Action plan after hospital death

Trust Medical Director Tony Stevens said a full investigation was under way

"I have no reason to believe a person died alone. What we are looking into is whether a particular patient received the level of care that is required."

Dr Stevens said the quality of care given by doctors and nurses was not a concern, nor was it about a problem with triage - where patients are seen initially for an assessment about the urgency of treatment needed. He said he was satisfied that a safe system was in place.

"We are focused on patients and we are delivering the best care," he said.

"But we came under sustained pressure last week which required our staff to work incredibly hard over a long period of time."

The trust director said it was focusing on getting people through A&E as quickly as possible and encouraging people who could get help from GPs not to come to the hospital.

"The key going forward is to ensure that we minimise the number of people who need to come to hospital," he said.

Director of the Royal College of Nursing NI Janice Smyth said fundamental reform of the health system in Northern Ireland was needed. She said too many people were turning up in hospitals because not enough services were available in the community.

She added that nursing staff's professional judgement was being compromised because of the volume of work they were being expected to get through.

Last November, Belfast City Hospital's Accident and Emergency Unit closed its doors and the Royal became the main hub of emergency care in Belfast.

Mr Compton said the latest action plan was "not to do" with this "temporary closure".

Poor literacy 'early death link'

Participants in the study were tested on aspirin dosage instructions Poor numeracy 'is ruining lives' One in three adults aged over 65 in England have difficulty understanding basic health-related information, suggests a study in the BMJ.

They are more than twice as likely to die within five years as adults with no literacy problems, it was found.

The University College London study tested nearly 8,000 adults on their understanding of aspirin instructions.

The Patients Association said patients should help draft information leaflets so they are "relevant and clear".

The researchers, from the department of epidemiology and public health at University College London, said that limited or low health literacy among older people has implications for the design and delivery of health services for this section of the population.

Using a short test containing four questions, based on instructions similar to those found on a packet of aspirin, the researchers assessed the participants' ability to read and understand the information.

Continue reading the main story“Start QuotePatients must be involved in the development of these information leaflets from the outset ”

End QuoteKatherine MurphyPatients Association They found that 67.5% had high health literacy (achieved the maximum score), 20% were classed as medium (made one error) and 12.5% had low health literacy (got two, one or no questions correct).

In the study, almost half of the adults aged over 80 could not correctly answer all four questions, compared to one-quarter of the adults aged 60 or less.

'Worrying'

The study followed the participants for an average of five years after the test.

During this time, 6.1% (321) died in the high health literacy category, 9% (143) in the medium category and 16% (157) in the low literacy category.

The researchers said that lower health literacy was linked to a higher prevalence of depressive symptoms, physical limitations and chronic diseases, such as heart disease, diabetes, stroke and asthma - but higher health literacy scores were linked to stronger cognitive abilities, including verbal fluency and working memory, they said.

When researchers adjusted for factors such as wealth, education, income, ethnicity and basic health, the link between low health literacy and mortality risk reduced, "but remained significant", the study said.

Katherine Murphy, chief executive of the Patients' Association said it was worrying that so many people struggle to understand health-related information.

"How are patients expected to make informed decisions if they do not fully understand the information being given to them?

"Patients must be involved in the development of these information leaflets from the outset to make sure they provide relevant and clear information."

Michelle Mitchell, director general of Age UK, said health professionals have a responsibility to give patients information that makes sense.

"That way, patients will be better empowered to manage their own health conditions and make the positive lifestyle choices that lead to better health and wellbeing."

Breaking Point: Obama and the Death of the Democratic Party

By Jane Hamsher
According to both the Washington Post and the New York Times, Obama is proposing cuts to Social Security in exchange for GOP support for tax hikes. Lori Montgomery in the Post:

 At a meeting with top House and Senate leaders set for Thursday morning, Obama plans to argue that a rare consensus has emerged about the size and scope of the nation's budget problems and that policymakers should seize the moment to take dramatic action.  As part of his pitch, Obama is proposing significant reductions in Medicare spending and for the first time is offering to tackle the rising cost of Social Security, according to people in both parties with knowledge of the proposal.

And Jay Carney's carefully chosen weasel-words today do not contradict this:

 "There is no news here - the President has always said that while social security is not a major driver of the deficit, we do need to strengthen the program and the President said in the State of the Union Address that he wanted to work with both parties to do so in a balanced way that preserves the promise of the program and doesn't slash benefits."

Nobody ever says they want to "cut" Social Security or Medicare. They want to "save" it.  Just ask Pete Peterson, he wants to "save" it. Likewise AARP.  They don't want reduced benefits for senior citizens, they want to "preserve" it for future generations.  If they have an enormous customer base they can market private "add-on" accounts and other retirement products to when Social Security goes bye-bye, I guess that's just a happy coincidence.

'Face death head-on'

As we are frequently reminded, we are in an ageing society and we live and die differently now.

Previously, most people died from accident, infection or childbirth having been previously well. This is still the way that many die in developing countries- from HIV, TB, infant diarrhoea, and trauma.

Over the last century the way we die has changed - most of us now dying later from more predictable gradual decline of one or many of our organs.

Previously we could be death-fearing or death-denying - now we have to be death-aware and "death-prepared".

For the first time therefore we have a chance , not only to know that one day we will die, but to prepare for it and to live in the context of our dying.

For many, death is still seen as failure as we perform futile heroics, postponing the inevitable whilst providing inadequate support for those at this crucial time in their lives.

How can we hold the balance of striving to prevent avoidable early death, yet facing its imminent reality by better supporting people at this vital time?

Good preparation

The answer is, in part, to listen harder.

When asked, most people say they want to live, and live as well as possible until they die.

