Health Matters #3

Following the volcanic eruption in Iceland, health advice was issued by the Health Protection Agency (HPA), to assure people that the ash should not cause serious harm but could cause irritation, particularly to those with respiratory conditions.

A new screening programme to detect early warning signs of bowel cancer could cut the number of deaths linked

to the disease by 15%, the Health Minister has said. The programme, the first of its kind in Northern Ireland in 20 years and the first to be offered to men, will be rolled out across the province, starting in the Northern and Western Trust areas.

Thousands of young people in Northern Ireland risk developing early hearing loss as a result of

playing iPods too loud, a leading charity has warned. The Royal National Institute for the Deaf NI says listening to music on MP3 players at high volumes for prolonged periods of time is equivalent to listening to a power drill at close range.

A University of Ulster researcher has claimed, that special computer games could help stroke sufferers recover. The Games for Rehabilitation project focuses on rehabilitation of the upper limbs and involves the player using their hands and arms to touch targets which move around the screen. Their movements

A monthly overview of news and developments within the health sector in Northern Ireland.

Diary FocusAsitis Breakfast Forum

AssemblyHealth on the Hill

News Review

ProfileMichaela McAleerDirector of Investigations for Health and Social Care, NI Ombudsman’s Office

“The e-zine is

excellent!” Gillian Creevy,

Northern Ireland Cancer

Fund for Children

Issue 3May 2010

www.asitisconsulting.com

Welcome to the third edition of Health Matters

In this edition we have included a feature on Michaela McAleer who provides insight into her role as Director of Investigations for Health and Social Care for the NI Ombudsman. Michaela will also be the key speaker at our breakfast

forum, taking place on the 10th June. In our diary focus there is information

of health issues that have hit the headlines during April and in ‘Health on the Hill’ we have highlighted some of the key developments up at Stormont regarding health, which includes an election special.

We have provided information on some of our own health focused events including information on an upcoming seminar which will review the health service, one year on from the restructuring as a result of the RPA.

News Review

Northern Ireland’s premium public

relations and public affairs agency

PAGE 2 HEALTH MATTERS – May 2010

News Review (continued)

are tracked by a webcam and the game responds to their interaction, giving them positive feedback on their performance and engagement with the system. The design of the games and interface means people do not need to have played computer or video games in order to engage effectively with the system.

According to a news article in the Belfast Telegraph during April, children who require orthodontic treatment will soon have to meet strict new criteria to qualify for the treatment on the NHS under new government guidelines. The

British Dental Association (BDA) has stated that the overhaul of the current system — under which NHS orthodontic treatment is free — will mean all but the more severe cases will have to pay.

Scientists have criticised the Government for refusing to take action on the controversial chemical bisphenol A (BPA), widely used in baby bottles — even though other countries have begun bringing in

their own bans. There has been growing scientific evidence which suggests the chemical could inhibit brain development and lead to serious health issues. Most mainstream baby bottle manufacturers have already begun producing BPA-free lines, but an investigation has revealed how leading high-street retailers are still selling off older bottles containing the chemical.

The Times, have reported that migraine sufferers could ‘find relief in three aspirin tablets’. It said that researchers have suggested that one in four migraine sufferers could be pain-free within two hours if they take up to 1,000mg of aspirin in one go. The Cochrane review combined the results of 13 trials, which compared aspirin to placebo or another migraine drug. It found that, in studies comparing aspirin with placebo, 24% of people given aspirin were pain-free at two hours compared to 11% of people taking placebo.

“Had a quick look at the Health Matters publication - It’s short and snappy and pulls together quite a diverse range of issues. It’s easy to read with a user friendly layout.”

Breedagh Hughes, Royal College of Midwives

AsseMblyDespite the shake up of Assembly

committee positions resulting from the appointment of David Ford as Justice Minister and the creation of a new Justice Committee, Jim Wells remains in position as Chair of the Assembly Health and Social Services Committee with Michelle O’Neill continuing as Deputy-Chair.

