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NHS will miss targets on foreign patient cost payments

The government is expected to fall well short of its target of recovering £500m a year from overseas visitors treated in NHS hospitals in England.

The government is expected to fall well short of its target of recovering £500m a year from overseas visitors treated in NHS hospitals in England.

The Department of Health has “refined” to £346m its target for 2017-18, says the National Audit Office. Some £289m was paid in 2015-16; £73m in 2012-13.

A new “surcharge” for non-EU patients accounts for much of the rise, but only about half of debts owed are recovered.

The Department of Health said the increase showed “very good progress”.

NHS Trusts in England are legally obliged to check whether patients are eligible for free non-emergency NHS treatment and to recover any costs from overseas patients.

People from the European Economic Area (EEA), and Switzerland, are usually covered by agreements such as the EHIC scheme – where their government is billed for their treatment – while those from outside the EEA are invoiced directly.

But the National Audit Office report estimated that only half of debts were recovered from patients from outside the EEA and found that only 58% of hospital doctors knew some people were chargeable for NHS healthcare at all.

The Department of Health’s “ambitious” £500 m recovery target was aimed at reducing NHS trusts’ deficits, which reached £2.45 bn in 2015-16.

That year, an extra £164m was raised from a new £200 a year surcharge on visa applications paid by temporary migrants from outside the EEA.

That year also saw a 53% increase on the amount NHS trusts in England charged directly to patients, mostly to visitors from outside the EEA – much of which is thought to be due to new rules that allow hospitals to charge up to 150% of the cost of treatment, rather than a case of more people being charged.

And although amounts charged to people visiting from countries within the EEA increased slightly, they remain “well below” the ambition to recover £200m a year by 2017-18. The latest forecast for EEA income for that period is £72m.

The report found some hospitals were better than others at recovering money – 10 NHS trusts in London accounted for half of the total amount charged to non-EEA patients in 2015-16. Twenty trusts said they had no patients using the EHIC scheme.

It praised the Department of Health for using IT systems to help trusts find patients who should be charged and for visiting 60 trusts to promote its “cost recovery programme”, and said new financial incentives for reporting and charging overseas visitors had had an effect.

But it estimated that “trusts recover around half of the amounts they charge directly to patients, mainly visitors from outside the EEA”, with recovery rates varying widely – and it was not really understood why.

Head of the National Audit Office, Amyas Morse said: “Hospital trusts remain some way from complying in full with the requirement to charge and recover the cost of treating overseas visitors.”

He said much of the increase in amounts charged and recovered over the past two years was due to changes to charging rules: “If current trends continue and the charging rules remain the same, the department will not achieve its ambition of recovering up to £500m of overseas visitor income a year by 2017-18.”

Implant register launched to safeguard patients

A register of patients in England with breast and other cosmetic implants has been set up to allow them to be traced in the event of any safety concerns.

A register of patients in England with breast and other cosmetic implants has been set up to allow them to be traced in the event of any safety concerns.

The move comes after faulty Poly Implant ProthËse (PIP) silicone breast implants were recalled in 2010, affecting thousands of women.

The inclusion of individual patients’ details will not be mandatory.

However, all providers of breast implant surgery will be expected to participate in the scheme.

Health Secretary Jeremy Hunt said: “We want the NHS to be the safest healthcare system in the world and anyone who chooses to have a cosmetic procedure has the right to safe care.

“The PIP breast implant scandal in 2010 affected thousands of people which is why we asked NHS Digital to develop a new register which will allow people to be traced swiftly if that is ever needed.”

As a result of poor record-keeping following the PIP scandal, many women were unable to find out if they had been given the faulty implants.

In some cases, because surgery providers had gone out of business, women who received the implants could not be traced.

The Breast and Cosmetic Implant Registry – which will be managed by NHS Digital – will include patients treated by both NHS and private providers.

And participation in the registry will be noted during Care Quality Commission (CQC) inspections.

The registry will be expanded in the future to also cover other cosmetic implants, such as buttock or calf implants.

It is expected to record more than 20,000 cases of implant surgery every year and allow complications with specific implants to be picked up.

Providers will be expected to submit data on patients via an online portal.

Explicit consent from patients will be required to add their details to the registry – and this is in addition to the usual consent for the surgical procedure.

Noel Gordon, chair of NHS Digital, said the registry marked a major step forward in improving patient safety for people who undergo breast implant surgery each year.

