NHS England to be pioneer in making available drug that could extend lives of cervical cancer patients by up to four months
Women in England who are dying of cervical cancer are to receive a drug that could extend their lives by as much as four months.
Women with advanced cervical cancer will be able to get Avastin, which is also known as bevacizumab, after NHS England decided to fund courses of treatment with it for such patients, at the cost of about £23,295 per person.
The cash will come out of the Department of Health's £200m-a-year Cancer Drugs Fund, which was started by the coalition to enable patients to access drugs which the National Institute for Health and Care Excellence (Nice), the government's official advisers, judges to be not cost-effective.
Avastin is already used to treat advanced forms of breast, lung, bowel, ovarian and kidney cancer. NHS England has now included it on the Cancer Drugs Fund's list of approved medications for use by cervical cancer sufferers who are near the end of their lives.
Its decision means England is the first country in the world to make the drug available for such patients, it said.
Robert Music, chief executive of Jo's Cervical Cancer Trust, said the drug's inclusion on the list was "very positive as for women who receive a late-stage diagnosis of cervical cancer, the prognosis can often be poor.
"When this is the case, any extra time that can be provided through new drugs becomes extremely valuable. We hope this will result in extended survival without impacting on quality of life for those facing non-curative treatment," he added.
Around 2,900 women a year are diagnosed with cervical cancer and 1,000 die from a disease which has become increasingly common in the past decade.
NHS England acted after a recent study in the New England Journal of Medicine showed that Avastin used alongside chemotherapy could extend women's lives by almost four months, from 13.3 months to 17 months, and by 30% compared with treatment with chemotherapy alone.
Its chemotherapy clinical reference group recommended the switch.
Drug firm Roche, which makes Avastin, said that "until now there have been limited clinical improvements for advanced disease, with patients only having a choice of traditional chemotherapies."
Although clinical trials show that Avastin can have side effects such as fatigue, diarrhoea and high blood pressure, most are manageable, it added.Denis Campbell
According to Age UK, the needs of nearly a million people are not being met
There have been two commissions, five white or green papers and three consultations in the past 15 years, and at last, sometime in the next few weeks, the first serious attempt to meet the non-medical needs of an aging population will reach the statute book. The care bill has admirable intentions. Its very first clause promises, uncompromisingly, to enable wellbeing. It will set limits to what an individual has to spend themselves on their care, try to build a national framework of standards for degrees of need, and create an environment where local councils and GPs work together to provide the kind of package of support that will keep older people out of hospital and in the community. But for all its high ambition, there are serious doubts that it is up to the complex and costly task ahead.
Age UK's latest research sets out the realities of meeting growing need with shrinking budgets, evidence borne out by analysis from the government's own Health and Social Care Information Centre. An ever-shrinking number of claimants is referred for further assessment, 9% down on 2007, and there's an even more dramatic fall in the total number receiving care, one in six fewer than in 2010. That's what happens when councils cut £770m out of spending on social care over three years. It means longer waits for care home places and home adaptations and less home care, too often of a poorer quality. It squeezes many out altogether: according to Age UK, the needs of nearly a million people are not being met.
The coalition squeeze on council budgets is set to continue, and the money newly squeezed out of the NHS budget for social care is also meant to contribute to improved primary care. But councils have been strikingly innovative in finding ways of coping with the resources crisis. Early reports of the care and wellbeing boards that will manage the new local responsibility for public health suggest they are putting real energy into new ways of delivering care. But what is most needed is clarity. The care bill is supposed to make the future affordable. The state can't do it on its own. Private finance has to be part of the mix. But for that to happen, the limits of state support have to be clearly set out so that policies allowing the better off to insure against the future cost of care are developed. Instead there is a bewildering complexity, even around fundamental questions such as the way the new spending cap of £72,000 will be measured and exactly who will be entitled to it, and when. For many people, it may still mean selling the family home. This is not the framework for a sustainable, affordable system that encourages planning and saving that was needed. As a result, councils and the NHS will have to go on delivering expensive crisis care that the state can no longer afford.Editorial
New hospital computer system failed to book Samuel a scan for 20 months after major cardiac operation, rules coroner
A three-year-old heart patient died after a new NHS computer system failed to schedule him for a vital hospital scan, leading to a delay in his treatment, a coroner has ruled.
