Monday, April 29, 2013

Serco & Parliament: Health & Death!

The answer my friend is blowin' in the wind
The answer is blowin' in the wind.

©2013Am Ang Zhang
The National Audit Office (NAO) relases a memorandum on the provision of the out-of-hours GP service in Cornwall.

Statement from the Rt Hon Margaret Hodge MP, Chair of the Committee of Public Accounts: 
"When people need urgent assistance from a doctor but surgeries are shut, they turn to out-of-hours GP services. Serco’s performance in a £32million contract to provide out-of-hours care in Cornwall has fallen unacceptably short of essential standards of quality and safety.

"Although no evidence suggests that patients have received unsafe care, it is shocking that there were not enough people on the job.

"I find it disgraceful that Serco staff fiddled the figures on an astonishing 252 occasions between January and June 2012. This tampering presented a false, much rosier picture of its poor performance.

"In one instance, Serco falsely claimed that 100% of emergency callers received a face-to-face appointment within 60 minutes when in reality it was only 75%, falling short of the performance standard.

"It is simply not good enough that neither Serco nor the PCT detected these problems. Furthermore, I find it deeply troubling that while a whistleblower policy was in place, in practice, Serco’s working culture meant that people trying to raise the alarm felt fearful of doing so.

"As the appalling failures in Mid-Staffordshire demonstrated, it is essential that there are effective whistleblowing processes and the right culture across the whole of the NHS and its contractors.

"The lessons from this episode are clear. Serco needs to raise its game and demonstrate that it is accurate and honest in reporting its performance.

"The PCT and, from April, the clinical commissioning group need to monitor every heartbeat of Serco’s performance, be watchful for substandard service and take a firm line against poor performance. The PCT must be ready to penalise false reporting and services that fall short of essential standards.

"More generally, out-of-hours contracts must establish a strong link between quality and payment incentives."

·                                 NAO memorandum on the provision of the out‑of‑hours GP service in Cornwall (PDF PDF 442 KB)Opens in a new window
·                                 Public Accounts Committee

From an earlier post:

Every time there is a medical disaster, the management will try and bring 
in a new protocol in the belief that it will be enough to avert criticism. 
But wait: We as doctors already have our protocol and it is called medical training.

The one condition that most of us remembered as an emergency is acute appendicitis and even ourBare Foot Doctors knew about those.

One could hardly believe that a father was asked to be the Bare Foot Doctor!!!

The father of a six-year-old boy who died as a result of a burst appendix was asked to examine him in a Cornish hospital car park, an inquest was told.
Ethan Kerrigan's father Lee had taken him to Penrice Hospital's out-of-hours clinic in June last year after his son had been vomiting for several days.

So he was taken to A & E but why was Serco OOH involved?

In the early hours of 15 June, his father took him to Penrice Hospital in St Austell.
When he arrived he was told to phone out-of-hours service Serco, which he did from the hospital's car park, the inquest heard.

Could this be why? 

It is not difficult over the New Year period for anyone in the NHS to see how the internal market has continued to fragment our health service.

Look at major hospitals in England: Urgent Care Centres are set up and staffed by nurse practitioner, emergency nurse practitioners and GPs so that the charge by the Hospital Trusts (soon to be Foundation Trusts)  for some people who tried to attend A & E could be avoided. It is often a time wasting exercise and many patients still need to be referred to the “real” A & E thus wasting much valuable time for the critically ill patients and provided fodder for the tabloid press. And payment still had to be made. Currently it is around £77.00 a go. But wait for this, over the New Year some of these Centres would employ off duty A & E Juniors to work there to save some money that Trusts could have charged.

Triage: I now cringe when I hear the term:
On the phone, a triage nurse asked him (father )to examine Ethan's abdomen.

