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Medico Legal

Doctors warn against annual refreshment of NHS mandate

Picture of Dr Mark Porter for Your Expert Witness storyThe BMA has warned that refreshing the NHS mandate with new policy initiatives every year could make it unachievable. The association said it supports the principles behind the recent update, which include improvements for older people’s care and mental health but is concerned about the “ever-changing goalposts”.

Created as part of the Health and Social Care Act 2012, the mandate sets out the government’s ambitions for the NHS and the funding available for the work, and must be refreshed annually. The updated mandate for 2014/15 includes a plan to develop care for vulnerable older people and those with complex needs.

BMA council chair Mark Porter (pictured) said the NHS mandate provided an “encouraging vision”, but success would depend upon having fewer and more strategic objectives and how that was implemented.

Last Updated on Monday, 18 November 2013 12:55

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New initiatives will progress the battle against cancer

Picture of a tumour for Your Expert Witness storyOn 28 September the Prime Minister announced that an additional £400m investment in the Cancer Drugs Fund will allow thousands more cancer patients in England to gain access to life-extending drugs recommend by their clinicians and medical experts.

More than 34,000 patients have benefitted from the Cancer Drugs Fund since it was created in 2010. The Fund is now confirmed for an extra two years until March 2016. The extension will allow new patients to benefit and guarantee that those currently receiving drugs will continue to get them. The new money means the amount committed will top £1bn in total.

Last Updated on Monday, 30 September 2013 10:33

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UK to host first dementia ‘summit’

Photo of Jeremy Hunt for Your Expert witness storyThe UK will be hosting the first ‘G8 Dementia Summit’ in December this year. David Cameron and Health Secretary Jeremy Hunt will be using the UK’s presidency of the G8 this year to take the lead in taking global action against what is fast becoming one of the greatest pressures on families, carers and health systems around the world.

In the UK alone, there are likely to be nearly a million people with the condition by the end of 2020. Now the government is looking to spark a worldwide effort by inviting health ministers from G8 countries to a summit in London on 11 December to discuss how they can co-ordinate efforts and shape an effective international solution to dementia. This includes looking for effective therapies and responses to slow dementia’s impact.

The summit will aim to identify and agree a new international approach to dementia research, to help break down barriers within and between companies, researchers and clinicians and secure a new level of co-operation needed to reach shared goals faster than nations acting alone.

It will draw on the expertise and experience of the OECD, WHO, industry, national research organisations, key opinion leaders, researchers and physicians.

Health Secretary Jeremy Hunt said: “Globally there is a new case of dementia every four seconds, and by 2020 we will see nearly 70 million people living with the condition.

Last Updated on Friday, 20 September 2013 08:55

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Extra cash will boost health research expertise

Picture of pills for Your Expert Witness storyThe Government has announced increased funding to tackle “the nation’s most pressing health problems”.

On 9 August Health Minister Lord Howe announced an investment of £124m from the National Institute for Health Research (NIHR) into treatments and techniques which could revolutionise future health care.

Experts from 13 research teams across the country are expected to spend the next five years working on ground-breaking projects.

The research that will be supported includes work to reduce the risk of dementia through exercise as well as strategies to improve the nutrition and health of those who have already been diagnosed.

Long terms conditions is another key area, the announcement said. Some research teams will be exploring ways to improve the diagnosis of chronic obstructive pulmonary disease (COPD), while others will be looking at better aftercare for stroke patients. There will also be research to help prevent at-risk groups from developing diabetes.

Some of the projects will be aiming aim to reduce pressures on A&E and include trying to cut down admissions in children under five and people with long-term conditions.

Last Updated on Monday, 12 August 2013 16:11

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NHS welcomes Neuberger report

Photo of Chief Nurse Jane Cummings for Your Expert Witness storyThe NHS in England has welcomed the report of the review by Baroness Julia Neuberger into the Liverpool Care Pathway (LCP).

Jane Cummings, Chief Nurse at NHS England and Chief Nursing Officer for England, said: “I would like to reassure everyone, particularly patients on the LCP and their families, that NHS England and the NHS are passionate about ensuring that every patient receives the best possible care at the end of their life. I have been a nurse for over 30 years and know how important care at the end of life is for our loved ones. I say this both on a professional and a personal level.

“The review and NHS England recognise the good principles of end of life care in the LCP, but there have been failings in the quality of care in some areas and this is never acceptable. Caring for someone when they are dying is difficult and emotional even for experienced healthcare professionals. But the NHS exists to provide personal and compassionate care to patients and their loved ones when they most need it.  Most of the time we do get it right but we have to get it right for everybody. Issues such as poor communication with relatives have nothing to do with any particular care plan. That is just poor care and we don’t want it in the NHS.

“Patients are at the heart of everything we do to ensure the NHS can deliver the right care to every patient at the end of their life to make sure it is the best it can possibly be. We will do this by listening to patients and their families and responding fully to the recommendations of this report to ensure that the principles of good end of life care are firmly embedded across the NHS.

“We will be carefully considering the findings of this report and working with our partners to respond fully in the autumn, to give the time and consideration such an important review deserves to meet the needs of patients and their families.”

The report, More Care, Less Pathway: a Review of the Liverpool Care Pathway, was published on 15 July and recommended that the LCP be phased out and replaced with an individual end of life care plan.

Baroness Neuberger said: “There is no doubt that, in the right hands, the Liverpool Care Pathway supports people to experience high-quality and compassionate care in the last hours and days of their life.

“But evidence given to the review has revealed too many serious cases of unacceptable care where the LCP has been incorrectly implemented. Examples include leaving patients without adequate nutrition, hydration and inappropriately sedated. This is not only awful for the patients, but it is deeply distressing to their relatives and carers.

“Caring for the dying must never again be practised as a tick-box exercise, and each patient must be cared for according to their individual needs and preferences, with those of their relatives or carers being considered too.

“Ultimately it is the way the LCP has been misused and misunderstood that has led to such great problems, along with it being simply too generic in its approach for the needs of some people. Sadly it is just too late to reverse this and turn the clock back to get it used properly by everybody.”

Other recommendations among the 44 made include:

•A general principle that a patient should only be placed on the LCP or a similar approach by a senior responsible clinician in consultation with the healthcare team

• Unless there is a very good reason, a decision to withdraw or not to start a life-prolonging treatment should not be taken during any ‘out of hours’ period

• An urgent call for the Nursing and Midwifery Council to issue guidance on end of life care

• An end to incentive payments for use of the LCP and similar approaches

• A new system-wide approach to improving the quality of care for the dying.

Last Updated on Tuesday, 16 July 2013 13:27