Samuel Starr, who was born with a congenital cardiac defect, underwent surgery not long after his birth in 2010 and made a good recovery. However, doctors said he would still need regular tests to check on his progress.
But a new booking system, called Cerner Millennium, was rolled out and Samuel was not given a scan for 20 months after his first major operation.
When he was finally given the appointment, doctors found Samuel needed urgent open heart surgery. He suffered a stroke and later died in the arms of his parents, Catherine Holley and Paul Starr, at Bristol Royal Hospital for Children.
Avon coroner Maria Voisin said the booking system was responsible for Samuel not being seen and not receiving treatment.
Sitting at Flax Bourton coroners court near Bristol, Voisin said: "Due to the failure of the hospital outpatients booking system, there was a five-month delay in Samuel being seen and receiving treatment. Samuel's heart was disadvantaged and he died following urgent surgery."
Samuel underwent cardiac surgery when he was nine months old and was thought to have been recovering well. But a new computer system at a second hospital, the Royal United in Bath, failed to generate the necessary follow-up. When he was finally seen, he was judged to need further urgent surgery at Bristol.
His mother told the inquest how he quickly deteriorated from a "happy and healthy" young boy after the second operation in August 2012.
She recalled how doctors had advised her and her husband to withdraw treatment. "So we agreed and we read him stories and sang him songs whilst they stopped giving him drugs. Our little boy died in our arms."
Samuel's inquest is the fourth in a series of hearings examining deaths of young heart patients at hospitals in Bristol.
Four-year-old Sean Turner and Luke Jenkins, seven, died after being treated in ward 32, the children's cardiac ward, at Bristol Royal Hospital for Children. Their parents have told previous inquests that their sons would still be alive if they had received better care.
Baby Rohan Rhodes also died after being treated at St Michael's Hospital in Bristol, whichis also part of the University Hospitals Bristol NHS foundation trust. Voisin has said opportunities were missed in the treatment of both Rohan and Sean.
Last month, the medical director of NHS England, Professor Sir Bruce Keogh, announced that an independent inquiry would examine paediatric cardiac care at the Bristol children's hospital.
News, comment and analysis across the sectorClare Horton
To mark National Apprenticeship Week, Candace Miller, director of the National Skills Academy for Health, spent a day on the frontline with an award-winning 17-year-old recruit
Like all new recruits on their first day, I'd been told to turn up "appropriately dressed and to be ready for anything". My assignment was to follow the footsteps of a 17-year-old apprentice in the support services team at one of London's best known and busiest NHS trusts, Guy's and St Thomas'. Knowing that I might need to slip on a uniform or sterile apron, I decided to exchange my usual businesswear for casual clothes and sensible, flat shoes!
I was met by the impeccably turned out, award-winning apprentice, David Lammas, who is working towards a level 2 certificate in support services in healthcare. I was instantly bowled over by his obvious competence and professional manner.
David's placement at Guy's and St Thomas', which started last July, has brought him to the hospital's inspiring Simon Hotel, accommodation designed to provide a safe and relaxing non-clinical environment for patients (either pre or post treatment) and families supporting a relative.
David explained that if the team caring for a patient feels they no longer need to stay on a medical ward – but still needs to remain close to the hospital for follow up care – the "lodge" provides the ideal half-way house.
He told me all about the experience he had gained training with the hospital catering teams and the housekeeping department but it was his current admin role in accommodation services and manning the main reception desk at the Simon Hotel that was giving him a clear steer towards a career path he now wants to pursue in the health sector.
After many years' experience in training, teaching and workforce development, I don't think I've witnessed such assured confidence in a young person and in such a potentially demanding position. David was quick to thank the support and encouragement he constantly receives from his team, as well as this expert hands-on training he feels he is so lucky to receive as part of his apprenticeship.
The National Skills Academy for Health was officially launched last September and, alongside our own apprentice training agency, we are here to help NHS trusts, and other healthcare providers, take on apprentices. We help to guide them through the red tape, which can sometimes be off-putting, and ensure they are securing the very best in training and qualifications for their new recruits.
