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  1. September starts key to eliminating August problems - report

    Most junior doctors will move jobs in September rather than August under plans unveiled today to put an end to the curse of "black Wednesday."

    Only new graduates starting their first hospital jobs would take up their posts in August, under the plans from the Academy of the Medical Royal Colleges.

    The changes would mean that relatively experienced juniors were still in post when new graduates began work.

    Academic studies have confirmed the popular view that patients treated in hospital in August fare relatively badly - because of the large number of inexperienced doctors starting work.

    The academy said the proposals now have the backing of all the medical royal colleges and faculties.

    Dr Simon Newell, who chaired the group that produced the proposals, said: "This has been an important piece of work which has been driven by concerns about patient safety. Evidence suggests that patients die because of the current arrangements.

    "I believe our proposals, which were the subject of considerable debate and consultation, will improve quality of care and patient safety, and it is therefore important that this work, while it should form part of the Shape of Training proposals, does not get lost within its wider agenda."

    The British Medical Association expressed concern that foundation stage doctors might find themselves suffering a break from employment in the August following their first year.

    Dr Andrew Collier, co-chair of the BMA junior doctors' committee, said: “We have concerns about proposed changes to rotation arrangements that would lead to an enforced break in employment, as this can affect employment rights and benefits, such as redundancy entitlements and pension arrangements.

    “To avoid a break in service, as well as a gap in doctors' training and income, the BMA has suggested that, if a staggered changeover is implemented, outgoing doctors should remain in post for an extra month to help with the induction of new trainees, or avail of training and development opportunities.

    "This would benefit both patient care and doctors' training experience."

    He added: “Ultimately, we want employers and the government to take action to make the changeover period less chaotic, addressing workload pressures on doctors and consider increasing staffing levels during the changeover.”

  2. Step up hand cleaning - guidance

    Healthcare workers in the NHS should "always" clean their hands thoroughly - before and immediately after contact with patients, according to guidelines published today.

    More can be done to reduce the rates of infection in hospitals, according to the National Institute for Health and Care Excellence.

    Although rates of infection have reduced dramatically in recent years, NICE says they are still too high.

    About 300,000 people a year contract infections in NHS facilities each year.

    Its quality standard says that workers should always clean their hands immediately before and after contact.

    They should also ensure they follow procedures to keep down the risk of infection from devices inserted through the skin, it says.

    It also calls for doctors to ensure antibiotics are prescribed according to local formularies to minimise risk of resistant infections emerging.

    The organisation's deputy chief executive Professor Gillian Leng said: “It is unacceptable that infection rates are still so high within the NHS.

    "Infections are a costly and avoidable burden. They hinder a patient's recovery, can make underlying conditions worse, and reduce quality of life.”

    She added: "Although there have been major improvements within the NHS in infection control, particularly in relation to Clostridium difficile and MRSA bloodstream infections in the last few years, healthcare associated infections are still a very real threat to patients, their families and carers and staff.

    "This quality standard gives primary, community and secondary care services the most up-to-date advice on the best ways to minimise the risks of infections.”

  3. Mothers should get skin contact after birth - study

    New mothers are wrongly being denied skin contact with their babies while a life-saving procedure is undertaken, researchers said today.

    Doctors have been advised to delay clamping of the umbilical cord by two-minutes to enable iron-rich blood to pass from mother to baby.

    But guidelines for performing this procedure have led to babies being held away from the mother for this period.

    And the awkwardness of holding the baby away from the mother is thought to be one reason why delayed cord-clamping is often not performed.

    Now a study in Argentina suggests alternative positions, which could mean the baby is held against the mother's chest or abdomen.

    The researchers tested alternative positions on 194 babies in three university hospitals in Argentina. Their health was compared with another 197 subjected to delayed clamping using the conventional procedure.

    Their findings, suggesting the baby can be held against the mother, are reported in The Lancet today.

    Researcher Professor Nestor Vain, of the Foundation for Maternal and Child Health in Buenos Aires, said: "Iron deficiency in newborn babies and children is a serious public health problem in low-income countries, and also prevalent in countries from North America and western Europe.

    "Our study suggests that when umbilical cord clamping is delayed for 2 minutes, holding the baby on the mother's chest or abdomen is no worse than the currently recommended practice of holding the baby below this level.

    "Because of the potential of enhanced bonding between mother and baby, increased success of breastfeeding and the compliance with the procedure, holding the infant by the mother immediately after birth should be strongly recommended."

    The findings were welcomed by the UK Royal College of Midwives.

    Jane Munro, of the college, said: "The RCM supports delayed cord clamping and has long championed skin to skin contact between mother and baby as soon as possible after the birth.  

    "This piece of research is useful in offering more support for early skin to skin contact which we know is so valued by mothers."

    The Lancet 17 April 2014 [abstract]

  4. Theatre innovation needs more backing - surgeons

    Surgeons and the government must find ways of ensuring useful innovations in the operating theatre are adopted much more rapidly than in the past, according to a new report.

    Shortages of equipment and the difficulty of retraining surgeons rapidly mean that even when a new procedure wins approval it is slow to be adopted, according to the report from the Royal College of Surgeons.

    In one instance, experts from NICE - the National Institute for Health and Care Excellence - ordered a new procedure, laparascopic colorectal surgery, should be introduced within three months.

    Instead the NHS was told it would have four years to train surgeons to undertake the procedure.

    Only the direct intervention of the former national cancer director Professor Sir Mike Richards led to training programmes being stepped up, the report reveals.

    The report says NHS England should work with NICE and the college to undertake "horizon scanning", to identify rapidly new procedures with potential.

    And there should be financial incentives to reward hospitals for backing surgical innovation, it says.

    College president Professor Norman Williams said: "Many patients are not benefitting from groundbreaking procedures even when surgeons firmly believe that they can save or extend lives and improve their quality. This cannot continue.

    "We cannot afford to neglect the kind of surgical innovation that has made such a difference to a chance of survival and recovery, for example, in keyhole surgery, advancements in transplant surgery and the rapid developments we are now seeing in robotic surgery."

 

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