Tag Archives: ‘made

Critically ill ‘should not be made to die away from home’

One in three people who die in hospital could spend their final days at home if the government introduces and adequately funds a modern community-based health and social care system, a new report says.

The Institute for Public Policy Research (IPPR) says that, while most people would prefer to die at home or in a good care home, they are often unable to do so because of inadequate and underfunded local care.

The researchers analysed investment in long-term care in several European countries, and concluded that there appears to be a correlation between funding levels, modern systems and the proportion of people dying in hospitals. Citing 2017 data from the Survey of Health, Ageing and Retirement in Europe, covering 28 countries, IPPR found the proportion of people dying in hospital in England (47%) was higher than in many EU states, with people dying at home (23%) the second lowest after Sweden and the Czech Republic (22%).

An elderly woman is tucked into bed at home by a care assistant


‘Enabling more people to spend their last days outside hospitals, in more appropriate settings, with properly funded support, will improve their experience of care,’ said IPPR research fellow Jack Hunter. Photograph: Gary John Norman/Getty/Cultura RF

If funding were increased to match that in countries with the lowest rates of deaths in hospitals and the most up-to-date systems – such as the Netherlands – IPPR argues, up to a third of those who currently die in hospital could be at home or in a care setting. Data for England cited in the report also shows marked regional variations, with more people dying in hospital in poorer areas. While 49% died in hospital in the north-west and West Midlands, the proportion was 43% in the south-east.

“Taken together,” the report says, “the variation in hospital deaths between European countries and within England suggests there is significant scope for policy to reduce the proportion of people who spend their final days in hospital, and in doing so potentially develop a model for end-of-life care that is of higher quality and lower net cost to the taxpayer.”

Around 60% of those who reported poor care experienced it in a hospital, and most say they would prefer to be at home, given adequate services.

IPPR research fellow Jack Hunter said: “For too many, the end of life is an even more difficult experience than it needs to be. The fact that those in the most deprived areas are more likely to die in hospital is wholly unjust. Where you live should not affect whether you experience good-quality care at the end of your life.

“Enabling more people to spend their last days outside hospitals, in more appropriate settings, with properly funded support, will improve their experience of care. It will also be more cost-effective for the taxpayer.”

A green paper on care and support for older people is due to be published this summer. In last January’s cabinet reshuffle, Jeremy Hunt kept his health portfolio, but his responsibilities and title were expanded to include social care. This was a signal of long-promised reform, merging the health and care budgets and systems.

The report calls for more power to be devolved to local authorities and for a big cash injection. But it concludes: “It is far from clear that the government’s vision will include the size and scale of investment for care that would be commensurate with a radical shift in funding, nor whether it will also consider long-term options (including devolved fiscal measures) to ensure the long-term sustainability of local authorities.”

47%

Proportion of people in England who died in hospital .

23%

Proportion of people in England who died at home.

£487

Estimated public saving, per person, of shifting care, in final three months of life, from hospital to community.

Critically ill ‘should not be made to die away from home’

One in three people who die in hospital could spend their final days at home if the government introduces and adequately funds a modern community-based health and social care system, a new report says.

The Institute for Public Policy Research (IPPR) says that, while most people would prefer to die at home or in a good care home, they are often unable to do so because of inadequate and underfunded local care.

The researchers analysed investment in long-term care in several European countries, and concluded that there appears to be a correlation between funding levels, modern systems and the proportion of people dying in hospitals. Citing 2017 data from the Survey of Health, Ageing and Retirement in Europe, covering 28 countries, IPPR found the proportion of people dying in hospital in England (47%) was higher than in many EU states, with people dying at home (23%) the second lowest after Sweden and the Czech Republic (22%).

An elderly woman is tucked into bed at home by a care assistant


‘Enabling more people to spend their last days outside hospitals, in more appropriate settings, with properly funded support, will improve their experience of care,’ said IPPR research fellow Jack Hunter. Photograph: Gary John Norman/Getty/Cultura RF

If funding were increased to match that in countries with the lowest rates of deaths in hospitals and the most up-to-date systems – such as the Netherlands – IPPR argues, up to a third of those who currently die in hospital could be at home or in a care setting. Data for England cited in the report also shows marked regional variations, with more people dying in hospital in poorer areas. While 49% died in hospital in the north-west and West Midlands, the proportion was 43% in the south-east.

