Monthly Archives: August 2006

Flaws found in NHS child services

 
Sick child
Millions of children are treated in hospital each year.
Many NHS trusts have significant flaws in the service they provide for children, a report finds.

The Healthcare Commission found that overall the quality of child services in NHS hospitals in England was good.

But day care and emergency care were both found lacking in 28% of trusts, and outpatient care was rated as weak in 46% of trusts.

The commission was assessing progress towards implementing national standards in 157 hospitals across England.

“Children’s healthcare is very distinct, it has real needs of its own and is not the same as adult care”
Anna Walker
Healthcare Commission

The standards were set out in the government’s 10-year National Service Framework for Children and Young People, launched in 2003.

Among the key recommendations were that children should be treated in a child-specific and child-friendly environment, and sufficient staff should be trained in the care of children.

Overall, a quarter of trusts assessed received a rating of “excellent” or “good”, 70% were rated as “fair” and only one in 20 was rated as “weak”.

Problem areas

However, the commission found problems in a significant number of trusts when it considered individual departments in isolation.

Outpatient services had the greatest room for improvement, with many trusts having particular problems providing sufficient staff cover with the right expertise, such as children’s nurses.

The same problem was found in many A&E departments, where many trusts also struggled to provide child-friendly environments, often forcing children to use facilities open to all ages.

This is despite the fact that up to 25% of the child population – around 2.5m children – are seen each year in A&E departments.

In addition, 28% of trusts scored “weak” on training for staff in emergency surgery, and 22% of trusts scored “weak” in elective surgery. None scored good or excellent in either category.

In contrast, 71% of trusts scored “good” or “excellent” for in-patient services, which were most likely to have appropriate staff cover and training, and where children were most likely to be treated in child-only wards.

Distinct skills

Anna Walker, the commission’s chief executive, said: “Some of the findings in this review are very encouraging, especially the “excellent” and “good” scores of so many hospitals and the success of inpatient wards in providing child focused healthcare.

“However, the problem areas seem to be accident and emergency, and outpatient services. More skills in dealing with children are needed here.

“Children’s healthcare is very distinct. It has real needs of its own and is not the same as adult care.”

The commission has sent detailed reports to every trust it assessed, and is working on action plans for those where performance was weakest.

The review of children’s services is the first of four assessments which will form part of the commission’s new system for assessing NHS performance.

Dr Sheila Shribman, the “Children’s Tsar”, said the results were encouraging, but there was still room for improvement.

“Although only 5% of trusts were rated as weak, we shall also be looking to the 70% of trusts rated as fair to see where standards can be further improved – to rate good and excellent,” she said.

Ive begun my

    Rhona and I began out Community Mothers Training today.

At the end of our course we are going to be trained to help support
mums in hospital and out in the wider community to breastfeed. The
funding for this has come from a need in our area of Scotland for this
support. Midwives are really struggling due to a shortage, and the
breastfeeding rate at 6 weeks is only 25%.

The first night was really interesting. We discussed what we already
knew about feeding and found out how it really benefits mum and
baby.

We also talked about our own personal breastfeeding experiences.

Most women decide whether they are going to try to breastfeed quite
early on in life- even before they meet their partners or contemplate
children! This was true for me. I always knew that breastfeeding
was best for babies and always knew I would try to do it. But, when
I had my wee boy 4 years ago I didn’t realise how hard it would be.
I wasn’t sure how to latch him on properly, I had little support from
my midwife, and although my mum had breastfed, it was so long ago
her advice meant well but wasn’t helpful. Thank goodness for my
friend who had breastfed. She was such a support, fountain of
knowledge and a lifeline! She advised me to go along to my local
breastfeeding support group.

The group helped me to understand why my baby seemed to be
feeding all the time, and the health visitors there showed me how to
latch my baby on properly. Instead of soaking my nipples the baby
should take the lots of the pink bit around the nipple into it’s mouth.
They showed me how to aim my nipple to the nose of the baby so
that it’s mouth opened wide.

I found out that I’d know if the baby was taking a proper full feed by
noticing how the baby sucks. At first the baby will suck quickly to get
the milk flowing and then that’ll be followed by longer sucks. If you
listen closely at this bit you can actually hear the milk going down!
At the end of the feed the baby will return to small “butterfly” fluttery
sooks.

I didn’t realise that milk changes every few weeks at first to suit the
needs of baby! When the baby is in the womb it is getting all the
nutrients it needs to develop- and a mum’s body helps maintain the
nutrients and immunity requirements of the baby in the big bad world
through breastfeeding.

If it wasn’t for the support and education I received through the
group and my friend I wouldn’t have maintained my breastfeeding.

