Healthcare improving but infections and GP waiting times need work

The quality of NHS care in England has improved by leaps and bounds over the past two years, the independent health watchdog says today.

However, 60% of hospitals are still not dealing with superbug infections effectively, and 69% of GPs do not provide patients with the easy access to appointments that ministers want to see.

The mixed picture emerged in the Healthcare Commission’s annual performance ratings for 391 NHS organisations. It said 62% of trusts were providing a good or excellent quality of service, compared with 41% two years ago. Financial performance improved even more sharply, with 69% getting high grades, compared with 16% two years ago.

Sir Ian Kennedy, the commission’s chairman, said patients should celebrate the success of 42 trusts that received a “double excellent” rating, scoring top marks for both quality and finance. Last year there were 19, and just two in 2006.

Foundation hospitals did particularly well on the scoring system, which measures performance against dozens of criteria including patient satisfaction and achievement of government targets.

But serious weaknesses remain across much of the NHS. In the year to April a quarter of trusts failed to put in place adequate systems of infection control. Just over half did not achieve the government’s target for reducing MRSA rates by 20% each year. Only 40% of trusts managed to introduce the right systems and hit the target.

Kennedy said trusts risked losing the licence to treat patients if they did not achieve an adequate standard of hygiene before the end of March, when his inspectorate is due to be replaced by the Care Quality Commission.

Spot checks over the past year found serious breaches of hygiene regulations at four hospitals and minor lapses at almost every trust visited. Inspectors will now begin a programme of spot checks of primary care, ambulance services and mental health trusts.

Anna Walker, the commission’s chief executive, said tackling MRSA and C difficile was not enough. Trusts should monitor other infections including norovirus, a vomiting disease that strikes in winter.

She noted “a dramatic decline” in the number of primary care trusts meeting the target that every patient should be able to see a GP within two working days. This year 31% of practices met the target, compared with 80% last year.

The change was due to a new sampling method that asked thousands of patients about their experiences of trying to get an appointment, instead of relying on information from GP practices.

Dr Hamish Meldrum, chairman of the British Medical Association, said the report was misleading about GP waiting times. He said “A recent survey showed almost nine out of 10 patients were satisfied that they were able to get an appointment within 48 hours.”

Gary Needle, the commission’s head of assessment, said it could not be ruled out that GPs had been lying about how well they conformed to the target.

The commission congratulated hospitals for cuts in waiting times for cancer patients and for making good progress towards treating all patients within 18 weeks of referral by a GP.

Ambulances reached 77% of life threatening emergencies within eight minutes, exceeding the government’s target of 75%. And mental health trusts helped thousands of patients by providing more crisis resolution teams in the community.

Trusts in northern England got the highest grades across all services, while standards in London fell well below average.

Alan Johnson, the health secretary, wrote to congratulate 57 high-performing trusts and told six “double weak” trusts to meet his officials to explain themselves.

EU Directive provides boost for medical tourism

The EU Proposal for a Directive on patient’s rights in cross border healthcare (to be announced on Wednesday 2 July) provides an added stimulus to the already growing number of medical tourists who seek hospital treatment elsewhere in the European Union.

The Directive will create a formal framework and remove obstacles for UK patients wishing to travel for treatment in other EU countries.

In some circumstances, patients will be able to travel to other EU countries for treatment and will be able to reclaim the cost of treatment from the NHS. Patients will have to pay their travel and accommodation costs, plus any top-up fees if charges in the foreign hospitals are higher than the NHS cost.

The Directive proposes the following developments in cross border healthcare:

• A legal framework for the reimbursement of treatment where it takes place elsewhere in the EU.
• Common principles in terms of guaranteeing patient safety and ensuring quality and continuity of care.
• Stimulating greater European cooperation on healthcare including the establishment of “European Reference Networks” which would create a concentration of expertise, training and resources for specific diseases and health issues.
• Establishment of a European network for the assessment of new medical technology.
• Establishment of standards for e-health, in particular the transfer of patient information and treatment records between member states.

Keith Pollard of Treatment Abroad (treatmentabroad.com) says; “This Directive is the first step to creating a truly European market in healthcare; it could revolutionise the way we experience healthcare in this country and throughout the rest of Europe. It’s very good news for the fast developing medical tourism industry. The Directive will take the concept of patient choice to a new level; www.treatmentabroad.com will assist that choice by providing the most up-to-date and relevant information that patients need when making decisions about travelling for treatment.”

Treatment Abroad is the most popular site on the web for UK and European medical tourists seeking information about cost effective surgery and medical treatment abroad. The site provides information covering the healthcare services available, doctor accreditation, treatment costs, travel and accommodation. There’s also an extensive and free Guide to Medical Tourism to download, for those considering overseas treatment.