“Taken together,” the report says, “the variation in hospital deaths between European countries and within England suggests there is significant scope for policy to reduce the proportion of people who spend their final days in hospital, and in doing so potentially develop a model for end-of-life care that is of higher quality and lower net cost to the taxpayer.”

Around 60% of those who reported poor care experienced it in a hospital, and most say they would prefer to be at home, given adequate services.

IPPR research fellow Jack Hunter said: “For too many, the end of life is an even more difficult experience than it needs to be. The fact that those in the most deprived areas are more likely to die in hospital is wholly unjust. Where you live should not affect whether you experience good-quality care at the end of your life.

“Enabling more people to spend their last days outside hospitals, in more appropriate settings, with properly funded support, will improve their experience of care. It will also be more cost-effective for the taxpayer.”

A green paper on care and support for older people is due to be published this summer. In last January’s cabinet reshuffle, Jeremy Hunt kept his health portfolio, but his responsibilities and title were expanded to include social care. This was a signal of long-promised reform, merging the health and care budgets and systems.

The report calls for more power to be devolved to local authorities and for a big cash injection. But it concludes: “It is far from clear that the government’s vision will include the size and scale of investment for care that would be commensurate with a radical shift in funding, nor whether it will also consider long-term options (including devolved fiscal measures) to ensure the long-term sustainability of local authorities.”

47%

Proportion of people in England who died in hospital .

23%

Proportion of people in England who died at home.

£487

Estimated public saving, per person, of shifting care, in final three months of life, from hospital to community.

Ralf Little tells Owen Jones: ‘Jeremy Hunt’s arrogance towards doctors made me angry’ – video

In an interview with the writer Owen Jones, Ralf Little says he has become embroiled in a Twitter row with Jeremy Hunt, the health secretary, because he believes the government is trying to turn people against doctors. The actor, who starred in The Royle Family and 24 Hour Party People, accuses Hunt of arrogance in dealing with recent strikes by junior doctors.

This interview was filmed before the news of Stephen Hawking’s death. 

Ralf Little tells Owen Jones: ‘Jeremy Hunt’s arrogance towards doctors made me angry’ – video

In an interview with the writer Owen Jones, Ralf Little says he has become embroiled in a Twitter row with Jeremy Hunt, the health secretary, because he believes the government is trying to turn people against doctors. The actor, who starred in The Royle Family and 24 Hour Party People, accuses Hunt of arrogance in dealing with recent strikes by junior doctors.

This interview was filmed before the news of Stephen Hawking’s death. 

Ralf Little tells Owen Jones: ‘Jeremy Hunt’s arrogance towards doctors made me angry’ – video

In an interview with the writer Owen Jones, Ralf Little says he has become embroiled in a Twitter row with Jeremy Hunt, the health secretary, because he believes the government is trying to turn people against doctors. The actor, who starred in The Royle Family and 24 Hour Party People, accuses Hunt of arrogance in dealing with recent strikes by junior doctors.

This interview was filmed before the news of Stephen Hawking’s death. 

Ralf Little tells Owen Jones: ‘Jeremy Hunt’s arrogance towards doctors made me angry’ – video

In an interview with the writer Owen Jones, Ralf Little says he has become embroiled in a Twitter row with Jeremy Hunt, the health secretary, because he believes the government is trying to turn people against doctors. The actor, who starred in The Royle Family and 24 Hour Party People, accuses Hunt of arrogance in dealing with recent strikes by junior doctors.

This interview was filmed before the news of Stephen Hawking’s death. 

Ralf Little: ‘Jeremy Hunt’s arrogance towards doctors made me angry’ – video

In an interview with the writer Owen Jones, Ralf Little says he has become embroiled in a Twitter row with Jeremy Hunt, the health secretary, because he believes the government is trying to turn people against doctors. The actor, who starred in The Royle Family and 24 Hour Party People, accuses Hunt of arrogance in dealing with recent strikes by junior doctors.

This interview was filmed before the news of Stephen Hawking’s death.

