The National Audit Office this week confirmed that it would conduct its own investigation into the scheme – which spent nearly £14m of taxpayers’ money – following requests from three MPs.

The inquiry will begin after North West London strategic health authority concludes its own independent review after abandoning the project last month.

A statement released by the SHA last week states: ‘The intention of the review is to ensure that lessons are learned from the experience of planning and implementing the project, and to improve the quality of future similar PFI projects across the wider NHS.’ The review is likely to take two months.

An NAO spokesperson said it would be engaging constructively with the SHA review but would then ‘consider whether its final product addressed all the concerns adequately’.

He added: ‘We are going to see how far the review goes and do our own report to the chair of the Paddington health campus.’

The SHA ploughed on with the project to merge St Mary’s and Royal Brompton and Harefield hospitals despite reservations from government finance experts about its viability.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=2851094

The crisis is hitting recent medical graduates who have completed the first part of their training as a house officer. They need to get a senior house officer (SHO) post to become fully qualified.

This two-stage training process is designed to give young doctors experience of treating a variety of illnesses.

But, despite shortages of doctors throughout the NHS, there is an increasingly limited number of SHO jobs.

The British Medical Association said many junior medics will be left without a job when their contracts expire next Tuesday.

A survey of recent graduates – who each received around £250,000-worth of training – found many without work were now considering leaving the country, switching career, or even claiming unemployment.

More than a third of doctors who completed the first stage of their training said they had not been able to get the advanced training job they needed. Nearly 58 per cent of the 276 surveyed said they would consider going overseas to train.

Planning

The BMA has written to Health Secretary Patricia Hewitt, pointing out the problem is partly the result of increasing demand for posts and partly due to poor planning.

It says the number of places at medical schools has increased and applications from overseas medics are rising.

But at the same time the number of postgraduate training posts has not been growing at the same rate. It adds that part of the problem is down to the new training structure for young doctors.

The BMA said the government had claimed there was no reduction in the number of SHO posts. But their own research of SHO jobs advertised in BMJ Careers showed such posts halved between May 2002 and May 2005.

Simon Eccles, chairman of the BMA’s junior doctors committee, said:“We keep hearing from doctors who’ve been turned down for hundreds of jobs. It makes no sense at a time when the country is short of fully trained medical staff, we’re pushing doctors into unemployment.”

The exact number of Greater Manchester’s 2,000 medics affected is unclear, but Dr Kailash Chand, who represents the BMA in the north west, said: “There are doctors who aren’t able to finish their training. The system is fundamentally flawed.”

A Department of Health spokesman said: “There has always been healthy competition for SHO posts, particularly in popular areas and specialities.

“No jobs have been phased out as a result of the new structure. There have been a small number of SHO posts and ‘Trust grade’ posts used to pilot the new training programmes.

“There will be further changes in August 2006 with the national roll-out of the second year of the Foundation Programme, but these changes do not impact on the overall number of training posts.”

http://www.manchesteronline.co.uk/men/news/health/s/167/167520_scandal_of_the_jobless_doctors.html

The independent inquiry into the outbreak of Clostridium difficile, which causes severe diarrhoea, was ordered by the Health Secretary, Patricia Hewitt, eight days after it was revealed by The Independent on 6 June. The Healthcare Commission, the Government’s NHS watchdog, announced on 14 June that it would conduct the inquiry.

More than five weeks on, the commission said it was not yet ready to go into the hospital. “The investigation will begin when it is clear the outbreak of C. difficile at Stoke Mandeville Hospital is under control.”

The number of infections with C. difficile have soared in hospitals across the NHS from about 1,200 in 1990 to more than 43,000 in 2004. Latest figures show there were 934 deaths in 2003, a 38 per cent rise in two years.

Stoke Mandeville was infected with a new strain of the bug, C. difficile 027, which is more virulent and harder to eradicate than existing strains, in late 2003. The number of infections peaked between January and March 2004, fell back in the summer and then peaked again last winter.

A spokesman for the hospital said yesterday: ‘We have now had a prolonged period of declining levels of infection. New cases are running at around eight to ten a month, which is about where they were before the outbreak began.’

Marcia Fry, head of operations at the Healthcare Commission, said it was for the Health Protection Agency to declare when the outbreak was under control. ‘The thinking is that it would not be helpful for us to be in there while the infection control people and the Health Protection Agency are in there getting it under control.

‘The evidence from Canada is that this has a seasonal pattern and can flare up again. If that were to happen we could find ourselves going in and then having to come out again.’

The aim of the investigation was to learn the wider lessons of the outbreak for the NHS, she said. ‘We expect them to accept us into the hospital in the early autumn. The investigation should take four to six months.’

Under terms of reference, the commission will examine all cases of infection with C. difficile from 1 November 2003 and the action taken to control and arrest the spread of the bug, as well as the role of local agencies and national policy.

A second outbreak of C. difficile struck the Royal Devon and Exeter Hospital, where 265 patients were infected in the first five months of the year and 23 died. The bug has also been identified in patients at 13 other hospitals across the nation.

Ms Fry said the commission would consider how the other hospitals were affected and how they had responded, but there were no plans to send investigators into them at this stage. ‘We want to take account of them and how they handled it and put all that in the pot.’

http://www.rednova.com/news/health/183972/superbug_still_spreading_through_hospital/

This key report – the first in a series – offers a unique overview of patient safety issues in the NHS for all those working in and using the NHS with an interest in improving patient safety and the quality of care. It features:
• The latest data from the Agency’s National Reporting and Learning System (NRLS) including a breakdown of reports from different healthcare settings
• An analysis of patient safety incidents and emerging issues from the NRLS that are being flagged to the NHS via a new bulletin
• An analysis of reported deaths in the NRLS
• A description of the NPSA’s Patient Safety Observatory (PSO) and how this will support improvement in patient safety
• A comparison of the latest data from the UK with results from six other key studies of adverse incidents from across the developed world
• Case studies to illustrate how the NRLS supports the NPSA to improve patient safety

Chief Medical Officer Sir Liam Donaldson said: “Patient safety is rightly now a key priority for the NHS – and many other health services around the world. We must ensure that when patients are harmed, sources of risk are identified, solutions are implemented and lessons are learned. But we can only do this if we know what is going wrong. This first report and analysis from the NPSA helps us to understand where systems are weak and drive forward improvement.”

There were 85,342 incident reports to the National Reporting and Learning System (NRLS) between November 2003 and March 31 2005 affecting 86,142 patients. The majority of incidents – 68 per cent – resulted in no harm to patients and about one per cent led to severe harm or death.

Reporting levels are increasing rapidly. Almost 75,000 reports were sent to the NRLS in the second quarter of the year between April and June.

230 Trusts reported to the NRLS during the period covered by the PSO report. In a separate analysis within the report, information from 18 of these acute Trusts that have reported incidents consistently over a three month period was used to estimate reported incidents and deaths for the whole of England.

From this analysis we estimate that there would be approximately 572,000 incidents and 840 deaths reported to the NRLS each year from acute hospitals.

Professor Richard Thomson, NPSA’s Director of Epidemiology and Research said: “It must be remembered that the great majority of NHS care is safe and effective with over a million patients successfully treated every day. However, it is inevitable in complex healthcare systems, treating often very sick patients, that sometimes things can and do go wrong.

“When things go wrong it is usually as a result of a problem in the system within which staff work. The NPSA will improve patient safety in large part by improving the systems that support staff in providing the highest quality of care.