The British Association of Plastic, Reconstructive and Aesthetic Surgeons, the Association of Breast Surgery and the British Association of Aesthetic Plastic Surgeons welcomed the registry.

In a joint statement, they said: “This will protect patients by providing a way to actively monitor all implants, track and trace their use and provide data for further research, which may be used to further technological advances. We hope that all patients will consent to the submission of data on their behalf.”

DVLA making unfair health driving licence decisions

The Driver and Vehicle Licensing Agency (DVLA) is not making fair decisions about medical fitness-to-drive cases, a report has suggested.

The Driver and Vehicle Licensing Agency (DVLA) is not making fair decisions about medical fitness-to-drive cases, a report has suggested
The Parliamentary and Health Service Ombudsman’s report found “major failings” in eight drivers’ cases. It said people’s lives had been put on hold for years because of flawed decision-making and poor communication.

The DVLA said the vast majority of cases it handles are dealt with swiftly and correctly.

Criticisms in the report are directed at the Drivers’ Medical Group – the part of the DVLA which considers whether drivers with a medical condition are safe to drive.

The DMG makes between 600,000 and 750,000 licensing decisions every year and around 10% of those are complex cases dealt with by medical experts.

The report looked at eight complaints in detail which were received by the ombudsman between 2014 and 2015.

These all concerned people with complex medical conditions who were unfairly prevented from driving, sometimes for several years, the ombudsman’s report said.

The report found “major failings”, including evidence of flawed decisions, significant delays, poor communication and complaint handling in those cases.

And it said it was concerned that other people had also been treated unfairly and that the same mistakes could be repeated.

The report recommends that the DVLA improves the way it communicates with people applying for a licence and with medical professionals, and sets up robust standards to assess people with medical conditions fairly.

In addition, it says financial compensation should be offered to those affected by failures, where appropriate.

Parliamentary and Health Service Ombudsman Julie Mellor said the DVLA’s failings had had a real impact.

“People’s lives have been put on hold for years because of severe delays and flawed decisions by the DVLA, leading people to lose their jobs, causing stress, worry and isolation.”

She said the DVLA had produced a new guide for medical professionals and improved its complaint handling and communications – but there was still more to do.

“Further action is needed to make the assessments of fitness to drive more robust, to prevent others from suffering the same injustice in the future.”
Improvements

Conditions that could affect your ability to drive safely include:

  • Epilepsy
  • Strokes
  • Other neurological and mental health conditions
  • Physical disabilities
  • Visual impairments

ESA benefit payments- retests axed for chronically ill claimants

Claimants of long term sickness benefits will no longer face repeated medical assessments to keep their payments.

Claimants of long term sickness benefits will no longer face repeated medical assessments to keep their payments.

Work and Pensions Secretary Damian Green said it was pointless to re-test recipients of Employment and Support Allowance (ESA) with severe conditions and no prospect of getting better.

More than two million people receive ESA, which is worth up to £109 a week. The move has been welcomed by charities supporting those with severe illness.

Shadow work and pensions secretary Debbie Abrahams said it was “a welcome U-turn” by the government, but “the devil was in the detail”. What about mental health conditions, conditions that are fluctuating, conditions that may not necessarily have a physical manifestation?” she said.

Applicants for ESA have to undergo a work capability assessment to find out if they are eligible and they are re-tested to ensure their condition has not changed. Some are re-tested every three months and others up to two years later.

Under the government’s change, those who are deemed unfit for work and with conditions that will not improve will no longer face re-testing.

Illnesses such as severe Huntington’s, autism or a congenital heart condition are among those that are likely to qualify for continuous payments without reassessment. The criteria will be drawn up with health professionals.

Mr Green said a “key part” of making sure those who were unable to work received “full and proper support” included “sweeping away any unnecessary stress and bureaucracy”.

Currently, those in the “work-related activity group” – deemed unable to work at the moment but capable of making some effort to find employment – receive up to £102.15 a week in ESA payments.

Those in the “support group” – deemed unable to work and not obliged to do anything to improve their chances of finding work – receive up to £109.30 a week.

From April 2017, payments will fall to £73 for new claimants in the “work-related activity” category as ministers argue that too few people in the category are moving into work.

Former Work and Pensions Secretary Iain Duncan Smith, welcomed the “progressive” reform to the re-testing regime, which he had set up when in office.

“I hope that the government will… move on to the fuller reform… where we lock together with the health department much more to be able to get a better health assessment of people, rather than a just strictly work assessment.”

