NHS ordered to end the ‘killing season’ when patient death rate jumps as thousands of graduate doctors start work
More consultants should be on duty to end the annual ‘killing season’ in the NHS when thousands of medical graduates start on hospital wards, a review of staff practices has warned.
Each year, the first Wednesday in August – dubbed ‘Black Wednesday’ – sees more than 6,000 newly qualified doctors start their careers in medicine.
But research has shown that their debut coincides with a 6 per cent increase in death rates and that it takes four months for this risk level to return to normal.
And now the Academy of Medical Royal Colleges (AMRC), which represents the 20 medical institutions responsible for maintaining standards in the NHS, has called for action to be taken.
It wants rotas to be ‘more flexibly and intelligently designed’ so that experienced doctors are on call during August and September to give trainees a ‘high-quality clinical induction’, with a particular focus on patient safety. The AMRC also wants a reduction in routine surgery to allow for this training to take place.
The proposals have been endorsed by Dame Sally Davies, the chief medical officer for England, and her counterparts in Scotland, Wales and Northern Ireland.
And this August new doctors will for the first time spend four days shadowing the jobs which they are to move into.
Referring to the 6 per cent rise in death rates, Alastair Henderson, chief executive of the AMRC, said: ‘The problem has been been known about for a long time, it is an increasing anxiety and it isn’t acceptable.’ He told the Independent: ‘There are practical complications with the changeover – if you are playing musical chairs everyone has to move or there won’t be chairs to move to.
‘The problem has been been known about for a long time, it is an increasing anxiety and it isn’t acceptable’ ‘But that doesn’t mean there can’t be a way of supervising and managing it safely. We are calling for better consultant cover to ensure there is absolutely proper supervision during this period.’
Mr Henderson said that the AMRC is also investigating the merits of staggering the changeover which affects 50,000 doctors in training each February and August. He believes that delaying this changeover for more experienced doctors would ‘greatly increase stability’.
NHS medical director Sir Bruce Keogh has admitted that the changeover ‘puts patients at risk’ and inexperienced doctors under great stress.
Mark Porter, chair of the British Medical Association’s consultants committee, has backed the proposals for more consultant cover in August. But he said NHS trusts must accommodate those who wanted to take holidays at that time.
He said there was ‘disturbing evidence’ that patients got a worse service during the junior doctor changeover in August but denied deaths were higher. He said: ‘We no longer get patients deteriorating because they are now on observation charts with mandatory checks which trigger automatic calls to the critical care outreach team.’
Midwife blamed for ‘catastrophic mistakes’ that led to death of baby after he was deprived of oxygen during birth
An experienced midwife whose ‘catastrophic mistakes’ led to the death of a baby boy has told an inquest: ‘I will regret what happened for the rest of my life.’ Julie Richards was speaking after a coroner heard how ‘gross failure’ at an NHS hospital caused Noah Tyler to be starved of oxygen, a condition from which he never recovered.
The inquest heard that Noah died aged 10 months because of errors made during his birth at the University Hospital of Wales in Cardiff.
Problems during the birth also put the life of Noah’s mother, Colleen Tyler, 31, in danger, the inquest in Cardiff was told. Mrs Tyler and her husband Hywel are suing the hospital for negligence.
Mrs Richards, who had 13 years’ experience of delivering babies, admitted to making ‘catastrophic mistakes’ by failing to take action when Noah’s heart rate was dangerously high. ‘With hindsight I would have acted differently,’ she said. ‘I don’t know if I looked at the heart scan properly. She added: ‘I will regret what happened for the rest of my life.’
Noah was born in the hospital’s maternity unit in February last year. Mrs Richards, who no longer works as a midwife, said: ‘I thought Colleen was pushing so well and the baby was imminent. ‘Her blood pressure was extremely high and I was very concerned with the reading. ‘I was wrapped up in the delivery of the baby – I didn’t think we needed to call the specialist neo-natal team.
‘When he was born I didn’t expect him to be in the condition he was in. ‘He was as bad as a baby could be. He was pale and his heart rate was less than 60 and we took him away to be resuscitated.’
Earlier Mrs Tyler sobbed as she told the inquest how she was ‘tortured’ by the memory of baby Noah’s birth. She said: ‘I asked if I needed to push but the midwife told me if I needed to push I would not need to ask. ‘She said I would just know but I was totally confused by this. I didn’t know whether I should push or not.
‘After three hours they took me out of the birthing pool and put me into a bed. ‘I kept asking for an epidural but they didn’t give me one. ‘I asked if I needed a doctor but they told me there was no need to get the doctors involved because they would just cut me. ‘In the end I told them they should do what they needed to to get my baby out.’
Mrs Tyler told the hearing that she knew instantly that something was wrong. ‘I was told I would hear him cry when they got him out but I didn’t hear anything,’ she said. ‘He was very white, not how I expected him to look.
