Serco may face fines over Suffolk NHS contract

Serco's care co-ordination centre in Ipswich provides a central point for patient referrals

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Serco may face fines over its community health service in Suffolk after NHS commissioners found it was failing to meet key targets.

The multinational private company took on the £140m contract to run community health services in Suffolk last autumn.

It has been issued with a "performance notice" and a review into patient safety issues has been launched.

The company says there has been a period of transition but insists it is delivering a high level of care.

Serco is one of the companies bidding for NHS contracts, worth £6bn, currently out to tender in England.

According to unpublished figures seen by the BBC, Serco's community intervention teams are failing to meet urgent four-hour response targets - for nurses and therapists to reach patients at home.

It was also failing to meet non-emergency 72-hour targets.

The report, by clinical commissioners in Suffolk, also reveals delays in producing care plans for palliative patients and carrying out health assessments for children in care.

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There are areas where the staff levels aren't as we'd like them to be”

Julian HerbertChief officer of Suffolk Clinical Commissioning Groups

The commissioners have raised a contract query and issued Serco with a performance notice. A quality review is also under way into "potential patient safety issues", including training, staff capacity and workloads.

The chief officer of the East and West Suffolk Clinical Commissioning Groups, Julian Herbert, says Serco has until the end of the year to meet the eight performance targets, or face fines in early 2014.

"Some of Serco's speed of response is not as we'd like. And we've picked up areas about care leader availability and care plans being in place," he said.

"There are areas where the staff levels aren't as we'd like them to be. Serco is looking to resolve those. It gives Serco a chance to put things right.

"If they aren't put right, we then get to the point where we start financially penalising them, by taking money away from them if they don't deliver," he added.

The commissioners say they are generally satisfied with the service and are working with Serco on a remedial action plan.

The BBC has heard concerns from some nurses working for Serco that staffing shortages mean some community intervention teams in Suffolk don't have cover at night, resulting in some patients being admitted to hospital.

Sharon Colclough, director of community services for Serco Health, says while there are some staff vacancies, the community teams are delivering a high level of care.

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"Some teams have some vacancies and we are giving them additional support at this moment, but every service is delivering the kind of care that we expect them to. We are recruiting two posts now and we're supporting staff as much as we can.

"We're coming out of six months of transition and we're trying to embed the changes. I'm not saying that we have got it perfectly right but we are absolutely committed to getting it right," she said.

Serco has invested £4m in the service, including new computer systems and a 24-hour care co-ordination centre in Ipswich which provides a central point for all patient referrals.

Serco signed a deal to run Suffolk Community Health for three years for £140m.

This was £10m less than the former NHS trust's best price. Serco has made a loss in the first year, and has told the BBC it doesn't expect to make a profit during the life of the contract.

Serco is also bidding for the biggest contract in the history of the NHS. It is one of nine providers shortlisted for a five-year, £800m contract to provide older people's services in Cambridgeshire. The winner of that tender will be announced next summer.

Across England, 160 NHS contracts worth a total of £6bn are currently out to tender.

(Credit; BBC; By Jane Deith)

Union claims nursing hit by 'hidden workforce crisis'.

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NHS trusts trying to recruit more nurses in the wake of the Mid Staffs scandal may struggle, a nursing union is warning.

The Royal College of Nursing (RCN) says there are nearly 20,000 unfilled posts in England.

And it says more than a fifth of trusts are recruiting nurses from abroad.

The government says staffing levels have improved - there are now over 1,350 more qualified nurses, midwives and health visitors than a year ago.

The RCN sent requests under the Freedom of Information Act to all acute, mental health and community NHS trusts in England as part of its three-year-old Frontline First campaign against job cuts.

Some 61 organisations replied - representing a response rate of 24%.

The trusts who responded had an average vacancy rate of 6% - though in some trusts this was as high as 16%.

The union believes this constitutes "a hidden workforce crisis".

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Unsafe staffing levels have been implicated in a number of high profile investigations into patient safety”

Dr Peter CarterRCN chief executive and general secretary

The RCN asked for the data because the government stopped collecting it in 2011. The last available figures showed a vacancy rate of 2.5%.

More trusts - 140 - answered questions about overseas recruitment. These replies showed 22% were recruiting nurses from abroad, while a further 9% were considering the possibility.

Earlier this year an inquiry highlighted the "appalling and unnecessary suffering of hundreds of people" at Stafford Hospital in Staffordshire.

The Francis report found systemic failures that went right to the top of the NHS in England.

On Tuesday the RCN's head of policy, Howard Catton, said: "In recent months we've seen the 'Francis effect' after the report into Stafford Hospital, with some trusts unfreezing posts that were vacant.

"But when they've gone to the market to try to recruit staff, they've found it difficult. This is because there's been a cut in the number of nursing student places.

"And overseas recruitment is more difficult, because there's a shortage of many thousands of nurses across the EU."

Official figures show 5,870 nursing posts have been lost in England since 2010.