“Good information is the first step to understanding what needs to be done. But without action, information is meaningless. We use this information to identify issues and highlight priority areas to develop solutions.

“The NRLS is an immensely rich source of data. However, incident reports on their own cannot tell us all we need to know about patient safety. That is why the NPSA has also set up the Patient Safety Observatory to bring together data from our reporting system with other sources of information such as confidential inquiries, litigation bodies, clinical data, industry, the public and patients. Together, these will provide a more complete picture of patient safety.”

Commenting on the study to estimate reported deaths and incidents in England, Professor Thomson said:“The number of incidents is of the same order of magnitude as previously quoted estimates of 850,000 adverse events a year but the number of deaths is considerably lower than the widely quoted figure of 40,000. Our analysis of reported deaths to the NRLS will contribute to the debate about the size of the problem, but further research is needed to arrive at a more precise figure.

“Nonetheless, every death is a tragedy for the patient, their family and, indeed, for the staff involved. We are committed to working with the NHS to prevent such tragedies.”

A new publication for the NHS is also launched by the NPSA today. Patient Safety Bulletin, a review of learning from patient safety incidents, has been developed to rapidly feed back data and safety concerns to NHS organisations and healthcare professionals.

It aims to raise awareness of specific patient safety problems, share evidence and where possible provide practical advice on how to minimise the risks. It will help to fulfil the NPSA’s commitment to feed back issues and share learning with the tens of thousands of NHS staff who take the time to report incidents and issues to the NPSA. The first issue features a number of emerging themes. They include:
• Safe medication practice with anticoagulant medication. The NRLS data included 311 incidents involving anticoagulants with two deaths. A recent study found that 6.5 per cent of hospital admissions were due to adverse drug events with problems caused by the interaction of anticoagulant medication and some painkillers featuring most commonly. Approximately 500,000 patients take anticoagulant medication at any one time.
• Missing equipment on crash call trolleys is putting critically ill patients at risk. Evidence is emerging from NRLS data of missing or unserviceable equipment on crash call trolleys. Trusts should ensure they have robust systems in place for the replenishment of trolleys.
• The management of patients with a tracheostomy. An issue has emerged over the care of tracheostomy patients, particularly when they are being cared for on general wards following time in the Intensive Care Unit. The NPSA is aware of four deaths in these circumstances. Management of these patients on general wards may be more risky than healthcare staff currently realise though this should be seen in the context of more than 10,000 tracheostomies
carried out in the NHS annually.

NPSA Joint Chief Executive Susan Williams said: “This report reflects the efforts of the tens of thousands of NHS staff who have taken the time and trouble to report errors and system failures to us so that we can identify what needs to change and make healthcare safer for patients.

“It demonstrates that having gained knowledge of issues, action has been taken by the NPSA and the NHS to address these issues. It is further proof that the NHS is at the forefront internationally of tackling patient safety issues head on and the NPSA has an important part to play in this,” she said.

http://www.npsa.nhs.uk/site/media/documents/1261_PSO_RepotNewsRelease.pdf

Those which are not so comprehensively covered by policy, like sexual health, maternity and dental services, have been left behind, according to the report, which focuses on the NHS from the patients’ perspective.

Some targets are having unintended consequences even within their own fields, said Ms Walker.

‘We need to recognise the side-effects that they [targets] could be having and adapt accordingly. We can do this by monitoring the side-effects,’ said Ms Walker. She used the example highlighted before the general election of patients being unable to make GP appointments in advance because practices feared pre-booking would restrict their ability to meet the 48-hour target.

Targets needed to be shared by the whole health economy, she added. ‘There has been less progress in areas which are not covered by targets or an NSF. The statistics on those finding it hard to sign up with a dentist are startling.’

She called for healthcare organisations to provide the commission with evidence about any unintended consequences caused by targets.

The report praises cuts in outpatient and inpatient waiting times along with improvements to cancer and heart services. It says that over 90 per cent of patients rate their care as good, very good or excellent.

However, the Healthcare Commission says that despite improvements, the NHS still has a long way to go if it is to achieve its ambition of becoming a patient-led service.

Some 58 per cent of dental practices are not taking on new NHS patients, up from 40 per cent in 2001; only 40 per cent of adults who require mental health treatment are getting it; and nearly 30 per cent of people who need sexual health services are waiting more than 48 hours for an appointment.

‘Patients are not interruptions to the NHS’

Patients are treated as if they are invisible and are not given adequate information on their care, the Patients Association has claimed.

In a passionate response to the State of Healthcare report, Patients Association policy director Simon Williams expressed dismay that ‘this country is still ranked so poorly on involving patients in decisions that affect their care’.

The Healthcare Commission report identified growing health inequalities and poor communication with patients about their treatment and aftercare as problems.

‘I find it astonishing that some of these patients report that they are spoken to as though they were invisible by too many hospital staff,’ Mr Williams said. ‘No organisation can survive if it ignores those it is here to serve. Patients are not interruptions, they are the reason for the NHS.’

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=2796544

The MORI survey revealed that patients believed the private sector was superior to the NHS on 12 out of 14 factors, including cleanliness and the quality of management. Over 70 per cent of those surveyed said they would be ‘fairly’ or ‘very’ happy for their NHS care to be carried out in the private sector.

The survey asked people in each local authority within the SHA which local hospitals they would choose for an operation. HSJ has seen information published on three of the six authorities. It showed that private sector hospitals were first choice in one area and second choice in two. In two of these areas, six NHS hospitals were ‘chosen’ by less than 4 per cent of local populations.

As a result, the SHA has carried out modelling exercises which show that about £35m of annual income is in jeopardy across its seven non-specialist acute trusts.

The SHA commissioned the survey of 1,200 people in order to assess the potential impact on the NHS of choice, including the ‘extended choice network’ from next April. The sample was skewed towards those aged 45-74 to take account of those likely to access elective care. Under extended choice, patients will be given a choice of 40-50 hospitals from a menu of all foundation trusts, the private sector and local services.

The SHA stressed that it was making the findings public so that NHS services could adapt their strategies accordingly. SHA director of strategy Peter Spilsbury said: ‘We are not sure every one in the NHS has clocked that from April 2006 we are going to move much quicker to a much wider range of choice. Choice is happening now; it’s real.’

He said the rest of the NHS could learn from the SHA’s research: ‘Although the survey is based on findings from our area, they could well be replicated in many other urban areas across the country.’

Mr Spilsbury said the implications of the survey amounted to about £35m in potential lost NHS income, equating to 13 per cent of the area’s £275m income: ‘The seven trusts on our patch could lose £5m-£15m each. Choice is going to have a significant affect on everyone. It would be foolish to suggest otherwise.

‘In every local authority, between 20 and 30 per cent [of those surveyed] would consistently choose the private sector,’ added Mr Spilsbury.

MORI asked respondents what would make them more likely to use the private sector. The top reason – cited by 85 per cent of those surveyed – was if the private sector was ‘MRSA-free’.

Mr Spilsbury said the survey demonstrated how drastic the impact of patient choice could be: ‘If people do what they say they will, the independent sector could be the single biggest provider of elective surgery. Across the SHA the level of demand to use the independent sector will be 15-20 per cent of the population’.

SHA chief executive David Nicholson said the survey showed that ‘introducing choice and contestability are the right policies; people clearly have an appetite for choice and are happy for the NHS to pay for private sector care’.