Continue reading the main story“Start QuoteIf we get it right for the dying, we get it right for the living too”

End Quote We then want to die well in the place and manner of our choosing with those we wish to be with, peacefully, with dignity, having done all we need to do and made good preparations for our final journey.

That is the essence of advance care planning and the movement to improve end of life care for all, of which I and many colleagues are involved.

It does not inevitably lead to an attempt to control death through euthanasia, but it is a fervent desire to affirm life, supporting people to live well until they die and to get it right when the time eventually comes to die.

It is time we face our own mortality head-on.

Surely we must firstly admit that this is going to hit us all; secondly, make strategic practical plans at every level to be prepared; and thirdly, initiate our own personal plans.

Dying matters

The majority of those working in health and social care who deal with people nearing the end of life are not specialists, but generalist frontline staff doing the best they can with the resources they have.

Continue reading the main story“Start QuoteWe need to deliver better end-of-life care for all in every setting”

End QuoteProfessor Keri Thomas Like the rest of us, they find it difficult to tackle the taboo subject of death and dying.

And yet, if people are not given the opportunity to discuss their preferences for how and where they would like to be cared for, the chances of fulfilling those wishes are inevitably reduced.

Advance care planning can play a major part in improving the care a person will receive.

Although in essence it is a considered discussion with family, friends and professional carers, it works best as part of a process of planning leading to the delivery of quality care in alignment with peoples' wishes.

We need to deliver better end-of-life care for all in every setting, and to have more discussions of matters related to death and dying.

There is much good work already going on, but more still to do.

This week is the national 'Dying Matters' awareness week, and next month we will hold our annual GSF meeting as part of the International Society for Advance Care Planning and End of Life Care conference, being held in London.

The NHS also has the National End of Life Care Programme, which works with health and social care providers across England to improve adult end of life care.

By actively and bravely living with dying and planning ahead, nationally, locally and personally, we might be able to affirm the full value of life so that "when our time comes to die, dying is all we have left to do".

If we get it right for the dying, we get it right for the living too.

 

G20 death pathologist faces probe

Dr Patel is currently suspended from working as a pathologist. An investigation has been launched into the pathologist who concluded newspaper seller Ian Tomlinson died of natural causes, the BBC has learned.

The General Medical Council is investigating Dr Freddy Patel's work on the case which resulted in an "unlawful killing" verdict earlier this week.

Dr Patel found Mr Tomlinson died of a heart attack due to coronary artery disease after the 2009 G20 protest.

At the inquest six experts said that he was wrong and blamed internal bleeding.

The jury concluded on Tuesday that the bleeding had been caused by a blow to the abdomen when Mr Tomlinson was pushed to the ground by PC Simon Harwood.

It is thought the GMC began its investigation after receiving a complaint from Mr Tomlinson's family.

Dr Patel is currently serving a four-month suspension from pathological work after the GMC found his fitness to practice was "impaired", following a sub-standard autopsy on a murder victim and his acting dishonestly by falsifying his CV.

Last year, the pathologist was given a three-month ban for failings in post-mortem examination work in three earlier cases.

The GMC said it could not confirm officially whether an investigation was under way because of issues of "confidentiality".

Death rates 'higher' in youth

The new report says mortality rates are now higher for teenagers than for children

The study in The Lancet looked at data from 50 countries - rich, middle-income and poor - over 50 years.

It found that while mortality had fallen overall, rates were now relatively higher in teenagers and young adults, than in young children.

Violence, suicide and road accidents are being blamed.

Disease down

The new study shows death rates among young people have fallen dramatically over the last 50 years across the globe.

Mortality in children aged one to nine has fallen by between 80% and 93%, thanks largely to fewer deaths from infectious disease.

Continue reading the main story“The teenage years were the healthiest time of our life. It's no longer true”

Dr Russell VinerUniversity College London Death rates have not been dropping as fast among teenagers and young adults.

In young men aged 15-24, mortality has dropped between 41% and 48%, again largely because of success in combating disease.

But 'injury', be it violence, suicide or road accidents, has emerged as the biggest killer of young men in all regions, and the biggest killer of young women in rich and eastern European countries.

Violent deaths are on the rise in both young men and women in real terms.

This means that although mortality has fallen overall, it is now higher among teenagers and young adults than in children.

Young men aged 15-24 are now two to three times more likely to die prematurely than young boys aged one to four, the researchers claim.

"Modern life is much more toxic for teenagers and young people," says Dr Russell Viner of University College London, who led the study. "We've had rises in road traffic accidents, rises in violence, rises in suicide which we don't see in young children.

"The teenage years were the healthiest time of our life. It's no longer true."

Urban young

This might not be the complete picture. The study doesn't take into account the poorest countries from sub-Saharan Africa, because the data was not available, say the researchers.

There are also regional variations. There was a peak in suicide rates observed during the post-communist countries in the late 1990s, for instance, while suicide rates have started to fall in rich countries in recent years.

But Dr Viner says trends first seen in the West are now being seen in developing countries, as the move to cities brings benefits and risks to the urban young.

"It seems that economic development, the move to cities, increasing urbanisation and social dislocation are actually quite toxic for our young people in terms of mortality," he says.

Co-author Dr Michael Resnick, of the University of Minnesota, told the BBC: "What is clear is that the greatest threats to young peoples' health, outside of living in extreme poverty and in 'hot zones' of infectious disease and war, stem from the behaviours in which young people engage, and the contexts in which they find themselves."

He said governments had to focus "on violent neighbourhoods, extreme impoverishment and lack of access to fundamental resources and services, and the hopelessness that comes from utter lack of prospects and opportunity".