Autumn response

Dr Peter Carter, chief executive and general secretary of the RCN, said: "Unsafe staffing levels have been implicated in a number of high profile investigations into patient safety.

"We call on employers in the NHS to put an end to boom-and-bust workforce planning and develop clear standards to ensure safe staffing levels are met, supported by robust inspection based on reliable data."

Health Minister Norman Lamb said: "Nursing leaders have been clear that hospitals should publish staffing details and the evidence to show the numbers are right for the services they deliver.

"Patient-safety experts agree that safe staff-patient ratios should be set locally.

"We will be announcing more on our plans to guide staffing decisions in our full response to the Francis report later this autumn.

"Overall, the number of clinical staff in the NHS has increased by nearly 4,100 and the number of admin staff has fallen by 22,800.

"The chief inspector of hospitals will be able to take action if trusts are found to be compromising patient care by not having the right number of staff on wards."

Jane Cummings, Chief Nursing Officer for England, said a growing number of Trusts were reviewing and increasing their nurse staffing levels to meet local patient need.

Shadow health secretary Andy Burnham said: "David Cameron is making matters worse. We should be bringing on the next generation of British nurses, but he's cutting trainee nurse posts whilst wasting money on overseas recruitment."

The organisation NHS Employers said the figures needed to be seen in the context of the 347,000 qualified nurses working in the NHS every day. Every month the NHS recruits around 10,000 staff through natural turnover, it said.

(Credit; BBC By Jane Dreaper)

Vaccination campaign against polio, other diseases begins in Mideast.

Health officials announced Friday a campaign to vaccinate more than 20 million children against polio and other diseases across much of the Middle East.

"The headline is the Middle East is reinfected," said Dr. Bruce Aylward, the World Health 

Organization's assistant director-general for polio, emergencies and country collaboration.

The announcement, by WHO and UNICEF, comes a week after an outbreak of polio was confirmed in Syria for the first time since 1999. Ten children have been left paralyzed, and hundreds of thousands are at risk.

Given that the virus paralyzes anywhere from 1 in 200 to 1 in 1,000 of the people it infects, "that means you've got probably thousands infected," Aylward told CNN in a telephone interview.

"So, if you do a campaign to respond, it would have to cover basically all of Syria."

Most of the victims are younger than 2 years of age, born since violence erupted in March 2011, wracking the country and shredding its once-robust public health infrastructure.

"We will expect to see more cases, certainly in Syria if not in surrounding countries," Sonia Bari, a spokeswoman for polio eradication for WHO, said in a telephone interview.

Syria's immunization rates have dropped from more than 90% before the conflict began in March 2011 to 68% now, the United Nations Office for the Coordination of Humanitarian Affairs, or OCHA, said Friday in a prepared statement.

Already, more than 650,000 children in Syria have been vaccinated, including 116,000 in the northeast province of Deir Ezzor, where the outbreak was confirmed, the OCHA statement said.

The campaign also will target Egypt, Iraq, Jordan, Lebanon, Turkey, and the West Bank and Gaza.

Over the past year, the virus has been discovered in sewage samples from Egypt, Israel, the West Bank and Gaza, a region that has not seen polio cases for nearly a decade, it said. Transmission of the virus occurs through close person-to-person contact and consumption of food or drink contaminated with feces.

"Preliminary evidence indicates that the poliovirus is of Pakistani origin and is similar to the strain detected in Egypt, Israel, the West Bank and Gaza Strip," the OCHA statement said.

Pakistan is one of three countries -- the others are Nigeria and Afghanistan -- where polio remains endemic.

But Aylward said health officials have a good chance of halting its spread in Syria, where 1.6 million children are to be vaccinated against not only polio, but against measles, mumps and rubella.

"They have a great history of vaccination in Syria; the immunity gap is in a relatively small part of the population," he said.

In addition, the region is entering its cool season, when transmission would typically slow, he said.

Aylward said he met last week with Syria's minister of health and was impressed by the response. "Everybody's playing ball," he said.

But it's a dangerous game. "The virus is unforgiving -- both what it does to kids and what it does to epidemiologists trying to stop it," he said.

Over the past few days, more than 18,000 children at Zaatari refugee camp in Jordan have been vaccinated, with a national goal of reaching 3.5 million people.

Vaccinations have also begun in western Iraq, with more planned for the Kurdistan Region in the north in coming days.

And the campaign is slated to begin this week across Lebanon, and in Turkey and Egypt by the middle of this month.

Though there is no cure for polio, it can be prevented through vaccination, which is credited with slashing cases around the world by more than 99% since 1988.

(Credit; CNN)

Heart attack risk identified by new scan.

A new way of scanning the heart can identify those who may be at high risk of a heart attack, early tests suggest.

It can identify dangerous plaques in the arteries which nourish the heart. If a fatty plaque ruptures, it can lead to a clot, blocking the flow of blood.

Scientists at the University of Edinburgh said an effective tool for predicting a heart attack would make a "massive difference" to patients.

Experts said it was an exciting start.