With a real prospect of permanent employment at the end of a 12-month apprenticeship scheme, this unique form of training – where you earn as you learn – is fast becoming a popular option for school leavers across the UK. Latest data published by the Department for Business, Innovation and Skills show there were 520,600 apprenticeship starts in the 2011-12 academic year – with health and social care remaining the most popular sector (67,020 new starts).
This underlines the fact that more young people are considering this route as a viable alternative to university. They tell us they are simply reluctant to take on the debt associated with three years of further education – often with no guarantee of a job at the end. Others just "want a break" from formal education or perhaps want to get stuck into work and start making their way up the career ladder.
What became clear to me though – after spending just one day with one of the 35 apprentices employed by Guy's and St Thomas' – is that their enthusiasm, skills, insight and total commitment to raising the standards of patient care should not be underestimated or undervalued.
These young apprentices are the workforce of the future and organisations such as the NSA Health and hospital trusts should be harnessing and developing such talent.
I often hear it said that having a young trainee entering your workplace creates a real energy and buzz and helps to keep everyone on their toes.
We can learn from them as much as they will learn from us and our years of experience. Indeed, what I learned from David is that there is no such thing as a traditional route into the workplace and by being brave and stepping off the "sixth form, A-level, university" conveyor belt that he felt just wasn't right for him, he is now thriving in a bespoke and rewarding training programme that he will leave qualified, experienced and probably several rungs further up than many of his contemporaries.
I enjoyed my day shadowing David so much that I am now pledging to leave my desk and do it more often – meeting and shadowing young apprentices from a range of roles. And, I've invited David back to spend a day shadowing me, with the team at NSA Health head office, where he will sit in – and hopefully contribute to – some key meetings and understanding how and why we make decisions and run things the way we do.
Candace Miller is director of the National Skills Academy for Health
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers
Keith McNeil aims to help make Cambridge the world's best academic centre for health
As a one-time special forces sniper and a former transplant physician, Keith McNeil, chief executive of Addenbrooke's hospital, Cambridge, has little time for leaders who can't make decisions. "If you are in a position where you're supposed to make decisions and you can't, get out of the chair and let someone sit there who will," he says.
The report into the Mid-Staffordshire NHS scandal is among several that have identified poor leadership as a cause of service failures. The NHS is now investing tens of millions in leadership training. McNeil calls himself a leader, not a manager. "I've never done any finance or management courses," he says, and he tries to imbue his staff with the self-belief to decide and act rather than wait to be told.
After his first year leading Cambridge University Hospitals NHS foundation trust – which consists of Addenbrooke's, world-famous for services such as transplantation, treatment of rare cancers and neurological intensive care, and the Rosie women's and maternity hospital – McNeil has just seen plans to move the renowned Papworth transplant hospital to a new facility next door to Addenbrooke's delayed by a last-minute Treasury intervention. "When you look at the highly specialist nature of what Papworth does, that can't be effectively done without the support of a tertiary teaching hospital," he says.
Addenbrooke's and Papworth excel at something the NHS in general finds difficult – turning research into treatments. The opportunity to do this was one of the key attractions of the Addenbrooke's job for McNeil, who moved from Australia to take up the post. The hospital and its science centre partners, which include the university, Papworth, and Cambridge and Peterborough Foundation Trust, are the linchpin of the Cambridge Biomedical Campus, which brings together research, development, education and treatment on one site. The pharmaceutical company AstraZeneca is building a £330m headquarters and research centre there. McNeil sees the campus as "an extraordinary opportunity for Cambridge, the region and the whole of the UK in terms of taking basic science and turning it into effective treatment". The recent announcement that, in an Addenbrooke's trial, the immune system of allergic children could be trained to tolerate peanut protein exemplifies this approach. McNeil wants Cambridge to be the world's best academic centre for health.
Regulators are concerned that, with growing waiting lists and demand for services, and dozens of trusts expected to end the financial year in deficit, there is a risk of a number of hospitals having serious problems in 2015. McNeil recognises that the big foundation trusts have a responsibility to make the local health economy sustainable. "Addenbrooke's can't be an island and watch the pieces fall apart," he says. Initiatives with other NHS organisations include joint clinical appointments with local hospitals, to attract specialists. But he opposes the Treasury's idea of using Papworth to prop up the financially struggling Peterborough City hospital.