The idea of group therapy for anxiety made me worry more, until I went along | Charles Graham-Dixon

Anyone who has suffered from depression-related illnesses such as anxiety may find the prospect of group therapy daunting. When I was first offered the opportunity to take part in an NHS “worry group” in 2013, I flatly turned it down. Barely allowing my NHS CBT (cognitive behavioural therapy) therapist to fully explain how the group worked, I simply refused to be involved. Panic alarms immediately sounded at the thought of sharing my problems with total strangers, themselves suffering with issues. I was almost indignant that a professional thought it would be a good idea to thrust me into a situation presenting such fear of the unknown, a breeding ground for anxiety. Did she not know me at all?

Two years later and bouts of anxiety and OCD would still rear their head just when I believed they had disappeared. By this stage I had developed a greater understanding of the condition and developed ways to tackle it via exercise, specifically cycling, but still something was missing from my armoury. I returned to CBT via my local NHS authority, determined to stick it out and be more open to suggestions this time.

Perhaps worn down by anxiety or just older and willing to embrace new approaches, my therapist again suggested attending a worry group, and this time I agreed. The prospect still made me anxious – I thought it sounded like AA for anxiety. What if it was uncomfortable? What if a worry group just made me feel more anxious?


Panic alarms sounded at the thought of sharing my problems with total strangers, themselves suffering with issues

As I left the first session I realised my fears, like so many related to anxiety and worry, were largely groundless. The group environment proved to be supportive and comforting as two CBT therapists oversaw talking therapy sessions involving four or five people suffering with issues relating to excessive worry. The aim was to collectively “check in”, share how we each felt that week, any good and bad things that had occurred and to explore ways to tackle our worries using CBT techniques. Those who had done CBT might have covered some of the ground, and in my case I had received one-on-one CBT sessions for six months prior, but these sessions added a new group dynamic. This felt like the final piece of the jigsaw.

Though issues were individual to each person, sharing my stories among others with a propensity to feel overwhelmed by worry provided solace and strength. Suffering with mental health issues can be isolating and lonely – as worries mount and stress increases it is easy to shut oneself off. Hearing others speak about anxieties relating to work, relationships and daily life was not enjoyable but it meant we could provide support by listening and offering advice based on how we approached our own problems.

In setting up these groups, the NHS has recognised the benefits of group and talking therapy both for the individual and for the health service generally. As resources are placed under further strain, with increasing numbers needing to use mental health services, access differs across the country. The availability of CBT appointments is mixed, and often involves lengthy waiting times depending on where you live. But perhaps there’s another way. The sessions I attended were punctuated with CBT, but they demonstrated the value that simple talking and group support can have in the fight to preserve good mental health. It could be done outside the NHS within our communities and could be a viable, sustainable alternative for those unable to quickly receive CBT or group therapy. Community-led groups in safe places, where people routinely “check in” and discuss their problems would provide support, performing a valuable function for society, individuals and a stretched health service.

In an ideal world, the numbers of people suffering with mental health issues would not be increasing and everyone would have quick and easy access to all the fantastic NHS services. However, this is not the case. Though the initial concept of group therapy can seem daunting, anyone with excessive worries, anxieties and other mental health-related issues should not discount talking to others with similar problems. When group therapy was first offered I turned it down but was fortunate enough to be given a second opportunity. I’m glad I took that chance.

Charles Graham-Dixon is a freelance journalist and keen road cyclist based in London and Madrid

NHS admits doctors may be using tools made by children in Pakistan

Closer scrutiny demanded as NHS supplier concedes surgical instruments in routine use could be product of child labour

A child in a surgical instrument workshop in Sialkot, Pakistan, shows a spoon-shaped curette he has just finished polishing


A child in a surgical instrument workshop in Sialkot, Pakistan, shows a spoon-shaped curette he has just finished polishing. Photograph: Haroon Janjua

Children as young as 12 are making surgical instruments in hazardous conditions in Pakistan, prompting fears that the tools could be used in the NHS, the Guardian has discovered.

In Sialkot, Punjab, where 99% of Pakistan’s surgical instrument production is centred, illegal child labour was witnessed in at least a dozen small workshops.

Boys are paid less than $ 1 (70p) a day to cut, drill, bend and polish steel pieces into gleaming surgical tools for export.

Inside the cramped workshops, metal dust is everywhere and the noise of the grinders, polishers and generators is deafening. But there is no sign of protective goggles, earphones, masks or other safety equipment.

Three companies that export to the UK said they buy instruments from these workshops.

The evidence has ignited fears in Britain that tools used routinely in NHS operating theatres and consulting rooms are made with child labour.

