Devastating report reveals 74% ‘are not doing enough to keep patients safe’

nhs staffThree in four NHS hospitals are unsafe, official watchdogs warned last night.

In an alarming report, they said casualty cases had been left in makeshift huts outside A&E. Other patients were given the wrong drugs or illegally sedated.

The Care Quality Commission also warned of a culture of bullying and blame, with staff scared to raise concerns or admit blunders.

The report came on the day that an NHS whistleblower was named by his shameless bosses. The professor had revealed that dozens of patients were needlessly put through the agony of chemotherapy.

The most comprehensive NHS assessment ever, the CQC’s 120-page report covers 150 hospitals. A shocking 74 per cent were graded either ‘inadequate’ or requiring ‘improvement’ in terms of patient safety.

The report’s authors noted desperate shortages of nurses and expressed their surprise and ‘intense concern’ at the low standards of care on some wards.

Responding to the findings, Janet Davies of the Royal College of Nursing said: ‘The quality of care is too often poor, and in some cases unsafe, and this requires urgent attention.

‘Too many senior nursing posts have been cut and the effects are now being felt.’

David Behan, who heads the CQC, said care standards varied around the country.

‘A key concern has been the safety of care – a failure to learn when things go wrong, or not having the right number of staff in place with the right skills,’ he added. ‘Where people are not receiving the quality of care they deserve, we will demand action.’ The report is further evidence that the NHS is struggling to care for an ageing population on a restricted budget. Last week it emerged that hospitals went £1billion into the red in the first three months of this year and waiting times are rising sharply.

The CQC highlighted stark figures showing that 22 per cent of NHS staff have been bullied, harassed or abused by colleagues or managers. And since April 2010, hospitals have lost 2,800 senior nurses while junior staff have not had basic training in dementia or end-of-life care.

The CQC inspected half of England’s hospitals between March 2014 and this May using a rigorous, new scoring system.

Each was given one of four grades: outstanding, good, requires improvement or inadequate. They were judged on safety, leadership, being caring, effectiveness and responsiveness. Just 26 per cent of hospitals were deemed to be good on safety and not one was outstanding.

In terms of overall care, 65 per cent of hospitals rated as requiring improvement or inadequate. Inspectors found examples of staff failing to take measures to prevent the spread of infections.

At some hospitals, including Medway Maritime in Kent, patients were kept on trolleys overnight on a ‘portable’ unit outside A&E due to a lack of space.

Elsewhere, staff were failing to keep records up to date or storing medicines in fridges that were too warm. The CQC found evidence that staff were restraining or sedating patients illegally.

Doctors or nurses must seek approval from their local NHS board if they want to lock patients in rooms or sedate them to prevent them coming to harm.

The CQC’s report extended to inspections of 8,318 residential homes and home help agencies and 1,852 GP surgeries.

It found that 10 per cent of care homes were inadequate or requiring improvement for safety, including one where mould was growing on walls.

Twenty-five per cent of GP surgeries required improvement for safety and 8 per cent were inadequate.

Cannot keep ignoring these warnings

Mr Behan stressed that the majority of patients were treated well and that many staff were dedicated and compassionate.

But Katherine Murphy of the Patients Association said: ‘It is worrying to see that there is still such variation in the quality of care being delivered.

‘This cannot continue. The safety of patients should be the primary concern of all healthcare professionals.’

Labour’s health spokesman, Heidi Alexander, said: ‘Jeremy Hunt cannot keep ignoring these serious warnings about unsafe and understaffed hospitals.

‘Under the Tories, nurse numbers haven’t kept pace with demand, and training places have been cut. This has left some hospital wards without enough nurses and has put patient safety at risk.’

Health Secretary Mr Hunt said: ‘We want to make our NHS the safest healthcare system in the world.

‘There are some excellent examples of high quality care across the country but the level of variation is unacceptable.’

First published on The Daily Mail website.

NHS reports 1,026 new cases of female genital mutilation in three months

There have been 4,989 FGM cases reported in the UK since September 2014. Photograph: Guardian

There have been 4,989 FGM cases reported in the UK since September 2014. Photograph: Guardian

Health and Social Care Information Centre figures show extent of illegal practice in UK, with 75% of FGM cases self-reported

More than 1,000 women and girls have been treated by the NHS in England for female genital mutilation in three months this year, according to figures that reveal the extent of the practice in the UK.

Between April and June, there were 1,026 newly recorded cases of FGM in England, latest figures from the Health and Social Care Information Centre show. Among the cases, there were nine girls under the age of 18.

Since the HSCIC started to record FGM data in September 2014, there have been 4,989 cases reported nationally. In the most recent tranche of data, 60 NHS trusts out of a total of 160 submitted data for one or more FGM attendances.