McNeil went from medical school into the Australian infantry and then the special forces. He trained in battlefield medicine, sniping and demolition. The connection with heart and lung transplants, in which he forged an international reputation when he joined Papworth in the late 1980s, is the ability to think clearly and make quick decisions when tired and stressed, he explains. "I learned that when you think you've given every–thing, you find you've always got just a little bit more – physical as well as psychological. I'm able to control my heart rate when I'm in a stressful situation. That might have been why I was good at sniping. Some people describe that as being a psychopath."
He was attracted to respiratory and transplant medicine by his passion for exercise and a fascination with intensive care. Transplantation exposed him to the need to take risks in developing treatments. "I was involved in transplant in the early days when we were learning so much. Patients would deteriorate rapidly, and … we made errors of judgment and mistakes because things came up which we hadn't seen before."
He returned to Queensland to set up a transplant team, before later turning to management. UK doctors are still reluctant to make this move. So what attracted him? "It struck me that if I got the whole of the North Brisbane health service running well, then 1 million people would benefit. That appealed to me; I like to set up systems."
Addenbrooke's shows how the NHS can both succeed and fail spectacularly. Its performance stumbled just before McNeil arrived, with long A&E queues, missed cancer treatment time targets, serious safety incidents and financial problems. The regulator Monitor declared it in "significant breach" of its foundation trust authorisation. Yet, days later, health data analysts Dr Foster Intelligence declared it the country's best trust, based on its mortality data.
McNeil believes the problem was one common in the NHS – clinicians and managers focusing on different things. "The clinicians were focused on patient care but they weren't necessarily as focused on delivering corporate targets. A key part of what I'm trying to do is to re-engage the clinicians into the whole business," he says. He believes his credibility as a clinician will help build that bridge.
McNeil seems baffled as to how the different parts of the NHS – hospitals, commissioners, regulators, NHS England, the Department of Health – are so badly co-ordinated, while "creating artificial silos or layers that don't do anything". "It feels like Nero fiddling while Rome burns. We keep buying new fiddles rather than put the fires out. We're struggling out there, guys … I can't believe people haven't got a bit more intelligence to think up something more joined-up."
The NHS talks about involving patients in decisions about their care, but progress is poor. McNeil talks passionately about listening to them and meeting their physical and psychological needs. "The psychological effects of chronic disease are very significant, and under-recognised. [In transplant] you look after [patients] through their transplant, through their life with their transplant and then through their death. When their transplant stops working you become more and more involved because there are more and more complications. It can be emotionally draining. Some patients just get under your skin."
Addenbrooke's is working with Cambridgeshire county council to provide more integrated community services, improve information sharing, and plan discharge support more effectively. McNeil is pushing his staff to discharge patients more quickly: "I did a ward round with the director of medicine and asked some pointed questions about why people were lying there in bed. That is critical to patient flow. It is about upfront senior decision-making," he says".
McNeil's 6ft 6in frame makes him very visible around the hospital. "I would like to think I can be approached, but CEOs seem to have this persona in the UK that doesn't exist in Australia. It's a hierarchical society here. I have a lot of enthusiasm and optimism and I would like to think that's infectious. I put my heart on my sleeve. I want people to know that I trust them and I'll back them."Curriculum vitae
Family Married, three children.
Education Caringbah hgh school, Sydney; Cairns state high; University of Queensland, degree in medicine.
Career 2013-present: chief executive, Cambridge University Hospitals (CUH); 2008-13: CEO, Metro North Health Service District, Brisbane; 2007-08: CEO, Royal Brisbane and Women's Hospital; 2001-07: head of transplant services, Prince Charles Hospital Brisbane; 1996-2001: lead transplant physician/director of pulmonary vascular disease unit, CUH; 1994-96: consultant physician, Prince Charles Hospital; 1987-94: registrar - senior transplant fellow, Papworth Hospital; 1984-87: Royal Australian Army Medical Corp.