NHS Supply Chain, among the largest suppliers to the NHS, bans child labour from its “first tier” suppliers, most of whom are based in the UK. However, it admitted it does not know which manufacturers are used in Pakistan.

Doctors, politicians and a labour rights group, the Ethical Trading Initiative, say more must be done to ensure child labour is not found in the NHS supply chain.

Dr Mahmood Bhutta, an NHS surgeon and founder of the British Medical Association’s (BMA) Medical Fair and Ethical Trade Group, said: “For many of the instruments I use, I have no reliable way of ensuring they have not been made by children.”

Britain is the third largest buyer of surgical instruments from Pakistan, accounting for 10% of the country’s total exports. In all, 80%-90% of surgical instruments are manufactured in the country, according to NHS Supply Chain.

Sparks fly as a child works on surgical tools at a workshop in Sialkot, Pakistan


Sparks fly as a child works on surgical tools at a workshop in Sialkot, Pakistan. Photograph: Haroon Janjua

Bhutta said that while pay and conditions have improved in some larger factories since the BMA first investigated the issue in 2008, serious worries remain.

“We still don’t know where most surgical instruments coming into the NHS are made. But we do know a lot of them will have come from Pakistan. I would be amazed if at least some of the instruments used in the NHS weren’t made in these small workshops.”

The protection of workers’ rights, as well as more transparency, should be written into the NHS constitution, Bhutta said.

Cindy Berman, head of modern slavery strategy at the Ethical Trading Initiative, said: “NHS budgets are tight, but savings mustn’t come at the expense of human rights.

“We know child labour exists in the surgical instrument sector in Pakistan, often in the initial stages of production, and it’s likely that some of these instruments will end up here in the UK. While NHS Supply Chain has taken important first steps in tackling these abuses, more can and should be done.”

She said child labour flourishes when adult workers cannot afford to feed, house and clothe their families, which is why public bodies like the NHS need to make sure they are paying fair prices and sourcing ethical suppliers.

The Pakistan export market in surgical tools is worth $ 358m (£255m), a tiny slice of a lucrative global market worth $ 17bn. Most of it is based in Sialkot, but local manufacturers receive only a small portion of the revenue, while outsourcing importers make the largest profits.

Iram Zafar, secretary general of the Surgical Instruments Manufacturers Association of Pakistan (Simap), said the sector had produced and exported more than 15,000 pieces to the UK between July and December last year, worth $ 11.4m.

According to Simap, 3,600 factories produce 150 million instruments a year. Labour forces vary from 15 to 450 people.

Pakistan has signed up to the UN’s sustainable development goals, which call for an end to child labour by 2025. Punjab laws ban under 18s from working in “hazardous industries”, and children under 14 from working at all. But child labour is common in a country where poverty is endemic, compliance with labour laws weak, unions scarce and profit margins low.

While no official survey has been carried out in Pakistan since 1996, the underage workforce is estimated at between 5.7 and 12.5 million. The ETI suggests the incidence of child labour is high, against a declining trend globally.

Zain, 12, who began work in one of Sialkot’s surgical instrument shops eight months ago after his father died, works eight hours a day, six days a week to bring home $ 25 a month.

“I know it’s dangerous, but I have to pay some debts and support my family,” he said.

At busy times, he can work as many as 12 hours a day. At night, the children often suffer from dry coughs, asthma and other respiratory problems.

His colleague Azwar got a job in a small workshop more than a year ago, when he was 12. “I have to support my parents and siblings to make ends meet,” he said.

The workshop’s owner, who declined to be named, said his business had never been inspected by the Punjab Labour Department in 25 years. He acts as a sub-contractor for the city’s larger factories, but refused to provide names.

The sub-contracting, combined with the complexity and lack of transparency of the supply chain, makes it difficult to trace the surgical instruments from forge to operating theatre.

NHS Supply Chain is not subject to the same transparency requirements of private companies under the Modern Slavery Act, something that campaigners, including the ETI, are keen to change.

Lola Young, Baroness of Hornsey, has proposed a private member’s bill to promote transparency across supply chains of British companies and public bodies, by requiring them to provide a statement on slavery and trafficking in their annual reports and accounts.

“If including child labour is in your business model, you have to change your business model,” said Young, who has been involved in supply chain analysis in the fashion industry.