There is likely to be a spike in the number in the next recording period after recording FGM attendance became mandatory for acute trusts on 1 June 2015, and becomes mandatory for GP practices and mental health trusts from 1 October. Only one GP provided data for April to June.

The HSCIC found that, in 75% of newly recorded cases, women and girls themselves reported that they had suffered FGM, rather than it being reported by someone else. Among those who went to the NHS, 43 had undergone deinfibulation, or “reversal”, where the vagina is reopened after a large part of it has been sewn shut, in the most extreme form of mutilation.

Tackling FGM has risen up the political agenda since last year, after high-profile campaigns and international gatherings attracted public support. A Guardian petition saw the Department for Education write to schools about the dangers of FGM, while steps have been taken by the Department of Health and the Home Office to ensure cases are recorded and victims receive more support.

The new figures exposed the shocking extent of FGM in the UK, said Tanya Barron, CEO of global children’s charity Plan UK, which campaigns against FGM.

“We’ve seen hugely increased attention on this problem in the past few years and we are now waking up to the scale of this terrible practice,” she said.

“What we must always keep in mind, though, is that this is not specifically a British problem. FGM is a practice with an inherently global dimension. And while it’s vital that we do everything we can to stop FGM here in the UK, as well as to support the girls and women affected by it, the reality is that this practice won’t end in the UK until it is ended worldwide.”

Mary Wandia, FGM programme manager at Equality Now, an NGO that campaigns for women’s rights around the world, said survivors in the UK were still not getting the medical and psychological support they needed. “Our figures with City University London show that nearly 10,000 girls under 14 living in England or Wales are likely to have undergone FGM. Cases are likely to exist in every single local authority,” she said.

“Providing these girls and also the other tens of thousands of older girls and women with support, examinations and quick responses will help alleviate pain and distress. It will also help ensure that we end this extreme violence once and for all.”

FGM has been illegal in the UK since 1985, with the law being strengthened in 2003 to prevent children travelling from the UK to undergo FGM abroad, but there has yet to be a successful prosecution.

In February, the Crown Prosecution Service came under fire for prosecuting a doctor at Whittington hospital in London. He was found not guilty of performing FGM by suturing a patient to stop her bleeding after childbirth.

The World Health Organisation estimates up to 140 million girls and women have been subjected to FGM, a traditional practice designed to curb sexuality that involves the partial or total removal of the outer sexual organs. The procedure can cause lifelong physical and psychological complications such as stillbirth, the need for infant resuscitation and low birth weights. Babies born to women who have undergone FGM suffer a higher rate of death.

The practice is most common in the western, eastern and north-eastern regions of Africa, in some countries in Asia and the Middle East, and among migrants from these areas. In Africa, more than 3 million girls are estimated to be at risk from FGM annually.

First published on The Guardian website.


Company disclosure requirements under the 2015 Modern Slavery Act

UKModernSlaveryAct_TI2Commercial organisations subject to the 2015 Modern Slavery Act (‘the Act’) must report annually on the steps that they have taken during the financial year to ensure that slavery and human trafficking are not taking place in their own business or in their supply chains.

The Act applies to all organisations with a turnover, or group turnover – that is, the total turnover of a company and its subsidiaries –  of £36 million or more which are either incorporated in the UK or carry on a business in the UK.

Section 54 of the Act requires those organisations to prepare and publish a statement setting out the steps that they have taken during that financial year to ensure that slavery and human trafficking are not taking place:

  • anywhere in their supply chains;
  • in any part of their own business.

The law came into force on 29 October 2015. The requirement to publish an anti-slavery statement only applies for financial years ending on or after 31 March 2016.

There are draft Modern Slavery Act 2015 (Transparency in Supply Chains) Regulations 2015 which provide that the combined turnover of a commercial organisation is the turnover of that company and its subsidiaries.

Businesses should now be considering whether they are subject to these new disclosure requirements, and preparing their approach to compliance.

Which businesses are subject to the new requirements?

A commercial organisation is required to comply with the reporting requirements if:

  • it is incorporated or a partnership;
  • it “carries on a business, or part of a business” in the UK;
  • its turnover or the turnover of a parent company and its subsidiaries is equal to or greater than £36 million per annum – although this threshold is still to be formally confirmed by way of secondary legislation;
  • it supplies goods or services.

The term “carries on a business” is not defined in the Act, although this is the same wording as is used in the UK’s 2010 Bribery Act. Guidance issued by the Home Office suggests that a “common sense approach” should be applied to determine if a company carries on a business in the UK.

Overseas companies with subsidiaries in the UK will need to analyse whether the Act applies only to the UK subsidiaries or also to the overseas parent. Overseas organisations that supply goods or services to UK-based customers, but which do not have an office or employees in the UK, will also need to analyse the application of the  Act to their business.