HOW MUCH MORE LIKELY WOULD YOU BE TO USE THE PRIVATE SECTOR THAN YOUR LOCAL HOSPITAL IF…..

It was MRSA free:
Much more likely: 73%
A little more likely: 12%
No more likely:11%
Don’t know: 3%

Waiting times were shorter – half those for your local hospital:
Much more likely: 69%
A little more likely: 17%
No more likely:12%
Don’t know: 3%

It was recommended to you by your GP:
Much more likely: 68%
A little more likely: 18%
No more likely:11%
Don’t know: 2%

It provided free door-to-door transport for yourself:
Much more likely: 57%
A little more likely: 17%
No more likely: 24%
Don’t know: 2%

It offered flexible appointment times:
Much more likely: 55%
A little more likely: 22%
No more likely: 21%
Don’t know: 2%

It guaranteed car parking facilities:
Much more likely: 51%
A little more likely: 16%
No more likely: 31%
Don’t know: 2%

It was recommended by your friends and family
Much more likely: 49%
A little more likely: 26%
No more likely: 22%
Don’t know: 3%

It offered a private room for those that want it:
Much more likely: 48%
A little more likely: 23%
No more likely: 27%
Don’t know: 2%

Base: 1,201 residents

Up to half of hospitals failed to comply or did not comply with safety improvements within the deadlines set, the report says.

“Compliance was slow and some deadlines were not met even though taking action could reduce the risk of a patient’s death. And some NHS trusts reporting compliance were found, on independent inspection, to be non-compliant.”

As a result some hospitals were stopped from delivering one type of cancer treatment until they had complied and all hospitals that provided it were being inspected again to see if they were following the safety measures.

This guidance followed the death of Wayne Jowett, aged 18, who “was killed in Nottingham” when a cancer drug was given into his spine instead of a vein. His death in 2001 followed 25 similar deaths.

Sir Liam said it was “hard to imagine a more high-profile case” than Wayne’s. Following his death, hospitals were given a year to introduce a safety checklist to avoid giving the injection wrongly in the future.

In 2002, three months after the deadline, one hospital in five was not fully complaint. In January 2003, the position had slipped back and a third were not fully compliant. By November 2004, with 12 per cent still not following all the checks, the Department of Health made the guidance more comprehensive.

In January this year all hospitals reported that they were following the new guidance. But in May a review of 19 hospitals found nine were “non- compliant on inspection despite three of these having claimed compliance prior to the inspectors’ visits”.

Another case was that of Najiyah Hussain, aged three, who died after she was mistakenly given nitrous oxide (laughing gas) instead of oxygen at Newham General Hospital, east London, in November 2000.

It then took two years for hospital trusts to report that all the resuscitation machines that delivered gas to patients had been replaced or fitted with warning systems.

The report also describes how this year, 45 per cent of trusts had failed to take action on a Safety Alert over a painkiller within a 245-day deadline.

The painkiller, wrongly given, had caused 25 deaths and 26 cases of “serious harm” over 10 years.

Sir Liam said they needed to understand why some trusts reacted so slowly. “These are not wilfully bad people down there in the hospitals. There is something about the way people respond to multiple priorities. We need to understand what is happening in an organisation,” he said.

“We have a locally-devolved NHS which is dependent on fulfilling standards which are set nationally. If the local NHS wants, rightly, to have that autonomy to meet the needs of patients and to use their budgets, then their part of the bargain is they have to meet national standards.”

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2005/07/20/nhosp20.xml

Since taking up the post of Chief Medical Officer, in the autumn of 1998, I have used my Annual Report to draw attention to the major challenges in health and healthcare facing our country, particularly those where I have felt that current action is not sufficient to fully address them.

I have sought also to identify smaller scale problems: for example, where an adverse trend in the occurrence of a disease is unexplained and is giving rise to concern. This very much captures the spirit of the earliest Chief Medical Officer Annual Reports – dating back to the 19th century – which fearlessly identified problems and actively championed the need for action.

This – my fourth Annual Report – comes at the end of a particularly busy year. Progress
has been made on two key public health threats which I highlighted in my 2002 Annual Report: second-hand smoke and obesity.

Since 2002, there has been widespread public discussion, ongoing media coverage and extensive consultation on these issues, as well as expert analysis and review. This culminated in the
production of a new public health White Paper. Choosing Health set out a wide range of proposed actions to improve tobacco control and curb obesity, as well as actions to address other major public health problems of today. Choosing Health puts population health and health inequalities squarely at the centre of the Government’s health policy agenda.

I have pushed very hard on the need for action to create smoke-free public places and workplaces. The proposals set out in Choosing Health represent real progress but, in my view, do not go far enough. I want this country to be alongside the best in the world in public health in protecting their populations and future generations from the scourge of tobacco.

The consultation on the proposed legislation to create smoke-free restaurants, food-led pubs/bars and workplaces offers the opportunity to strengthen the approach originally planned,
should the weight of opinion be behind this simpler and more rigorous option.

This year has also witnessed important developments in the area of infectious disease control. There has been great concern about the frequent occurrence of methicillin resistant staphylococcus aureus (MRSA) infections in NHS hospitals. MRSA is one of the so-called ‘superbugs’, a common bacterium that has become resistant to successful treatment with commonly used antibiotics.

The rate of MRSA infection is higher in this country than many other European countries.

A range of actions to improve hygiene and infection control is already being undertaken, including substantial investment in cleanliness, the recruitment of new matrons and the
establishment of infection and prevention control teams in each NHS Trust hospital.

Figures published in June 2005 indicate that these measures are beginning to work: the
total number of MRSA blood infections in England dropped by 6.1% in 2004/05 compared with 2003/04. This programme, which is being led by the Chief Nursing Officer, is vital for the safety of patients in NHS hospitals and it is essential that the current momentum is maintained.

Tuberculosis (TB) is another infectious disease that is re-emerging and work is under way to implement an action plan which I published in October 2004.

Recommendations include: quicker and more effective screening of high-risk groups, DNA fingerprinting to track the spread of the disease in communities and better co-ordination of clinical care. The rate of TB has been rising in England over the last 10 years, particularly in London and other major cities.

There are now 13 cases per 100,000 people, and every year around 350 people die from the disease. The long-term goal is not only to reduce TB infections but to all but eliminate the disease from this country.

Major planning has also been undertaken to combat the impact of an influenza pandemic. The World Health Organization (WHO) and other international organisations have recently warned that a flu pandemic is both ‘inevitable’ and ‘imminent’.

Such warnings have been largely fuelled by the persistence of a highly virulent strain of bird
(avian) flu in Asia. While these warnings aim to ensure countries are prepared for such an event, they have also caused public concern over the nature of the threat and our ability to respond to it.

The consequences of an influenza pandemic would be serious, with the numbers of people falling ill and dying being far higher than those associated with ‘ordinary’ winter flu outbreaks.

My team has worked tirelessly to bring together the best ideas and expertise, both globally and in this country, to anticipate and respond effectively to an influenza pandemic should one occur. A national plan and other supporting documents were published in March 2005, which collectively provide a proper understanding of the nature of the threat, its likely impact on the United Kingdom and the action necessary to mitigate pandemic influenza when it comes to this country.

From August 2005, the two-year Modernising Medical Careers Foundation Programme begins. All junior doctors starting their pre-registration house officer year in August will benefit from this innovative development in postgraduate medical training. Under the new curriculum,
junior doctors will need to demonstrate their competence in a number of areas not previously addressed in medical training, including: communication and consultation skills, pat ient safety, clinical governance and team-working. Trainee doctors will need to show they have learned a range of skills, including the undertaking and use of research, time management and use of
evidence and data.