After Easter recess, the committee returned to its scrutiny of the Safeguarding Board Northern Ireland (SBNI) with a briefing for departmental officials and evidence from the Voice of Young People in Care (VOYPIC).

DepArtMentAlThe Health Minister announced a new

screening programme to detect early warning signs of bowel cancer. In Northern Ireland, the programme will initially offer bowel screening to men and women aged 60 to 69. Four out of five people who develop bowel cancer are over 60. Bowel cancer kills over 400 people in Northern Ireland each year, and there are 1,000 new cases annually.

A new multi-million pound trauma and orthopaedic facility at Craigavon Area Hospital was official opened this month. The £9.4million trauma and orthopaedics unit is the final phase of a £15million investment project, designed to improve waiting times for fractures and orthopaedic services.

During MS Week it was announced that £50,000 of funding has been designated for the establishment of a regional network to boost neuro-physiotherapy services for patients suffering from conditions such as Multiple Sclerosis (MS).

The Department published details of cancer waiting times for October, November and December 2009. Waiting times for a first assessment with a breast cancer specialist saw 99.9% of patients receive their assessment within two weeks of referral. Targets of 98% of patients

commencing treatment within 31 days were met. However figures showed waiting times for treatment following an urgent GP referral for suspect cancer were below the 95% target.

The Department also published statistics relating to time spent in accident and emergency departments within Northern Ireland during the month of March 2010. The figures found that 79.8% of patients were either treated and discharged or admitted within four hours of their arrival in an A&E department during March 2010, compared to 82.1% in February 2010 and 80.4% in January 2010. 1,238 patients waited longer than 12 hours across all of the Trusts in March 2010, compared to 541 in February 2010 and 825 in January 2010. There were a total of 61,038 attendances at A&E Departments for the month of March, 2010 compared to 51,131 in February 2010 and 55,032 in January 2010.

reVIeWsThe Health Minister, Michael McGimpsey

announced plans for a comprehensive review of maternity services. Dr Paul Fogarty, Royal College of Obstetricians, and Professor Cathy Warwick, General Secretary of the Royal College of Midwives, have been invited to co-chair the review. It will consider the current provision, quality and safety of services for women at each stage of their pregnancy, including ante-natal care, delivery and post-natal care.

In the final count down to the results of the General Election, we compare the overall health pledges of the three main national parties. Additionally with Health issues devolved, we consider what priorities the local parties have raised during their campaigns.

ConservativesWith the polls showing a narrow

Conservative lead, the party has committed to increasing health spending in real terms every year to 2015. They also want to replace what they call ‘process’ targets, such as maximum time before seeing a cancer specialist, with ‘outcome’ targets, such as number of people dying from cancer.

The Tories have also pledged to ensure all hospitals [in England and Wales] become Foundation Trusts and that performance data is made available online. Under their plans they will also allow patients to choose any healthcare provider that meets NHS standards.

By implement a ‘payment for results’ system throughout NHS they will also link GPs’ pay to results and ensure that every patient can access a GP in their area between 8am and 8pm, seven days a week.

Other measures will include the introduction of a single phone number for every kind of urgent care; increasing the number of single rooms in hospitals and end mixed-sex wards; and provide access to an NHS dentist for one million more people. >>>cont. on Page 4

Health on the Hill

ELECTION SPECIAL

PAGE 3 HEALTH MATTERS – May 2010

Asitis Consulting can provide an in-depth weekly monitoring service for clients. Phone or email for

further details

“The e-zine looks really good” Bill Halliday, MindWise

PAGE 4 HEALTH MATTERS – May 2010

Under their plans retirees will be allowed to paying a one-off premium of £8,000 to prevent their homes from being sold to fund residential care.

Overall they hope to cut the cost of NHS administration by a third and create an independent NHS board.

labour Often considered the party of the ‘NHS’,

Labour pledges to protect ‘frontline’ NHS from spending cuts. They too will seek to ensure all hospitals become foundation trusts and pledge to allow successful foundation trusts to take over failing hospitals. They will give patients requiring elective care the legal right to choose from any provider who meets NHS standards of quality at NHS costs.