Tim Nicholls, policy manager at the National Autistic Society, said ESA was a vital benefit for those unable to work, covering basic daily living costs such as food, heating and clothes.

“The flawed assessment process can be highly stressful for autistic people who can experience high levels of anxiety meeting new people or when their routine is broken, particularly when the stakes are so high,” he said. “We will be looking out for more details from the government.”

The smoking ban has led to a sharp fall in heart attacks

Major research suggests that the introduction of a smoking ban has resulted in a 40 per cent fall in the number of people suffering from heart attacks as the result of passive smoking.

Major research suggests that the introduction of a smoking ban has resulted in a 40 per cent fall in the number of people suffering from heart attacks as the result of passive smoking
Heart attack rates in the UK have fallen by up to 42 per cent since the 2007 smoking ban, major research suggests.

A review of 77 studies found that reduced exposure to passive smoking has caused a “significant reduction” in heart problems across the population.

Several of the studies found that non smokers and ex-smokers gained most the benefits.

The Cochrane study examined a range of health outcomes in 21 countries, including the UK, which have introduced bans in recent years.

Researchers concluded that there was strong evidence that reduced exposure to passive smoking reduced the number of people suffering from cardiac problems.

The studies examined included a Liverpool study of 57,000 hospital patients. This found admissions for heart attacks fell by 42 per cent among men and 43 per cent among women in the five years since the ban was introduced in 2007.

And US research reviewed found a 14 per cent reduction in strokes in counties which introduced a ban, compared with those which did not.

Some 33 out of the 44 studies reviewed on heart disease found a “significant reduction” following the introduction of smoking bans.

Researchers said the studies took account of other trends over the period – such as a large increase in rates of statin prescribing, to protect against heart disease.

Review author, Professor Cecily Kelleher, from University College, Dublin, said: “The current evidence provides more robust support for the previous conclusions that the introduction of national legislative smoking bans does lead to improved health outcomes through a reduction in second hand smoke exposure for countries and their populations.”

Professor Peter Weissberg, medical director of the British Heart Foundation, said: “This review strengthens previous evidence that banning smoking in public places leads to fewer deaths from heart disease and that this effect is greatest in the non-smoking population.

He said the studies were observational and all had their limitations, but it would be difficult to study the effects of passive smoking in a more robust scientific way.

Researchers said the evidence was less clear about whether the introduction of bans had actually helped people to give up smoking.

Nonetheless, smokers seemed to benefit from some reduction in exposure to passive smoke.

One Scottish study, which found no fall in smoking rates after a ban was introduced in 2006, found a 14 per cent reduction in hospital admissions for heart problems among smokers, and a 21 per cent reduction in admissions among non-smokers.

The research found the impact of the ban on respiratory health, and conditions such as asthma, was less clear cut, though seven of 12 studies on asthma found reduced hospitalisations since the ban.

Overseas nurses denied NHS jobs

Thousands of overseas nurses were denied permission to work in England last year, despite hospitals facing staff shortages.

The Royal College of Nursing (RCN) has found that the refusals have hit high profile hospitals in Cambridge, Newcastle and Manchester.

A Freedom of Information request to the Migration Advisory Committee (MAC) found more than 2,341 refusals.

The RCN asked for the number of applications to allow overseas (non-European Union) nurses to work in England between April and November 2015 and the number refused.

It found that East Lancashire Hospitals NHS had the highest number of refusals with 300 out of 300 applications.

The research found that Brighton and Sussex University Hospitals and North Cumbria University Hospitals both had about 240 refusals.

Nursing was temporarily placed on the MAC shortage occupation list (allowing more overseas nurses) in December.

Janet Davies, chief executive of the RCN, said: “These figures show that when nursing is not on the list, many trusts are unable to recruit enough nurses, which could have an impact on patient care.”

Catherine Morgan, director of nursing at The Queen Elizabeth Hospital in King’s Lynn, said that she had been prevented from recruiting a number of overseas nurses.

“It is frustrating because we are running a hospital and do want it to be safe, and we had the opportunity to recruit from India and the Philippines and we had nurses keen to come over but haven’t been able to bring them over,” she said.

A Department of Health spokesman said: “The MAC is currently reviewing the shortage occupation list. Staffing is a priority and there are already more than 8,500 more nurses on our wards since 2010 and 50,000 more nurses in training.

“We want more home-grown staff in the NHS and our recent changes to student funding will create up to 10,000 more nursing, midwifery and allied health professional training places by 2020.”