‘No one said anything and I was left feeling confused. I was in a state of shock – I thought: “This cannot be happening”. ‘I expected to be holding my baby by then but he wasn’t there. ‘I knew from the doctor’s face that something terrible had happened.’
Noah was taken to an incubator where he was put on a cooling mat in an attempt to prevent his brain being damaged permanently.
Mrs Tyler, who is heavily pregnant, said: ‘Nothing could prepare me for what I saw, that little thing lying in the incubator with loads of tubes going into him.
‘I keep replaying the birth in my head and torturing myself. What if I could have done anything different to save Noah? ‘The thoughts just go on and on.’
Mrs Tyler told how she later saw the midwife on the ward. She said: ‘I thanked her for doing everything she could to save Noah which I believed was the truth at the time. ‘She didn’t say anything and looked very awkward.’
Specialists at the hospital treated Noah for months, but he showed little progress and he was moved to a children’s hospice. He died two days before Christmas last year.
Pathologist Alistair Lammy told the inquest: ‘Noah’s brain had been irreversibly damaged due to lack of blood and oxygen around or during birth.’
Cardiff coroner Mary Hassell said: ‘I am very, very concerned with the circumstances surrounding Noah’s death. ‘What struck me very forcibly was that we might today be dealing with two deaths rather than one.’
Miss Hassell recorded a narrative verdict saying Noah of natural causes ‘contributed to by neglect’. She said: ‘Noah and his mother suffered gross failure of basic medical attention. There were failures.’
Speaking outside court, Mr Tyler said: ‘It is because of the failings of one person that my boy isn’t here any more and there’s no reason why he shouldn’t be.
‘We know it’s a good unit and the experience we’ve had with our new little boy proves they do know what they’re doing.
‘When the coroner said this could have been an inquest around two deaths it hit me like a ton of bricks to think I could be here on my own not with my wife or our new little boy.’
The family’s solicitor, Stuart Bramley, said: ‘We have heard about changes being made as a result. ‘Colleen and Hywel Tyler hope that these changes will prevent other parents from having to live through the same nightmare.’
Cardiff and Vale University Health Board has admitted that the level of care to Mrs Tyler and Noah fell below the acceptable standard.
Plans for same sex marriage doomed in Britain
Ditch plans for same-sex marriage, voters tell MPs. Plans to legalise same-sex marriage are the number one issue in MPs’ postbags – with an overwhelming majority of voters opposed to the move – according to a new poll.
The survey of MPs from across the political spectrum by ComRes also shows that only one in 25 parliamentarians believes that allowing gay unions is a main priority for voters.
The poll comes in the wake of a growing number of Conservative heavyweights declaring that they do not support moves to allow same-sex marriage by law by the time of the next election, May 2015.
Last week Downing Street backed down by signalling that there would a “free vote” on the issue in parliament – as is traditional with matters of conscience – in what has become a divisive issue for the coalition.
Earlier senior sources had indicated that the measure would be “whipped” – meaning that ministers would have to support government plans.
Campaigners believe up to five cabinet ministers would vote against same-sex marriage in the Commons, three of whom are claimed to be Iain Duncan Smith, the Work and Pensions Secretary, Owen Patterson, the Northern Ireland Secretary and Philip Hammond, the Defence Secretary.
By contrast, Theresa May, the Home Secretary, last week recorded a video in support of the proposals, saying “marriage should be for everyone.” Her intervention was seen as highly significant since she is the minister leading the public consultation on the plans.
David Cameron is said to remain firmly committed to allowing same-sex marriage – despite his stance being held at least partly to blame by some Tory MPs for his party’s poor showing in this month’s local elections. Liberal Democrat ministers are strong supporters of the move.
Ministers are expected to press ahead with plans, permitting same-sex unions in non-religious venues, within the next year. With Labour supporting the move it would be assured of a majority in the Commons – but would run into significant opposition in the Lords.
The survey, commissioned by the Coalition for Marriage (C4M), which is leading the campaign against the government’s proposals, shows that same-sex marriage is the issue which most stands out in MPs correspondence from voters.
According to the polls, findings, seen by The Sunday Telegraph, around one in three MPs (34 per cent) cited it as one of the main concerns raised with them by voters, putting ahead of welfare reform (23 per cent), NHS reform (19 per cent), pensions (13 per cent), fuel prices (13 per cent), fuel taxes (13 per cent), unemployment and jobs (8 per cent) and the Budget (8 per cent).
Asked how voters divide on the issue, MPs say their constituents are overwhelmingly against – with, on average, three in four voters either opposed to the measure (19 per cent) or strongly opposed (55 per cent), according to the MPs’ assessments. Just 16 per cent of those who are in touch with their MPs support the plans.
Strong opposition to the move is reported by MPs of all three main parties, with Conservatives getting the heaviest flak from voters. Among Tories, 45 per cent say that letters and emails opposing same-sex marriage are the number one item in their postbag and email accounts – with the figure falling to 30 per cent of Lib Dems and 23 per cent of Labour MPs.
