health service is undoubtedly needed. But it must not happen like this, driven by too many of the wrong considerations – narrow questions of short-term finance – and not enough of the right ones – the most efficient way of delivering the best, most affordable care, from district nurses to specialised cancer units, to everyone in the area.

Veterans of attempts at health reform are usually convinced that in the end there has to be some kind of top-down command and control system. Otherwise local interests obstruct every change. All politicians remember Kidderminster 2001 – when Dr Richard Taylor snatched a safe Labour seat with a campaign in defence of his hospital’s A&E unit – and shudder. No secretary of state would sacrifice the power to intervene for political reasons in order to pursue the greater good, at least not if they valued their job. If this seems unduly cynical, look back only a few weeks to the case of Mid Staffordshire NHS trust, where the trust special administrator and the health regulator, Monitor, had painstakingly agreed a programme of managed decline, which involved among other measures losing maternity services to the larger University Hospital of North Staffordshire. Hours before the recommendations were to be announced, David Cameron told the Commons he thought mid-Staffs needed its maternity unit. The report was sent back for reconsideration. Jeremy Hunt had to rewrite his statement to MPs.

Mr Hunt could reasonably warn that there is now real concern that delays in reconfiguration are leaving some services in some hospitals in protracted death throes. That means – local campaigners should remember – that some will be less safe than they could be. But that does not justify forcing through change on the back of a rushed and narrowly focused process. What is so alarming is that in the process of driving through changes so big they can be seen from space, the mechanism for making primary care the driver of reconfiguration got swallowed up in second thoughts – and now there’s no mechanism to provide an evidence-driven holistic assessment of service need that ordinary people can believe in.

Sweeping up all the powers of reconfiguration into the office of secretary of state and his appointees will make that worse. That’s likely to be the first big headache for the highly rated if controversial Simon Stevens who takes over NHS England next month. Early in his career, he commissioned NHS services for Brighton. Useful expertise for the man who has to piece together the parts that have fallen off the NHS aeroplane and get it airworthy again.

NHS reform: Special measures | Editorial

NHS reform: Unique measures | Editorial

The query of how to make adjust take place to a Nationwide Overall health Service that is beloved to the final bedpan has been preoccupying well being secretaries for at least 50 years. As each and every 1 has to uncover out for themselves, adjust in healthcare is extraordinarily complex, not least simply because no one particular very understands what it ought to look like. Now it is Jeremy Hunt’s turn.

The regime that will prevail if the care bill goes by means of the Commons unchanged is one far more botched effort to deal with the unintended consequences of a crisis that originates in failure. Clause 119, which offers with hospital closures, means that good hospitals that are working effectively could have their very best companies asset-stripped in buy to prop up a neighbouring trust dealing with bankruptcy. It could finish up shaping the way healthcare is offered without paying correct focus to the wider demands of the local community that it is supposed to serve. It is a failure regime that will almost undoubtedly make failure more very likely.

Clause 119 is a speedy rethink following a court ruled that the trust special administrator – in impact, the receiver – of the South London healthcare NHS trust could not force neighbouring Lewisham hospital to run down some services to make the South London believe in more financially viable. What is occurring in South London now will be coming soon to a dozen or a lot more of the scores of hospital trusts across England that – after the fierce budget squeeze – are teetering on the edge of collapse. Reconfiguration of the overall health services is undoubtedly essential. But it must not happen like this, driven by too several of the wrong considerations – narrow queries of brief-term finance – and not ample of the proper ones – the most effective way of delivering the very best, most inexpensive care, from district nurses to specialised cancer units, to everyone in the location.

Veterans of attempts at health reform are typically convinced that in the end there has to be some type of top-down command and handle system. Otherwise local interests obstruct each change. All politicians bear in mind Kidderminster 2001 – when Dr Richard Taylor snatched a secure Labour seat with a campaign in defence of his hospital’s A&ampE unit – and shudder. No secretary of state would sacrifice the electrical power to intervene for political factors in purchase to pursue the higher very good, at least not if they valued their task. If this seems unduly cynical, appear back only a number of weeks to the case of Mid Staffordshire NHS believe in, where the trust particular administrator and the wellness regulator, Monitor, had painstakingly agreed a programme of managed decline, which involved amongst other measures losing maternity solutions to the more substantial University Hospital of North Staffordshire. Hours just before the recommendations had been to be announced, David Cameron informed the Commons he believed mid-Staffs essential its maternity unit. The report was sent back for reconsideration. Jeremy Hunt had to rewrite his statement to MPs.