NHS Supply Chain said it does not know which manufacturers its suppliers use in Pakistan. Neither does it require its suppliers to audit their Pakistani suppliers, although it said that some do.

The Guardian wrote to 22 of NHS Supply Chain’s “first tier” suppliers asking if they source instruments from Sialkot. Only six replied, one of which said it did not supply to the NHS. Two confirmed they did source instruments from Sialkot and three said they did not. NHS Supply Chain confirmed 11 of its suppliers source from Pakistan, but declined to give company names.

A spokeswoman said NHS Supply Chain was committed to working with suppliers serious about managing labour standard issues in their supply chains, but accepted more needed to be done.

She said: “We are aware of the potential for labour standards abuses to occur within supply chains [for] surgical instruments, which is why we have taken steps to increase requirements for supplier due diligence in our contracts and worked … to develop guidance and systems to address these issues.

“We believe that the supplier code of conduct, the LSAS [Labour Standards Assurance System] approach and the guidance and advice that we have provided to our suppliers has been effective in shining a light on the issue across the industry, however, we are not complacent and we recognise that it will require continued effort and vigilance across the sector to raise and maintain standards uniformly.”

The LSAS was introduced in 2012, requiring first tier suppliers to map their supply chain and assess labour abuse risks.

NHS hospitals made £174m from car park charges this year

NHS hospitals made a record £174m from charging patients, visitors and staff to park in 2016/17, up 6% on the previous year.

Data from 111 hospital trusts across England shows that as many as two-thirds are making more than £1m a year. More than half of trusts now charge disabled people to park.

Some trusts defended the charges, saying they were essential to pay for patient care. But opposition parties and patient support groups were critical, with one group saying they were “cynical” but blaming the state of NHS finances rather than the trusts themselves.

The Liberal Democrats condemned the charges as a “tax on sickness” while Labour said it was committed to ending them.

The government condemned “complex and unfair” parking charges and called for reform, but a Department of Health spokesman said they were a matter for local NHS organisations rather than central regulation.

Parking remains largely free at hospitals in Scotland and Wales.

The 40 trusts in England that provided data on parking penalties made £947,568 in 2016/17 from fining patients, visitors and staff on hospital grounds, up 32% on the £716,385 taken by the same trusts the previous year.

A total of 120 NHS trusts across England were asked to provide data on charges and fines, in requests under the Freedom of Information Act by the Press Association, and 111 responded.

Some were giving private firms hundreds of thousands of pounds to run their car parks.

The Heart of England NHS foundation trust took in the most in parking income across the year (£4,865,000). Royal Surrey County hospital, in Guildford, charged the most at £4 per hour.

If a patient required a day’s worth of treatment then they would have to pay £32 for an eight-hour day. Longer-term concessions were available at some hospitals, such as for people having regular chemotherapy.

Some hospitals defended the charges, saying some or all of the money was put back into patient care or was spent on site maintenance.

Rachel Power, chief executive of the Patients Association, said the current state of NHS finances meant it was sometimes difficult to blame hospitals for trying to find money, although this did not make the current situation acceptable.

“For patients, parking charges amount to an extra charge for being ill,” she said. “The increase in the number of trusts who are charging for disabled parking is particularly concerning.

“Patients who require disabled parking may have little choice but to access their care by car, and may need to do so often. Targeting them in this way feels rather cynical.”

Jonathan Ashworth, the shadow health secretary, said: “Hospital parking charges are an entirely unfair and unnecessary burden, which disproportionately affect the most vulnerable people using our health service.

“Even Jeremy Hunt has described this outrageous practice as a ‘stealth tax’, and yet Tory underfunding of our NHS has resulted in hospitals and private companies extracting record fees from patients and staff. Labour will abolish car parking charges and scrap this needless strain on already worried families.”

The Lib Dem health spokesman, Norman Lamb, said: “The vast sums of money that hospitals are making from parking charges reveal the hidden cost of healthcare faced by many patients and their families. All hospitals should be following the national guidelines to make sure that patients, relatives, and NHS staff are not unfairly penalised.”

A Department of Health spokesman said: “Patients and families should not have to deal with the added stress of complex and unfair parking charges. NHS organisations are locally responsible for the methods used to charge, and we want to see them coming up with flexible options that put patients and their families first.”