They continue their commitment to guarantee cancer patients will see a specialist within two weeks of diagnosis and get test results within one week, in addition to one-to-one dedicated nursing for all cancer patients

On waiting times they guarantee NHS patients the legal right to wait no longer than 18 weeks from the moment of GP referral to hospital treatment. They plan to offer everyone between 40 and 74 free, five-yearly NHS health check and ensure all patients have access to a GP practice in their area that is open at evenings and weekends.

Future commitments included the introduction of free and indefinite personal care for those in highest need from 2011; the establishment a “National Care Service” free at the point of use for all adults with an “eligible care need”, with funding arrangements decided by a Commission by 2015 and a commitment that elderly people’s care costs will be met after they have spent two years in residential care from 2014.

They will create a new national telephone number for non-emergency medical services and establish national standards of hospital infection control that get tougher every year.

liberal DemocratsHaving seen a huge swell in support in

the wake of the televised leaders debates the Liberal democrats plan to scrap Strategic Health Authorities in England and Wales and create democratically elected local health boards with power to prevent hospital closures.

They hope to reduce the number of health targets and introduce “patient contracts” specifying what patients can expect from NHS. They plan to make it easier to switch GP and allow patients to register at more than one practice and have committed to reforming NHS dental contracts to encourage dentists back into the NHS.

On social healthcare they will extend access to end-of-life services and hospices and establish an independent commission, with cross-party support, to develop proposals for long-term care of the elderly. They support more cost-effective purchasing of drugs, including greater use of generic drugs and a ban “below-cost” sale of alcohol and back minimum pricing “in principle”.

DUpThe largest Party in Northern Ireland has

pledged to increase investment in health promotion and disease prevention, and support the creation of a National Institute of Policy Evaluation to assess the cost-effectiveness of early intervention projects.

They support minimum pricing for alcohol and the extension of Winter Fuel Payment to cancer patients. They propose to outlaw smoking in cars with children and ban “junk food” adverts on television before the watershed.

They plan to give charities and other providers with a proven track record the opportunity to deliver health services and explore feasibility of giving those who are dissatisfied with their NHS treatment a “personal rebate” to seek alternative treatment from another trust or provider

They are committed in the long-term to the provision of universal free personal care for the elderly, but would consider, as an interim policy, publicly funding a substantial fixed proportion of domiciliary or care home costs, with the remaining percentage being paid for by the individual.

UCUAs the party with Ministerial

responsibility for Health under the devolved institutions, the Conservatives and Unionists have highlighted their track record in

improvements in the fight against hospital-acquired infection, the reduction in senior management numbers, establishment of the Patient and Client Council, introduction of free prescriptions and creation of Local Commissioning Groups.

As part of the Ulster Conservative and Unionist ‘new force’ they will seek to “Urge” increased health spending year-on-year in Northern Ireland in line with what is proposed in England by the Conservatives; increase the number of single rooms in hospitals, as resources allow; and strive for the introduction of a new dentistry contract.

sDlpThe SDLP have voiced their objection

to any potential health department budget cuts in Northern Ireland, and have vowed to ensure frontline NHS services are protected. They have also called for greater cooperation with Republic of Ireland on provision of health services.

sinn FeinSinn Fein have went a step further calling

on a creation of an all-Ireland health service that provides full equality of access, and that is free at the point of delivery as of right. It opposes cuts to frontline health services, and has endorsed greater investment in mental health services and an extension of winter fuel payment to cancer payments.

AllianceThe Alliance party voiced support for a

UK-wide commission to look into funding for social care, and want to address the structural underfunding of mental health services.

It is supportive or more cross-border co-operation with the Republic of Ireland on the provision of healthcare. Again it is committed to a free NHS that is free to all at the point of entry

tUVThe TUV are campaigning to ensure no

hospital is closed until there are the extra beds available in other hospitals equal to the numbers of beds to close, and that Northern Ireland NHS patients wait no longer than the rest of the UK for new treatments. It would also allow senior doctors to authorise transfer of patients to British mainland for treatment without seeking decision from health officials, and give a single “super-council” at Stormont control of health policy.