Mr Hunt could fairly warn that there is now genuine concern that delays in reconfiguration are leaving some companies in some hospitals in protracted death throes. That means – neighborhood campaigners ought to remember – that some will be less protected than they could be. But that does not justify forcing by way of change on the back of a rushed and narrowly centered method. What is so alarming is that in the procedure of driving by means of adjustments so large they can be noticed from room, the mechanism for producing principal care the driver of reconfiguration received swallowed up in 2nd ideas – and now there is no mechanism to provide an proof-driven holistic assessment of service want that ordinary people can think in.

Sweeping up all the powers of reconfiguration into the workplace of secretary of state and his appointees will make that worse. That is very likely to be the very first large headache for the highly rated if controversial Simon Stevens who takes above NHS England following month. Early in his profession, he commissioned NHS providers for Brighton. Valuable experience for the guy who has to piece collectively the elements that have fallen off the NHS aeroplane and get it airworthy yet again.

NHS reform: Unique measures | Editorial

Public wellness: half measures | Editorial

After four many years in office and far more false commences than the Grand National, the government last but not least has a commence date for its national alcohol strategy. From six April, there will be a basic ban on marketing alcohol, as some supermarkets do, for significantly less than the value of duty and VAT. It is not a move that is most likely to revolutionise drinking routines. In truth even the House Office analysis suggests the distinction it will make is virtually negligible. Campaigners dismiss it as laughable. For a government that set off with this kind of substantial ambitions for a public overall health revolution, this is a puny gesture.

The miserable value in human and financial terms of Britain’s dysfunctional relationship with drink is all also nicely-charted. This week’s headlines are about young folks throwing themselves into rivers to meet online dares, last week’s involved a York art student who, it’s feared, may possibly simply have fallen into the river following a evening out. No 1 who lives in a city is unaware of the very noticeable misery of homeless alcoholics or reduced grade antisocial behaviour. And there is the less visible price in the hyperlink in between drink and violence, the avoidable hospital admissions and the premature deaths. Now, as we reported on Tuesday, alcohol consumption is recognised as a substantial factor in the rising quantity of cancer deaths.

In opposition, Conservatives were assured, initial that one thing had to be completed to lessen the harm accomplished by extreme drinking, and 2nd that any strategy to do it would involve rising the cost. Last year, when the government reached a higher-water mark of enthusiasm for action, it looked as if the technique might embrace a minimal cost per alcoholic unit like the 1 the Scottish government intends to carry in this year. It’s a policy backed by each the Nationwide Institute for Well being and Care Excellence and Liam Donaldson, the former chief medical officer – who considered it could save 3,400 lives a year. Investigation on the impact of a comparable scheme more than eight years in British Columbia advised a ten% enhance in the value of most drinks led to a 32% fall in alcohol-related deaths. Most medical professionals are convinced of its benefits. Proposals for a 45p unit price duly went out to consultation – only to be rejected, apparently on the basis of the responses. Right after some head-scratching, one analysis advised sleight of hand with the outcomes. Digging by the British Medical Journal uncovered much more than 130 meetings among Whitehall officials and the drinks industry – which prompted 21 senior physicians to complain that huge company was trumping public wellness. Now the minimalist technique to reform has been confirmed. It will affect only the very most affordable drinks. Sheffield University calculates that the affect on product sales will be just .three%. All round alcohol consumption will almost certainly fall by .04%, the equivalent of .3 units, or significantly less than half a pint of beer per drinker per yr. However cheap alcohol is so damaging that even this small reduction is projected to conserve 15 lives, 500 hospital admissions and hundreds of thousands of lbs in the expenses of alcohol-connected crime.

Modifying gear on public overall health is difficult operate. It requires demanding the two potent vested interests and previous and satisfying routines. The outcomes consider many years to emerge. The measurable wellness positive aspects of the ban on smoking in public areas, 7 years on, are so far constrained to a striking fall in heart ailment. Monitoring a fall in cancers will be a much slower approach. Alcohol abuse is much more complicated, for it is not only a trigger of social dislocation but a symptom of it. That implies raising the value may possibly not be the only lever for addressing its costs. However it is indisputably the one particular that is closest at hand, if only the government could control to get a grip on it. Instead it continues to send out conflicting messages: a Residence Office refusal to enable pubs to stay open throughout the Globe Cup earlier this week was promptly overruled by Downing Street. Now the Residence Workplace has set a date for its ban on promoting alcohol below value. This was a government that promised what it known as “an ambitious strategy” to prevent unwell wellness. Acquiring everybody to drink half a pint less a 12 months doesn’t very fit the bill.

Public wellness: half measures | Editorial