More than 100,000 people have a heart attack in the UK each year and disease of the arteries around the heart is the leading cause of deathin the world.

Light up

The researchers used a radioactive tracer which can seek out active and dangerous plaques. This was combined with high resolution images of the heart and blood vessels.

The overall effect is a detailed picture of the heart with the danger zones clearly highlighted. The technology is already used to detect tumours in cancer patients.

The first tests of the technique for danger spots in the heart were on 40 patients who had recently had a heart attack.

The scan highlighted the plaque which caused the heart attack in 37 of the patients according to a study published in the Lancet medical journal.

It is the first time a scan has been able to identify danger zones but further tests are needed to see if detecting dangerous plaques before, rather than after, a heart attack has the potential to save lives.

"I suspect not all plaques detected will cause a heart attack, but it could be useful for identifying high risk patients who need aggressive therapy," cardiologist Dr Marc Dweck told the BBC.

This could include drugs such as statins or aspirin, drastic lifestyle change or even inserting stents into the arteries to keep them open.

The scan shows a cross-section of the heart and the high risk plaque in orange

'Massive difference'

The researchers will look at high risk patients, including those about to have surgery, to see if the scan can save lives.

Dr Dweck said if this scan or similar ones proved successful it would make a "massive difference".

He said: "Heart attacks are the biggest killer in the Western world and there is no prior warning, the first time people know about heart disease is when they have a heart attack.

"If we can treat and stabilise the plaques then we might be able to prevent heart attacks and stop people dying."

Prof Peter Weissberg, the medical director of the British Heart Foundation, said: "Being able to identify dangerous fatty plaques likely to cause a heart attack is something that conventional heart tests can't do.

"This research suggests that PET-CT scanning may provide an answer - identifying 'ticking time bomb' patients at risk of a heart attack.

"We now need to confirm these findings, and then understand how best to use new tests like this in the clinic to benefit heart patients."

Prof Andrew Morris, the chief scientist for health in Scotland, said: "These are exciting data - being able to prospectively identify patients at the highest risk of a heart attack and provide treatment to prevent this would be a significant step forward."

(Credit; BBC News)

Europe at 'polio risk' from Syria.

Europe could be at risk from polio following a recent outbreak in Syria, infectious disease experts say.

In the Lancet journal, two doctors in Germany say the cases in Syria - which had been free of wild poliovirus since 1999 - could endanger nearby regions.

BBC News go on to report, they say because only one in 200 people infected develops paralysis it could take a year of "silent transmission" before an outbreak is detected.

In that time hundreds of individuals could be carrying the infection.

Prof Martin Eichner, of the University of Tubingen and Stefan Brockmann, of Reutlingen Regional Public Health Office explain that most European countries use inactivated polio vaccine (IPV) rather than the live oral polio vaccine (OPV), because the latter can, in rare cases, lead to cases of acute flaccid paralysis, the main symptom of polio.

Threat

Whilst IPV is highly effective at preventing polio disease, it does not give the same level of protection against the virus as the oral drops, so vaccination coverage needs to be very high. The doctors say that countries with low coverage such as Austria (83%) and Ukraine (74%) risk a sustained outbreak should the virus be introduced via refugees fleeing Syria. Polio vaccine coverage in the UK is at 95%.

The doctors said Israel could also pose a potential polio threat.

Prof Eichner told me: "Wild poliovirus has also been found in sewage in Israel and from samples taken from some symptom-free individuals since February 2013. Although there have been no cases of polio in Israel, tourists could risk bringing the infection to other countries."

Dr Benjamin Neuman, a virologist at the University of Reading, said: "The Syrian outbreak puts Europe at risk because of the way we give vaccines. In parts of the world where it is still possible to catch a wild strain of poliovirus, children are usually vaccinated with a live but genetically weakened poliovirus which gives excellent protection but has a tiny risk of changing back to the more dangerous form.

"However, in parts of the world where polio has been eradicated, like the UK, children are usually given a killed vaccine. It doesn't protect quite as well but it cannot mutate, so it protects reasonably well while preventing polio from being accidentally reintroduced to a country.

He added: "Vaccination is never perfect, so despite being vaccinated, a small percentage of children in the UK would be at risk of contracting polio if they were exposed to the virus. Until the virus is completely extinct, it is essential that we continue to vaccinate our children."

'Invisible enemy'

Most of the 22 cases of polio-like paralysis in Syria (10 of which have been confirmed as wild poliovirus type) are among children below the age of two who were unimmunised or who had not received all three doses of vaccine.

The World Health Organization warned last month there was a high risk of polio spreading internationally because of the movement of refugees across the region and low immunisation rates in Syria.

Prof Eichner said: "The WHO wants to get rid of polio completely and had got pretty close until recent outbreaks. The fact that most of those infected do not display symptoms but can still spread the disease makes it a very hard virus to get rid of as it is like fighting an invisible enemy."

So far this year 322 cases of wild poliovirus have been confirmed, more than half of them in Somalia.