One simple, seldom used word can often make all the

difference in dealing effectively with complaints: it’s the five letter word, sorry.

That’s the view of Michaela McAleer, Director of Investigations for Health and Social Care at the office of the Northern Ireland Ombudsman.

“Never underestimate the power of an apology,” she says. “From time to time all organisations make mistakes; when we do we should face up to them. People do understand this and acknowledging an error can be the key to resolving a complaint.”

It has not taken Michaela long to become an important figure in how Northern Ireland’s health and social care bodies handle complaints. She was appointed to the post three years ago, after eight years in the sector.

She studied Social Psychology at the University of Ulster, and as part of her degree secured a work placement at the Northern Health Board in Ballymena. Her role involved carrying out a series of research projects, including a GP satisfaction survey.

Within weeks of graduating in 1999 she was back in the HPSS, filling the role of her former boss - Research Officer at the Board.

These were exciting times in the health service – and Michaela found herself right at the forefront of change.

“These days patients, the public and their needs are at the centre of decision-making, back then the Service was just starting on that journey – it was the beginning of serious engagement with the public by the health service. These days the service is much more inclusive and that is entirely to the good” she said.

Michaela strongly defends a group so often attacked by politicians - health service administrators.

She argues that their contribution to the development of the health service has been immense – though often unrecognised.

She said: “Take waiting lists for example. If you wanted a hip operation 5 years or so back you might have to wait 5 years or more – now you’ll have the operation within 6 months. This progress has been achieved by managers working in partnership with doctor and nurses

– a partnership based on mutual respect.”“That’s great progress. I do understand why

a lot of people in the Health Service don’t like targets – they say their work is about people and targets de-humanise this. But the evidence is that they work by allowing both the service and the public to measure progress and, in any event, what is the alternative?”

“If you want an effective and efficient health service you need top class management and organisation of services. It is fashionable to criticise management in the health service and argue you should cut out administrators but it is time that their important role was acknowledged.”

She argues that the more intense the services become with the inevitable faster turn-around time for patients in hospital, the more important it is to have effective organisation co-ordination and management of all the critical logistics that today make up an acute hospital service.

In 2002 she was promoted in the Northern Board to Consumer Services Manager, handling complaints and investigations. Her role also involved in developing patient and public engagement through focus groups

“It was great to be part of this innovative initiative“ she says, “the majority of people in the board at that time did not as a routine have the opportunity to meet the public – whilst for me it was a central part of my role to inter-act with patients and the general public”.

So what do people really think about the NHS. Michaela says that the general view is a very positive one: “Most people are very positive about their own interaction with the HPSS and are genuinely thankful that we have it.”

But she says that in terms of complaints the biggest problem can often be around poor communication rather than the quality of care or treatment.

She said: “We sometimes find that while we cannot identify any deficiencies in patient care, relatives or the patient themselves were never really effectively informed about their conditions – they are left to interpret events for themselves without the right information and this can sometimes lead to false assumptions and conclusions being drawn about their care.”

“Some of the problem is that staff do no prioritise this – the nature and pressure of the work is such that they sometimes do not feel that they have the time.

Also people have raised expectations there was a time when older people never used to complain – they had so much respect for medical professionals. Those days are gone and today the public are more likely to complain than ever before”.

Michaela took up her current role three years ago. The Ombudsman is the office of last resort for complaints about health and social care, and has significant authority, in relation to collecting evidence, even down to the power to subpoena witnesses. Workload for the office has doubled since April 2009 when the Independent Review Stage of the complaints procedure was abolished and replaced by a new one stage Health and Social Care complaints procedure.

So what advice would Michaela give to health professionals when they receive a complaint?

“Have the courage to deal with a complaint full-on. Investigate just once, but do it thoroughly”, she says. “Poorly investigated complaints are not good news they often ensure you generate two complaints out of one set of circumstances.”