“With the announcement of this new Directive we are expecting a significant increase in traffic to the website not only from British patients but also from members of other EU countries looking for reliable, comprehensive and practical information about treatment options within EU member countries”, continues Pollard.

Last year, around 100,000 “medical tourists” left the UK for treatment. Their experiences were resoundingly positive with 97 per cent of patients willing to travel abroad for treatment again, according to Treatment Abroad’s recent medical tourist survey.
Treatment Abroad’s newly launched patient ratings and reviews system lets medical tourists share and rate their experiences and its “Code of Practice for Medical Tourism”, the first of its kind in the industry has been set up to encourage the adoption of best practice in medical tourism through the commitment of international healthcare providers to a voluntary code of practice.

Both the “Code of Practice” and the ratings and reviews have been introduced to give further reassurance to prospective health tourists.

Potential eco-town sites revealed

The shortlist of sites for a series of “eco-towns” is due to be unveiled by the Government.

The top 15 proposals for the new low-carbon, environmentally friendly developments will be revealed by the Department for Communities and Local Government (DCLG).

Over the next six months the shortlist will be whittled down to up to 10 successful bids – which will then have to go through a full planning process, the department said.

The department said all 15 sites have excellent potential to be eco-towns. Affordable homes will make up between 30% and 50% of the houses built.

According to the Government, the bids make significant use of cutting edge green technologies and brownfield land – including former Ministry of Defence sites, disused airfields and industrial sites.

While some of the more than 50 proposals received for the eco-town scheme were for green belt land, DCLG said none of those shortlisted would involve building new homes on the green belt.

Housing Minister Caroline Flint said: “Eco-towns give us a unique opportunity to tackle two of the greatest challenges facing the country in tandem – the pressing need to confront climate change and deliver more affordable housing.”

She will tell potential developers who have made it on to the shortlist that she wants to see proposals improved even further, and that they must provide green technology, affordable housing and key infrastructure, safeguard wildlife and promote green spaces.

The eco-town scheme was the first major policy announcement made by Gordon Brown as he began his campaign to succeed Tony Blair as Prime Minister last year.

There were originally due to be up to five eco-towns, which aim to provide zero-carbon homes, businesses and schools and be “exemplars” in at least one area of environmental sustainability. But at last year’s Labour Party conference, the Prime Minister announced that a positive reaction to the project had spurred him to expand the plans to up to 10 towns, providing up to 100,000 green homes.

Dentist shortage hits ‘millions’

Lack of access has prevented one in six people from seeing an NHS dentist for almost two years, a poll suggests.

Citizens Advice surveyed 1,800 people in England and Wales and found 300 had been frustrated – suggesting as many as 7.4m adults could be affected.

It questioned people about treatment since April 2006 when a new NHS contract was brought in.

Health minister Ann Keen said the government was “working hard” to improve access to NHS dentistry.

Private treatment

Extrapolating from their poll result, the authors estimate that of the 7.4m who tried and failed to see an NHS dentist, 4.7m eventually opted for private treatment, and 2.7m went without treatment altogether.

Offical figures suggest the number of people who have failed to access NHS dentistry is 2m.

Citizens Advice chief executive David Harker said “People on low incomes are particularly affected as private treatment is just not an option.”

The survey showed huge regional variations throughout the country, with the south west and north west of England the worst hit.

Lester Ellman, of the British Dental Association, said: “It is clear dentistry is not getting any better.

“The bottom line is that there are not enough dentists working in the NHS and that is because the government have failed to make it attractive enough.”

He denied it was a matter of money and said instead dentists wanted to spend more time with their patients.

Health minister Ann Keen said: “We are working hard to improve access to NHS dentists and the government remains fully committed to expanding services.

“It is now a national priority for the health service.”

She added the dentistry budget was being increased by 11% from this year to help achieve this.

Long-running problem

NHS dentistry has been a long-running problem for the government.

A new contract aimed at giving dentists more time with patients to get away from the so-called “drill and fill” culture was introduced as part of a reform of NHS dentistry in 2006.

It was hoped the move would stem the loss of NHS dentists to the private sector.

But despite getting paid the same for seeing less patients, 1,000 of the 21,000 NHS dentists in England refused to sign it, believing it was not as radical as they were led to believe it would be.

New dentists have been gradually recruited to the health service, but figures are no higher than they were before the new contract.

Barry Cockcroft, Chief Dental Officer for England, said access to NHS dentistry had been a long-standing problem, which could not be ironed out straight away.