The development of the Foundation Programme curriculum for the first two years of postgraduate medical education will help ensure that trainees’ acute clinical and professional skills are secure and robust. It is a curriculum focused on quality of care and ensures that, at the end of their two years’ training, doctors are both confident and competent and so patients will benefit.

The issue of how best to quality assure medical practice came to the fore in the Shipman Inquiry’s fifth report produced by Dame Janet Smith. I have been asked by the Secretary of State for Health to consider the implications of this report and recommend further measures to strengthen procedures aimed at ensuring the safety of patients in situations where a doctor’s performance or conduct poses a risk to patient safety or the effective functioning of services.

The proposals will also seek to ensure the operation of an effective system of revalidation (the five-yearly review of a doctor’s licence to practise) and will examine the role, structure and functions of the General Medical Council. At present, this work is at the consultation stage and I have appointed an expert advisory panel to assist me with this task.

The United Kingdom has the Presidency of the European Union (EU) in 2005. For the health element of the Presidency, two areas have been chosen that are of great importance in improving health outcomes in all EU countries: tackling health inequalities and improving patient safety.

There will be over 20 meetings and summits scheduled between July and December 2005. With the enlargement of the European Union there will not be another Presidency for the United Kingdom until 2017, when it will be shared with two other member states.

Our Presidency in 2005 therefore represents a vital opportunity for the United Kingdom to
make a significant contribution to the EU agenda, and from the health perspective we want to play our full part.

I have selected five new topics for attention in this year’s Report. Firstly, I have reviewed the extent to which the movement of cigarettes across international borders, either through smuggling or duty-free imports, is seriously undermining the traditional effectiveness of price increases to reduce tobacco consumption.

It is estimated that up to 25% of all cigarettes and hand-rolled tobacco in this country is not being taxed, leading to concerns about long-term health implications and the need for greater awareness are issued by the Department of Health and its agencies.

Awareness of the problem of patient safety has grown greatly over the last few years and, as illustrated in last year’s Annual Report, it is a worldwide problem.

Ours is one of the leading countries working to improve patient safety. It is important, however, that when serious risks to patients are identified, action is taken rapidly to reduce those risks. This action needs to be taken not just on an incident-by-incident basis but as part of a long-term strategy to be implemented throughout the NHS. It is clear that the culture of some NHS organisations needs to change. It is not enough to be aware of the problem of
improving patient safety nor to report adverse events when they occur. When alerts are issued, there needs to be commitment from the very top of the organisation to initiate immediate action to address the identified risk, to ensure that all staff are properly and consistently informed,
and to establish new procedures and processes of care to sustain the reduction of the risk in question.

In compiling this report, I am grateful for the help of a number of colleagues in the Department of Health. I am also indebted to a number of colleagues outside Whitehall in particular Elizabeth Draper, Angela Towers and Sean O’Kelly.

I should like to make clear, however, that the conclusions and opinions expressed in the Report are my own.

I hope you enjoy reading this Report. Every one of us has a role to play in addressing the issues raised. The progress, described in this Report, on issues highlighted in my previous Annual Reports, shows that public discussion as well as individual and collective action does make a
difference in improving health and the quality of healthcare in this country.

Sir Liam Donaldson
Chief Medical Officer

On the state of public CMO ANNUAL REPORT 2004 blic health 5

http://www.dh.gov.uk/assetRoot/04/11/57/83/04115783.pdf

The independent Commission is publishing its flagship annual report to Parliament on the state of healthcare in England and Wales, focusing for the first time on the experience of patients.

The Commission strongly praises the improvements that have taken place in some services, such as cancer and heart services. But other services have been left behind, such as sexual health, mental health, maternity and dental services.

The Chairman of the Healthcare Commission, Sir Ian Kennedy, said:

“There are many achievements to celebrate in the provision of healthcare. Services subject to targets and the requirements of national frameworks have produced significantly better outcomes, particularly for people with cancer and heart disease. People are not waiting as long for care in hospital. New ways of providing services, such as NHS Direct and walk-in centres, are helping to make services easier to obtain.

“The Government has set itself the aim of a ‘patient-led NHS’. But our health services still have a long way to go before we can say that they are really putting patients first. Being an NHS patient is too often a frustrating experience. Services can seem fragmented and seem to be designed more to suit the needs of those providing them than those using them. People want better access to services, and they also want to understand what doctors tell them and to be treated and spoken to in a caring manner. They need more comprehensive information about their health and appropriate involvement in the decisions about their care and advice on how to look after themselves when they leave hospital.”

The picture in Wales is harder to judge because the information is more limited. However it is clear that access to care in Wales is improving. The number of people waiting longer than 18 months for an outpatient appointment is down from 6,270 in December 2004 to 28 in March 2005.

The report asks three questions: do people receive effective healthcare services, do they have enough control over the care that they receive, and do some get a better deal from healthcare services than others.

The report pulls together the most available existing evidence on the experience of patients, including the Healthcare Commission’s own surveys of patients. The emerging findings were also checked with a series of patients groups.

In relation to the effectiveness of care, while overall patients’ satisfaction is high for most NHS services, there are a number of areas highlighted as concerns:

* Many people across the country have difficulty making an appointment with an NHS dentist. Nearly 60% of NHS dental practices are not taking on new patients, an increase from 40% in 2001. In some areas, no dentists are taking on new NHS patients.
* There are long waiting times for sexual health services, with 28% of people who need to be seen urgently having to wait more than 48 hours and 29% of people who have symptoms waiting more than two weeks. Only half of sexual health clinics in the UK are open more than 21 hours a week.
* Many maternity services do not meet the needs of women. Three independent investigations into maternity services over the past two years have highlighted a range of problems including: inadequate support and information for women who do not speak English; over-crowding; poor standards of cleanliness, and a lack of support and advice on issues such as feeding and bathing.
* Although services have improved for some people who need for mental health care, many mental health services still fall short of what people need. For example: fewer than half the people needing crisis care report being able gain access to it; half of people with depression are not receiving treatment; 23% of those on mental health wards and learning disability wards report having to share rooms with the opposite sex; and many people detained under the Mental Health Act say that their rights have not been explained to them.

On whether people have enough control over the care they receive, the Commission found:

* Many people are not getting enough information about healthcare, particularly about diagnostic tests and medication. Some say they do not have enough time to discuss their health with doctors and other professionals, and 70% of general practices did not have information available in a form suitable for people with learning disabilities. It is particularly worrying that more than a third of patients were not given information on the side effects of medicines, and 22% of patients with heart disease were not being told of alternatives to coronary artery bypass surgery and 49% were not given advice about necessary changes to make in their diet before being discharged.
* Many people have been given more control and choice over where they go for treatment. In areas where people were able to choose quicker treatment when they had waited six months, between 50% and 70% took up the offer. In England, 24,300 people have taken the option of faster treatment. In Wales almost 11,500 people took up the option for faster treatment in an alternative hospital.
* The Expert Patient Programme is an initiative that shows real potential and benefits, in terms of patients taking more control over the services they receive and the provision of help and support. In England, 17,000 people with long term conditions have attended courses to help them manage their own condition and become more involved in influencing how care is provided in their community. It has led to less use of A&E; and greater confidence in patients in managing their pain, tiredness and depression.