They encouraged and were a shoulder to cry on- even through
mastitis attacks, cracked nippled and exhausting growth spurt days
when the baby seemed to be constantly feeding. And I got through it
to the point where feeding was so convenient! No bottles to wash
and sterilise (unless, of course I was going on a wee night out or
day trip!) During the night when my baby woke up distressed from
teething or a wee bad dream I could cuddle baby close and comfort
with some milk without the trailing downstairs to warm a bottle. Also
lovely hormones are released that help mum drift back to sleep with
ease!

it’s good to know that I have reduced my baby’s risk of ear
infections, asthma, eczema, gastric problems, obesity and diabetes.
And that’s why I have sighed up to be a community mum. I know
how hard it can be to maintain breastfeeding, how much
misinformation is out there and how much support and the right
advice and education can help.       

Met my Midwife today

Well my midwife came round for the first visit today and she is lovely.

She is going to ring me in the next couple of days and give me my scan date but she said it should be next week. The Hospital over here is quieter than the one I was in in the UK last year.

The other piece of news which was quite exciting is that I get more scans over here as standard. Because of the way the Germans do things every anti-natal appointment I have at the hospital, which apparently is where I go rather than the doctors, I will have a scan.

I have a German friend who is pregnant at the moment, she is 14 weeks and because she is totally on the German system she has had 3 or 4 scans already, she has one every time she goes to the doctors. Also at 22 weeks as standard she will have a 3D scan, then again they do pay for their health care, quite a bit each month as well.

I won’t get the 3D scan and obviously haven’t had any early scans because I am still on the British system but using a German hospital, very confusing. I’m glad anyway because I don’t want to know what we are having (something else they tell you as standard) so I have to be sure to tell them I don’t want to know at every scan rather than asking if they can tell me… LOL

Anyway, I shall stop waffling LOL. Hope everyone else pregnancies are going well.

    

Call for fertility ban for obese

 
Image of a baby
Many NHS trusts take obesity into account over access to fertility therapy.
Very obese women should be denied fertility treatment, experts say.

The British Fertility Society is recommending women with a body mass index of 36 and over should not be allowed access to fertility treatment.

Underweight women and those classed just as obese (BMI over 29) should be forced to address their weight before starting treatment, the society said.

NHS guidelines say overweight women should be warned of the health risks, but do not impose any ban on treatment.

Being overweight can put both the health of the mother and child at risk through problems such as gestational diabetes and high blood pressure.

“Obese women are less likely to get pregnant and more likely to encounter health problems”
Richard Kennedy, of the British Fertility Society.

 
 

In reality, many primary care trusts do not fund women who are obese.

Richard Kennedy, of the BFS, said: “The NHS is already stopping women who are obese from having fertility treatment.

“What we are saying is that they should be less stringent and more consistent with how they apply this.

“Obese women are less likely to get pregnant and more likely to encounter health problems. It makes sense to address obesity before seeking fertility treatment.”

The BFS, which represents health fertility professionals, also recommended single women and same sex couples be given the same priority as heterosexual couples.

At the moment, the NHS is duty bound to take the welfare of the child into account, including the need for a father.

The BFS said the welfare of the child should still be taken into account, but single women and same sex couples should not be automatically denied treatment as they often are.

Cycles

NHS guidelines say women aged 23 to 39 should be entitled to three cycles of IVF, although the government gave the health service a deadline of April last year to provide one cycle with a view to working towards three.

The society made its recommendations after surveying 64 fertility clinics in England and Wales.

It received responses from 37, showing one in 10 was not providing IVF treatment free on the NHS because they were not being given funding by the local PCTs.

None of the clinics was providing three cycles, the poll, which will be published in the Human Fertility journal in September, said.

The poll also showed many of the PCTs which did provide IVF treatment were restricting access by taking social factors into account.

These included barring people from treatment if one of the partners already had a child from a previous relationship or because the couple had paid for private treatment before going to the NHS.

And it also revealed a quarter of clinics were also restricting treatment according to age, with most only allowing women in their late 30s to have IVF.

The Department of Health said that, while it did not support bans being imposed, the current NHS guidelines were broadly in line with the recommendations on obesity.

A spokeswoman added: “Primary responsibility for implementing NICE guidelines, including the rate of implementation, rests with the NHS at local level and we have made it clear that we expect these guidelines to be followed.”

She said the government was working with patient group Infertility Network UK to ensure PCTs listened to the views of patients.

Strange red sore near section scar

    Faint hearted and squeamish people, please turn away now!

I have a red, sore area on the right of my c-section scar. It started to hurt a bit yesterday, but I thought it was because I was hot and a little sweaty! This morning, its bright red and quite shiny. There’s a little area that is oval in shape and is bright red and looks almost like hole.

I’ve washed and dried it and I’ve put sudocrem on this morning to see if that helps. Being a larger lady, I have a overhang of a stomach that probably isn’t helping as it does rub sometimes. This is gross, but after I’d had Ella and needed to air the scar, I used to walk round holding my tummy up to let the air in!

Has anyone had anything similar? Its looks quite angry, but its clean – there’s no sign of any discharge or puss (told you to look away!). Its not as sore now I’ve put the sudocrem on.

Any ideas?

Bed Wetting at 6 years old

Im posting this on behalf of my sister, my nephew is 6 and has for the last 9 weeks been wetting the bed.  He was late at potty training and eventually stopped wearing a nappy to bed just after his 4th birthday. 