Asked what issues matter most to their constituents, MPs cite fuel tax (79 per cent), cutting the deficit (74 per cent) and ensuring the tax burden is “spread fairly” overall (69 per cent).
Gay marriage is cited by just four per cent of MPs as a key priority for their constituents, just one per cent ahead of House of Lords reform.
Colin Hart, Campaign Director of C4M, said: “This poll shows that, right across the Commons, MPs do not regard gay marriage as an important priority.
“It also demonstrates that public opposition to the measure is vociferous and widespread.
“If Ministers decide to press ahead regardless of popular opinion, they will further undermine public confidence in Parliament and reinforce the growing impression that the ruling elite is out of touch with the strongly-held concerns and opinions of the British people.
“David Cameron should drop this idea before it causes yet more social divisions and ill-feeling.”
Andrew Hawkins, Chief Executive of ComRes said: “Clearly this issue has touched a raw nerve with the public, and not in a positive way.
“It is however entirely in line with public polling which shows that Mr Cameron’s stance on same-sex marriage has already cost the Conservatives some support and could well be responsible for a number of the party’s MPs losing their seats at the next election.”
THOUSANDS of jobless layabouts risk having benefits stopped in British government crackdown on the workshy
Ministers now want to make ALL able-bodied claimants do unpaid community tasks in return for their dole.
The move follows the success of a tough new regime aimed at pushing the long-term unemployed into work.
Job centre staff have power to send suspected shirkers to join supervised gangs painting schools or trimming hedgerows.
Those who refuse to put in 30 hours a week have their £67.50-a-week unemployment benefit stopped. Next month the government will DOUBLE the number on the programme.
Employment Minister Chris Grayling, who set up the scheme last year, wants to extend it to capture thousands more he believes play the system.
And he has launched a secret trial in one area to see if tough sanctions can be imposed on EVERY claimant. An insider said: “He wants this scheme to be the norm, rather than an optional extra.
“They are planning to extend it rapidly from next month and have already found funding for thousands more places.
More than 18,000 jobless have already joined community projects or had their handouts docked.
But a study shows half of claimants would rather lose their cash than do unpaid work. (Because they are in fact working)
Death by a thousand regulations: Britain’s new Energy Bill
The Bill is designed primarily to implement the government’s proposed electricity market reforms (EMR) (which were discussed in previous Oxford Energy Comments
Return of the P-word in July 2011 and Back to the Future of December 2011
It contains provisions to implement Contracts for Differences (CfDs), the Capacity Market and so-called Investment Instruments, which are intended to prevent delays in investment as the other measures are being developed.
What is noteworthy in the Bill is that despite the words “contract” and “market”, all these provisions are designed around the same pattern – a power for the Secretary of State to make regulations by means of which obligations would be imposed on electricity generators and all suppliers. In other words, what will underpin both decarbonisation and security of supply in the future electricity industry will not be a market or private contracts but a complex set of government regulations – an ironic outcome for a process originally described as one of “deregulation”.
That is, however, deliberate. The government believes that the risks of investment (and along with them required rates of return) would otherwise be too high to be acceptable to investors and consumers; the regulated approach is designed to reduce risks and costs. But it also entails a massive and unprecedented degree of centralisation and detailed decision-making by the government.
For instance, the regulations on CfDs can specify:
* The means by which electricity is to be generated
* Generating capacity
* Plant location
* Location of supply
* Duration of the CfD
* Requirements to enter into agreements with third parties
* Setting the strike price
* Setting the market reference price
* Setting maximum overall costs
* Penalties, enforcement and many other administrative matters.
Similar provisions apply to the other instruments, and it is this complex web of regulation which will govern the future operation of the industry.
Other provisions in the draft Bill
Other provisions in the Bill are less radical but generally point in the same direction. For instance, one new power is for the Secretary of State to issue a Strategy and Policy Statement setting out its energy policy priorities. Ofgem will then have to act in the manner best calculated to further the delivery of these policy outcomes. Again (although the government does not admit it) this is a significant change. Originally Ofgem’s duties focused exclusively on economic regulation – the promotion of competition and consumer protection. There was a clear demarcation – the government was responsible for energy policy; the regulator for the operation of markets.
This distinction can no longer be drawn. It started to become blurred in the early 2000s. The regulator’s duties were amended to include the promotion of sustainable development and a requirement to have regard to the effect on the environment in carrying out its functions. Under the Utilities Act 2000, it also had to have regard to social and environmental guidance issued by the government.
By the late 2000s “E-Serve” (which implements the environmental aspects of the regulator’s functions) constituted the bulk of Ofgem’s spending. The latest development is the outcome of the recent Ofgem review. Ofgem will not just have to take account of the government’s policy goals; it will be expected to set out annually how it plans to deliver its contribution to each policy outcome. In other words the job of the regulator will be as much to help deliver the government’s policy goals, as to police markets.
Much more HERE