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Expert Witness : Medico Legal

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

Claims against NHS up 18% and expected to soar

Stethoscope-2Government figures published in May show a dramatic increase in the number of medical negligence claims being made against the NHS and the health sector. According to statistics compiled by the Compensation Recovery Unit of the DWP the number of cases brought against the health sector in the year to March increased by 18% from 13,517 to 16,006.

Ian Pryer, senior partner at medical negligence solicitors Axiclaim, says NHS hospitals must now brace themselves for an “explosion” in medical negligence claims. In the wake of the Mid-Staffs hospital scandal, he believes publication of the Francis report has removed a mental barrier many victims may have had about claiming against the NHS.

Last Updated on Sunday, 09 June 2013 10:27

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College publishes its treatment plan for emergency medicine

Picture of an ambulance outside an emergency department for your Expert WitnessOn 15 May the College of Emergency Medicine published a comprehensive report into the state of emergency care systems in the UK and highlighted its view of the way forward.

In the report – The drive for quality – how to achieve safe, sustainable care in our emergency departments – experts in emergency medicine at the college have called for fundamental changes in the way we design, fund and run our emergency care systems. Ten recommendations are made across four domains that the college believes must be considered and adopted by national policy makers, commissioners, clinicians and trust boards in order to return systems to stability and deliver the quality of care patients expect when they seek help in an emergency.

The college states: “Emergency care systems…are facing their biggest challenge in well over a decade as they aim to cope with unsustainable workloads and a lack of sufficient numbers of middle-grade doctors and consultants in emergency medicine to deliver consistent quality care. Both the Care Quality Commission and NHS England have recognised the scale of the crisis and the need for urgent action.”

Last Updated on Wednesday, 15 May 2013 17:29

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Misdiagnosis leads to most medical claims, US study finds

Logo for John Hopkins Medical School for your Expert Witness storyResearchers studying 25 years of medical malpractice claims in the US found that diagnostic errors accounted for the largest number of claims. Diagnostic errors also caused the most severe patient harm and attracted the highest compensation payments –amounted to $38.8bn between 1986 and 2010. The research was carried out by a team from the Johns Hopkins University School of Medicine in Baltimore, Maryland, and was published online by the journal BMJ Quality and Safety.

The leader of the research, Prof David E Newman-Toker MD PhD, said: "This is more evidence that diagnostic errors could easily be the biggest patient safety and medical malpractice problem in the United States. There's a lot more harm associated with diagnostic errors than we imagined."

While the new study looked only at a subset of claims – those that resulted in a compensation payout for malpractice – the researchers estimated the number of patients suffering significant, permanent injury or death as a result of misdiagnosis ranges from 80,000 to 160,000 in the US annually.

Last Updated on Friday, 26 April 2013 14:37

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