Interests Marathon running, guitar, basketball.Richard Vize
People have been waiting on ambulance trolleys for upwards of four hours, says the president of the college of emergency medicine
The coalition recently lost a battle to close the thriving and solvent Lewisham hospital when an adjacent hospital was suffering financial problems due to government cuts and disastrous PFI debts. The coalition subsequently rushed through an amendment to the care bill (clause 119) which gives sweeping powers allowing Whitehall bureaucrats to close any English hospitals without full and proper local consultation (Report, 27 February). With this "hospital closure clause" in place, no English hospital will be safe from financially driven closures. Local patients, clinicians and commissioners will have little meaningful say in the closure process. Whatever happened to the mantra used by the coalition to sell the recent NHS reconfiguration to us all – "no decision about me without me". In effect clause 119 brings about a fast-track hospital closure process. Clause 119 is pernicious and hugely damaging to the future of healthcare in England and we implore politicians to withdraw clause 119 or vote against it as it moves through parliament.
Dr David Wrigley GP, Carnforth, Lancashire
Dave Prentis General secretary, Unison
Paul Kenny General secretay, GMB
Frances O'Grady General secretary, TUC
Len McCluskey General secretary, Unite
Professor Cathy Warwick Chief executive, RCM
Phil Gray Chief executive, CSP
Dr Kailash Chand Deputy chair, BMA
Dr Clive Peedell Leader, National Health Action Party
Dr Jacky Davis Co-chair, NHS Consultants Association
Christina McAnea Head of health, Unison
Dr Ron Singer President, MPU
Profesor Ray Tallis
Professor Allyson Pollock
Dr Louise Irvine
Rachael Maskell Head of health, Unite
Dr Iona Heath
Dr David Nicholl
Prof Sue Richards Co-chair, Keep Our NHS Public
John Lipetz Co-chair, Keep Our NHS Public
• Notwithstanding the Home Office's duty to manage Britain's borders, everyone living here should have access to essential healthcare. This is critical for the sick, to help contain disease and, in the long run, for our economy. The immigration bill being scrutinised in the Lords proposes to substantially extend charging for NHS services, including to pregnant women, children, and trafficked people. Around 90% of pregnant women seen at Doctors of the World's clinic for excluded migrants in east London have received no antenatal care, despite most having lived here for three years before seeking medical help. Home Office access to patients' data will further exacerbate the problem, as more sick people will be too afraid to access care for fear their details will go to the UK Border Agency. The NHS constitution is clear that healthcare should be available to all regardless of status or ability to pay. Our health service should not be used as a tool of exclusion or immigration control.
Lord Richard Rogers
Trustee, Doctors of the World UK, part of the Médecins du Monde network
• If as Jackie Ashley (Comment, 27 February) indicates, NHS Change Day has empowered staff to speak out, then it will be a positive force in addressing the business management hegemony, introduced in the 1980s. However, it may just reinforce a sort of "Boxer syndrome" (Animal Farm), where staff believe that problems are their fault and they must work harder. The result will not be a better service in the long term, but one where staff, in identifying areas of change, create a rod for management to beat them with. In working better or harder, staff will find that this often results in staff cuts, time and motion studies, and an increase in staff dissatisfaction.
Many of those in senior positions act as administrators and not, as the service desperately needs, leaders. Change is often viewed negatively, or merely cost-related, and as attacks on the status quo. So to suggest that the clinicians at the sharp end of the NHS can create lasting change in a system that doesn't normally value their views seems to me highly unlikely.
Dr Peter Wimpenny
The proposal to link hospital and general practice records through the intended care.data system has generated intense discussion (Care.data is in chaos, 1 March). This has so far been confined to concerns over inappropriate commercial exploitation of the data and leakage of confidential information.
While these are important aspects, we also have concerns relating to what happens when data are not linked accurately. There is increasing international evidence that the inevitable errors occurring during data linkage can distort types of analyses that care.data aims to support. Data such as NHS number and date of birth, which are used to link records, are never perfect and often it is particular kinds of people, for example ethnic minorities, who fail to get linked and thus fall outside the system. Failing to link records for the same person or wrongly linking different people can produce seriously misleading results, even when only a small minority are wrongly linked. More transparency about the nature and extent of linkage processes and linkage error would help medical researchers assess potential distortions and help service providers to improve data quality.
As for confidentiality, this is best preserved by proper monitoring of patient records, with strict security controls on access. Proposals to "scramble" patient identifiers before data leave the GP record systems are not the solution, and would actually make matters worse by increasing the numbers of wrongly matched records. In our view, the current debate needs to include a full discussion of all these linkage quality problems.