On whether some people get a better deal than others, the Commission found:

* There are wide variations in service and treatment, depending on which hospital patients go to and where they live. These are again highlighted as a national problem. For example, rates of immunisation and the take-up of screening programmes, as well as stop smoking services, showed lower levels of take up in poorer areas. The experience of ‘seldom heard’ groups, such as people with learning disabilities, homeless people and travelers, can be significantly worse than that of others using the health service.
* Last year, the Commission revealed that primary care trusts (PCTs) serving more deprived populations tended to fare worse than others. This year, the Commission has found that extra funding is now going to PCTs in deprived areas in England, and distribution is now more in line with levels of deprivation. Progress has also been made in Wales, where £41 million has been redistributed and the five areas that were most below their target allocations in 2003/2004 are now getting closer to these allocations.

The report also highlights a number of lessons for healthcare organisations and regulatory bodies, such as the Healthcare Commission. In particular, it emphasises the need to:

* ensure services are assessed on a broad enough basis
* improve information for patients at all stages of their care
* involve patients and the public in the design of services
* spread good practice and take action on wider inequalities in health

http://www.healthcarecommission.org.uk/NewsAndEvents/PressReleases/PressReleaseDetail/fs/en?CONTENT_ID=4018541&chk;=KvG1sX

Prostate Research Campaign UK surveyed over 1,000 people who had the disease or were close to someone who did.

They found 96% felt there should be more investment in research and therapies for a disease which is the UK’s commonest form of male cancer.

Experts said advances in treatment were being made, but were not always available to all patients.

“Although, we are making significant steps in treating prostate cancer, such advances don’t always reach patients.” Professor Roger Kirby, Prostate Research Campaign UK

The survey also found 90% felt the negative impact of prostate cancer was under-estimated by the general public.

The survey follows a report from the National Audit Office published in February this year, which found prostate cancer patients were dissatisfied with the information they received about side effects and treatment outcomes, as well as waiting times to be seen by a specialist.

Each year, around 30,100 men are diagnosed with prostate cancer, and 10,000 die from the disease.

Drug review

Professor Roger Kirby, Visiting Professor in Urology at St Georges’s Hospital, London and chairman of Prostate Research Campaign UK said: “The findings of our survey should help us understand the needs of those directly affected by prostate disease and ensure that we direct resource where it will be most valued.

“Although, we are making significant steps in treating prostate cancer, such advances don’t always reach patients.”

Studies have shown the drug Taxotere (docetaxel), currently used to treat breast cancer, can help men with advanced prostate cancer.

It has been licensed for treating men with prostate cancer, but is not yet widely available, pending a review by the drugs watchdog, the National Institute for Clinical Excellence.

Professor Kirby said: “Men living with prostate cancer should be given the opportunity to make an informed choice about and have access to new treatments which provide prolonged survival and better quality of life.”

A second organisation, the Prostate Cancer Charity is beginning its own national survey of patients’ experiences of their diagnosis and treatment for the disease.

John Neate, the Charity’s Chief Executive says: “Our job is to drive hard to secure the very best NHS services for men affected by prostate cancer.”

A spokeswoman for NICE said: “People should not be denied any drug simply because it is under review by us.”

She said it would its conclusions would be published next summer.

http://news.bbc.co.uk/1/hi/health/4682299.stm

The Healthcare Commission highlighted overcrowding, dirty toilets, a shortage of midwives and inadequate organisation after investigations at three units.

Health Minister Liam Bryne admitted services were “not yet good enough” and said an action plan was being drawn up.

The commission blamed bad management for the problems. It is due to publish a broader report on the NHS on Monday.

UNITS INVESTIGATED
Northwick Park, north London: 10 women died during or after birth over two years
New Cross Hospital, Wolverhampton: A review of 20 deaths between 2001 and 2003 found that half might have lived with better care
Ashford and St Peter’s NHS Trust, Surrey: “Feuding” between consultants was jeopardising patient care

‘My care was sub-standard’

The investigations – at three units that have suffered high mortality rates in the last two years – also found doctors who did not explain what was happening to patients, and staff too busy to advise on feeding and bathing of new babies.

Sir Ian Kennedy, who chaired the report, called on NHS trusts in England and Wales to review their maternity services because of huge differences between the best and worst.

Poor practice

He blamed a lack of effective leadership and management in units which were failing to achieve high standards. Staff training and the ability to work in teams was also lacking.

“I find it surprising that a service like the NHS, with so many dedicated people working in it, can have pockets of really poor practice, where we have not learned from the wisdom and knowledge and experience that has been put around for a long time as to how to deliver babies in a safe manner, and how to look after mothers.

“We are still not doing it as well as we should, and it is a matter that we need to get a grip on.”

The majority of the 650,000-plus births every year in the UK take place in NHS hospitals.

Services are not yet good enough to meet the needs of all women and babies
Health Minister Liam Bryne
Mr Byrne said: “We welcome his acknowledgement that giving birth is safer now than ever before and that very few babies or mothers die.

“However services are not yet good enough to meet the needs of all women and babies, wherever they live and whoever they are, and that is why the government continues in reforming, as well as investing in, maternity services in the UK.”

Shadow health secretary Andrew Lansley said: “These findings from the Healthcare Commission are deeply worrying. “They show that despite increasing resources for the NHS, a lack of genuine reform means resources are wasted and services are not held accountable for the standards they meet and to the wishes of patients.”

Mikaela Morris, a senior midwife at St Peter’s Hospital in Surrey, which was investigated by the commission, said her unit had suffered from a shortage of midwives.

At one stage they were operating with about 70 when they needed 100.

“It is a big national problem. We have not had enough people wanting to become midwives.”

But she urged people to join the profession, saying while it could have “tragic moments” it was “very very rewarding”.

The report into the broader NHS is expected to show that staff shortages, aged buildings, poor training and weak management are hitting standards.

http://news.bbc.co.uk/1/hi/health/4691977.stm

Sellers have condemned the move, saying mushrooms are not harmful and accusing ministers of a knee-jerk reaction.

But the Home Office said the drug was harmful to some users and added the move clarified the existing law.

Home Office Minister Paul Goggins said in a statement: “Magic mushrooms are a powerful hallucinogen and can cause real harm, especially to vulnerable people and those with mental health problems.

Psychedelic qualities

“The law has not been clear with regard to the status of fresh magic mushrooms and some have tried to exploit this apparent loophole.”

Magic mushrooms, more properly known as psilocybe, contain the psychedelic chemicals psilocybin and psilocin.

These chemicals were already class A but previously the law did not apply to fresh or raw magic mushrooms which contain far less of the drug gram-for-gram than when dried.

Under Clause 21 of the Drugs Act 2005, it is now an offence to import, export, produce, supply, possess or possess with intent to supply magic mushrooms, including in the form of grow kits.

Exceptions will be made for people who unknowingly pick the mushrooms in the wild or find them growing in their garden, and critics have argued the act will be difficult to police.

Fresh magic mushrooms had been legal to sell

Magic mushrooms have risen in popularity dramatically in recent years, especially since becoming openly available over the internet or at about 400 “headshops” around the country.

According to Home Office figures, use of the fungi has risen 40% in a year, with more than quarter of a million people estimated to have taken them in 2003/04, compared with 180,000 in 2002/03. However, they still represent a tiny proportion of all drug use.

Although some psilocybe mushrooms do grow in the wild, the vast majority of mushrooms sold on the open market come from mushroom farms in Holland.