What information needs to be included in the statement?

If a business falls within the above criteria, the obligation to publish an anti-slavery statement is mandatory. However, the content of this statement is not mandatory, and it would be acceptable for a business simply to state that it does not take any specific steps or that it follows the procedures of its parent company.

The Act contains a list of information that may be included within an organisation’s statement, as follows:

  • the organisation’s structure, its business and its supply chains;
  • its policies in relation to slavery and human trafficking;
  • its due diligence processes in relation to slavery and human trafficking in its business and supply chains;
  • the parts of its business and supply chains where there is a risk of slavery and human trafficking taking place, and the steps it has taken to assess and manage that risk;
  • its effectiveness in ensuring that slavery and human trafficking is not taking place in its business and supply chains, measured against such performance indicators as it considers appropriate;
  • the training about slavery and human trafficking available to its staff.

Further guidance from the Home Office on the scope of the requirement and the type of information to be included in the statement has now been issued.

Who must approve the statement?

If the organisation is a body corporate, then its anti-slavery statement must be approved by the board of directors (or equivalent managing body), and be signed by a director (or equivalent). If it is a partnership, the anti-slavery statement must be approved by the partners or members.

Where should the statement be published?

The anti-slavery statement must be published in a prominent location on the organisation’s website, with a link to the anti-slavery statement on the organisation’s homepage.

What are the sanctions for non-compliance?

Civil proceedings in the High Court for an injunction in England and Wales . In Scotland, civil proceedings for the Court of Session for specific performance.

First published on

Care Act 2014: Information gap ‘denying’ people sufficient choice and control over care

Photo by Gary Brigen

Photo by Gary Brigen

Campaigners claim ‘yawning gap’ exists between policy and practice as research suggests local authorities are struggling with some reforms

Local authorities are denying people sufficient “choice and control” over the care and support they receive under the Care Act 2014, according to research published last week.

A review of Care Act materials produced by local authorities found that councils “generally” failed to give people adequate information about their rights to different care options locally. The situation left people unable to exercise sufficient choice and control over their care, despite this being a core principle of the act itself, researchers found.

The study, carried out by the Independent Living Strategy Group and published by the charity In-Control, marks one of the first gauges of how the Care Act has been implemented since the legislation came into force on April 1.

The act places a duty on councils to provide information and advice for all people in their area. The statutory guidance underpinning the legislation states that this must include the choice of types of care and support, and the choice of care providers, available locally.

Under the legislation, all service users assessed as having eligible needs are entitled to a personal budget. But InControl’s review found that this entitlement was ‘rarely emphasised’ in quick guides to the Care Act produced by some councils.

Researchers also found evidence of some local authorities inferring that people opting to have their personal budget managed by the council would have less control over how it was spent than if they chose to receive a direct payment. The Care Act guidance states that the way a person opts to manage a personal budget should put “no constraint” on how their needs are met as long as “this is reasonable”.

Official figures show that in 2014-15 most people supported in the community by local authorities had a council-managed personal budget (57%) and just 24% received a direct payment. Among people aged over 65, 65% of community-based clients had a council-managed personal budget and 20% had a direct payment.

The researchers also asked people in receipt of care and support about their experiences of services over the year prior to the Care Act coming into force.

Of 399 people who responded to the survey, almost half felt their quality of life had reduced and almost a third (30%) said that they had experienced a reduction of choice and control. Some 29% reported restrictions being placed on their use of direct payments or personal budgets, with 14% limited to choosing their care from a shortlist of providers. The study authors said these limited lists are at odds with the “vision of personalised care” underpinning the Care Act.

The researchers acknowledged that councils were “struggling to adjust to unprecedented cuts” but said providing more choice and control to people should be embraced as a “much-needed solution” to the challenges facing social care.

Disability researcher Jenny Morris said there was a “yawning gap” between the principles of the act and how it was being implemented in practice.

“Personal budgets were supposed to enable everyone who needed social care support to have the kind of choice and control that was previously only open to those receiving direct payments. Instead, they have been rolled out in the context of a major financial crisis facing adult social care, and the result is not only a reduction in choice but also a decrease in the quality of people’s everyday lives,” she said.

“This is the government’s responsibility and they must act.”

In a bid to help local authorities meet their Care Act obligations, In-Control has produced a checklist of information for people receiving care and support.

The survey also provided an insight into the experiences of some people who had been supported by the Independent Living Fund prior to its closure in June of this year. Of the survey respondents who were transitioning from ILF to council support, 14.5% said they had been told they should expect less support in the future while most (56.5%) had not been told whether their support would change.


First published on Community Care website by Andy McNicoll.