Professor Harvey Goldstein University College London & University of Bristol, Professor Ruth Gilbert University College London, Dr Katie Harron University College London, Dr Gareth Hagger-Johnson University College London, Dr Mario Cortina University College London , Dr Nirupa Dattani City University
• There is a simple step which can be taken to address the care.data controversy. The Health and Social Care Information Centre should give a public undertaking that it will provide only analysis of GP patient data to outside bodies. Patient data would never be disclosed to outside bodies. Ideally this should be formalised by statute and applied to all patient data gathered by NHS services. Any analysis requested could be subject to ethics committee review and, when complete, identified on the HSCIC website. These steps, quickly taken and appropriately publicised, might support public acceptance of the creation of a highly valuable national healthcare asset.
• Your piece on use of patient record data (MPs' anger at missing data on who has seen patient records, 26 February) quotes Dr Stephanie Bown as saying that GPs "worry that patients' concerns about care.data could prevent them from speaking openly to their doctor". Such concerns already do so, whenever an individual is seeking life insurance. The insistence of the insurance industry on an applicant's agreeing to their GP's report often leads to reluctance on the part of patients to share symptoms they think might affect their premiums. Similar damaging reluctance to engage in healthcare may precede holidays when travel insurance cover depends on absence of pending hospital appointments.
The public benefit that will follow successful implementation of the care records system is likely to be enormous and the challenge to confidentiality nugatory. By contrast, there is no identifiable general public benefit in the long-established collusion between the insurance industry and the NHS. It should be banned.
Professor Robert Boyd
• Improving health services, as far as the government is concerned, will also mean cutting costs by delaying treatment, reducing eligibility for expensive drugs or operations, increasing charges, and furthering privatisation. The care.data computer system would enable it to monitor whether doctors and nurses carry out central instructions. Whether it would really be much use for evaluating treatment – given that so many factors influence outcomes, such as lifestyle and whether patients actually take all the drugs they are prescribed – is another question when it comes to justifying the cost of yet another huge computer system. The Office for National Statistics is trusted and has great experience in analysing the census and other large data sets. It would be much preferred to any private firm. Otherwise the money might be better spent by the Medical Research Council.
Dr Richard Turner
Sir David Nicholson admits 'bitter regret' about Mid Staffs and says service should spend hospitals' money closer to home
Outgoing NHS boss Sir David Nicholson has combined a belated public admission of his mistakes over the Mid Staffs scandal with a warning that the service must undergo painful changes if it is to remain viable.
Nicholson, who retires at the end of March after eight years as the NHS England chief executive, said on Tuesday that he regretted not intervening properly when concerns about Stafford hospital emerged and was wrong not to meet relatives of patients who received poor care there.
"The biggest and most obvious mistake I made [in his 36-year NHS career] was when the Healthcare Commission reported on Mid Staffordshire [Stafford] hospital [in 2009] and I went into the hospital and I didn't seek out the patient representatives and the people who were in [local patient campaign group] Cure the NHS and I didn't do it because I made the wrong call," Nicholson told an audience of health professionals and policymakers at the NHS's health and care innovation expo in Manchester.
He also admitted he was "wrong, absolutely wrong" not to meet the families, who were campaigning to expose inadequate care at the hospital, simply because he feared his visit would "turn into a media circus".
"There are absolutely no shortcuts to understanding and talking to patients and relatives and people. That's a mistake that I made that I bitterly, bitterly regret", he added.
Nicholson – dubbed "the man with no shame" by campaigners and tabloid newspapers for refusing to resign over the affair or apologise directly – spoke with feeling and remorse, and went much further than his previous statements about his actions over the hospital, though again did not say sorry.
He also admitted doing too little about Stafford in 2005 when he was chief executive of the NHS's West Midlands strategic health authority.
Addressing the NHS's future sustainability in the face of rising demand for care but what are expected to be tight budgets for years to come, Nicholson called for hospital funding to be slashed and instead used to provide medical care closer to patients' homes. At a hospital he visited recently, he said, 28% of the patients were diabetics, many of whom could have been treated better elsewhere, except lack of money means few other facilities exist.
"We need to reduce investment in hospitals to make that happen. But we find it very difficult to live with the consequences of doing that," he said. He urged politicians to stop adopting short-term approaches to the NHS and be prepared to defend the greater centralisation of hospital services.