Dementia patients face Russian roulette in hospital

Dementia patients admitted to hospital in England play “Russian roulette” with their health, a charity is warning.

Dementia patients admitted to hospital in England play "Russian roulette" with their health, a charity is warning.

The Alzheimer’s Society said it had found “shocking” evidence of poor and variable care during its review.

The report, based on Freedom of Information (FOI) requests, found problems with falls, night-time discharges and readmissions, and said standards needed to improve urgently.

The Department of Health said the disease was a key priority as one in four hospital beds is believed to be occupied by a person with dementia.

The Alzheimer’s Society called for all hospitals to publish an annual statement of dementia care, to include information on satisfaction, falls, readmissions and staff training as part of its campaign to improve standards.

The charity received responses to their FOI request from half of the 163 hospital trusts in England; however, for some of the questions the figures were based on a fifth of trusts as not all hospitals could provide answers to all the questions.

Its report showed:

  • more than one in four people over the age of 65 who fell had dementia, but in some trusts it topped 70%
  • people with dementia stay five to seven times longer than other patients over the age of 65 in the worst-performing hospitals
  • one in 10 people over 65 who were discharged overnight had dementia – with the numbers rising to nearly four in 10 in the worst trusts
  • more than half of over-65s readmitted within 30 days – a sign of inappropriate care – had dementia in the worst-performing trust.

The Alzheimer’s Society also carried out a survey of dementia patients. It found examples of patients being treated with excessive force, not being given enough help with meals and drinks and being left in wet or soiled sheets.

Nine in 10 said hospitals were frightening and only 2% felt all staff understood the needs of people with dementia.

The charity described these findings as unacceptable and a sign that dementia patients were not getting the standard of care they should.

Alzheimer’s Society chief executive Jeremy Hughes said: “In the worst cases, hospital care for people with dementia is like Russian roulette. People with dementia and their carers have no way of knowing what’s going to happen to them when they are admitted.

“In many cases they are well looked after but, as our investigation shows, too often people with dementia fall and injure themselves, get discharged at night or are marooned in hospital despite their medical treatment having finished.”

A Department of Health spokesman said the disease was a key priority and in recent years £50m had been spent on making hospitals and care homes more “dementia friendly”, while 500,000 staff had received extra training.

“People with dementia and their carers deserve the very best support,” he added.

Suicide gene therapy kills prostate cancer cells

A new gene therapy technique is able to modify prostate cancer cells so that a patient’s body attacks and kills them, US scientists have discovered.

A new gene therapy technique is able to modify prostate cancer cells so that a patient's body attacks and kills them, US scientists have discovered.

The technique causes the tumour cells in the body to self destruct, giving it the name ‘suicide gene therapy’.

Their research found a 20% improvement in survival in patients with prostate cancer five years after treatment.

Prostate cancer is the most common cancer in men in the UK with more than 41,000 diagnosed each year.

The study, led by researchers from Houston Methodist Hospital in Texas, appears to show that this ‘suicide gene therapy’, when combined with radiotherapy, could be a promising treatment for prostate cancer in the future.

The technique involves the cancer cells being genetically modified so that they signal a patient’s immune system to attack them.

Usually, the body does not recognise cancer cells as the enemy because they have evolved from normal healthy cells. Unlike an infection, which the body reacts against, the immune system does not react to kill off the offending cancer cells.

Using a virus to carry the gene therapy into the tumour cells, the result is that the cells self destruct, alerting the patient’s immune system that it is time to launch a massive attack.

In two groups of 62 patients, one group received the gene therapy twice and the other group – who all had more aggressive prostate cancer – received the treatment three times. Both groups also received radiotherapy.

Survival rates after five years were 97% and 94%. Although there was no control group in this study, the researchers said the results showed a five to 20% improvement on previous studies of prostate cancer treatment.

And cancer biopsy tests performed two years after the trial were found to be negative in 83% and 79% of the patients in the two groups.

Dr Brian Butler, from Houston Methodist Hospital in Texas, said it could change the way that cancer is treated. “We may be able to inject the agent straight into the tumour and let the body kill the cancer cells. Once the immune system has knowledge of the bad tumour cells, if they pop up again, the body will know to kill them.”

Kevin Harrington, professor of biological cancer therapies at The Institute of Cancer Research, London, said the results were “very interesting” but more research was needed. We would need a randomised trial to tell if this treatment is better than radiotherapy alone.”