Users of fresh mushrooms experience effects ranging from giggling fits and intensification of colours, lights and sounds to, more rarely, hallucinations. Negative effects can include vomiting, and anxiety.

‘Patronising’

Critics of the ban say that the mushrooms are harmless to physical health and would only be bad for people with existing mental health problems.

“Obviously I would not suggest someone with schizophrenia took magic mushrooms but nor should they probably take alcohol,” said Chris Bovey, owner of online retailer Potseeds, based in Totnes, Devon.

“Our customers feel patronised by the government, victimising them for doing something harmless and enjoyable in their own homes, just because they need to sound tough on drugs.”

“To see magic mushrooms alongside crack cocaine and heroin doesn’t seem proportionate.” Petra Maxwell of Drugscope. “Now that they’re class A if people are found in possession the ultimate, if unlikely, sanction is seven years in prison and a fine.”

Others fear that the ban could mean an increase in accidental poisonings as people go foraging for mushrooms in the wild and mistakenly pick a toxic variety.

Mushroom retailers have formed the Entheogen Defence Fund and plan to launch a legal challenge to the change in the law, saying it contravenes European trade rules and the 1971 Vienna convention.

Mike Bashall, chairman of the EDF said: “We would have welcomed regulation because through regulation you do get control – as with alcohol. This is a badly-drafted piece of legislation that was pushed through the House of Lords without proper scrutiny or discussion.”

A spokeswoman for drugs information body Drugscope said the government did need to clarify the law on magic mushrooms but should not have made them class A.

The law change does not affect another, much more rarely used magic mushroom: Amanita muscaria – more commonly known as Fly Agaric.

http://news.bbc.co.uk/1/hi/uk/4691899.stm

The Duke University Medical Center study of 700 patients, in the Lancet, said music, image and touch therapy did appear to reduce patients’ distress.

Heart experts said patients could benefit from feeling more optimistic.

“Further evidence is emerging that people with a more positive outlook appear to be less affected by stressful events, such as having surgery.” Dr Charmaine Griffiths, British Heart Foundation

Therapies such as prayer and homeopathy are widely used, although past studies looking at the impact of care on patients’ health have had mixed results.

The results of this study contradict earlier findings from the same team which suggested a drop of a quarter or more in “adverse outcomes” – including death, heart failure or heart attack.

However, that trial involved only 150 patients. Other research since has found no evidence of any benefits.

This study looked at 700 patients undergoing angiograms (an X-ray of the blood vessels) or other heart operations at nine hospitals across the US.

Christian, Muslim, Jewish and Buddhist prayer groups were assigned to pray for 371 of the patients. The rest had no prayer group.

In addition, 374 of the patients were assigned MIT therapy and the rest none.

MIT involved teaching the patients relaxed breathing techniques and playing them easy listening, classical, or country music during their procedure.

The researchers found that neither therapy alone, or combined, showed any measurable treatment effect on serious cardiovascular events, hospital readmission or death.

But those given music, imagery and touch therapy had less emotional distress and had a lower death rate after six months, though this was not seen as statistically significant.

‘Proper subjects’

Dr Mitchell Krucoff, who led the study, said: “If we want to understand the role of human capacities and resources in the midst of our most advanced medical technologies, we have to do good science.

“With no notion of the actual mechanisms involved in ancient healing practices such as prayer or touch or music, structured outcomes research allows us to collect data that we can learn from in many ways.”

A Lancet editorial on the paper said it would be premature to rule out the use of such therapies in modern medicine.

It added: “The contribution that hope and belief make to a personal understanding of illness cannot be dismissed so lightly.

“They are proper subjects for science, even while transcending its known bounds.”

Dr Charmaine Griffiths, spokesperson for the British Heart Foundation, said: “While this research suggests that prayer and alternative therapies do not improve the clinical outcome for patients undergoing heart procedures, there is increasing interest in the possibility that positive emotional states are beneficial to heart health.”

She said associations had been seen between positive emotional states and low levels of the stress hormone cortisol.

“Further evidence is emerging that people with a more positive outlook appear to be less affected by stressful events, such as having surgery.”

She added: “Patients learning to relax by using breathing techniques and listening to music, and being aware that others are thinking of them may contribute to a more optimistic outlook.

“Whether these effects are significant remains unproven.”

http://news.bbc.co.uk/1/hi/health/4681771.stm

London hospitals told HSJ they were inundated with phone calls and visits from people desperate to find out whether their loved ones were safe after the four bombs exploded from 8.50am onwards last Thursday. The Metropolitan Police did not issue a national helpline number until 3pm.

Clinical staff at the Royal London Hospital, which bore the brunt of the casualties, were unable to communicate with colleagues in other departments because phone lines were so clogged up. The hospital, which treated 208 casualties of the blasts, found itself dealing with calls from embassies across the world, as well as e-mails and faxed photographs of people feared missing.

Chief medical officer Professor Sir Liam Donaldson told HSJ: ‘The emergency phone line for the public came up relatively late in the day; it is not the NHS’s responsibility to do that.’

‘I think we would be giving feedback to the police that on future occasions it would be helpful to have that up earlier because some of our hospitals were taking inquiries from people ringing around London, wondering whether their relatives or friends were safe.’

Paul White, chief executive of Barts and the London trust, which includes the Royal London Hospital, said not having an emergency helpline number was a ‘real issue’.

‘Some of the phone lines were so clogged that clinical staff, instead of being able to phone colleagues, were having to walk around the organisation to check up on things.’

‘It wasn’t until Thursday afternoon that the number was identified and that was certainly a lesson to be picked up on,’ said Mr White.

‘It means that our switchboard and other staff in the organisation are tied up responding to calls from relatives, and these same people will be phoning all the other hospitals in London as well.

‘One co-ordinated number can handle the call once rather than it being repeated around the system.’

Mr White added that dealing with the inquiries was one of the most ‘harrowing’ aspects of the day.

‘We had lots of relatives of missing persons either phoning the hospital, turning up… or faxing photos.

‘I had personal e-mails from relatives of missing persons asking for help in finding them… Our switchboard received literally hundreds of calls, not only from relatives but embassies. We had virtually every country you can think of in touch.’

Royal Free Hampstead trust divisional director for medicine Lorna Donegan said it drafted in extra clerical staff to deal with the calls as part of its major incident plan.

But she added: ‘It would have been handy if we had one central number, rather than having embassies calling every hospital in turn as I’m sure they did. What we lost were the economies of scale.’

A Metropolitan Police spokeswoman said: ‘[The hotline] was opened at 3pm. It is a very large facility and it cannot be opened until it is going to be fully staffed, otherwise it wouldn’t work.’

Healthcare community members still missing

As HSJ went to press several members of the healthcare community remained missing.

Elizabeth Daplyn, 26, a manager in the neuroradiology department at University College Hospital, has not been seen since she travelled to work on the Piccadilly line to Russell Square. Healthcare Commission analyst James Mayes, 28, is believed to have travelled through King’s Cross on his way to a seminar. And Behnaz Moxakka, 47, a biomedical officer at Great Ormond Street Hospital, has not been seen since leaving home at 8am on Thursday.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=2755242

Following a meeting of strategic health authority chief executives and Department of Health directors, a plan has been devised under which SHAs that are currently in credit will be encouraged to lend money to their poorer counterparts.

No decision has been taken on the proposal. The DoH is in negotiations with the best-off SHAs about how to motivate them to lend significant sums, with suggestions that they could be paid 10 per cent interest on the loans.