“Apologise where it is warranted – and be prepared to admit mistakes – patients can accept this. We all need the space and scope to acknowledge we make mistakes.

But this does not apply to all complaints and complainants.

Public resources are more precious than ever. Everyone in the health and social care sector is being asked to make some hard choices about how they commit those resources to achieve the best outcomes. The time and money spent on complaints handling has never been collated but Michaela imagines if it were to be calculated it would turn out to be quite a substantial figure.

Michaela notes that for a very small number of complainants their sense of injustice may not be supported by the detail affecting their complaint or indeed by the efforts expended by the Health service in addressing those concerns. It is vital that the health service has effective policies and procedures in place for handling such situations to ensure that vital resources are not disproportionately depleted by a minority of individuals at the expense of others citizens who also have complaints they wish to have addressed in a timely and efficient manner.

Michaela McAleer – Director of Investigations for Health and Social Care, NI Ombudsman’s Office Profile

PAGE 5 HEALTH MATTERS – May 2010

“Apologise where it is warranted - and be prepared to admit mistakes... ”

PAGE 6 HEALTH MATTERS – May 2010

Alexander House,17a Ormeau Avenue, Belfast, BT2 8HD

T. 028 90 438 677 | F. 028 90 324 685 | [email protected]

The General Medical Council (GMC) has launched a consultation on revalidation for people within the health profession.

Revalidation is about providing further assurance that doctors in the UK are up to date and fit to practise medicine. The proposals set out a system which is designed to be flexible and relevant to doctors’ day-to-day practice and builds on processes that should already exist to support high quality care. The consultation poses 20 key questions for those affected in order to help shape the process.

Professor Peter Rubin, Chair of the General Medical Council said, “As doctors we are among the most trusted of all professionals. We have to ensure that this trust in doctors continues to be justified. For the past 150 years, the GMC has sought to provide assurance through the

registrar of medical practitioners. It remains one of the most robust and well used registers anywhere in the world, but it has always been a historical record of exams and qualifications, not of competence or performance. As such it offers a limited assurance about whether each of us is maintaining the high standards expected of us throughout our careers. Revalidation will plug this gap.”

“We want to hear from doctors, employers and patients across the UK in response to the consultation – we need to know the views of all those affected to ensure that revalidation works, and that it is proportionate and flexible to meet the needs of a busy and diverse workforce.”

The consultation runs until 4th June 2010 and full details can be found on the GMC website: www.gmc-uk.org/revalidation.

Asitis breakfast ForumMichaela McAleer the Director of Investigations for Health and Social Care at the Northern Ireland Ombudsman’s Office will be the speaker at our next breakfast seminar.

Michaela, who is the subject of our interview this month, will give a short talk about her work before answering questions and engaging in debate with our guests.

The session will be held at the Asitis offices on June 10 at 8.30 am sharp. There is no charge for attending, but numbers are strictly limited and we are expecting a high degree of interest. If you would like to attend please contact [email protected]

GMC Opens Consultation on Doctors ‘MOt’

Face2Face seminar: A Healthier service?The Health Service has undergone rapid and fundamental change as a result of the RPA. It created the Health and Social Care Board, Local Commissioning Groups, Public Health

Agency, the RQIA, Patient Client Council and the Business Services AgencyOne year on from the establishment of these bodies, and a structure designed to be more efficient

and effective, we re-convene to question how well these changes have bedded in - and if they are now delivering for patients.

Post election, we will also consider the potential prioritising of services that could result from an overall cut in public spending. Our panel of health experts will discuss the remedies and actions that can be taken to protect front line services, reduce dependencies on acute care and produce an integrated Health Service focused on prevention.

This seminar will take place in the Radisson Hotel, Belfast on 19th May 2010. Our line-up of expert speakers currently includes: • George O’Neill Chairman, Belfast Local Commissioning Group• Jim Wells MLA Chairman, NI Assembly Health Committee• Hugh McCaughey Chief Executive, South Eastern TrustAdditional speakers will be confirmed in the coming week and further information on this seminar

can be found on the Asitis Consulting website.

Diary Focus