“The viruses used in this study cannot reproduce. Next generation viral therapies for cancer can selectively replicate in cancer cells, something that can kill the cancer cell directly, and also help spread the virus to neighbouring cancer cells.”

“It would be interesting to see this approach used with viruses that could reproduce to see if it makes for a more effective treatment.”

NHS trust failed to investigate hundreds of deaths

The NHS has failed to investigate the unexpected deaths of more than 1,000 people since 2011 according to a new report.

The NHS has failed to investigate the unexpected deaths of more than 1,000 people since 2011 according to a new report.

It blames a “failure of leadership” at Southern Health NHS Foundation Trust and that the deaths of mental health and learning disability patients were not properly examined.

Southern Health said it “fully accepted” the quality of processes for investigating and reporting a death needed to be better, but had improved.

The trust is one of the country’s largest mental health trusts, covering Hampshire, Dorset, Wiltshire, Oxfordshire and Buckinghamshire and providing services to about 45,000 people.

The investigation, commissioned by NHS England and carried out by Mazars, a large audit firm, looked at all deaths at the trust between April 2011 and March 2015.

During that period, it found 10,306 people had died. Most were expected. However, 1,454 did not.

Of those, 272 were treated as critical incidents, of which just 195 – 13% – were treated by the trust as a serious incident requiring investigation (SIRI).

The likelihood of an unexpected death being investigated depended hugely on the type of patient.

The most likely group to see an investigation was adults with mental health problems, where 30% were investigated. For those with learning disability the figure was 1%, and among over-65s with mental health problems it was just 0.3%.

The average age at death of those with a learning disability was 56 – over seven years younger than the national average.

Even when investigations were carried out, they were of a poor quality and often extremely late, the NHS England report says.

Repeated criticisms from coroners about the timeliness and usefulness of reports provided for inquests by Southern Health failed to improve performance, while there was often little effort to engage with the families of the deceased.

Key findings from the report

  • The trust could not demonstrate a comprehensive systematic approach to learning from deaths
  • Despite the trust having comprehensive data on deaths, it failed to use it effectively
  • Too few deaths among those with learning disability and over-65s with mental health problems were investigated, and some cases should have been investigated further
  • In nearly two thirds of investigations, there was no family involvement

The reasons for the failures, says the report, lie squarely with senior executives and the trust board.

There was no “effective” management of deaths or investigations or “effective focus or leadership from the board”, it says.

Even when the board did ask relevant questions, the report says, they were constantly reassured by executives that processes were robust and investigations thorough.

The culture of Southern Health, which has been led by Katrina Percy since it was created in 2011, “results in lost learning, a lack of transparency when care problems occur, as well as lack of assurance to families that a death was not avoidable and has been properly investigated,” the report says.

UK pays less for cancer drugs than some countries

The UK is paying less for new cancer drugs than a number of other high income countries, according to a report in The Lancet Oncology.

The UK is paying less for new cancer drugs than a number of other high income countries, according to a report in The Lancet Oncology

While the UK, Greece, Spain and Portugal pay the least, on average, for the drugs they use, Germany, Sweden and Switzerland pay the most.

The authors said more transparency was needed because some countries risked overpaying for drugs. The pharmaceutical industry said the UK was getting a fair deal on medicines.

Prices of cancer drugs have risen steeply in recent years, placing major stress on many healthcare systems, including the NHS.

The report said drugs had accounted for nearly a third of the EU’s £37 billion cancer healthcare spending in 2009.

And the researchers then compared the 2013 price of 31 cancer drugs in 18 high-income countries, including the UK, Australia, New Zealand, France, Greece, Switzerland, Sweden and Portugal.

Prices in Greece were the lowest for 14 out of the 24 cancer drugs available there.

The price of drugs in the UK was also low.

Prices of drugs in Switzerland, Germany and Sweden were frequently the highest – and for some drugs, such as interferon alfa 2b to treat leukaemia and skin cancer, were twice as high.

The price figures come from the Pharma Price Information service in Austria, which details what manufacturers charge per unit – a single tablet or vial of a drug, for example.

But although the official list prices published in this report are freely available, any further discounts – which are often negotiated by organisations in different countries – remain confidential.

David Watson, director of pricing and reimbursement at the Association of the British Pharmaceutical Industry, said the report was evidence that newer medicines “are affordable in the UK”.

He said the UK was “getting a fair deal with regards to medicines pricing” and the NHS was “getting good value for money”.