The DoH has drawn up a list, sent to chief executives two weeks ago, which classifies the financial performance of England’s 28 SHAs into three groups.

HSJ has been told that the first group is made up of six SHAs that have ‘no hope’ of achieving financial balance by March 2008, the period covered by the government’s spending plans (see below). Those in the first group will need ‘significant help to stop the bleeding and pay off debts’, according to one senior SHA source. Their more successful counterparts could loan them up to £200m.

The second group, comprising 11 SHAs, have to make savings in the region of £250m.

Under the proposals, SHAs would not be given any extra cash to do this, but have been told that they need to cut back dramatically to address their combined historic and recurring debts, and hit the £500m NHS efficiency savings target demanded by the government by 2008.

It is from these first two groups that the significant job losses will come. Senior sources are predicting that the numbers of redundancies from the second group alone could top 8,000.

The last 11 SHAs have been identified as the most financially stable and successful. The DoH wants this group to provide up to £200m to the worst-off SHAs.

HSJ understands that the DoH is currently negotiating with these SHAs. The favoured option is to offer the 11 SHAs in the third group a significant return on their investment of 10 per cent per year.

One source close to the negotiations told HSJ that without this incentive there would no reason for SHAs to lend money.

‘Otherwise why should SHAs that are under-funded [in their financial allocations from the DoH] but have good financial performance lend to those that are over-funded?’

A DoH spokesman said NHS chief executive Sir Nigel Crisp had made it clear that organisations needed to get their finances under control.

He added: ‘In a small number of cases where people don’t think it will be possible to achieve financial balance we want to make sure any brokerage system is well managed, fair and efficient. There have been discussions about how to achieve this, but no decisions taken yet.’

And he stressed: ‘Any brokerage scheme we develop with the NHS would be entirely voluntary.’

THE SHA GROUPS: THE PROPOSAL
Group1: could be lent money by high-performing SHAs
* North West London
* Norfolk, Suffolk and Cambridgeshire
* Bedfordshire and Hertfordshire
* Surrey and Sussex
* Hampshire and the Isle of Wight
* Cheshire and Merseyside

Group 2: need to make significant saving to achieve balance
* South West London
* Thames Valley
* Leicestershire, Northamptonshire and Rutland
* South West Peninsula
* North and East Yorkshire and Northern Lincolnshire
* County Durham and Tees Valley
* Shropshire and Staffordshire
* Essex
* Cumbria and Lancashire
* West Midlands South
* Avon, Gloucestershire and Wiltshire

Group 3: in a position to lend up to £200m
* Trent
* South Yorkshire
* Dorset and Somerset
* Birmingham and the Black Country
* Northumberland, Tyne and Wear
* Greater Manchester
* West Yorkshire
* Kent and Medway
* North East London
* North Central London
* South East London

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=2755254

Andrew Lansley (South Cambridgeshire, Con)

To ask the Secretary of State for Health whether Health Direct will be established as a subsidiary of NHS Direct; whether NHS Direct and Health Direct will share the same access points; and if she will make a statement.

Caroline Flint (Parliamentary Under-Secretary, Department of Health)

Health Direct will be set up from 2007. It will be developed as a telephone, internet and digital television service. The aim is to provide easily accessible information on health choices. It will include links to existing health improvement services, including diet, nutrition and support for parents.

A scoping study is being undertaken during 2005 to establish customer, operational and technical requirements for Health Direct. The decision to determine which are the most appropriate management and operational structures to deliver the Health Direct service will be taken in spring 2006, prior to commencement of a procurement phase, which we expect to complete by the end of 2006.

http://www.theyworkforyou.com/wrans/?id=2005-07-05.7477.h

George Rae, a BMA Council member, said that the government seemed to be “obsessed with the private sector.” Payment by results, whereby hospitals are paid for operations according to a set national tariff, could only work if all parties, both public and private, were treated equally, he said.

“There must be no preferential treatment for the private sector. We must not have a competitive market that works against the NHS.” Dr Rae asked the government not to dilute or fragment the health service and not to engage in superficially attractive policies with potentially damaging results.

Jacky Davis, a consultant radiologist in London and a member of the BMA’s consultants committee, pointed out that this government had once described the internal market as a cancer, but now favoured having a rigged market, in which independent treatment centres were given a guaranteed income.

The meeting unanimously passed a motion that said that “more emphasis should be placed on collaboration as opposed to competition,” and that the new competitive market must not prejudice the NHS through any guaranteed flow of income to the private sector.

But it threw out a proposal that the BMA should join with other unions to campaign for the restoration of public and planned provision of the NHS as the only way to maintain a universal equitable healthcare system.

http://bmj.bmjjournals.com/cgi/content/full/331/7507/9-b?ck=nck

All medics from outside Europe are tested by the General Medical Council before being allowed to work, but those from within Europe are exempted.

The British Medical Association is seeking legal opinion on whether the EU labour law ruling can be overturned.

The government said it did not share the BMA’s concerns.

There are more than 230,000 doctors registered with the GMC, of which 162,000 are UK nationals, 12,000 from the European Economic Area – the EU countries plus Norway, Iceland, Switzerland and Liechtenstein – and 60,000 from the rest of the world.

“Patients lives are being put at risk because some doctors just do not have good enough communication skills” Dr Surendra Kumar, of the British International Doctors Association

Dr Surendra Kumar is president of the British International Doctors Association and a former member of the GMC’s registration committee, which determines the requirements doctors need to fulfil to show they are fit to practise.

She said: “Quite often doctors from outside Europe have better language skills than those from within Europe because they may have trained in English. But the problem is that we cannot test those from Europe. It was immensely frustrating when I was on the registration committee.”

“Patients lives are being put at risk because some doctors just do not have good enough communication skills, and since they are not tested it only becomes apparent when they are dealing with patients.”

Dr Edwin Borman, chairman of the BMA’s international committee added: “It’s essential that all doctors, whether from Europe or outside Europe, can communicate effectively, both with patients and colleagues.

“We know that hasn’t always happened under the present system.”

‘Proficient’

He added: “Currently, NHS trusts have responsibility for ensuring the doctors they employ are proficient in English, but the BMA believes the GMC should also have the power to test doctors’ language skills.”

The BMA is awaiting legal opinion from the European Commission on whether the practice of not testing European doctors can be overturned.

A spokeswoman for the GMC agreed it was an issue and that it would like to take on the responsibility.

However, she added: “We want to be able to assure patients that all doctors on the medical register are able to communicate effectively in English.”

The Department of Health said it did not share the concerns, pointing out that it was up to NHS trusts not to employ doctors with insufficient English skills.

She added the department’s code of practice recommended that foreign doctors demonstrate a level of English language proficiency “consistent with safe and skilled communication with patients, clients, carers and colleagues”.

http://news.bbc.co.uk/1/hi/health/4642003.stm

Medics can be charged with involuntary manslaughter if they make a mistake because of reckless behaviour.

Doctors argue the law is too open to interpretation and needs reforming. Prosecutions used to be rare, but have risen sharply since 1990.

The Home Office said the issue was likely to be looked at in its murder review, to be launched shortly.

Involuntary manslaughter is defined as when an individual kills someone as a result of some blameworthy act on their part, but without actually intending to cause death or serious injury.

The offence has long being controversial because of its lack of clarity – nine years ago the Law Commission called for its abolition on those grounds.