Recalling the five health secretaries he has worked with, he confirmed for the first time the suspicions that Andrew Lansley, the architect of the coalition's radical restructuring of the NHS in England, wanted him out.
After Lansley unveiled his plans in 2010 "he made it clear that he didn't see me as the person who would take that forward", Nicholson said. He stayed and made the plans "as workable as possible", though had "frank and difficult discussions" with Lansley about their implementation.
Nicholson's plans for his next move are unclear, and he is thought to be barred from working at all for a set time, and only with Whitehall approval for a further period.Denis Campbell
Coverage of the Health and Care Innovation ExpoSarah Johnson
A new project where patients and NHS staff work together to improve services shows that even small changes can have a big impact on the quality of care
When Louise Lusby came round after a lifesaving operation at the Royal Berkshire hospital in Reading she was hallucinating. "The first thing I remember was being in a wonderful, soft, warm fluffy bird's nest. As I got more conscious of my surroundings, I thought I was in a space station and that the nurses were weightless because they were moving so slowly," she recalls.
Hallucinations are common among intensive care patients. When Lusby had the opportunity to take part in a new project where patients and staff worked jointly to improve services in intensive care, she leapt at the chance to reduce what she had found to be a strange and bewildering experience.
After discussions between staff and patients, the hospital published an information booklet and DVD for relatives about how to respond to hallucinations. It also changed the curtains in the intensive care unit (ICU) from bright blue to a soft pale green, because so many patients said the blue colour made their hallucinations worse. "The bright shiny blue reflected things, so I thought all the blond nurses had silver hair," explains Lusby.
The process also identified improving the care given to ventilated patients, who cannot talk while they are on a ventilator. Matt Wiltshire, who spent 46 days in intensive care at the Royal Berkshire with acute pancreatitis, says: "When the patients explained how voiceless they felt one of the nurses came up with the idea of using an iPad with software they already utilised for patients with autism or learning disabilities to help them communicate." The iPad has symbols so patients can say they are hungry or thirsty and a keypad so they can type words, which are then "spoken" by the software. "Now ventilated patients can communicate with their relatives and the medics," says Wiltshire.
Lusby and Wiltshire are among 27 patients at the Royal Berkshire taking part in the project, designed by academics from Oxford university's health experience research group, which studies patients' experience of illness. Working with professor Glenn Robert at King's College London, who had developed a new approach to help the NHS make better use of patient feedback, the Oxford academics compiled short videos about patients' experiences of intensive care and lung cancer services.
The videos were drawn from Oxford University's healthtalk online archive of more than 3,000 patients talking about their illnesses. They formed the basis for small group discussions between medical staff, managers, patients and relatives who identified priorities for change.
Jane Woodhull, a cancer clinical nurse specialist at Royal Berkshire, says many of the changes in lung cancer services would not have been possible had patients and staff not been working collaboratively. One change involved creating a quiet room, where patients and relatives can go after a lung cancer diagnosis. "Someone gave up their office to create the quiet room for patients. That wouldn't have happened if a manager had said 'you will give up your room'. But because they had seen what a difference it would make to patients, they were happy to."
The project is also taking place at the Royal Brompton and Harefield NHS trust in London, where noise and sleep deprivation were identified as priorities for change in intensive care. Previously patients were woken early in the morning to be washed, but now they are washed in the evening to help aid rest and sleep. "We're also trying to make ICU quieter but that requires a more fundamental cultural change," says Ruth Tollyfield, an intensive care sister at Harefield hospital.
NHS England says the project, which was relatively cheap to implement, has caught the attention of other hospitals. Neil Churchill, improving patient experience director at NHS England, says: "Trusts should be acting on patient feedback forms and delivering small improvements as a matter of routine. But [this approach] is really useful when the desired improvement in patient experience requires more complicated or fundamental changes to services."
Royal Berkshire is looking at how it can be extended to other parts of the trust. "There's no reason why it couldn't be used in most areas of a hospital," says Louise Locock, director of applied research at Oxford university's health experiences research group.
One of the legacies of the project has been participants' personal satisfaction. Lusby says it was her chance "to give something back to the hospital because without them I wouldn't be here".Anna Bawden