He gets put on the toilet every night just before my sister goes to bed but he still wets the bed.

She has cut out all his juice at night and limits what he has in the day, neither his routine has changed nor has anything happened to explain why he has started bed wetting.  She has even asked if he’s having bad dreams but he says he hasn’t

Has anyone got any idea’s?, as my sister is getting quite fustrated now

Tea ‘healthier’ drink than water

 
Image of a mug of tea
The researchers recommend people consume three to four cups a day.
Drinking three or more cups of tea a day is as good for you as drinking plenty of water and may even have extra health benefits, say researchers.

The work in the European Journal of Clinical Nutrition dispels the common belief that tea dehydrates.

Tea not only rehydrates as well as water does, but it can also protect against heart disease and some cancers, UK nutritionists found.

Experts believe flavonoids are the key ingredient in tea that promote health.

Healthy cuppa

These polyphenol antioxidants are found in many foods and plants, including tea leaves, and have been shown to help prevent cell damage.

“Tea replaces fluids and contains antioxidants so its got two things going for it”
Lead author Dr Ruxton

Public health nutritionist Dr Carrie Ruxton, and colleagues at Kings College London, looked at published studies on the health effects of tea consumption.

They found clear evidence that drinking three to four cups of tea a day can cut the chances of having a heart attack.

Some studies suggested tea consumption protected against cancer, although this effect was less clear-cut.

Other health benefits seen included protection against tooth plaque and potentially tooth decay, plus bone strengthening.

Dr Ruxton said: “Drinking tea is actually better for you than drinking water. Water is essentially replacing fluid. Tea replaces fluids and contains antioxidants so its got two things going for it.”

Rehydrating

She said it was an urban myth that tea is dehydrating.

“Studies on caffeine have found very high doses dehydrate and everyone assumes that caffeine-containing beverages dehydrate. But even if you had a really, really strong cup of tea or coffee, which is quite hard to make, you would still have a net gain of fluid.

“Also, a cup of tea contains fluoride, which is good for the teeth,” she added.

There was no evidence that tea consumption was harmful to health. However, research suggests that tea can impair the body’s ability to absorb iron from food, meaning people at risk of anaemia should avoid drinking tea around mealtimes.

“Tea is not dehydrating. It is a healthy drink”
Claire Williamson of the British Nutrition Foundation

Dr Ruxton’s team found average tea consumption was just under three cups per day.

She said the increasing popularity of soft drinks meant many people were not drinking as much tea as before.

“Tea drinking is most common in older people, the 40 plus age range. In older people, tea sometimes made up about 70% of fluid intake so it is a really important contributor,” she said.

Claire Williamson of the British Nutrition Foundation said: “Studies in the laboratory have shown potential health benefits.

“The evidence in humans is not as strong and more studies need to be done. But there are definite potential health benefits from the polyphenols in terms of reducing the risk of diseases such as heart disease and cancers.

“In terms of fluid intake, we recommend 1.5-2 litres per day and that can include tea. Tea is not dehydrating. It is a healthy drink.”

The Tea Council provided funding for the work. Dr Ruxton stressed that the work was independent.

Did anyone have a high risk pregnancy?

When I was pregnant, I was classed as low risk as I suspect most people are. That was until my blood pressure started to play up and then I became high risk. I’ve been told that next time, I’ll be high risk from the start due to the blood pressure problems, polyhydramneos and the emergency section.

I just wondered what other factors can make you high risk and what peoples experiences are of being high risk?

Trust cuts teen pregnancy rates

 
A health trust, which backed a decision to administer a contraceptive jab to a girl in a McDonald’s toilet, has cut teenage pregnancies by over 20%.

Figures published by the Department for Education and Skills (DfES) showed Gateshead Primary Care Trust made the reductions over six years.

In September 2005 nurse Angela Star gave the injection in McDonald’s as part of a scheme to engage teenagers.

At the time, the company called the practice “completely inappropriate”.

In 2005, Bob Smith, chief executive of Gateshead Primary Care Trust, said Mrs Star was successfully attempting to connect with girls who would otherwise not seek help.

Statistics published by the DfES Teenage Pregnancy Unit showed that in Gateshead in 1998, 57.1 girls aged 15-17 per 1,000 conceived, which by 2004 had dropped to 44.5 per 1,000.

The trust said it is in the top 20 authorities in England who have seen the biggest decrease in the numbers of teenage pregnancies.

Vulnerable groups

It was invited to share its methods with the rest of the country in the Teenage Pregnancy Next Steps’ guide published in July.

Barbara Convery, teenage pregnancy co-ordinator at Gateshead Council, said: “We offer judgement-free, confidential advice and support through our young people’s clinics and also through outreach workers.

“I believe we are unique in the country because we have an equal and sometimes greater number of young men using our clinics than young women.”

The trust has specialist workers targeting the vulnerable groups and, unusually, it employs a dedicated sexual health worker for children in care.

Nationally, there has been a drop of 11% in under-18 conceptions since 1998.