“It used to be that if you made a genuine mistake and a patient died you would not face charges, that is not the case anymore.” Dr Paddy Glackin, from Brent

Prosecution of doctors used to be rare – from 1867 to 1989 there were only seven cases, according to British Medical Journal research.

But during the 1990s, 17 doctors were charged with the offence, which is also known as criminal negligence, and since 2000 another 11 have been charged.

Cases have involved doctors being charged following deaths of patients during surgery and after being given medication.

Dr Paddy Glackin, a GP from Brent, in London, put forward a motion on the issue to the British Medical Association’s annual conference in Manchester last week.

He said prosecutions should be stopped until the law was reformed.

“It used to be that if you made a genuine mistake and a patient died you would not face charges. That is not the case anymore. Prosecutions are being pursued arbitrarily, and it is unfair because too much is left to interpretation.”

Ian Barker, a solicitor in the Medical Defence Union’s legal department, said the rise in prosecutions had occurred because the definition of the offence had been relaxed and because society had become more litigious.

And he added: “What you will not see in the statistics is that there has been a significant rise in those doctors that are investigated, but not charged.”

Dr Jan Wise, chairman of the BMA’s medico-legal committee, said it was concerning as doctors could often face months of not being able to practice while unfounded allegations were followed up.

She said: “It is a serious matter.”

A spokeswoman for the Home Office said there was set to be a murder review in the forthcoming months which would look at a host of issues and concerns, including those raised about involuntary manslaughter.

http://news.bbc.co.uk/1/hi/health/4642743.stm

The Foundation Trust Network is to call for their borrowing to be taken off the government’s balance sheet potentially reigniting a three year old dispute between the prime minister and Gordon Brown.

When the semi-independent hospitals were being set up in 2002, the chancellor insisted their borrowing must remain on the government’s books because it could not allow a major hospital to close if it went on a reckless spending spree.

Just three of the first 25 foundation trusts set up to operate as commercial businesses have so far used their borrowing powers, the Financial Times has learnt.

The three Stockport, Moorfields Eye Hospital and Homerton in east London all say the £35m they have borrowed in total from the health department’s financing facility has allowed them to open new facilities faster than under the standard NHS finance regime.

That is likely to renew charges from critics that they are using their status to jump the NHS queue for capital.

But as the Healthcare Commission, the NHS inspectorate, is due to give the trusts’ first year in operation a relatively clean bill of health in a report to parliament this week, the Network will in its own report re-open the borrowing debate.

Sue Slipman, the network’s director, said it wanted trusts to be allowed to use more of their assets as collateral for loans. At the moment they cannot borrow against the core assets they use to deliver healthcare. Instead, services rather than physical assets should be protected, she said. That would make it easier for the hospitals to borrow and to reshape how and where they delivered care in the new competitive market.

As importantly, the strongest trusts are to be allowed to borrow up to 40 per cent of their capital.

That would “break through the limit of public borrowing if it is kept on the government’s balance sheet. The government will have a problem if it does not go off balance sheet”, added Ms Slipman.

Expanding the trusts’ powers could also mean more business for big City institutions if they can offer competitive rates.

All three trusts that have borrowed so far talked to commercial lenders among them the Royal Bank of Scotland, Royal Bank of Canada and UBS although they eventually decided to borrow from the health department’s own trust financing facility which offered a better deal.

However, the foundation trusts’ demands are likely to be opposed by Mr Brown who will argue that whatever the rules say, in practice the government would remain liable for big hospitals’ borrowing.

Frank Dobson, the former health secretary, echoed that view on Sunday. “This is where the whole crackpot idea [of competing hospitals] breaks down”, he said.

“If a private sector organisation fails it will go broke and close. But nobody is going to let Leeds General Infirmary shut. The minute you take away that sanction, most of the intellectual rigour of this so-called market collapses in a little heap.”

http://news.ft.com/cms/s/7a0ab76c-ebfe-11d9-9796-00000e2511c8.html

Aware of these concerns, the King’s Fund established an Inquiry in 2004 into the way in which care services are provided for older people in London, examining the evidence that might reinforce or refute claims about a care crisis and a failing care market.

The Inquiry was established to find out:
Whether the care system operating in 2004 was meeting the needs and preferences of older Londoners who require care and support because of long-term ill health or disability; and whether there will be sufficient care services of the right design and quality to meet the needs of older people in London in 20 years.

An independent committee, chaired by Julia Unwin, collected evidence through written submissions, Committee hearings, focus groups and research studies specially commissioned
for the Inquiry.

Putting the spotlight on London inevitably means that some of the challenges affecting care services for older people are quite specific to the capital. However, many of the strengths and weaknesses identified in the London care system are echoed across England as a whole. The Inquiry report therefore has national relevance. Its verdict on the poor state of current care and support for older people is also very timely, as the government has launched proposals for modernising social care for adults in its Green Paper Independence, Well-being and Choice.

The key finding from our Inquiry is that there are major shortcomings in the current care system that disadvantage older people and their carers. They experience:

• restricted access to care and practical support
• limited choice and control over care services
• being put at risk from untrained and unqualified staff
• hardship caused by inadequate funding and controversy about who pays for long-term care.

“There are patients strewn all over the unit, sitting in non- medical areas with serious medical conditions,” she said. “It’s inappropriate and frankly dangerous. We do not have the facilities to cope with these things. Morale among the staff is terrible.”

Miss Hewitt was taking questions at the British Medical Association annual conference in Manchester.

Dr Blackwell, 27, appealed to her: “Please, please, please reduce this target. It’s awful for patients and it’s awful for us.”

Dr Blackwell, a member of the council of the junior doctors’ committee, who works in North-West England, said she did not want to name her hospital for fear of reprisal.

She was describing a medical assessment unit (MAU) taking many more cases from the accident department so that the waiting time target could be achieved. Patients also go to MAUs straight from their GP or the ambulance service.

“I have seen the whole corridor full of trolleys with the waiting room full as well. To make matters worse, some patients come in with paramedics, so they are waiting too as they must stay with their patients until we take over.”

Dr Blackwell said she had known of patients waiting seven hours to be dealt with in the MAU. Another problem was receiving patients from the accident department before test results were ready.

Miss Hewitt said she was “very well aware” of difficulties in achieving some of the targets. She accepted that targets were crude but said their number had been reduced.

“I am not going to resile from the importance of this new and limited number of targets. Although they are crude, they are helping to achieve much-needed improvements in services.”

Dr Jonathan Fielden, the deputy chairman of the BMA consultants’ committee, said later that many MUAs were very effective in dealing quickly with patients.

“There is an issue in some when the trust focuses on the target without looking at the whole process of the care of the patient,” he said.

Miss Hewitt, (“call me Patricia”) the first secretary of state to address the conference, promised that she wanted to listen to the profession.

But there were cries of “shame”, “rubbish” and “not good enough” when she spoke of the Government proposal to allow smoking to continue in pubs and bars that did not serve food. The BMA has long called for a total smoking ban in enclosed public areas.

She added that she expected all pubs would eventually be smoke free.

Miss Hewitt also offered an olive branch to consultants who have complained about the growth of private specialist treatment centres. In order not to deprive the NHS of their services, they have been banned from working in them.

The ban has been lifted except in areas where there are extreme staff shortages. In this case a consultant who leaves an NHS hospital must wait six months before working in a private treatment centre.

http://news.telegraph.co.uk/news/main.jhtml?xml=/news/2005/06/29/nbma29.xml