Mr Kerrigan and Ethan's mother, Theresa Commons, both told the inquest that the nurse had asked them to give him ibuprofen, a hot water bottle and make an appointment to see a GP the next day, saying there was nothing to worry about.
The next day, Ethan collapsed in the doctors' surgery in Roche and died later at the Royal Cornwall Hospital, near Truro, from acute gangrenous appendicitis.

It is such a tragic story and it happened in England!

In a statement, Serco said that the death was "a terrible tragedy".
It said: "Serco is committed to providing the highest quality of service to the NHS and the people of Cornwall and the Isles of Scilly, and like any responsible healthcare provider, we seek continuously to learn lessons and to improve how we work.

"Since then we have worked with the local NHS to develop enhanced protocols for handling illness in young children, and these have now been in place for some time".

But wait: this would be the very first clinical lesson from any decent medical school. Why is Serco allowed to continue?

But something is not making sense: in an NHS hospital when this happens, heads roll, but this is Serco and this was reported:

"Serco, which receives over 90% of its business from the public sector, paid Christopher Hyman an estimated £3,149,950 in 2010. This is six times more than the highest paid UK public servant and 11 times more than the highest-paid UK local authority CEO."                       The Guardian

No sign of any resignation!!!

Remember: The best money is Government money, our money. Cherie Blair knows too.

“The medical profession has not been allowed to do its job. The government has forced doctors to implement focus group predicated health care. Professional judgment is neither respected nor required. Doctors' morale is at an all time low. Medical care is now all protocols and process. Protocol driven medical care can be done by monkeys, and often is.”            NHS Blog Doctor.

Protocol unfortunately is there to protect the Serco staff and in turn Serco itself. It really has little to do with actual patient care!!!

Has Serco got a good record of providing GP services?

No. The company runs an out-of-hours GP service (OOH) in Cornwall. It won the contract in April 2006, undercutting local GPs by reducing staff, clinics and  cars. Since then, many people have had problems seeing a doctor in the  evenings and at weekends, and Cornish MPs have warned that patients’ lives  are being “put at risk”. Serco missed almost all of its targets, including emergencies and urgent home visits. Only 55% of emergencies received a visit within one hour in the peak holiday month of August 2006, and the service regularly failed to hit the 100% target for non-urgent cases that should be attended within 6 hours. It was even forced to fly in doctors from Eastern Europe because of a shortage of local GPs willing to work for the company.

One GP who resigned said that during a busy shift a non-medical supervisor “insisted” they leave a patient who was in a “potentially life-threatening situation” to go to the next appointment.

A private out-of-hours provider has found itself in hot water after it ‘overstated’ its performance on its national quality requirements, says a report by the Government’s public spending watchdog.
An internal investigation revealed by the National Audit Office found employees at Serco – which is contracted to deliver out-of-hours services in Cornwall until 2016 – had made 252 ‘unauthorised’ changes to performance data during a six-month period, which were innappropriate.
The NAO said as a result, Serco’s performance was improved, in one case changing what should have been a red rating into a green one.
The report - published earlier this month - said: Serco’s performance in meeting the national quality requirements for out-of-hours services was overstated in seven instances.
‘In five cases, performance should have been rated as amber (partially compliant with the requirements) but was reported as green (fully compliant).
‘In one case, performance should have been rated as red (not compliant) but was reported as amber. And in one case, performance should have been rated as red but was reported as green.’

How many deaths will it take till he knows

That too many people have died?

Bob Dylan   

No Serco for this doctor:

Witch Doctor Blowin’ in the Wind

Hearing of any death from appendicitis always brings back horrible memories to The Witch Doctor because her elder son some years ago had an acute gangrenous appendix with septicaemia followed by weeks of several complications any of which could have proved fatal. Fortunately, this young man’s mother was a doctor and well capable of being a belligerent one at that. As a result the consultant in charge was given an earful and within the hour had propelled her son into theatre instead of being sent home the day after admission as had been decided at the ward round.
Appendicitis is a serious disease if not managed promptly.
It cannot be accurately diagnosed by telephone.

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