He said: “You won’t turn it around absolutely completely in one year – but these reforms are a sound basis.”

The Welsh Assembly Government said the new contract had been successful in developing dental services in Wales, with six new practices in recent months and others expanding the numbers of NHS patients.

A spokesperson said £30m additional funding had made a “noticeable difference” and problems of an access were now “confined to a very few areas”.

UK paying for ‘migrant baby boom’

The NHS is spending £350m a year to provide maternity services for foreign-born mothers, £200m more than a decade ago, the BBC has found.

Immigration has raised the birth rate so fast that some units have closed, so that midwives could be moved to areas of urgent need.

A unit in Ascot, Berkshire, shut for two months in 2007 because staff had to be transferred to Slough.

The NHS says it is working to “build in” the extra capacity needed.

Other maternity units have turned expectant mothers away because they could not cope with unprecedented increases in the local birth rate.

When Labour came to power, the NHS spent around £1bn a year on maternity services, with one baby in eight delivered to a foreign-born mother.

Ten years on, spending has risen to £1.6bn, with almost one baby in four delivered to a mother born overseas.

While the number of babies born to British mothers has fallen by 44,000 a year since the mid-1990s, the figure for babies born to foreign mothers has risen by 64,000 – a 77% increase which has pushed the overall birth-rate to its highest level for 26 years.

In central London, where six out of every 10 babies born has a foreign-born mother, senior consultants and health managers blame the lack of resources to deal with the pressures of migration for unacceptably poor standards.

Professor Philip Steer, editor of the British Journal of Obstetrics and Gynaecology, said: “The Department of Health has been taken by surprise. The demographic change, the sheer numbers, has in some areas increased very substantially without there being any forward planning really to allow for that.”

According to figures from the Office for National Statistics, in 2006 there were 15,000 more Eastern European babies born here than a decade earlier.

‘Unprecedented increase’

The statistics go on to show that 11,000 more babies were born to a mother from the Indian sub-continent, while 8,000 extra babies had mothers born in Africa.

Heatherwood Hospital in Ascot closed its maternity unit for two months in the summer of 2007 because of an “unprecedented increase” in the local birth rate.

Midwives were moved to Wexham Park Hospital, closer to the pressure-point of Slough where in the last year staff have witnessed an extra 150 babies delivered to foreign-born mothers.

In a statement at the time, local health officials said they “reluctantly took the decision to temporarily close the delivery suite at Heatherwood Hospital for two months so we can ensure we offer mothers-to-be a safe, high quality service at Wexham Park Hospital.”

The knock-on effect was experienced in nearby Reading where the local maternity unit could not cope with the extra demand.

Tharlie Cooper was supposed to have been born in Reading, but when mother Lavina went into labour two weeks overdue she was told that, despite her being booked in, her local birthing unit was full.

Tharlie’s father Dean was furious. “Basically we got turned away and the reply I got on the phone was wherever you ended up is where you end up”, he said.

He drove his wife to Basingstoke in neighbouring Hampshire where doctors conducted an emergency caesarean.

Lavina, herself a migrant from South Africa, believes she and her baby could have died without prompt medical help.

The Royal Berkshire Hospital has apologised to the Cooper family.

In a statement the trust said: “It is a very difficult decision to close the unit and one which is not taken lightly.

“We are undertaking a strategic review to look at what sort of maternity services should be provided over the next 10 years, based on future population growth and birth rates.”

How to cope

Peterborough has seen a huge increase in births from Eastern Europeans. There were just three such babies in 2000, but almost 200 in 2006.

At the Thistlemoor Medical Centre, births among patients have increased 33% in just two years. GP Nalini Modha fears the authorities have not planned for the new arrivals.

“Hopefully somebody who is in authority is actually looking at the figures to try and work out how they’re going to cope with the influx” she said.

“If you’re going to provide responsible care for all the population – the indigenous as well as the newcomers – then we will have to stop and think about what we can and can’t afford.”

In parts of Greater London, seven out of 10 babies are now delivered to mothers born overseas.

The Strategic Health Authority argues that this partly explains why maternity services in the capital performed so poorly in last week’s Healthcare Commission report.

Births within migrant groups can often be more difficult, more dangerous and more expensive – with much higher rates of type 2 diabetes, tuberculosis and HIV among mothers who often turn up very late in their pregnancy.

London’s chief nurse, Trish Morris-Thompson, admitted that the NHS had not realised how immigration would affect maternity services.

“The timing of the impact is much quicker than we had anticipated”, she said.

“We’re working with our commissioners and our maternity providers now to ensure that we’re building in the capacity they need.”